Aging & Mental Health

Vol. 14, No. 8, November 2010, 891–899

EDITORIAL
Music and dementia: Observing effects and searching for underlying theories

Introduction Dementias: Definitions and needs

Is music helpful for people with dementia, and if so, Dementias may affect a large number of functions
why? Opinions are divided: on the one hand, the (DSM-IV, American Psychiatric Association, 1994),
Cochrane Review of music therapy for people with including: emotional state and perception; cognition,
dementia concluded that there was ‘no substantial memory and linguistic capacities; and level of anxiety
evidence to support nor discourage the use of music and agitated behaviours. Consequently, they also
therapy in the care of older people with dementia’ influence the interaction and communication of indi-
(Vink, Birks, Bruinsma, & Scholten, 2006); on the viduals with their surroundings. Alzheimer’s disease,
other hand, small–scale studies have suggested that characterised by a diffuse pattern of cortical deficits, is
music is useful in improving the state of individuals the dominant form of dementia. Many studies of
with dementia (Brotons, Koger, & Pickett—Cooper, music, music therapy and dementia focus on this form,
1997; Sherratt, Thornton, & Hatton, 2004a; Witzke, though some do not (Omar, Hailstone, J.E. Warren,
Rhone, Backhaus, & Shaver, 2008). This question is Crutch, & J.D. Warren, 2010) and other studies include
particularly important as dementia care constitutes an a range of diagnoses. Indeed, symptoms and severity
‘unsolved’ problem. Though pharmaceutical treat- leading to this diagnosis can vary between people and
ments have been developed, there are many aspects over time.
of the condition that remain untreatable using these Accompanying the difficulties of the illness, prob-
methods from which there are also often unwanted side lems regarding quality of life in care homes such as
effects. There is much debate regarding the extent to lack of activity have been observed, and there have
which music is therapeutically useful in dementia. On been many calls for improvements (NICE-SCIE 2007;
the practical side, there are many music therapists Harmer & Orrell, 2008). To some extent, these have
worldwide working with individuals with dementia, been answered by increasing provision of activities in
and outreach programs that include music are increas- care homes from different organisations.
ing in popularity. As in other areas of music therapy, The popularity of music and music therapy, with its
however, there is insufficient rigorous evidence about increasing resource investment, invites and requires the
the effect of music in the form of systematic testing or development of the understanding of the mechanisms
randomised controlled trials. Moreover, there is only involved in the perception and production of music by
partial understanding of the processes underlying the individuals with dementia and its effect on physiolog-
interventions and results of music therapy. Three ical and neurological processes. Two of the main
dominant groups of symptoms of dementia, which questions are: (1) Which musical characteristics enable
have been suggested to be positively influenced by the observed improvements in dementia? and (2) What
music, form the focus of the current discussion: are the aspects of dementia that these are acting on? To
memory (particularly autobiographical memory) and explore these questions it is necessary to bring together
language retention; mood and depression; and aggres- evidence from behavioural studies of music and
sion and agitation. However, a lack of an evidence base dementia on the one hand, and theories of underlying
mechanisms driving the observed behavioural patterns
for the use of music in dementia care, and an
on the other. In this editorial, I aim to contribute to
understanding of the underlying processes related to
this process by bringing together evidence and theories
behavioural observations, remain. This Editorial illus-
from music psychology studies in healthy individuals
trates the evidence to date and, in an attempt to
and in those with health conditions including, but not
explore the possible reasons for the reported success of
restricted to, dementia.
music in this context and better understand these
underlying processes, brings together evidence and
theories from the fields of music and dementia, music
psychology and the study of diverse health conditions. Music in care: Activities, classification and definitions
In order to contextualise the existing evidence, and The range of music-based activities in care homes is
possible underlying processes and approaches to increasing. However, music provision is not the same as
investigating those processes, a brief discussion of the music therapy and distinctions are made between
types of dementia that have been focussed on in music different types of musical activity and their intended
research and definitions of music in therapeutic and outcomes. A delineation by Raglio and Gianelli (2009)
other contexts is presented. emphasises differences in the theoretical foundation and
ISSN 1360–7863 print/ISSN 1364–6915 online
ß 2010 Taylor & Francis
DOI: 10.1080/13607863.2010.519328
http://www.informaworld.com
892 N. Spiro

music therapeutic professionalism. Music therapy, Is structured musical initiatives (rhythmic use of instru-
music helpful for people with dementia, and if so, why? ments, singing, movement associated to music, etc.)
Opinions are divided: on the one hand, the Cochrane and listening to music, including classical or favourite
Review of music therapy for people with dementia music (exemplified by Cooke, Moylea, Shumb,
concluded that there was ‘no substantial evidence to Harrisonc, & Murfield (2010) this issue).
support nor discourage the use of music therapy in the These are not rigid categories and many studies
care of older people with dementia’ (Vink, Birks, that have implications for music therapy do not
Bruinsma, & Scholten, 2006); on the other hand, explicitly relate themselves to one. Indeed, concur-
small–scale studies have suggested that music is useful rently, musical activities and music therapies can be
in improving the state of individuals with dementia viewed as belonging to three types: ‘Active’ – interac-
(Brotons, Koger, & Pickett–Cooper, 1997; Sherratt, tive, improvised music therapy (Raglio et al., 2008);
Thornton, & Hatton, 2004a; Witzke, Rhone, Backhaus, ‘Receptive’ – music listening on its own or during
& Shaver, 2008). This question is particularly important another activity (e.g. being bathed Clark, Lipe, &
as dementia care constitutes an ‘unsolved’ problem. Bilbrey, 1998); and activities that include music but do
Though pharmaceutical treatments have been devel- not necessarily have it as a main focus (e.g. reminis-
oped, there are many aspects of the condition that cence therapy, Ashida, 2000). Additionally, there have
remain untreatable using these methods from which been a number of studies using direct tests of the effect
there are also often unwanted side effects There is much of music on responses in dementia that have implica-
debate regarding the extent to which music is ther- tions for activities and therapy (Omar et al., 2010). The
apeutically useful in dementia. On the practical side, definition of music in all of these studies is varied. The
there are many music therapists worldwide working musical characteristics emphasised are context depen-
with individuals with dementia, and outreach programs dent, focussing on valence when emotion or arousal
that include music are increasing in popularity. As in are explored, familiarity when memory is investigated
other areas of music therapy, however, there is or music making when social difficulties are tackled.
insufficient rigorous evidence about the effect of music This issue of the Journal of Aging & Mental Health
in the form of systematic testing or randomised presents two examples of research on the use of music
controlled trials. Moreover, there is only partial under- and in dementia care: one on music therapy (Raglio,
standing of the processes underlying the interventions 2010) and one on musical activities (Cooke et al., 2010).
and results of music therapy. Three dominant groups of Raglio et al. investigate the effect of a cycle of sessions
symptoms of dementia, which have been suggested to be of music therapy on a range of behavioural disturbances
positively influenced by music, form the focus of the including, among several, agitation and anxiety. Cooke
current discussion: memory (particularly autobiogra- et al. investigate the effect of a live group music
phical memory) and language retention; mood and program, involving facilitated engagement with song-
depression; and aggression and agitation. However, a singing and listening, on agitation and anxiety. Raglio
lack of an evidence base for the use of music in dementia et al. find that there is a significant reduction in
care, and an understanding of the underlying processes agitation (as well as delusion and apathy) in the music
related to behavioural observations, remain. This therapy group but not in the control group. In contrast,
Editorial illustrates the evidence to date and, in an Cooke et al. observe no significant effect of the live
attempt to explore the possible reasons for the reported group music program on agitation and anxiety and that
success of music in this context and better understand the musical activity is no more effective than the reading
these underlying processes, brings together evidence control group. The only change that is statistically
and theories from the fields of music and dementia, significant in Cooke et al.’s study is an increase in verbal
music psychology and the study of diverse health aggression in participants who attended more than 50%
conditions. In order to contextualise the existing of the music sessions. In posing different but related
evidence, and possible underlying processes and research questions, these studies illustrate the variety of
approaches to investigating those processes, a brief pathways currently present in the field some of which
discussion of the types of dementia that have been are explored in this editorial.
focussed on in music research and definitions of music
in therapeutic and other contexts is presented (exem-
plified by Raglio et al. (2008) and Raglio (2010) this Is music therapy useful for dementia care?
issue, see also Davis, Gfeller, & Thaut, 2008 for
There is an understanding that music therapy is in need
discussion of music therapy approaches).
of evidence and there are a number of reasons why it is
Musical activities, in contrast, have broader aims:
lacking, including the wide range of possibilities
providing temporary well–being, improving mood,
encompassed by music therapy and musical activities.
promoting socialisation, memories and stimulation of
It may be helpful to view music in dementia care as
frames of mind, and relaxation. In addition, they are
having a number of possible roles:
characterized by the absence of a specific intervention
model, long–term goals, and a specific therapeutic (1) Music constitutes a leisure activity, contribut-
setting. Also, the music therapist is replaced by a music ing to the well being of the healthy population.
professional. Finally, the contents are described as In environments such as care homes these
 Aging & Mental Health 893

leisure activities need to be consciously pro- In addition, subcortical structures spared from the
vided and the outcome may be similar to that progressive destruction of cortical tissue may play an
of leisure activities elsewhere. important role (Cuddy & Duffin, 2005, p. 234). In this
(2) Cognitive deterioration is a symptom of demen- way, music’s complexity seems to be its strength in
tia. Music seems to have positive effects on contributing to the preservation of its memory.
cognitive capacities such as memory and com- Music is not the only often-retained complex skill
munication in dementia (Foster & Valentine, in dementia; others include bridge and chess. However,
1998; Irish et al., 2006; Powell, 2006). music may be special. Not only is it nonverbal, it is
(3) A number of psychological and behavioural often acquired through enculturation rather than
difficulties often accompany cognitive deterio- through formal training and without declarative
ration in dementia. Music seems to positively knowledge of the rules of composition and production
affect state of mind and behaviours, particu- (Cuddy & Duffin, 2005). These characteristics are
larly those affected in dementia including social referred to in explaining music’s importance in social,
behaviours, emotion, depression, anxiety and cultural, emotional and communicative contexts
agitation (Lord & Garner, 1993; Odell-Miller, (Cross, 2007). Much musical understanding, unlike
1995; Olderog-Millard & Smith, 1989; Raglio the specific knowledge required for expertise at bridge
et al., 2008). or chess, is commonly held by members of a culture
However, it remains unclear whether any of these and plays a role from early in life (Trehub, 2009). Thus,
three areas plays a dominant role or whether they are not only is music complex, facilitating its preservation,
all equally important; whether music’s role in dementia but it may be the most available and accessible
care is as a leisure activity or whether underlying complex skill spared in dementia (Cuddy & Duffin,
processes associated with cognition or emotion are 2005).
driving changes. There have been several literature Another theory for the preservation of musical skill
reviews on music and dementia (Brotons, Koger, & is one of dissociation. One such dissociation is between
Pickett-Cooper, 1997; Sherratt, Thornton, & Hatton, declarative and procedural memory (also observed in
2004a; Witzke, Rhone, Backhaus, & Shaver, 2008) and amnesics; Cohen & Squire, 1980). In some dementia
of studies of music perception and production in cases well-preserved procedural (or motor skill)
healthy individuals and in other health conditions. This memory for musical performance among musicians
editorial aims to bring together these separate research has been observed alongside impaired declarative
trajectories in order to discuss and help clarify the role semantic memory and the language associated with it
of music in dementia care. (Brotons et al., 1997; Gunther et al., 1993; Polk &
Kerstesz, 1993; Swartz, Walton, Cummer, Hantz, &
Frisina, 1992).
Music and memory
Is music special, and if so, why?
Retention of music and language
Some individuals with dementia remember music and
old songs, and sing and dance to them for longer than On the basis of a review of neurological studies,
they remember and respond to other information Brotons et al. (1997) suggest that dissociation may also
(Cuddy & Duffin, 2005; McColskey, 1990). These explain differences in retention of musical and linguis-
observations are surprising: memory of music is a tic abilities. Some dementias include a progressive
complex skill. According to Cuddy and Duffin (2005, deterioration of language functioning while musical
p. 234) it requires the integration of various compo- abilities persist. Dissociation between language and
nents, including pitch, rhythm, timbre, dynamic, musical abilities ‘may reflect differential hemispheric
linguistic, visual, kinesthetic and emotional ones. The degeneration’ (p. 210); preserved music processing may
explanation of these observations by way of the be occurring in different parts of the brain from the
relationship between behavioural observations and linguistic mechanisms. Moreover, processes related to
neurological processes is multifaceted. However, music may be the last to deteriorate in the disease
according to Cuddy and Duffin ‘[a]t early stages of process, at least in some cases (p. 211). Interestingly,
auditory processing, hemispheric specialisation may however, memory for linguistic information contained
operate; the right auditory cortex, for example, is in songs has been found to be superior but not limited
thought to be specialised for spectral (pitch) analyses, to memory of old songs. Prickett and Moore (1991)
while the left auditory cortex is thought to be found that individuals with dementia remembered the
specialised for rapid temporal resolution’ (2005, p. words of songs they had sung during therapy sessions
234). They go on to explain that complex musical tasks better than spoken material, and the percentage of
engage many processes and these simultaneous cortical recall was better for older than for newer songs. A
activation patterns indicate widely distributed and more general outcome was found by Brotons and
partly interchangeable brain substrates. Therefore, in Koger (2000), who showed that following music
some cases weakened components may be supported therapy, performance on speech content and fluency
and reinforced through co-activation processes. of spontaneous speech was better than following
894 N. Spiro

therapeutic conversation sessions. Brotons and Koger encourage the return of other functions. Another
point out that it is unclear whether the purported effect theory regarding the enhancement of autobiographical
of music on language production is direct or indirect memory recall relates to anxiety reduction: a significant
via short-term memory activation. The understanding reduction in anxiety has been observed while music
of the mechanisms underlying these relationships played during autobiographical memory recall tests
between music and language is fundamental for the (Foster & Valentine, 1998). A further theory suggests
characterisation of changes of capacities in dementia that music therapy, like other creative arts therapies,
and informed music-therapeutic methods. relies relatively little on verbal processing, therefore
The role of music in aiding verbal memory is not offering a unique approach to accessing stored knowl-
limited to dementia. For example, in a single-blind, edge and memories that control certain behaviours
randomised and controlled music listening study on the (Brotons et al., 1997).
effect of music on language abilities of the acute
recovery phase of 60 post-stroke patients by Särkämö
et al. (2008), results suggested that recovery of verbal Mood and depression
memory and focused attention improved significantly
A positive outcome of reminiscence music therapy is
more in the music group than in the language and
a reduction in depressive symptoms (Ashida, 2000).
control groups. This indicates a possible relationship
Depression is not unique to dementia and it is possible
between music, superior attention and resulting
to learn about the effect of music on depression also
improvements in capacities such as language. Brotons
from other conditions. Maratos, Gold, Wang and
and Koger (2000) explored language problems in
Crawford (2008) found that of the five studies that met
dementia in the broader context of the effect of
the inclusion criteria for their Cochrane review on
music on language in other aphasias. Indeed, there is
music therapy and depression, four studies reported
a growing body of research exploring music and
greater reductions in symptoms of depression among
language in aphasias. For example, Racette, Bard
those randomised to music therapy. Despite the
and Peretz (2006) investigated the production of sung
variation in the interventions offered and different
and spoken utterances in aphasics. When they sang or
views regarding the role of music and human interac-
spoke along with an auditory model (choral singing or
tion in positive effects (Maratos et al., 2008), the
speaking) while learning novel songs, they repeated
underlying assumption of some music therapy
and recalled more words when singing than when
approaches is that music stimuli directly induce phys-
speaking. The results suggest that such choral singing
ical and emotional changes and that music therapy
is more effective than choral speaking because the
may help to reduce stress, sooth pain and energise the
former may entrain more than one auditory–vocal
body (Bruscia, 1991).
interface (Racette et al., 2006). There are continuing
More broadly, listening to music has been reported
debates about music and language processing indicate
to affect emotional state in the healthy population,
the complexity of the relationship between the two
with individuals choosing to use music as an aid to
(among many Cross, 2007; Levitin & Tirovolas, 2009).
mood regulation in self-report studies of the general
Nevertheless, such observations may have implications
population (e.g. Sloboda, 1999) and older people
for the relationship between music and language in
(Hays & Minichiello, 2005; Laukka, 2007).
dementia.
Furthermore, there have been physiological and neu-
rological studies of the brain responses to music in the
healthy population. A study by Lundqvist, Carlsson,
Music and memory in therapy Hilmersson and Juslin (2009) suggested a coherent
One of the main outcomes of the identification of the manifestation in the experiential, expressive and phys-
positive retention of music in dementia is its use in iological components of the emotional response
reminiscence therapies. Music has been suggested to system. Happy music generated more zygomatic
enhance autobiographical memory recall in individuals facial muscle activity, greater skin conductance, lower
with Alzheimer’s disease (Foster & Valentine, 1998; finger temperature, more happiness and less sadness
Irish et al., 2006). Several theories have been put than sad music. Furthermore, a neurological study by
forward concerning the underlying processes. One is Blood, Zatorre, Bermudez and Evans (1999) suggested
that music processing enhances a general level of that music may recruit neural mechanisms similar to
activation, possibly prompting motor activity or those previously associated with pleasant/unpleasant
memory recall (Cuddy & Duffin, 2005). This can be emotional states, but different from those underlying
related to the general context of reminiscence therapy in other components of music perception, and other
which related tasks are carried out such as singing, emotions such as fear.
verbalising and moving. Furthermore, singing familiar In a more specific study, cerebral blood flow
old songs seems to act as a memory trigger, encourag- changes were measured in response to participant-
ing feelings of connectedness to past events and selected music that elicited the highly pleasurable
emotions associated with them (Cuddy & Duffin, experience of chills (Blood & Zatorre, 2001).
2005; Smith, 1986). This, in turn, is thought to Subjective reports of chills were accompanied by
 Aging & Mental Health 895

changes in heart rate, electromyogram and respiration. to pleasant memories and creates a positive emotional
As intensity of chills increased, cerebral blood flow state in the present (Gerdner, 2000; Sherratt et al.,
increased, and decreases were observed in brain regions 2004a). Indeed, the effect may be generalised, as
thought to be involved in reward/motivation, emotion suggested by Raglio et al. (2008), who showed that a
and arousal, including brain structures known to be wide range of behavioural and psychological symptoms
active in response to other euphoria-inducing stimuli, of moderate-severe dementia, as well as active partic-
such as food, sex and drugs of abuse. These studies ipation in music therapy, improved following the
suggest that listening to music on its own may have nonverbal music therapeutic intervention. In this issue
direct effects on emotional response independently of of Aging & Mental Health, Raglio presents a develop-
social interaction. It is unclear whether in dementia ment of the implementation of this music therapy model
similar processes continue to underlie basic responses and suggests that positive effects of music therapy are
to music, and whether these can explain, at least in seen on agitation, delusion and apathy in the more
part, music’s importance for emotional communication efficient ‘cycle of sessions’ timetabling. In contrast, and
and for problems in a condition in which other also in this issue, Cooke et al. find that there is no
capacities are impaired. It can provide an individually significant effect on agitation and anxiety and that a
tailored, easy-to-conduct and inexpensive means to musical activity is no more effective than an control
facilitate cognitive and emotional improvement. This reading activity. As mentioned above, the only change
may be of particular relevance in the context of the that is statistically significant in Cooke et al.’s study is
observations discussed above of possible superior an increase in verbal aggression in participants who
retention of music in dementia. attended more than 50% of the music sessions.
Now that there is increasing understanding of the As in the context of depressive symptoms, when
relationships between music, self-report, physiological music does help, it may be acting as a positive
and neurological responses in healthy individuals (e.g. distracter through, among other characteristics, its
Lundqvist et al., 2009), this can form a basis for regularity, predictability, emotional effects or positive
investigation of the use of music in dementia care, and associations for the listener. Alternatively, music may
allow a number of questions and comparisons. For provide a regular predictable stimulus to which the
example, do individuals with dementia benefit from listener entrains, thereby settling the agitated, arrhyth-
using music as a basis for reminiscence and the related mic behaviour.
self-identity, mood regulation, or socialisation? Are the
processes underlying these benefits comparable to the
healthy population? Are the physiological and neuro- Driving forces
logical responses found in healthy individuals still Music
found in dementia or do the neurological changes The discussion so far has illustrated that what is meant
typical of dementia interfere, and if so, at which stage by the terms ‘musical activity’ and ‘music therapy’ can
of the illness? be varied. Similarly, the factors important in character-
ising the music heard or played are context dependent,
including emotional valence, familiarity, or style.
Agitated and aggressive behaviours Tailoring music to individuals’ preferences and the
Music seems to positively affect agitated and aggressive desired outcome seems important. For example, live,
behaviours in dementia during different activities and as opposed to pre-recorded music has been suggested
times: when awake (Brotons & Pickett-Cooper, 1996; to have the additional benefit of promoting arousal
Sung & Chang, 2005; Svansdottir & Snaedal, 2006), and social engagement (O’Connor, Ames, Gardner,
when getting to sleep (Lindenmuth, Patel, & Chang, & King, 2009a; Sherratt, Thornton, & Hatton, 2004b);
1992), and at bathing time (Clark et al., 1998), with and levels of agitated behaviours seem to decrease
preferred music often having best outcomes. These more with individually tailored music than generic
effects can be linked to the observations cited above ‘classical relaxation music’ (Clark et al., 1998; Gerdner,
regarding emotional state or to stress levels. The 2000; Groene, 1993; O’Connor et al., 2009a;
progressively lowered stress threshold model (PLST; Ragneskog, Bråne, Karlsson, & Kihlgren 1996). The
Hall & Buckwalter, 1987) suggests that external and contrast in effects of different music types is illustrated
internal stress inducing factors may rise to a level where by the papers in the current issue.
anxious or dysfunctional behaviours, including agita-
tion, occur. As dementia progresses and neurological
damage increases, the individual is less able to receive Musical behaviours
and process information and their stress threshold Music psychology has undergone major changes. For
decreases. By controlling factors that lead to increased many years, research focussed on music as heard
stress levels and providing support to compensate for information, with studies such as Rauscher, Shaw, and
impaired abilities, stress levels return to, or stay within, Ky (1995) suggesting that listening to music can
the normative range. Music here renders extraneous improve performance on some spatial tasks.
noise more familiar and predictable and possibly links However, the connection between music listening and
896 N. Spiro

performance on such tasks has been shown to be the dementia literature and in more general music
problematic. Since then, it has been argued that the psychology research: affective valence (Thompson,
participatory, social aspect of music making, is the key Schellenberg, & Husain, 2001) and familiarity with
to positive effects on mood, cognition and social piece or genre (Sung & Chang, 2005) have all been
interaction (e.g. in healthy individuals, Kirschner & suggested as important but a clear investigation of the
Tomasello, 2010, and in dementia, Powell, 2006). More effect of music type on outcome in dementia remains to
recently, music listening has been observed as posi- be carried out. Such investigations are necessary for
tively affecting mood and cognition (post-stroke, the identification of the musical aspects that are
Särkämö et al., 2008, and in dementia, Ziv, Granot, driving changes in behaviour and which processes are
Hai, Dassa, & Haimov, 2007). The multiplicity and contributing to them. For example, is the main driving
perhaps flexibility suggested by these observations is mechanism one of arousal, memory, mood or attention
pertinent in dementia care where flexibility in partic- or a combination of the four? Some responses to
ipation is important. different music types could be based in the same
processes (such as arousal or attention) but others may
be music specific: affective valence being related to
Summary mood and emotion, familiarity being related to
Numerous small-scale research studies have suggested memory and predictability.
music listening, participation or therapy can be useful Raglio and Gianelli (2009) claim that one differ-
in dementia care, indicating that music could play a ence between music therapy and activity is in the goal
prominent role here. of long term effects in the former and the absence of
Many of the studies and calls for future research such a goal in the latter. However, the evidence for
have focussed on gathering evidence and refinement of effect length is so far lacking (for contrasting results see
research methods (e.g. O’Connor, Ames, Gardner, & Ledger & Baker, 2007 and Takahashi & Matsushita,
King, 2009b; Vink, Birks, Bruinsma, & Scholten, 2006) 2006). Studies such as that by Särkämö et al. (2008) on
and some have suggested theoretical frameworks (e.g. post-stroke recovery and Raglio on music therapy in
the personhood approach, Sherrat et al., 2004a). dementia illustrate the feasibility of tackling such
However, it seems that the fundamental question of questions but have not yet provided the evidence
the underlying mechanisms can now be addressed more base needed either for practice or for clear under-
fully. This requires the clarification of the relationships standing of the effect length or required frequency of
between (1) musical activity and music type, (2) such activities. This has direct implications for an
dementia severity and type and other person charac- understanding of underlying processes; are they imme-
teristics such as musical training, and (3) neurological, diate responses that do not last, do they involve
physiological, psychological characteristics or quality learning or, especially in the case of dementias, do they
of life descriptors. The possibility of obtaining credible function in such a way as to slow deterioration?
evidence is suggested by studies such as those by
Lundqvist et al. (2009) on music and emotional
responses in a healthy population and Särkämö et al. Person characteristics: Prior musical training,
(2008) and colleagues with a clinical population. It dementia type and severity
seems that the field is now ready for a systematic The effect of musical training has been explored in the
exploration of the underlying processes driving context of superior music compared with language
responses. retention, an effect observed in musicians with demen-
tia (Crystal, Grober, & Masur, 1989; Swartz et al.,
1992). A number of characteristics set musicians apart
Musical activity and music type from untrained individuals related to practice and
As discussed above, there has been much debate memory of movement, patterning and auditory mate-
regarding the effects of different types of musical rial – aspects that are particularly important for
activity and music therapy, and the relationship dementia. In-depth comparison may reveal which of
between change in behaviour and specific musical the suggested processes is dominant in each population
aspects remains unclear. Many comparisons can be and characteristics of perception and production
made and some already have, especially in the context affected by the condition in the two populations.
of social communication. In contrast, many of the The identification and characterisation of the
studies on agitation and aggression have been based on relationship between these factors and a search for
music listening. Such differences in approach to studies underlying processes is not limited to dementia. It is
are not surprising but lead to different underlying therefore possible to turn to the reported effects of
mechanisms being posited. Therefore, systematic com- music on healthy individuals and on the symptoms of
parison of these conditions is necessary for an dementia that occur in other conditions for which
evidence-based grounding. music therapy has been found to be beneficial. For
Similarly, music type has been discussed as an example, links between music, affect and behavioural,
important influencing factor in some contexts, both in physiological responses have been identified by
 Aging & Mental Health 897

Lundqvist et al. (2009) in healthy individuals, between Blood, A.J., Zatorre, R.J., Bermudez, P., & Evans, A.C.
music and language or verbal memory in other health (1999). Emotional responses to pleasant and unpleasant
conditions (e.g. aphasias, Racette et al., 2006, and post music correlate with activity in paralimbic brain regions.
stroke, Särkämö et al., 2008), and the behavioural and Nature Neuroscience, 2, 382–387.
Brotons, M., & Koger, S. (2000). The impact of music
neurological work about post-stroke recovery carried
therapy on language functioning in dementia. Journal of
out by Särkämö and colleagues has promising impli-
Music Therapy, 37, 183–195.
cations. Although dementia is different from other Brotons, M., Koger, S.M., & Pickett-Cooper, P. (1997).
conditions, comparison with these may help delineate Music and dementias: A review of literature. Journal of
the processes of music perception and production in Music Therapy, 34, 204–245.
dementia. Music, with its multifaceted nature, has been Brotons, M., & Pickett-Cooper, P. (1996). The effects of
suggested to have a positive influence on numerous music therapy intervention on agitation behaviours of
mind-body capacities (Cross, 2006), to be therapeutic Alzheimer’s disease patients. Journal of Music Therapy, 33,
in a host of conditions, and to be effective in activating 2–18.
abilities and affect specific processes. As dementia is Bruscia, K.E. (1991). Case studies in music therapy. Gilsum,
potentially a whole body condition affecting the NH: Barcelona.
Clark, M.E., Lipe, A.W., & Bilbrey, M. (1998). Use of music
individual and their interaction and communication
decrease aggressive behavior in people with Dementia.
with others, the nature of music makes it a good
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approach seems promising.
Maryland: Silver Spring.
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Faculty of Music, University of Cambridge of the Alzheimer type. Musicae Scientiae, 2, 143–155.
11 West Road, Cambridge CB3 9DP, UK Gerdner, L.A. (2000). Effects of individualized versus
classical relaxation music on the frequency of agitation
Email: ns319@cam.ac.uk
in elderly persons with Alzheiemers disease and related
disorders. International Psychogeriatrics, 12, 49–65.
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