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THE WEEKEND AUSTRALIAN FEBRUARY 23-24 2008

16 HEALTH www.theaustralian.com.au

ASK THE DOCTOR

Music lifts Symptoms


in common
dementia’s can confuse
constant fog
Music therapy is showing promise in helping dementia
LINDA
CALABRESI

A few weeks ago you wrote about


patients tune into reality, writes Jane Lyons interstitial cystitis. I have heard about a
condition called vulvar vestibulitis
syndrome, which sound like it involves very

D
OROTHY sits in her ward, gazing at maintained the capacity to respond coher-
nothing in particular. Lost in time ently and in context.’’ similar symptoms. Are they the same?
and space, she asks very little from Music therapists have long reported symp- No, they are different conditions, although
her small world. She seeks no tomatic improvements in Alzheimer’s pa- some symptoms can be common to both. The
comfort or companionship, no intellectual tients, including increased social interaction, most common and characteristic features of
stimulation. When she does speak, she seems reduced depression, lower levels of agitation interstitial cystitis are bladder pain and an
to follow the rhythm and cadence of and greater focus, and improved cognition, often-painful feeling that you need to empty
conversation with ingrained habit, but her language abilities and emotional skills. A new your bladder frequently. Women with this
responses are disjointed and devoid of intent. study in the journal Brain has also just condition can get pain with sexual
intercourse, and pain in the vagina, urethra or
Wherever Dorothy is, it is not here. And reported potential benefits for stroke patients
vulva, but that is far less common. Vulvar
‘‘here’’ is Alzheimer’s. (see The Pulse, opposite page).
vestibulitis syndrome is characterised by
A progressive and degenerative illness, But with most reports lacking an explora- vulval pain and pain associated with sexual
Alzheimer’s disease attacks the brain, de- tion of the physiological whys and where- intercourse at the point of entry. While the
stroying cells and creating a build-up of fores, Barber — a musician and former music cause of this syndrome remains unknown, it
plaques and ‘‘neurofibrillary tangles’’ that educator who has completed a doctorate is generally thought to be an inflammatory
damage neural connections and disrupt the looking at the electro-physiological processes condition. Sometimes it is triggered by a
flow of messages. As the brain cells die, that music stimulates in the brain — decided Candida infection also known as thrush. In
information can no longer be recalled or it was time to investigate further. other cases there is a history of using soaps or
assimilated and a variety of functions such as The aims of his research were to find out if other irritants on the skin of that area, which
memory and language, reasoning, planning there are objective measures to show the could have precipitated the problem.
and decision-making, social interaction and extent of any benefits from music therapy, Unfortunately both conditions can persist,
emotional responses are lost. which could then be used to help design and often prove difficult to treat.
According to the Alzheimer’s Association, music intervention protocols. Therapy: Bruce Barber and Loretta Quinn believe Alzheimer’s patients benefit from music Picture: Michael Potter
once these abilities are lost they can rarely be In his first study Barber enlisted the help of Over the last two years my urine seems to
regained or relearned. 11 Alzheimer’s sufferers whose impairment The results, he says, also indicate that the months. The other group began with an Henry Brodaty, professor of psychogeriat- have developed a very strong smell. Not all
ranged from moderate to severe, and 17 patients are not just reacting haphazardly or average of 183.5, dropped to 180.67 and then rics at the University of NSW and the director the time — just every now and then, and it
However, preliminary research by the
control subjects. Once connected to an EEG automatically to music. Such music-induced, rose slightly to 182.75. of aged-care psychiatry at Sydney’s Prince of is not associated with any urinary tract
National Ageing Research Institute in Mel-
machine, which records brain electrical intra- and inter-hemispheric activity is like But with just 15 people involved in the Wales Hospital, agrees that music can often infections or any urinary symptoms. The
bourne has discovered that music not only
activity from the surface of the scalp, the the ‘‘normal’’ process by which the regions study, Barber knew more rigorous research go where words and memory have failed. start of the problem seemed to have
soothes the savage beast, it also calls to those
participants were read stories and played both that control movement, emotions, memory, was required. He received funding from a ‘‘Music memory seems to be more resist- coincided with a new relationship. I am 54
like Dorothy (not her real name) who are lost
in the wilderness. familiar and unfamiliar music. visualisation, language and auditory proc- private philanthropic trust to continue the ant to decay than verbal memory. We can see and had a hysterectomy 10 years ago.
Barber then measured the frequency gen- esses work together in an integrated fashion. research in a two-year, randomised controlled people with quite severe dementia who are USUALLY urine has very little odour —
On her first visit to the institute’s labora-
tory, Dorothy was passively co-operative as erated at each electrode point and the degree ‘‘When it comes to asking why people who study, which is now about half-way through musicians who can still play instruments,’’ however, it can become more concentrated
researcher Bruce Barber, the study’s team to which the 171 electrode pairs worked are severely cognitively impaired respond to its two-year duration. professor Brodaty says. when you are dehydrated, and then there is
leader, set up the equipment. They played her together. This is known as EEG coherence, an music, the obvious thing is that there is a So far about 60 patients have been He has also used music to treat his a stronger smell. Check you are drinking
a swirling and passionate orchestral piece by index of co-operation between various func- highly integrated and complex process that recruited, all of whom have dementia. Barber sufficient water each day and see if the
Alzheimer’s patients, bringing in music ther-
Edward Elgar, and when asked to describe tional regions of the neocortex. probably hinges on emotional function, hopes to enrol a total of 200. While it’s too problem recurs. Having excluded urinary
apists once a week to the aged care unit at
how the music made her feel, Dorothy Not only did Dorothy and all the other number one, that activates memory proc- early to give any definitive results, he says tract infection (presumably a urine sample
Prince of Wales Hospital.
responded with ‘‘loving’’. Alzheimer’s sufferers respond to the music, esses, that activates motor processes, it ‘‘an interesting trend is going on’’. was sent to pathology for testing), other
activates cognitive processing in some way,’’ ‘‘The objective of this study is to determine But while Brodaty welcomes research such possible causes of the smelly urine include
But it was the next piece, a 1937 Art Tatum their brains did, too — and in a most as Barber’s, he cautions against placing too
surprising way. Barber says. whether the frequently reported effects of certain foods, such as asparagus, and some
version of Gone with the Wind , which had much hope in music therapy’s long-term
Believing that music may temporarily music therapy stand up in the context of a medications including vitamin B6
the most profound effect. Immediately, her Music is known to stimulate the limbic effects.
reactivate established neural pathways, Bar- randomised controlled trial,’’ he says. supplements. There are some medical
left hand started to beat in time to the music region of the brain, which has a role in ‘‘Clinically we certainly see that people conditions as well that could be causing the
and her face was suddenly suffused with a regulating autonomic processes and basic ber decided to conduct a longitudinal study ‘‘With a lot of complementary therapies
that would measure the impact of a daily there are all sort of claims. Music therapy has respond to music when they may not be problem, such as diabetes or liver disease, but
joyous smile. When asked if she had danced emotions such as fight and flight. Higher generally speaking you would normally be
music-therapy regimen over six months. got up to 400 (research) reports talking about reachable in other ways. Whether it has any
in her youth, 82-year-old Dorothy began to functions such as sensory perception, motor having some other symptoms as well as
commands, spatial reasoning, abstract Fifteen Alzheimer’s sufferers were enlisted the benefits of music therapy specifically for lasting effect beyond the duration of the
talk animatedly about the three girlfriends strong-smelling urine if one of these was the
thought and language are the responsibility of at the time of their diagnosis. One group was the symptoms of dementia. music, I don’t think that has ever been
she used to go dancing with each Saturday. cause, especially after two years. Sometimes a
She was able to recall the two different venues the neocortex, the grey wrinkly matter that given cholinesterase inhibitors, a commonly ‘‘The problem is they don’t meet the level shown.’’
smell attributed to the urine is, in fact,
they danced in, and the names of the bands covers the brain and degenerates as Alzhei- prescribed drug, while the other took the of research rigour required to constitute He also thinks Barber should introduce
originating from a vaginal discharge. Vaginal
that played. mer’s progresses. medication and followed a daily regimen of evidence, as evidence is defined in health care more measures to his study before making infections such as gardnerella or trichomonas
‘‘For a period of no more than five Barber was excited to discover that music music. Fifteen minutes was the minimum, but now.’’ any judgments on whether music improves are commonly associated with an odour —
minutes, Dorothy talked animatedly and engaged the brain extensively, with wide- most would listen for an hour. Barber is anxious to stress that music Alzheimer’s patients’ quality of life. most often fishy-smelling. Once diagnosed
spontaneously with us about these and other spread interactions between most regions of Using the Hierarchic Dementia Scale, a therapy is not a potential cure. ‘‘The Hierarchic dementia scale just meas- they are very treatable.
aspects of her life as if there was no the cortex and across both hemispheres. cognitive function test that involves a series of ‘‘I would argue that it may be shown to ures function. You also need to look at
impairment,’’ Barber says. ‘‘She appeared, These interactions were also greater than questions and activities, Barber measured help people with progressive pathologies such cognition and you also need to measure I am approaching 40 and have started
for the first time since we had met her, to be those measured after listening to the story. both groups before they started their regimen, as Alzheimer’s disease to maintain cognitive behaviour and look at quality of life,’’ taking multivitamins. Are these beneficial?
alert, attentive, responsive and very much in ‘‘It’s saying that the whole brain in then at three and six months. and functional status at their highest poten- Brodaty says. ‘‘You can’t say whether it will I am generally healthy although I do take
the present. The initial effect seemed to Alzheimer’s patients still functions in res- The music group scored an average 185.1 at tial,’’ he says. ‘‘This would help to delay and improve quality of life just because we can medication for high blood pressure.
diminish quite rapidly, but for the remaining ponse to music, even in moderate to severe the onset, rising to 190.8 at the three-month ameliorate the severe quality of life deficits show something clinically. To make those THERE is plenty of evidence that suggests
30 minutes we were together, Dorothy levels of the disease,’’ Barber says. mark and dropping back slightly to 190 at six caused by dementia.’’ further claims needs a lot more research.’’ eating a lot of fruit and vegetables is
associated with a longer, healthier life. Such
a diet is associated with a reduced risk of
various cancers and heart disease. Because of
CASE NOTES: NUTRITION this, many people believe that by taking
supplements of the vitamins and minerals

Salt reduction campaign could benefit from a sprinkling of advice on herbs found in fruits and vegetables they will
receive the same health benefits.
Unfortunately, however, the evidence
actually change their behaviour is what’s salt-reduced foods are flavourless. Smart food meat, chicken, salads and grain-based dishes

A
NATIONAL public health campaign doesn’t generally support this. It seems the
called Drop the Salt held an event in really needed to make a difference in this area. companies are getting around this by reducing rather than using salt and salty sauces and value of a high fruit and vegetable intake is
Sydney recently to further highlight SHARON One of the complexities of the whole salt
reduction campaign is that it focuses on salt,
the salt content of their products without
actually telling you that they’re doing this.
seasonings can provide flavour as well as
health benefits.
not simply related to particular vitamins and
concern about salt content of our food.
Many Australian food companies, research
NATOLI while food labels don’t. They use the term Ideally, many companies will work simulta- Cooking with wine or adding a splash of
minerals. Supplements do not appear to be an
adequate substitute. Also, supplementing a
institutes, individuals, and non-government ‘‘sodium’’ — the part of salt, sodium chloride, neously to reduce the salt content of the total lemon juice can work wonders with fish, while diet that is not nutrient-deficient has not
organisations are behind the campaign to that causes all the problems such as high blood food supply so that the differences between rosemary is a match for potatoes, tarragon been shown to offer any increased protection
reduce salt intake from a current average of 9g pressure, increased risk of kidney stones, brands of the same product type will be with chicken and curry powder with eggs. against cancer or heart disease. Mind you, if
per person daily to 6g or less within the next consumer survey conducted as part of the stroke and heart disease. minimal and harder to detect. After so much focus on avoiding fat and sugar, your diet is deficient in certain nutrients —
campaign launch was that most Australians It may, therefore, be easier to change It would be a shame to see lower-salt foods a positive spin on a negative campaign perhaps the result of a vegan diet, or because
five years.
behaviour and assist in understanding the salt fail due to poor consumer acceptance. message would be a nice change — as well as you have particular nutritional requirements
According to the campaign organisers this are already aware that too much salt is bad for
content of foods if the term ‘‘salt’’ was used. Another difficulty that may be faced with advising people to drop the salt we could also for reasons of chronic ill-health — then
can be achieved by working with the food their health, and that most of it comes from Asking people to translate grams of salt into the whole campaign is the idea of ‘‘dropping
processed foods. Some even read and under- suggest they pick up the herbs. supplementation is often worthwhile.
industry to reduce the salt content of the food milligrams of sodium so they know how much the salt’’. For lovers of meats with seasonings
supply, educating the public, enabling the stand what’s on a label. However, the real issue they’re actually eating relative to the target or vegetables covered in oil and salt, it can be Sharon Natoli is an accredited practising Linda Calabresi is a Sydney GP and
easier reading of labels and forming partner- is that despite all this, very few of these people intake is probably far too complex for anyone, hard to imagine you can achieve the same level dietitian and director of Food & Nutrition executive editor of www.6minutes.com.au,
ships with key health-related organisations are doing anything about it. and will only add to the already difficult of enjoyment with herbs, spices and other Australia. a news service for Australian doctors.
and charities. Along with reducing the salt content of the process of changing consumer behaviour. flavour combinations. However, smartly www.foodnut.com.au Send your queries to
However, a very relevant finding from the food supply, strategies to motivate people to Another challenge is the perception that matching the flavour of herbs with vegetables, lindacalabresi@gmail.com

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