Making Music To Sharpen Aging Brains

SOPHIE BUSHWICK: This is Science Friday. I’m Sophie Bushwick. Alzheimer’s disease remains a devastating illness for those it touches. While the FDA has approved the first new medication to reduce symptoms in nearly two decades, evidence of its effectiveness remains to be seen.

But in the meantime, even the Mayo Clinic and the Alzheimer’s Association recommend the therapeutic use of music to soothe agitation and even trigger positive memories for those in the middle and late stages of the disease. But can music work wonders for people in earlier stages of Alzheimer’s? Specifically, can playing music have therapeutic effects?

JENNIE DORRIS: (SINGING) together [INAUDIBLE] left, rest.

SOPHIE BUSHWICK: That was my next guest, University of Pittsburgh PhD student Jennie Dorris. She’s a professional percussion player who’s working on her doctorate in rehabilitation science, and she coaches one of many groups focused on making music as a brain training exercise for older adults. She went looking for evidence and gathered studies involving more than 1,400 participants around the world.

They pointed to a small but meaningful improvement in brain function for adults with mild cognitive impairment. That’s a very early stage of Alzheimer’s who participated in making music in programs like hers. Her work appeared in the Journal of the American Geriatrics Society earlier this year. Here to talk more about this work is Jennie Dorris. Welcome, Jenny.

JENNIE DORRIS: Thanks for having me.

SOPHIE BUSHWICK: Let’s start with the research you did. You went looking at a very specific kind of music therapy program. What did you find?

JENNIE DORRIS: Sure. When we were reading research, so often you would see so much music mixed together, whether people were listening or whether they were actively participating. And I thought, what would happen if we only looked at active participation? What would we find?

And what was so surprising is seeing how this type of work is being done all over the world. You see so many different activities if you look at research being done in Italy versus research that’s being done in Taiwan versus, maybe, research that’s being done in France. And so we see a lot of different really beautiful cultural music programs happening.

SOPHIE BUSHWICK: Can you give us some more examples of some of the specific music in each of those places?

JENNIE DORRIS: One of my favorites happens in Italy, and they utilize Italian scat singing. So if you can imagine hearing Louis Armstrong kind of beebopping around but then hearing that in Italian, I think that is so genius. But if you can imagine having Alzheimer’s, you might forget a word to a song. That doesn’t matter if you’re scat singing. Then you can sort of improvise over a song that you really love. We also saw some really beautiful work coming out of South Korea, where the design is to really have you reminisce about childhood songs. And you actually make a wind instrument to play along to a very popular childhood song from the area.

SOPHIE BUSHWICK: So participants in that study weren’t just playing music. They were making their own instruments?

JENNIE DORRIS: They were very physically involved in the making of music, yes.

SOPHIE BUSHWICK: And all of these studies, did they all seem to indicate that people improved?

JENNIE DORRIS: That’s right. We looked at a range of things, both cognitive functioning as well as emotional well-being, like your quality of life, your mood, anxiety, and depression. And that’s what we saw so many different positive effects. The main thing that people are looking at is cognitive functioning. We were able to do a meta analysis because so many different people were measuring it in a similar way.

But we also saw that single studies were affecting mood, quality of life. There was a drum circle in Taiwan that had beautiful results in terms of affecting anxiety, and that was really neat to see.

SOPHIE BUSHWICK: And what do we know about what’s happening in the brain as people are playing music? Why is it this specific thing that’s affecting their cognition?

JENNIE DORRIS: It’s a really cool process that happens in our brains when we start to play. If you can imagine yourself standing behind a drum, you have to coordinate your motor regions as you’re coordinating, which hand am I going to use? Or both, right? How am I going to play it?

And then your motor region has to connect with your visual perception because there’s some type of music in front of you, and you’re trying to remember, what is the rhythm? How am I going to connect that with my motor? And then we have our sensory perception. All of these sounds are happening around us, and we’re changing our motor to really match and blend with those sounds. I’ve seen it called a full-body workout. And when you’re in the middle of playing a song with a group of people, it really does feel that way for your brain.

SOPHIE BUSHWICK: And why is mild cognitive impairment, this very early stage of Alzheimer’s, an important stage for study?

JENNIE DORRIS: I think that’s a stage where people want to be able to do anything they can to stimulate their brain. It’s also a stage where we don’t know if you’re going to go on to get Alzheimer’s. And we want to support you to do any type of activity that we know is good for brain health.

SOPHIE BUSHWICK: And this particular research is different from research that just looks at listening. You mentioned there’s a ton of studies about that. So why, for you, was active music making such an important thing to study?

JENNIE DORRIS: Well, I used to lead a class for older adults with mild cognitive impairment that was a marimba band. And as I was leading this class, I did so for years, and I saw people able to learn a brand new instrument. They learned to read music’s notation. And for anyone who knows about that, it’s a very difficult skill. And they were able to memorize and recall songs.

And I literally was thinking, am I seeing what I think I’m seeing here? Are people able to kind of build different memory muscles through the use of music? And that’s what led me to go back to school and get my PhD and really dive into the research.

SOPHIE BUSHWICK: And can we get a little bit into what is changing for people who are doing this type of program. We talked about there being like a small effect. But just what does that mean in terms of a person’s mental capacity?

JENNIE DORRIS: So what we were looking at is general thinking and memory. And so if you can imagine those cognitive tests that ask you what day it is, to remember a list of words, maybe to follow instructions, that’s where we were seeing the difference in scores. Now, that can play out differently for different people. And we’re still learning what does an improvement in scores look like for MCI versus, maybe, mild dementia. So we haven’t quite normed that out.

But I think what it is is something that’s hopeful. To be able to move the needle is really exciting to know. These people want to support their cognition, and this might be one of the many activities that could do so.

SOPHIE BUSHWICK: And is this something that it’s possible to express in terms of a, say, percentage of improvement?

JENNIE DORRIS: Unfortunately, not yet. That’s something– we can kind of see how it might affect you if your scores decline, but I think something that’ll be exciting is to see, if you get better, how it might feel in your everyday life.

SOPHIE BUSHWICK: You’ve mentioned you teach a marimba class. Can you tell us a little bit more about what happens in your class, what it’s like for the participants?

JENNIE DORRIS: We taught marimba for many years, leading up until that point. And these classes were really fun. We would start by working with a metronome. Something we wanted to work on is, can we improve people’s reaction time with their mallets?

And so we’d set our metronome and maybe do a C major scale and then start cranking the speed and see if people could get quicker as they were negotiating those scales. We also had exercises and improvisation. So people learned different arpeggios and different keys, and we would play songs that changed keys and that also had soloists and accompanists.

We also had everyone compose, and we would write songs as a group. And each day, we’d write a melody. And it secretly was a memory exercise because, at the end, after we played the melody that we wrote together, we’d erase it from the board and see if we could remember it, both right then and then, again, at the end of class. And we were really using chunking techniques to try to remember what notes went together.

And finally, we would play repertoire. We learned how to read music. And we would play songs, both songs that were familiar and brand-new songs to the participants.

SOPHIE BUSHWICK: Over the course of teaching this class, did you personally see some of the small improvements, the small effects that you described in your paper? And what did that look like?

JENNIE DORRIS: What I was able to see, particularly in the composition, is that people had a fluency in a confidence in the music itself. But then I was seeing them remember more music. I’d erase that melody, and people could play a longer and longer melody.

And then I had people who were like, can I now try to demonstrate that for you at the end of class, so, say, 30 minutes later? I had one student who said, now I’m going to challenge myself. I’m going to come back here on Monday, and I want to play that for you. And he’d have it ready to go.

So I think something that music does is that it also motivates us. It’s really fun. And so, in trying to stimulate our memory, it’s also a really fun way to do so.

SOPHIE BUSHWICK: And does it seem to matter if people are playing in that big group or if they’re playing alone? Can you see similar effects?

JENNIE DORRIS: I have I’ve seen other research that’s been done that show more of the brain is activated when we play with others. I haven’t done that research myself. But I have always found knowing that it’s good to socialize as we get older, knowing that Alzheimer’s can isolate us, I think it’s always been in my mind to create interventions that bring people together as a group.

SOPHIE BUSHWICK: You talked about there being a variety of genres, a variety of different kinds of music. Did you notice– does it seem to matter if a person is playing music with an instrument or even making an instrument, like you mentioned in the South Korean study, and then using that versus just singing or doing sort of a self-guided participation in music making? Just how involved, how tactile does the teacher need to be?

JENNIE DORRIS: That’s a great question. What we did was level the playing field and consider all of it equally. And so one of the fun results is to be able to say that, yes, you can sing. Yes, you can play an instrument. And they all have the same effect because that’s the way we ran our model.

Now, I think that this is the direction that research is going to go. We’re going to start really looking at, is it a certain instrument, is it a certain activity that could make more of a difference or not? But what our study found is that any type of active engagement in music means that you’re supporting cognitive functioning.

SOPHIE BUSHWICK: Is music difficult to study because of that variety? Can you really standardize it from a scientific perspective?

JENNIE DORRIS: So that was one of our objectives. We found the work of another researcher, who created these reporting guidelines for music-based interventions. And she did a lovely job categorizing music in a really smart way. So she has one category called recreating music, so that might be if you’re singing “Amazing Grace” with your choir. Now, she has another category that’s improvisation, so that might be if you were doing scat singing over “Amazing Grace” and doing whatever you wanted in the moment.

And I think using this type of categorization system across our field could be really exciting because then we’re getting at the different activities of music and seeing is one, maybe, a little more important than the other. Do they work really well together? You know, what– and it also helps us compare very creative and different music interventions. How do we know if a marimba band in Pittsburgh is the same as a Taiwanese drum circle? This type of categorization and reporting, I think, can really help us.

SOPHIE BUSHWICK: There is so much we still don’t seem to know about Alzheimer’s and the brain. But is music itself special in some way? Or do you think some other activity that involved learning a new skill or being social or even just being creative would also help people’s brains?

JENNIE DORRIS: I think all of those things are important. We know being social is so key. Physical activity is important. Sleep is important. Music can highlight a few of these things as well, and that’s what makes me excited about it.

It can be a social pursuit. It can activate many regions of our brain at once as we’re playing. There’s a couple of things about music that I think make it special in particular for people with Alzheimer’s.

As I was working with people, the two big fears that people would express is that they were going to lose the memories that were so important to them and that they wouldn’t be able to express themselves. They hated it when they couldn’t think of the word that they wanted at the end of the sentence. And I think about how music can help to support those two fears.

If we think about playing songs that are important to your life, it’s sort of like reinforcing your memories through the soundtrack of your life. And I’ve become really passionate now in interventions that I’ve been developing to have music that is important to the older adults so that we are really enforcing those memories.

SOPHIE BUSHWICK: I’m Sophie Bushwick, and this is Science Friday from WNYC Studios. So you mean like specific songs that are meaningful to the people playing the music?

JENNIE DORRIS: Exactly. We recently developed an intervention where young musicians, teenagers, came on Zoom– which we’re on Zoom now– and they joined our members. And what we did was ask, members, what are your favorite songs? And these young musicians arranged them for their instruments. And the older adults get such a kick out of hearing their favorite song on the clarinet or on the piano. I just think it’s a beautiful empathy exercise for us as musicians to sort of bring forward your stories through our modality.

SOPHIE BUSHWICK: And what’s next? Do you think we could design a specific dose of music or something like that, like a prescription, that might help people maintain their routines while they’re dealing with these early stages of Alzheimer’s disease?

JENNIE DORRIS: You’re really reading the mind of this field. There’s an amazing initiative called the Sound Health Initiative that was started by Renée Fleming, and it brings together the NIH with the NEA. In this entire year, they’re doing a series of workshops to look at how we can do better research as musicians and researchers and figure out the answers to those questions.

Do you need 30 minutes a day? Do you need to be in a group? Do you need to be alone? Kind of figuring out what’s best for people.

SOPHIE BUSHWICK: Thank you so much for joining us.

JENNIE DORRIS: Thanks for having me.

SOPHIE BUSHWICK: Jennie Dorris is a PhD student in rehabilitation sciences at the University of Pittsburgh.

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