Music & Neurosciences V – Blog 9 (Music and Dementia)

Hello Dear Reader

The last blog of Music and Neurosciences V (Day 4) covers the final symposium of the event, which focused on Music Cognition and Dementia. This symposium was organised by my colleague Andrea Halpern and one of her collaborators, Jason Warren.

I was looking forward to this symposium given the focus on music and memory.

lady“Dementia” is not a single disease. It is a term that represents roughly 100 different conditions, including Alzheimer’s. Dementia currently affects about 10% of those over 65 years of age, and 47% of those over 85. Based on current projections, with an ageing population, the raw numbers of people dealing with dementia are only going to grow. This is therefore a topic of the highest relevance for us all.

Lola Cuddy (editor of Music Perception) gave the first talk. Lola was kind enough to mention to me in passing – after her talk –that she reads and enjoys this blog. This absolutely made my day, as you might imagine!

Lola reported on her work with Alzheimer’s Disease patients (AD). AD has three broad stages of progression, from mild through to moderate and finally, a severe state. Lola has conducted research studies with patients from all these stages.

She showed a wonderful video of a patient known as EN, a lady in her 80s who at the time of filming had severe AD. EN had a very low score on a test of mental state (MMSE 8/30) but she still enjoyed music. She performed above chance on all the music memory tests that she was given and from the video is was clear that she reacted instantly to changes to familiar melodies.

EN’s lovely smile reminded me of my dear recently departed Grandmother.

(image from HARDWAX on Flickr)
(image from HARDWAX on Flickr)

Lola reminded us that the kind of music memory we see spared in AD is a form of semantic memory, not episodic memory. The music (familiar tunes) and music structures (tonality) that these patients can still access form part of their memory for ‘facts’ rather than episodes in time – the latter are largely lost.

I have no idea if there is any work in this area but it would be interesting to see if music memory function is impaired in patients with semantic dementia.

The next speaker was Jason Warren, a neuroscientist who is interested in probing social cognition function using music in dementia patients.   Jason works with patients who have a very different form of dementia to AD, termed fronto-temporal dementia (FTD). These patients present with a reduced ability to recognise and react appropriately to emotion.

The question for the talk was, do their muted reactions to emotion apply to music too?

Music_by_BalakovJason showed data that FTD patients have supressed responses to all types of emotion presented as faces, vocal sounds, or music. Interestingly though, their performance was especially poor in music. This meant that their muted responses to emotional music were the best predictor of correct group membership, in identifying their condition.

As a contrast, and just to underlie the variety in clinical populations, Jason talked about (rare) cases of musicophilia in FTD patients, people who develop a sudden passion for music that was not there before their illness. These patients may have a special spared area of function in the hippocampus that appears to underlie this unique presentation of FTD.

Paralysis agitans-1892
Paralysis agitans-1892

The third talk was a concise summary of a new project conducted by Andrea Halpern. Andrea presented a summary comparing the manifestations of AD and Parkinson’s disease (PD).

1) AD is association with cognitive impairments but preserved motor function while PD is the opposite.

2) AD has hippocampal damage as a primary presentation, PD features damage to the basal ganglia.

3) AD is associated with dysfunction in acetylcholine while PD damages dopamine function.

Andrea showed preliminary evidence from two studies that are running in London right now. The first looks at auditory imagery ability in AD. New data from this work suggests that music perception ability might be impaired in AD, while musical imagery might be preserved. This final result of this study will help narrow down the possible surviving brain pathways that support music memory in AD.

listenAndrea’s second study looks at auditory executive function in PD; the ability to suppress one sound (or aspect of a sound) and focus on another. Her paradigm is a little complicated to explain but involves asking patients to focus on either a pitch or timbre judgment (same/different) when the other aspect of the music is kept either constant or varied.

The underlying finding for this study to date is that PD is associated with a slowing of around 40% in decisions relating to complex auditory stimuli that require suppression.

This result suggests there may be an auditory executive dysfunction in PD.

The final talk was by Severine Samson who spoke about 3 of her studies where she trialled musical interventions in care homes. She compared musical interventions to a cooking class (and a baseline condition in the 3rd study). To date the data suggest that there is nothing unique about the musical intervention, as the cooking appears to provide as many benefits to the measured outcomes, such as mood and cognitive ability.

A note on this final talk came while speaking to music therapy colleagues after the session. They were concerned that the above music interventions were run by musicians who had an interest in care – not music therapists. I can see their point and would prefer to see music interventions trialled with properly trained individuals.

And that was it! End of the Music and Neurosciences V.

Elena_DijonAfter this final session we had a brief wrap up from the organizers and headed for our final lunch and poster session. Sadly I could not stay too long as I had to catch the TGV back to Switzerland.

But I left Dijon with a head full of new ideas and wonderful memories of good times – tired but inspired.

 

Music & Neurosciences V – Blog 8 (Music and Infants)

Hello Dear Reader

palaisThe morning of Day 4 of the Music and Neurosciences V conference featured yet another beautiful blue sky. It has rained quite a bit in Switzerland lately so it has been nice to experience a run of pleasant weather. One of the best things about Dijon is the recent pedestrianization of the streets, which means I have had lovely walks every day past the Palais Des Ducs to the talk venue. This pleasant amble will be missed.

Although tired – this was the last day of the conference – I was determined not to miss the final two symposia of the conference. They featured comment along the lines of my new field of interest – music, health and wellbeing.

The first symposium was organised by Marie Cristina Caccuman and featured presentations by Joanne Loewy and Sandra Trehub, both seasoned professionals and highly respected researchers in developmental work.

Joanne has spent 20 years building an amazing therapeutic centre called the Louis Armstrong Center for Music and Medicine at Mount Sinai Beth Israel Med Centre in New York. Sandra was recently awarded a lifetime achievement distinction in our field for her contribution to our understanding of musical development in infants.

allstaffJoanne has created an atmosphere of aesthetically pleasing wellness within her hospital setting where, in particular, her research involves assisting premature parents and their infants to cope with the unexpected and often traumatic transition in their lives. Joanne’s centre has other research studies including cancer patients, pain experiences and surgical interventions.

The work she presented at the conference focused on her breakthrough work with premature babies.

She showed a touching video of a mother with her premature baby, a mother who had been taught by the researchers in Joanne’s group about the use of specially created songs and sounds for soothing and modulating the arousal level of her new son.

Joanne sings to babyJoanne’s approach favours live music, which allows for a feeling of reciprocity and permits active entrainment to vital signs.  One thing that I learned from Joanne was her approach termed ‘song of kin’ whereby a song of parental choice is adapted to a lullaby format. This is then used by therapists and parents in the care of the baby. This technique not only benefits young infant but also reduces fear and anxiety perception in new parents.

Sandra gave a talk on a research-based approach to understanding the relative efficacy of singing and speech for arousal regulation in young children. Not premature infants this time, but relatively older children, between 3-5 years.

6543676751_cd9633b51c_zThe first study she presented focused on how long children will attend to different forms of sound.

The result was striking – children listened on average for between 4 to 4.5 minutes to adult directed speech and infant directed speech respectively; this increased to 9 minutes for infant directed singing.

Clearly young children are more engaged, distracted or interested (not sure which) by musical sound, a finding that has intriguing possibilities for learning.

The second study sounded a little cruel but was well controlled and focused on a crucial question – singing attracts a child’s attention but does it actually soothe them once they are already distressed, any more than speech?

Infants first engaged in play with their mother, followed by a short period where the parent stopped playing and remained passive in front of them: just sitting staring, basically. Quite quickly the infants became a little distressed by this situation.

2171285963_a476f0f782_bOnce they showed the first signs of distress the mother began the ‘reunion phase’ based on either soothing speech or singing. The researchers took measures of the child’s reaction – the clearest was the skin conductance response, which measures anxiety. After 30 secs of singing children showed recovery from their distress however, with soothing speech, anxiety continued to rise for another minute after reunion had commenced.

Sandra had many insights into why singing was a much more effective communication for reducing anxiety in a stressed infant, including the distraction and engagement triggered by the increased rhythmic aspects of the sound. She also pointed out that it is easier for a mother to sing a song that continue speech at the same consistency and rate.

Also, singing may be more comforting for the mother as an action, and this may be perceivable by the infant.

All in all – a fascinating start to the morning. There was no break before the next session but I was happy to hear from the next symposium as it covered one of my favourite topics – music and memory…