Newly published research has found familiar music can elicit an extended emotional response in patients with Alzheimer’s-type dementia. The findings from this potential new approach were featured in issue three of volume 78 of the Journal of Alzheimer’s Disease.

Building on the belief that music has emotional and behavioral benefits, researchers under the leadership of University of Kentucky School of Music’s Alaine E. Reschke-Hernández, assistant professor of music therapy, set out to explore if those emotions provoked by music remain without declarative memory (conscious recollection of the music). In the article, “Hooked on a Feeling: Influence of Brief Exposure to Familiar Music on Feelings of Emotion in Individuals with Alzheimer’s Disease,” the team of researchers from UK, Missouri University of Science and Technology, Harvard University and University of Iowa studied the response of people with Alzheimer’s.

As part of this study, 20 participants with Alzheimer’s and 19 participants without dementia were asked to listen to two four-and-half-minute blocks of music of their choice with the goal of eliciting either a happy or sad response. The group reported their feelings before and after each listening session. They also took recall and recognition tests on the music after each induction.

While the research found Alzheimer’s participants had “impaired memory for music selections” when compared to their healthy counterparts, both groups reported an increase in happiness or sadness after listening to corresponding musical selections for up to 20 minutes after the music session ended. The findings indicate lasting emotion can be induced by stimuli without memory for the cause of that emotion and implies that how people are treated matters — whether they remember it or not. The findings also suggest with careful selection and response monitoring, strategies utilizing music listening may be an effective therapeutic tool when caring for Alzheimer’s patients.

Without a solid understanding of music therapy’s impact on the brain, Frederick A. Schmitt, professor in the Department of Neurology who works with UK’s Sanders-Brown Center on Aging, explained the need for such research in this arena.

“Understanding music's impact on the 'normal' brain and in Alzheimer's disease (as in this study) could lead to more effective music therapies, especially when self-selected music is used. Building on this study by Dr. Reschke-Hernández and colleagues, more tailored music therapies could be developed. These could then be studies to see if they are useful in reducing the severity of behavioral symptoms such as agitation, often seen in persons with Alzheimer's disease and reducing the care provider's stress and burden.”

Reschke-Hernández sat down with UK Research Communications to talk about her research.

Though you worked with older patients in a clinical setting previously, this is your first research related to that population. How did you get interested in the impact of music on people with Alzheimer’s disease?

Reschke-Hernández: I've always been interested in how music impacts people in general regardless of their age or their disability or their walk in life. As far as in older adults, I grew up in a neighborhood where there weren't little kids. My parents had me late in life, my siblings are 20 years older than me. I've just sort of always been around older individuals and comfortable around them.

So, when I was in Dr. (Daniel) Tranel’s class as a graduate student — who is the last author on this study — we were reading a study about prolonged experience of emotion in older adults with dementia that one of his other students had worked on with him. I was fascinated and I immediately saw the implications. Music is such an emotive medium that why not replicate the study with music?

I started talking with Dr. Edmarie (Guzmán-Vélez) and Dr. Amy (Belfi) — the other authors on this study — and the three of us put our heads together and sort of put little pieces of all of our interests and expertise together and then went to Dan. At the center of it is just our interest in trying to look out for the well-being and interests of older adults and what we can do to try and help.

In terms of the study’s most significant findings, what were the keys that were intriguing or unexpected?

Reschke-Hernández: Well as far as the key finding, listening to a few minutes of music can profoundly impact somebody's mood, which I think we just intuitively know. But in terms of not being able to remember, just listening to music and still having those prolonged experiences of emotions, that's really impactful and has great implications for how we treat people who can't remember what just happened to them.

I think that's first and foremost, the key finding is that you can play just a few minutes of music for somebody and turn their mood around maybe for the better, but that it can also impact them, you know, and stir up some negative emotions as well. And so, it's important to be mindful of that.

Things that surprised me is you really just cannot predict what music people are going to like and want to listen to and how they’ll respond in that moment. This study really reinforced that observation I've had in my clinical work. We asked people to tell us what music they thought would make them feel sad or happy, and we had some of the same songs show up on opposite lists depending on the person.

I don't know that it was really that surprising to me, but it just reinforced that you have to go about this with an open mind and think about, “who is this person that's in front of me right now and what matters to them?” and be with them while they're listening to music, so that if they start having a negative response, you can be there to comfort them and talk about it or just change the song altogether.

That’s really interesting, personal experience. I think we’ve all experienced different emotions from the same song. It’s the same way with any form of art — that it’s very subjective.

You had them self-select music. Was that an important key to the study?

Reschke-Hernández: Oh, absolutely. I mean there are different schools of thought of looking at research with music. In one camp you pick music, everybody listens to the same thing, because it has a great deal of experimental control, but music is so personal and so tied to our culture and our experiences, our age, everything about us as human beings, that trying to find music that everybody is going to predictably respond to a certain way is really hard, so I think it was a key aspect.

We were interested in looking at: Is the music going to impact their emotions? How does that interplay with what they remember? And do the emotions that are induced linger? Do they stick around? And if we really want to find out if they experience these emotions whether or not they remember, then we better make sure we have music that's going to evoke emotion, which means personally meaningful music.

Tell us about the memory test aspect. How did you approach that in this study?

Reschke-Hernández: Oh, that's a lot of Amy in this. She very cleverly came up with the idea that we needed to have some kind of a trick as part of the test or everybody would do too good on the test.

First, we started off just asking, “What do you remember just hearing with me here in the last 10 minutes?” and they could sing it for me or hum it, tell me the artist, lyrics, anything. I mean we had largely non-musicians, so I accepted any answer that indicated memory for what they just listened to.

But then the part Amy came up with was very short clips of all of the selections that they listened to along with some that they'd provided us with that we didn't actually use in the experiment, and then I went through and found some selections that kind of sounded similar but weren't on their list at all and those were the trick questions. And so, that way we were able to gauge if they could recall what they just listened to, but also if they could recognize whether they just heard it or not.

How do you think music therapists can use this research in day-to-day practice?

Reschke-Hernández: Being ready for the unexpected to happen — having a really broad varied repertoire. That's one thing that I talk with my students about is listen broadly, listen a lot, so that you're familiar with all kinds of things, and you are ready for when the 75-year-old grandmother wants to hear Beyonce! Because that did happen in my study.

I had a woman in the study, and she said, “Well, I listen to this with my grandchildren, and I love how I feel when I'm with them.” And it's such an empowering song that she put it on her happy list. You know that's not necessarily something you would think of to play for somebody of that age. And so, being ready for our assumptions, “What am I assuming that I know about this person before actually getting to know them?”

As far as that is concerned, it's just being ready with an arsenal of repertoire and being really aware that after you leave working with that person and making music with them, there's a good chance that their emotions are going to linger after you leave and after the memory of you fades, and I think that's something anecdotally I've observed and heard report from nurses. That potential for even longer changes in mood is also an important implication that I think is worth looking into in the future in research.

Where do you think we go from here based on your findings?

Reschke-Hernández: Well first, I think it's really important to understand that this is a sample of all white, older adults from Iowa, so that cohort is going to potentially have different responses than a more diverse sample, but we don't know unless we study it. So, replicating the study with a different sample would be really valuable information. A lot of music research that's out there has been done with younger adults anyway, so a lot of what we know about responses to music, we don't know if it will translate directly to older adults unless we study it.

So, the diversity is really important, and then just looking at translations to clinical practice. If I sit with somebody and listen to music with them in a clinical setting rather than a controlled research setting, are we going to find the same things? And then what if we do it live versus recorded. Music therapists usually use live music, so we can adapt it in the moment to how people are responding — how does that translate? Does it translate?

Is there anything else about this study you want readers to explore?

Reschke-Hernández: I think the most important is just to consider how our actions impact people regardless of whether they remember it or not. And to me, what I keep seeing in the news — in times of COVID — I don't know that people really think about what it means when they have to do a COVID test with somebody with dementia and that they don't remember what's going on in the world or what's happening to them or why it's necessary.

If you've had that test, it's pretty invasive and uncomfortable. That is an experience, and based on this line of research, I would predict that they are having an emotional response that could linger past their memory for what just happened. So, is that a time when maybe you could know what their favorite song is and have it on or sing it with them while you're going through this process or at least right after. Maybe one could use music to try and turn their mood around or mitigate some of those responses in some way.

Even everyday things like, for example, resistance to taking a shower. There are nurse’s aides that I've worked with who just learned, “Oh if I sing this song with them while we're going through the whole process, it makes it go a lot better.” And that's a wonderful intuitive thing and a tool we have at our hands freely at our disposal in ourselves, and we don't have to be a professional musician to simply sing.

I would encourage anybody that hears this or reads the story to just think about, “Am I providing music? Am I making it available? Am I making it accessible?” Meaning, you know, is the technology something that this person knows how to use and can operate, and can they tell me if they don't like it, so that I can change the song for them or help them do that. And so, I think that would be the primary thing to think about is not just how do our actions impact others, but how am I not thinking about using music when it's at my disposal all the time anytime I want.

 

Reschke-Hernández’s co-authors on this study included Amy Belfi, of the Department of Psychological Science at Missouri University of Science and Technology; Edmarie Guzmán-Vélez, of the Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School; and Daniel Tranel, of the Department of Psychological and Brain Sciences and the Department of Neurology, in the Division of Neuropsychology and Cognitive Neuroscience at Carver College of Medicine, University of Iowa. This research was supported by the Iowa State Fraternal Order of Eagles and the Kiwanis Neuroscience Research Foundation.

Co-author Tranel was excited to get to work again with his fellow researchers on this advancement in dementia studies. "This work, which was done in collaboration with three of my rising star graduate students (Alaine, Edma, and Amy), builds on previous breakthroughs in my lab which have shown how critical it is to respect the feelings of persons with dementia, even when those persons seem not to remember even basic facts of life. I am extremely fortunate to have had this opportunity to contribute important new science with the collaborative efforts of my three absolutely stellar students."

A board-certified music therapist, Reschke-Hernández came to UK College of Fine Arts from the University of Iowa, where she was a Ballard & Seashore Doctoral Fellow, senior researcher in the Tranel Cognitive Neuroscience Lab, and recipient of the Spriestersbach Award for her dissertation (a finalist for the national dissertation award). She completed her master’s degree in music at University of Missouri - Kansas City. Reschke-Hernández’s clinical experience includes children with autism, adolescent post-surgical pain management and older adults with dementia. 

A member of the Gerontological Society of America, Graduate Women In Science, the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment, and the American Music Therapy Association, Reschke-Hernández was recently awarded an Igniting Research Collaborations grant from UK to work with College of Social Work’s Allison Gibson to combine social work and music therapy telehealth intervention in a pilot study to see how older adults utilize technology.