Alzheimer's Disease Meets the "Mozart Effect".

Why nursing facilities are beginning to discover the restorative powers of music

At Hazel I. Findlay Country Manor, a long-term care facility in St. Johns, Michigan, residents sit in a circle, many of them lost in their own minds--eyes unfocused, seemingly unaware of any outer reality, or themselves, for that matter. Others are anxious, muttering phrases repeatedly or moving in an agitated fashion. Some have Alzheimer's disease; others suffer from dementia from other causes. Yet when soothing music, with a hint of bright flutes and piano, begins playing in the background, the residents' behavior begins to change subtly. Those who might have been upset or disturbed become less so; unfocused eyes begin to sharpen and try to locate the source of the music.

A man in the middle of the circle picks up a guitar and begins playing and singing an upbeat, happytune, stopping to look at each person fully, laughing, maintaining eye contact with them as he moves around the circle, smiling broadly. His audience becomes more animated. Some begin clapping with the beat, smiling, nodding their heads. The transformation appears almost magical: People who previously had been completely withdrawn appear more aware of themselves and their surroundings, more focused, displaying interest.

Dr. Steven Hale, PhD, ACC, music therapist/gerontologist, provides music therapy for residents at the Hazel I. Findlay Country Manor nursing home once a month. Director of activities Michelle Aylor-Robbins and nursing home administrator Mary-Ann Bond had heard about Dr. Hale's music therapy program from another facility and went to observe a session. "We decided it would definitely be beneficial," says Aylor-Robbins.

A $500 donation from the local St. Paul Lutheran Church Youth Group was approved for use in the new music therapy program. It has continued, supported by a donation from a resident's family. Says Aylor-Robbins, "...We work to create programs for people of all cognitive functioning levels, and this particular program was specifically designed for lower cognitive functioning residents."

"Music therapy in a long-term care setting has a particular value for residents who become isolated, withdrawn and depressed," adds Vicki Ritz, RNC, director of nursing.

In long-term care facilities, music is used with elderly residents to increase or maintain their level of physical, mental and social/emotional functioning. It is used to elevate mood and counteract depression, to promote movement for physical rehabilitation, to calm or sedate, to counteract apprehension or fear and lessen muscle tension.

The idea of music as a healing influence is at least as old as the writings of Aristotle and Plato. David Luce, who is working toward his PhD in music therapy at Michigan State University, explains that the ancient Greeks considered music a prerequisite to the study of philosophy and the achievement of knowledge so that one could become wise and contribute to society. Based on the premise that music is based on numbers, ratios and proportion, the Greeks proposed that the study of numbers would discipline the mind and allow them to understand greater meaning in the universe.

Dr. Hale notes that music was used for dementia clients at the turn of the century by a medical student of Freud's named Mesmer. Mesmer wore flamboyant, brightly colored clothing and had a dramatic, dynamic personality, which was part of his routine as he played and sang to his patients.

Mesmer made outrageous statements about the effects his therapy produced, claiming that after 30 minutes, many of his patients who had lost much of their cerebral function began to gain some back, through the physical effort of movement with the music and its effects on mood. Other physicians scoffed at his claims, charging that his patients had been hypnotized. Hence, the term "mesmerized," a synonym today for "hypnotized."

Mesmer practiced at the dawn of the 20th century, but the movement toward using music as a healing influence began following World War I, when community musicians of all types, both amateur and professional, began to visit veterans' hospitals around the country to play for the thousands of men suffering both the physical and emotional trauma of war. This practice continued following World War II, as well. The patients' physical and emotional responses led medical staff to request that hospitals hire musicians routinely.

It was soon evident that hospital musicians needed some prior training before entering the facility, and the demand grew for a college curriculum. The first music therapy degree program in the world was founded in 1944 at Michigan State University.

The idea that music has a relationship to health and wellness, or any curative or restorative process, is today becoming more mainstream. Approximately 70 universities across the country offer programs in music therapy. "Interest in the field is enormous," says Luce. "The demand is there--we just don't have enough qualified music therapists to fill the need."

In considering music therapy for cognitive dysfunction, the problem lies in patient stimulus, response and processing. "In dementia it seems as though the difficulty lies in the processing of information, if not in the expression of response," Luce says. Music might form a bridge between the cognitive and creative sides of the brain, opening a small window of opportunity to strengthen the cognitive function.

Can music really improve the lives of dementia clients? "Absolutely," says Dr. Hale. "While individuals with Alzheimer's disease might have lost much of their cognitive functioning, they still retain the ability to respond to emotion, a right brain function. Creativity is the last to go."

There is still, however, no overall scientific theory that explains the restorative power of music on human physiology. Much is still a mystery, but there is plenty of research to support the theory that music therapy can have a definite, positive impact on individuals who have lost some cognitive functioning. Researchers have long known that listening to music can directly influence pulse, blood pressure and the electrical activity of muscles. Neuroscientists now suspect that music can actually help build and strengthen the connections among nerve cells in the cerebral cortex. This could be why listening to Mozart before an IQ test boosted scores by roughly nine points, as discovered in 1993 by researchers at the University of California in Irvine.

The researchers theorized that complex music facilitates certain complex neuronal patterns involved in higher brain activities, such as mathematics and chess. They suggested that listening to Mozart helps "organize" the firing patterns of neurons in the cerebral cortex, especially strengthening creative right-brain processes associated with spatial-temporal perception. In other words, listening to Mozart's music can improve concentration and enhance ability to make intuitive leaps--the "Mozart Effect."

In 1996, researchers at Colorado State University tried giving 10 stroke victims 30 minutes of rhythmic stimulation each day for three weeks. Compared with untreated patients, they showed significant improvement in their ability to walk steadily. People with Parkinson's disease enjoyed similar benefits. A musical beat from any genre seemed to provide a rhythmic cue, stimulating the brain's motor systems.

Scottish researchers have found, for example, that a daily dose of Mozart or Mendelssohn significantly brightens the moods of institutionalized stroke victims. Using psychological testing, patients receiving 12 weeks of daily music therapy were less depressed and anxious, and more stable and sociable, than other patients in the same facility. Deforia Lane, a music therapist at University Hospitals in Cleveland, has shown that music can boost immune function in children. This is consistent with a 1994 finding by Louisiana researchers that premature babies exposed to lullabies in the hospital went home earlier.

From research results, it seems apparent that music therapy can benefit a wide range of individuals with various physical and cognitive impairments. It is also universal--clients need not have any particular musical ability to benefit from music therapy. Also, although Mozart has been singled out for attention, one style of music isn't necessarily better than another. The therapist uses different pieces according to the client's needs.

Dr. Hale says that the difference in affect of dents undergoing 30 minutes of music therapy is quite noticeable. "After the peak period, you can ask a resident a question and sometimes get a reality-based answer."

During his most recent session at Hazel I. Findlay Country Manor, two residents were asked about their experience immediately after the session. Richard, known as "Jim," Kumrie responded with a deeply emotional affect and a fond reminiscence. "It's great," he said, referring to the music. "I think it's what everybody needs, to come here from time to time. When I hear good music, I always cry a little bit. When I was a boy, I learned to play the piano. I played at the Kimball Music Hall in Chicago. There were 12 of us from all the public schools. We were at 12 grand pianos, all Kimballs. As time went on, why, I gave up my piano playing. I've kicked myself forever after."

Lorna Smith, another resident, had a brief moment of lucidity. "I just got all around the music and let it get all around me," she said, smiling.

"If you can only imagine the terror and isolation that is brought on by dementia, music is a way to connect through that isolation on the most basic level," says Luce.

The Hippocratic oath -- every physician's creed -- says, "First do no harm." Music therapy certainly meets that criterion: A little music never hurt anyone.

Mary Ann Humphrey is community relations director for Health Care Associates of Michigan, East Lansing. For further information, call [phone].