Music and Dementia Expert Roundup

Because the music we love is not related to loss of short-term memory, but rather to our emotional system, which is still very much intact, we will always love our music no matter how advanced our dementia.

Grab our free guide, How to Create a Personalized Playlist for Your Loved One.

Songs that are tied to memories, typically from one’s youth.

Watch this overview of Alive Inside, a film about how Dan’s Music and Memory project connects people through song:

 

Music may be used to stimulate and structure physical movements in those who are less likely to engage in exercise or other physical activity. It is well known that physical activity facilitates health of the cardiovascular, digestive, lymphatic, muscular/skeletal, nervous, respiratory, and vestibular systems. Yet, those in the later stages of dementia cannot follow verbal directions for exercise programs and may lack motivation for participating in exercise, including walking. Music can be used to structure physical movements through rhythm and to stimulate participation through additional musical elements of dynamics, timbre, tempo, and melody.

Singing has physical benefits associated with deep breaths required to sing a phrase of a song. Deep breathing is a prerequisite to physical relaxation, which precedes calmness and sometimes sleep. Further, singing is very comforting and enjoyable for many individuals.

Emotionally, music associated with pleasant times through life is concomitantly associated with the emotions that accompanied those times. Such music has the power to trigger the emotions every time it’s heard. To use music effectively to facilitate positive emotions requires knowledge of the explicit musical experiences of a particular individual. It is not possible to assume that musical selections that are emotionally significant to one person will matter at all to another person. It is also important to note that the same music could give rise to strongly undesirable emotions in another individual.

1. Use the music the care receiver prefers.
   This can be done through family members’ awareness of the type of music and any particular song selections regularly heard in the home. If such information is not available, it’s possible to determine preferences for popular music played on the radio or listening device when an individual was in their young adult years. With a birthdate, you can determine someone’s age in high school up through mid-late twenties and beyond. A quick search on the web will reveal popular music of any given year. If someone does not prefer popular music, then finding classical or other musical genres is a matter of trying certain music and watching for positive reactions indicated by body tension and type of physical body movements, facial expressions, the presence or absence of agitation, and the level of engagement.
2. Dancing or moving/exercising to the music can stimulate alertness and provide directed and well managed physical activity.
   Dance styles of young adults vary over time and it’s good to use that which is familiar to an older person. Caution: Some people believe dancing is gravely wrong and to ask someone to dance when the belief system prohibits it can have traumatic results. Still, exercising to music can make a dreaded routine less boring, more engaging, and of longer duration. Attention to musical selections that fit the speed, range, and force of the moments is recommended. Then, when persons become so frail that they cannot stand up to dance or exercise, adaptations to moving in rhythm with the music while seated is very satisfactory.
3. Singing facilitates engagement in many people, but those who have never sung are not likely to start once they have dementia.
   People can be very self-conscious regarding the quality of their voices over their lifetimes and may not have ever gained a level of comfort with singing that allows them to engage. A great deal of enjoyment and satisfaction can be derived from singing by those who like to sing.
4. Using music to cue certain activities throughout the day can lead to better transitions between activities.
   For instance, music used upon waking may be slow and quieting but can be changed to music that has a faster tempo and some percussive sounds when it’s time to get out of bed and walk to the bathroom for a morning routine. Then, music played in the bathroom during activities of daily living such as bathing, brushing teeth, and dressing may facilitate engagement through managing the level of stimulation. Likewise, using quiet music in the afternoon may provide a cue for rest and relaxation.
5. Music provides a common ground for interaction among family members when words and language are no longer possible.
   Using positive facial expressions such as smiles and lifted eyebrows while singing to/with someone may elicit a facial response or singing in someone with dementia.
6. Singing to someone who is distressed or agitated can calm them.
   A person who’s singing may be interpreted by a confused person as someone who means no harm. Further, individuals with dementia may have had experiences very early in their lives with their mothers or other family members who sang to them to comfort them or sang to prepare them for sleep once in bed. If so, singing to them tends to have comforting effects.

The songs that have the most meaning and elicit the most positive responses are those that were familiar and enjoyable to a person earlier in life. This is true for most people whether or not they have a dementia diagnosis. It is essential to know which songs lead to positive memories that are associated with positive feelings. An individual’s preferred music is likely to elicit the most desirable outcomes. However, not all familiar music triggers positive reactions. The outcome depends on the personal associations with particular music.

Typically, popular music of the young-adult years leads to the most vibrant responses. If someone has associated a given piece of music with pain, tragedy, disappointment, grief, or some other strong negative emotion, that music will likely trigger those same emotions when it is heard years later. The outcomes can be catastrophic and music can be harmful when it causes such reactions.

Sometimes the only way a caregiver can know the influence of specific music is to play it and carefully observe a person’s posture, movement type and level, vocal quality, and body tension. If the person engages readily and positively, the music is likely desirable. If someone does not engage with the music and shows beginning agitation or discomfort through these outward signs, the music must be stopped immediately and another selection presented.

Music is a natural tool to help promote exercise and movement. Our bodies instinctually start moving to the rhythmic beats. As it motivates us to move, we often don’t realize we are exercising. Dancing, clapping, or using instruments like maracas are examples of movement through music.

Music often imprints itself in our memories based on significant moments in our lives. As a result, hearing this music again stirs up images of past events and time periods, and their associated feelings. When these memories are positive, one’s spirit is lifted.

In a group setting, music becomes a social tool where everyone enjoys the time together. Smiles are shared and hands are held. This creates a bonding situation where friendships are kindled.

Joy is maximized when shared with another person. As such, music should be enjoyed together when possible. Headphones, while beneficial, should be the exception and not the norm. Singing, dancing, playing instruments, clapping, or even humming are ways to enjoy music together.

Music can also be a great conversation starter when we reminisce together. To take it a step further, try watching music videos on YouTube together. When we also see the musicians from our past, the images of the past are more vivid, and the resulting conversations can be fabulous.

Unless you grew up side by side with the individual, it will take some creativity and detective work to find the right songs. It’s important to start with music from the individual’s past. Ideally, family members will have suggestions.

Otherwise, start with music from when the person was a young adult. Understand where they grew up, and what music was popular in their homeland or region at that time.

Knowing their past experiences and preferences also helps. If religion is important, gospel songs can be powerful. If they were in the military, patriotic songs may arouse their spirit.

Stay creative and experiment, because you might be surprised by what gets each person going.

The music/rhythm part of our brains is one of the last affected by dementia. Using music stimulates the part of the brain that allows people to move rhythmically and sing songs they are familiar with from their pasts. A song may connect to a specific memory, like their wedding or first date, etc., and as music therapists, we connect to that memory with the person.

Use music that’s familiar to the person. Sing with the person. Dance or move to the music.

Any song that is most familiar to the person with dementia. This may be best captured by music of their twenties and early thirties. This music sticks with them the longest, as do folk songs passed down from family. Some popular ones I include in my sessions are “You Are My Sunshine,” “Amazing Grace,” and “Home on the Range.”

Because of the neurological stimulation, familiar music can make us want to dance and help us be more physically active. Music also helps us identify and express emotions, and boosts our mood.

Singing favorite songs and talking about memories associated with them can help you interact with your loved one when interaction becomes more difficult. Active music-making has a greater effect than passively listening. Earbuds tend to isolate, so playing music along with social interaction is best.

Familiar, favorite songs, generally from the time period when a person was in their teens or twenties.

I facilitate their creation of personally meaningful songs as a way of stimulating cognition, expressing emotion and identity, addressing social isolation, and building self-esteem and confidence.

Select music that has significance for your loved one. That usually means songs from their youth. For example, when they were in their twenties.

Everyone is different.

Music creates a nonthreatening and normalizing environment. Familiar melodies are comforting and can help ease the frustration of individuals who now struggle to communicate. It provides expanded opportunities for self-expression and emotional expression, without the need for verbal or cognitive processing. Music’s rhythm, form, familiarity, and predictability gives disoriented seniors a sense of structure and security and can help prevent them from regressing alone and feeling socially isolated. Music can help individuals with dementia recall lost memories and also help them regain, at least for a while, their identity and personality. Multiple studies involving Alzheimer’s disease and other memory disorders conclude that patients retain musical information longer and out of proportion with the simultaneous state of their nonmusical memory. Musical memory remains intact for quite some time, even with severe cognitive decline. Additionally, studies show that music can decrease agitation and wandering in individuals with Alzheimer’s/dementia, and it also stimulates better responses in both reality-orientation programs and facilitated reminiscence programs.

Patient-preferred music will spark the most joy. Actively engage your patient by singing along with them, encouraging them to tap their toes, or holding their hands to “dance” along.

Patient-preferred music is always best. If you are unsure of what music to play, try the songs that were popular when your patient was in their late teens or early twenties.

Music can reach all listeners, regardless of their cognitive/physical condition, unless the person is completely deaf. Music can sonically create a safe space in which listeners experience an equalisation of status, where all listeners can share the possibility of being transported away from their present realities, and into either the past when listening to familiar music, or into an entirely different dimension when the music is less familiar, where connecting and reconnecting is possible, where the basic human needs set out by Tom Kitwood (Dementia Reconsidered, 1997) can be met (inclusion-occupation-identity- inclusion-attachment-comfort-love).

Begin by finding out as much as possible about the person’s history, especially their younger years.

• Did they attend church?
• Sing in a choir?
• Go to dances?
• Like particular musical artists when they were young, up through their twenties?

From there, a caregiver can search for music and begin playing some music, always being present and attentive to both verbal and nonverbal signals and responding quickly by either changing music, repeating music, or stopping the music altogether and trying again another time.

Another good trick is to locate through a web search what tunes were popular during the years that the person with dementia was say, 15 to 25, and to begin playing those tunes, again whilst remaining vigilant for nonverbal signs of enjoyment/engagement, or boredom/disengagement/distress, and quickly responding.

I feel it’s very important to understand two concepts:

1. Entrainment
   Matching the tempo or speed of the music to the current perceived temperament of the person who is listening. So if someone is agitated, play fast moving music. If they’re tired, then play slower, more gentle music.
2. The Iso-Principle
   Matching the mood of the music to the current perceived mood of the person who is listening. Thus if someone is sad, play sad music, if they’re happy, then start with happy music. This approach both validates the listener’s current mood/temperament, and also provides a much better chance that the listener will engage with the music that’s being played. Once the listener is engaged with the music, the person who is playing/administering the music may gradually shift the music toward a more positive realm if that seems beneficial for the listener’s wellbeing.

This is situational, individual, and changeable.

The engaging qualities of music make it a powerful tool that we can use for therapeutic purposes. We know that even when cognition and communication are severely impaired, musical memory and motor (physical) skills required to engage in music are often preserved into the late stages of dementia. We also know that there’s a strong association between memory and emotion in the human brain, and music is an evocative stimulus of both. This interrelationship between musically evoked memories and emotions means that music therapy is a perfect tool to use with someone who is agitated, confused, and/or isolated, because the music transports people back to familiar times in the past. For people with dementia, the past often represents their present reality, and so the music helps them successfully engage with others, leading to feelings of validation and comfort.

Use music that is very familiar, and where possible, provide live music. We know that live music is more powerful than recorded music, because we can manipulate the music to meet the care recipient’s needs in that moment. For example, we might alter the pitch or the tempo to meet the care recipient’s vocalizations and movements.

Singing is great. It’s a form of accentuated human connection and is readily available. Caregivers can sing to their care recipients during everyday activities, such as showering and dressing to reduce stress and make the experience more enjoyable for all.

Of course recorded music is also useful, but it has to be carefully selected and monitored. Registered Music Therapists are specifically trained to assist with these techniques, so if you’re in Australia, please contact the Australian Music Therapy Association for more information.

Songs that strike a chord are unique for each of us whether we are young or old. For people with dementia, we will try to find familiar songs from their past, but we also need to be careful that the person can manage emotions and memories evoked by the songs. Music is a very powerful resource and should be used with care. A Registered Music Therapist will carefully assess people with dementia and their families for music preference, and will then monitor responses to maximise benefits and reduce negative effects.

Music can help facilitate the production of serotonin, which is a neurotransmitter that creates pleasurable sensations. The inherent pulse in the music can help provide structure, a sensorial beginning and an end.

To connect with your loved one with dementia, play music from their young-adult years. Encourage movement and singing. Repeat the music to create a familiar and predictable container for the person’s experience.

Whatever music is preferred by the person with dementia. Discern the patient’s musical preferences first and then provide live music for the happiest results.

In my experience, residents are more in the present with familiar music. They sing along, sway, clap, and smile.

Watch your resident’s face. They will let you know what they like. Don’t impose your tastes on them.

Songs with a strong melody, particularly from their childhood.

Upper chest movement, stature, self-esteem, and inclusion.

Sing together

Songs from the World War II era.

Watch this video of David’s dad, who has vascular dementia, singing from his heart:
 

Music can activate and enliven a person with dementia and enhance their physical and emotional regulation. The act of making music together connects people, affirming positive relationships with one’s self, others, and the music. Because of the creative nature of music making, there is a natural focus on the possibilities and potentials of a person to make something—a sound, a song lyric, a reimagining of their own self—that enhances life and creates meaning for those with dementia.

Start with an attitude of acceptance and deep respect for all musical engagement—from humming and foot-tapping to playing instruments, singing, dancing, improvising in all its forms, receptive listening—and look for ways to build on even the smallest initiation of a musical sound or movement.

There is no right or wrong way to engage with music or to respond to music, and there should be no judgment.

Give SPACE for music to happen. We can’t predict how someone will engage with music, but providing opportunities for a person to play and experiment can lead to the most astonishing connections.

Popular songs from a person’s coming-of-age often elicit the most engagement. Musical memory can be intact in people who otherwise struggle to remember their own lives. Singing, playing, and moving to these familiar songs can create an immediate and strong connection.

Agitation is common and persistent in people with mid- to late-stage Alzheimer’s. Their behavior is linked directly to the progressive breakdown of the brain because of the disease. Medication is often ineffective or even harmful in solving this type of behavioral problem, but there is significant evidence regarding nonpharmacological interventions, which include reminiscence, art, crafts, and music therapy techniques.

While each of these techniques can be effective, the use of music within the evolving relationship between patient and caregiver appears to have a nearly immediate impact and encourage the physical, mental, emotional, and spiritual well-being of the care recipient.

The person diagnosed with Alzheimer’s will eventually experience deterioration in speech. As the disease progresses they will tend to speak less and their speech will become confused and at times incomprehensible. However, their ability to sing familiar, popular old tunes remains intact throughout the disease.

Stated simply, music taps into remote memories, which are better preserved than recent memories.

Selecting music from a person’s past can stimulate conversation. Considering the deterioration of speech in people with mid- to late-stage Alzheimer’s, the emphasis belongs on the value of their spontaneous engagement and human reconnection.

The consistent accumulation of scientific evidence is undeniable: Music therapy meets the standards of evidence-based medicine. We must recognize the care recipient’s need for sensory and environmental stimulation and the need to redefine quality of life for individuals living with Alzheimer's disease. Music is an affordable luxury with the ability to improve the quality of life and provide a focus of attention for the care recipient.

Music creates bridges and opens doors between people. It’s most effective when the care recipient and the caregiver are engaged together in sharing the listening experience. Let me present an example.

You may be familiar with the film Alive Inside [see clip above], which is a cinematic exploration of music’s capacity to calm and reawaken the remote memories of individuals impacted by Alzheimer’s disease. The film documents the uniquely human connection we find in music and how its healing powers can be successful where prescription medications often fall short. It is well worth seeing.

The most powerful scene is the first introduction of music to make someone “come alive.” This is also the most powerful image: The smile of a man named Henry who was once unresponsive to having wide eyes and erupting with delight. You can actually see the dullness of his eyes light up into a gleaming sparkle.

While watching Henry’s joy in listening is heartwarming, the most impressive impact comes when his headphones are removed from him. An interviewer then takes him through a serious of questions.

• Do you like music?
• Who is your favorite artist?
• What is your favorite song?

In the conversation between the interviewer and Henry, we see the making of the human connection. Henry is in the moment, aware and engaged.

Until the headphones were removed, Henry was happier but still isolated in his own world.

Certainly, listening to music is good, but listening to music and having a conversation is best. Simply put, the combination of music and conversation creates the environment that leads to improving the cognitive skills of the Alzheimer’s patient.

Care consultant Teepa Snow says, “We should not allow iPods and headphones to become a ‘babysitter.’” Putting an individual with Alzheimer’s in the corner with a set of headphones is as isolating as not doing anything at all. The critical thing is that we want to have the music spark the memories and then for us to engage with the person in why the song is important to them. This is where we find the human connection.

Research conducted by our company indicates that music that was familiar and popular at the time that musical memories developed (between the ages of eight and 20) resonates with the older person and produces highly favorable outcomes. The result is a calmer, more receptive care recipient capable of more rapidly making connections and completing thoughts.

Music helps with distracting a person from pain or other physical symptoms. It also helps with redirection, elevates mood, promotes relaxation, and reduces agitation and wandering. Music brings families together.

Use music the patient loves. Get them singing along either a capella [without instrumental accompaniment] or via recorded music.

Songs that the person prefers.

The research is becoming clearer that physical exercise is very good for folks with dementia. Music helps someone with dementia by motivating them to engage in various types of movement. Examples range from activities including:

• Simple toe-tapping
• Finger-tapping
• Hand-clapping
• Reaching for instruments
• Shaking and hitting instruments
• Singing and making oral movements
• Full-on ballroom dancing with a partner

Regarding emotions, music is an emotionally rewarding stimulus and experience for most people. There is music associated with some of our most cherished memories, be it the first dance at your wedding or the sounds of the holidays. In the degenerative process of dementia, the emotion centers of the brain stay intact and functional for a very long time. Using familiar music from one’s past has been demonstrated to activate the emotion centers of the brain and stimulate arousal. This opens up a tremendous amount of opportunity when working with someone who has dementia. Furthermore, research demonstrates that music has a significant impact an agitation as well.

Develop a comprehensive music intake form that collects the relevant music information for each individual. Questions should include:

• What are _______’s favorite songs?
• What song was played for ______’s first dance at his/her wedding?
• What are some songs that _______ would definitely recognize?
• What is a memory of _____’s that also involved music? What song was played?

The best bet when shooting in the dark is to start with songs that were popular when the individual was between the ages 13 and 21 years old.

Music gets the toes tapping and the blood flowing! Rhythmic music from a client’s past (popular dance tunes, perhaps) can be great for getting loved ones active for short periods of time. Take their hands and dance with them, whether sitting or standing, and move to the beat!

To stimulate deep breathing and vocal production, encourage loved ones to sing along to familiar tunes. But remember this: Not everyone likes a solo! Sing WITH the person to create deeper, meaningful connections.

Music can be a great way to communicate emotions when words begin to fail. For example, someone with dementia may have trouble speaking the words “I love you,” but they may look you in the eye and sing their heart out to you if you give them the opportunity.

Repetition is your friend! Don’t be afraid to sing the same song multiple times if your loved one knows it and enjoys it. When people and places from day-to-day life become difficult to recognize, a familiar song is like gold. In some cases, it’s not until the fifth or sixth time singing a song that life comes back into their eyes as they fill with joy and happiness.

Every person values different songs for different reasons. Any song may be a key to unlocking past memories or associations, which may be difficult for those with dementia to retrieve on their own. Songs that marked life events, holidays, or other special moments are likely to stand out, particularly if they were heard or sung through the years, such as “Happy Birthday,” “Jingle Bells,” and “You Are My Sunshine.”

Music is a whole-brain experience. When we listen to, move to, and create music, our brains are activated in many different areas. Because of this, the clinical application of music has the potential to stimulate and improve a person’s physical, cognitive, social, personal, communication, and emotional development.

As the brain deteriorates through the process of dementia, music has the power to impact the active parts of the brain, creating opportunities for a person who may otherwise be out of reach. Research indicates that through various musical interventions, an individual can experience an increase in immunoglobulins, a decrease in cortisol, and a release of endorphins, which in turn can improve mood while also decreasing pain and agitation.

While caregivers can use a person’s preferred music (if known) to spark joy, it’s also important to know that music can spark other, potentially unjoyful emotions. Caregivers may not be aware of the deep-rooted connections a person has with particular songs.

It’s important to know that when using music, it’s the musical experience coupled with the interaction that typically evokes the best response.

Caregivers should also remember to use music for themselves as a means to de-stress and cope with their feelings as they care for a loved one or are in a work setting caring for many individuals.

Every person will resonate with different pieces of music and songs depending on their preferences. We look to a person’s formative years of development when they cannot tell us what they enjoy. Songs from the period of time of someone’s childhood, adolescence, military duty, love and marriage, and major life experiences tend to be of great importance.

Music is special because it can have a physical and emotional effect on anybody. This is because humans appear to be neurologically and physiologically hard-wired for music. The automatic neurological and physiological responses that we have toward music and its related properties, such as rhythm, tempo, melody, and harmony, make music something that can be accessible for someone with dementia at any stage of the disease.

With someone who has dementia, music can be helpful for facilitating movement and beneficial physical activity. These movement and physical activities can include being redirected towards the various activities of the day, or activities of daily living. Music can also inspire one to feel motivated to move as part of a consciously-designed exercise program, or even to move spontaneously, such as through dancing. Another physical activity that music can help reinforce and support is physical therapy, as music can provide structure and pacing for the exercises—but seek consultation from a physical therapist and a qualified music therapist beforehand.

Emotionally, music can help reduce anxiety and agitation, which can be a significant problem for someone with dementia, which can affect their caregiver(s). Music can be helpful for refocusing attention and reorienting to the present moment. With this, music can uplift us, inspire us, but also help us experience emotions that we may otherwise try to deny and suppress. Likewise, music can stimulate memories that can be shared with others, especially caregivers.

1. Know what styles of music the person likes.
   Do they have a favorite musician or artist? A favorite song? Make sure that the music you use matches the person’s preferences.
2. When selecting music, think about how the tempo (i.e., the speed of the music) and rhythm could affect the person.
   If you’re looking to help a person feel energized, select a song that’s upbeat and lively. If you want to help someone become more relaxed, select music that’s slower and calming.
3. Observe how the person is responding to the music or a particular song.
   For example, if someone is displaying signs of agitation, that may be an indication that they don’t want to listen to music at that moment. Or perhaps that particular song is causing them physical discomfort, due to the qualities of the music and their own auditory processing issues. As well, the song could be triggering painful memories or emotions. Keep these possibilities in mind and be observant.
4. Be available to be present with a person through music.
   Music can bring people closer together, and it can be an especially meaningful way to get to know someone better, as well as to better understand their inner state.
5. Don’t underestimate the power of silence.
   While music is a pretty amazing thing, it’s not a cure-all, and sometimes we need silence so that we can later appreciate the music.

Not everyone likes the same kind of music, and even among those who like the same kind of music, their reasons may not be the same. Along with this, our emotional responses to music can shift and vary with our life experiences.

Music relaxes a person with dementia and promotes memory recall. I have seen very agitated people calmed almost instantly by music. It also stimulates hand movement and toe-tapping.

Use large headphones. Be sure to talk to the person you put headphones on, and touch their hand to get their attention. Don’t startle them by suddenly putting the headphones on. Also check the volume levels. Start off quietly and increase the volume if you need to.

Waltzes, carols, big band music. Try to match the person’s age to a musical era.

Music can be used during music therapy to aid in the management of agitation, to increase emotional closeness, to facilitate in fine and gross motor movements, and to create opportunities for positive social interactions. There is so much that music can do for human beings that after 11 years in the field I am still in awe!

Use music the person preferred in their twenties. Often they can recall every word even in the later stages of dementia. Sing and talk about the songs and how they relate to the day. For example, sing “Button Up Your Overcoat” and talk about the weather and how you need a coat that day.

Songs they learned in their late teens and early twenties. What spoke to them at that time in their lives will most likely speak to them again! Songs that are associated with specific past events, such as a wedding, can often provoke the memory of those events.

Physically, listening to music can:

• Lower blood pressure
• Assist in relaxing contracted muscles
• Increase breath support and lung capacity
• Regulate gate stride (i.e., for stroke victims)
• Assist with communication and speech development
• Establish connections within the brain that might have diminished due to the disease process

It also creates an increase in dopamine levels in the brain, which in turn elevates mood, which can assist in depression. Music can also be used to assist with anxiety through entrainment, breathing, and relaxation techniques.

The most important thing to keep in mind is the music preference of the individual. If you use music that is not preferred, not only will it most likely not be effective, it could be harmful.

Also, address the loved one’s current mood or state of being when considering what type of music to use. If the person is demonstrating anxiety or appears to be overstimulated, use preferred music that’s slower and more calming. If one is understimulated and/or appears sleepy, try to use preferred music that might be a bit more upbeat.

Keep in mind that those with dementia have the capability not just one day to another, but also from one moment to another, so be prepared to change a song or approach within the moment if you see something isn’t working.

For today’s aging adult with dementia, the songs that most really enjoy and trigger singing or memories are traditional songs such as “You Are My Sunshine,” “God Bless America,” “Happy Birthday,” “Jingle Bells,” and “Home on the Range.”

Our bodies naturally become in sync with the strongest auditory stimuli. When a person with dementia is engaging with music that has a strong pulse or beat, it may encourage them to tap their toes, clap their hands, dance, or exercise with guidance.

Music and our emotions are tightly associated in a deep part of the brain that’s often untouched by dementia until the very late stages of the disease progression. This means that some music may elicit strong emotional responses in people with dementia—smiles or tears that arise from the feelings they have when they hear a song closely associated with their emotions.

Caregivers may choose to play prerecorded songs that may be familiar to the person with dementia and encourage them to sing along, move to the music, or reminisce about the music, emotions associated with it, or a related topic based on the lyrics of the song. Sometimes clapping along, tapping toes, or holding hands while listening can be a good way to connect with the person with dementia.

The songs that are more likely to elicit strong emotional responses and active engagement for the person with dementia are the songs of their musical preference. They may not be able to communicate these preferences, so a good starting point is to explore songs and styles of music that were popular when the person with dementia was in their late teens and early twenties. Use contextual clues about their life and culture for making educated guesses about what music to present that they may enjoy or have been familiar with.

Music gives voice to the unspoken words that even individuals who are not afflicted in some way have difficulty expressing. A song can trigger a memory or sensation in ways that traditional talk therapy simply cannot. Art goes deeper than talk.

You cannot force it, or simply throw an individual or group into a musical environment, as it can have a negative effect. The power of attraction comes into play by just making it available and showing how easy (and fun!) it can be. Almost every time, I have seen results through that method.

It really changes from person to person, but “Here Today” by Paul McCartney. Mainly though I try to have clients write their own material, as it’s easier to “make things up” than to have a “lesson” (and you certainly get more out emotionally that way).

Music-based interventions can aid cognitive, socio-emotional, and physical functions. They cannot reverse the course of the disease. There is research on the cognitive/memory domain. We are studying the neural bases of musical memory formation in Alzheimer’s disease (AD), both long- and short-term, relative to biomarker development in AD, and if music interventions can provide cognitive boosts to maintain levels of functions. The clinical techniques and training are formalized in Neurologic Music Therapy.

Just for joy, engage the person in actively listening to and/or playing long-term, familiar music.

Music with personal associations will be more effective to help memory and may reduce agitation, confusion, wandering, etc.