THE WEEKEND AUSTRALIAN FEBRUARY 23-24 2008
16 HEALTH
Music lifts
dementia’s
constant fog
Music therapy is showing promise in helping dementia
patients tune into reality, writes Jane Lyons
D
OROTHY sits in her ward, gazing at
nothing in particular. Lost in time
and space, she asks very little from
her small world. She seeks no
comfort or companionship, no intellectual
stimulation. When she does speak, she seems
to follow the rhythm and cadence of
conversation with ingrained habit, but her
responses are disjointed and devoid of intent.
Wherever Dorothy is, it is not here. And
‘‘here’’ is Alzheimer’s.
A progressive and degenerative illness,
Alzheimer’s disease attacks the brain, de-
stroying cells and creating a build-up of
plaques and ‘‘neurofibrillary tangles’’ that
damage neural connections and disrupt the
flow of messages. As the brain cells die,
information can no longer be recalled or
assimilated and a variety of functions such as
memory and language, reasoning, planning
and decision-making, social interaction and
emotional responses are lost.
According to the Alzheimer’s Association,
once these abilities are lost they can rarely be
regained or relearned.
However, preliminary research by the
National Ageing Research Institute in Mel-
bourne has discovered that music not only
soothes the savage beast, it also calls to those
like Dorothy (not her real name) who are lost
in the wilderness.
On her first visit to the institute’s labora-
tory, Dorothy was passively co-operative as
researcher Bruce Barber, the study’s team
leader, set up the equipment. They played her
a swirling and passionate orchestral piece by
Edward Elgar, and when asked to describe
how the music made her feel, Dorothy
responded with ‘‘loving’’.
But it was the next piece, a 1937 Art Tatum
version of Gone with the Wind , which had
the most profound effect. Immediately, her
left hand started to beat in time to the music
and her face was suddenly suffused with a
joyous smile. When asked if she had danced
in her youth, 82-year-old Dorothy began to
talk animatedly about the three girlfriends
she used to go dancing with each Saturday.
She was able to recall the two different venues
they danced in, and the names of the bands
that played.
‘‘For a period of no more than five
minutes, Dorothy talked animatedly and
spontaneously with us about these and other
aspects of her life as if there was no
impairment,’’ Barber says. ‘‘She appeared,
for the first time since we had met her, to be
alert, attentive, responsive and very much in
the present. The initial effect seemed to
diminish quite rapidly, but for the remaining
30 minutes we were together, Dorothy
CASE NOTES: NUTRITION
Salt reduction campaign could benefit from a sprinkling of advice on herbs
A
NATIONAL public health campaign
called Drop the Salt held an event in
Sydney recently to further highlight
concern about salt content of our food.
Many Australian food companies, research
institutes, individuals, and non-government
organisations are behind the campaign to
reduce salt intake from a current average of 9g
per person daily to 6g or less within the next
five years.
According to the campaign organisers this
can be achieved by working with the food
industry to reduce the salt content of the food
supply, educating the public, enabling the
easier reading of labels and forming partner-
ships with key health-related organisations
and charities.
However, a very relevant finding from the
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maintained the capacity to respond coher-
ently and in context.’’
Music therapists have long reported symp-
tomatic improvements in Alzheimer’s pa-
tients, including increased social interaction,
reduced depression, lower levels of agitation
and greater focus, and improved cognition,
language abilities and emotional skills. A new
study in the journal Brain has also just
reported potential benefits for stroke patients
(see The Pulse, opposite page).
But with most reports lacking an explora-
tion of the physiological whys and where-
fores, Barber — a musician and former music
educator who has completed a doctorate
looking at the electro-physiological processes
that music stimulates in the brain — decided
it was time to investigate further.
The aims of his research were to find out if
there are objective measures to show the
extent of any benefits from music therapy,
which could then be used to help design
music intervention protocols.
In his first study Barber enlisted the help of
11 Alzheimer’s sufferers whose impairment
ranged from moderate to severe, and 17
control subjects. Once connected to an EEG
machine, which records brain electrical
activity from the surface of the scalp, the
participants were read stories and played both
familiar and unfamiliar music.
Barber then measured the frequency gen-
erated at each electrode point and the degree
to which the 171 electrode pairs worked
together. This is known as EEG coherence, an
index of co-operation between various func-
tional regions of the neocortex.
Not only did Dorothy and all the other
Alzheimer’s sufferers respond to the music,
their brains did, too — and in a most
surprising way.
Music is known to stimulate the limbic
region of the brain, which has a role in
regulating autonomic processes and basic
emotions such as fight and flight. Higher
functions such as sensory perception, motor
commands, spatial reasoning, abstract
thought and language are the responsibility of
the neocortex, the grey wrinkly matter that
covers the brain and degenerates as Alzhei-
mer’s progresses.
Barber was excited to discover that music
engaged the brain extensively, with wide-
spread interactions between most regions of
the cortex and across both hemispheres.
These interactions were also greater than
those measured after listening to the story.
‘‘It’s saying that the whole brain in
Alzheimer’s patients still functions in res-
ponse to music, even in moderate to severe
levels of the disease,’’ Barber says.
SHARON
NATOLI
consumer survey conducted as part of the
campaign launch was that most Australians
are already aware that too much salt is bad for
their health, and that most of it comes from
processed foods. Some even read and under-
stand what’s on a label. However, the real issue
is that despite all this, very few of these people
are doing anything about it.
Along with reducing the salt content of the
food supply, strategies to motivate people to
Level Application Kit
AO7 (07) 3234 1319 (Info-line)
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AO7 (07) 3234 1319 (Info-line)
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AO6 (07) 3636 1646 or (07) 3636 0380
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A criminal history check may be conducted on the recommended person for the job. A non-smoking policy applies to Queensland
Government buildings, offices and motor vehicles.
Therapy: Bruce Barber and Loretta Quinn believe Alzheimer’s patients benefit from music
The results, he says, also indicate that the
patients are not just reacting haphazardly or
automatically to music. Such music-induced,
intra- and inter-hemispheric activity is like
the ‘‘normal’’ process by which the regions
that control movement, emotions, memory,
visualisation, language and auditory proc-
esses work together in an integrated fashion.
‘‘When it comes to asking why people who
are severely cognitively impaired respond to
music, the obvious thing is that there is a
highly integrated and complex process that
probably hinges on emotional function,
number one, that activates memory proc-
esses, that activates motor processes, it
activates cognitive processing in some way,’’
Barber says.
Believing that music may temporarily
reactivate established neural pathways, Bar-
ber decided to conduct a longitudinal study
that would measure the impact of a daily
music-therapy regimen over six months.
Fifteen Alzheimer’s sufferers were enlisted
at the time of their diagnosis. One group was
given cholinesterase inhibitors, a commonly
prescribed drug, while the other took the
medication and followed a daily regimen of
music. Fifteen minutes was the minimum, but
most would listen for an hour.
Using the Hierarchic Dementia Scale, a
cognitive function test that involves a series of
questions and activities, Barber measured
both groups before they started their regimen,
then at three and six months.
The music group scored an average 185.1 at
the onset, rising to 190.8 at the three-month
mark and dropping back slightly to 190 at six
actually change their behaviour is what’s
really needed to make a difference in this area.
One of the complexities of the whole salt
reduction campaign is that it focuses on salt,
while food labels don’t. They use the term
‘‘sodium’’ — the part of salt, sodium chloride,
that causes all the problems such as high blood
pressure, increased risk of kidney stones,
stroke and heart disease.
It may, therefore, be easier to change
behaviour and assist in understanding the salt
content of foods if the term ‘‘salt’’ was used.
Asking people to translate grams of salt into
milligrams of sodium so they know how much
they’re actually eating relative to the target
intake is probably far too complex for anyone,
and will only add to the already difficult
process of changing consumer behaviour.
Another challenge is the perception that
Enquiries
Trisha Johnston (07) 3234 0068
John Harrington (07) 3234 1318
Geoff Evans (07) 3636 6942
Sandra McDonnell (07) 3237 1421 or 0437 088 318
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Donna Kostellar (07) 3636 1603
months. The other group began with an
average of 183.5, dropped to 180.67 and then
rose slightly to 182.75.
But with just 15 people involved in the
study, Barber knew more rigorous research
was required. He received funding from a
private philanthropic trust to continue the
research in a two-year, randomised controlled
study, which is now about half-way through
its two-year duration.
So far about 60 patients have been
recruited, all of whom have dementia. Barber
hopes to enrol a total of 200. While it’s too
early to give any definitive results, he says
‘‘an interesting trend is going on’’.
‘‘The objective of this study is to determine
whether the frequently reported effects of
music therapy stand up in the context of a
randomised controlled trial,’’ he says.
‘‘With a lot of complementary therapies
there are all sort of claims. Music therapy has
got up to 400 (research) reports talking about
the benefits of music therapy specifically for
the symptoms of dementia.
‘‘The problem is they don’t meet the level
of research rigour required to constitute
evidence, as evidence is defined in health care
now.’’
Barber is anxious to stress that music
therapy is not a potential cure.
‘‘I would argue that it may be shown to
help people with progressive pathologies such
as Alzheimer’s disease to maintain cognitive
and functional status at their highest poten-
tial,’’ he says. ‘‘This would help to delay and
ameliorate the severe quality of life deficits
caused by dementia.’’
salt-reduced foods are flavourless. Smart food
companies are getting around this by reducing
the salt content of their products without
actually telling you that they’re doing this.
Ideally, many companies will work simulta-
neously to reduce the salt content of the total
food supply so that the differences between
brands of the same product type will be
minimal and harder to detect.
It would be a shame to see lower-salt foods
fail due to poor consumer acceptance.
Another difficulty that may be faced with
the whole campaign is the idea of ‘‘dropping
the salt’’. For lovers of meats with seasonings
or vegetables covered in oil and salt, it can be
hard to imagine you can achieve the same level
of enjoyment with herbs, spices and other
flavour combinations. However, smartly
matching the flavour of herbs with vegetables,
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ASK THE DOCTOR
Symptoms
in common
can confuse
LINDA
CALABRESI
A few weeks ago you wrote about
interstitial cystitis. I have heard about a
condition called vulvar vestibulitis
syndrome, which sound like it involves very
similar symptoms. Are they the same?
No, they are different conditions, although
some symptoms can be common to both. The
most common and characteristic features of
interstitial cystitis are bladder pain and an
often-painful feeling that you need to empty
your bladder frequently. Women with this
condition can get pain with sexual
intercourse, and pain in the vagina, urethra or
vulva, but that is far less common. Vulvar
vestibulitis syndrome is characterised by
vulval pain and pain associated with sexual
intercourse at the point of entry. While the
cause of this syndrome remains unknown, it
is generally thought to be an inflammatory
condition. Sometimes it is triggered by a
Candida infection also known as thrush. In
other cases there is a history of using soaps or
other irritants on the skin of that area, which
could have precipitated the problem.
Unfortunately both conditions can persist,
and often prove difficult to treat.
Picture: Michael Potter
Over the last two years my urine seems to
Henry Brodaty, professor of psychogeriat- have developed a very strong smell. Not all
rics at the University of NSW and the director the time — just every now and then, and it
of aged-care psychiatry at Sydney’s Prince of is not associated with any urinary tract
Wales Hospital, agrees that music can often infections or any urinary symptoms. The
go where words and memory have failed. start of the problem seemed to have
‘‘Music memory seems to be more resist- coincided with a new relationship. I am 54
ant to decay than verbal memory. We can see and had a hysterectomy 10 years ago.
people with quite severe dementia who are USUALLY urine has very little odour —
musicians who can still play instruments,’’ however, it can become more concentrated
professor Brodaty says. when you are dehydrated, and then there is
He has also used music to treat his a stronger smell. Check you are drinking
sufficient water each day and see if the
Alzheimer’s patients, bringing in music ther-
problem recurs. Having excluded urinary
apists once a week to the aged care unit at
tract infection (presumably a urine sample
Prince of Wales Hospital.
was sent to pathology for testing), other
But while Brodaty welcomes research such possible causes of the smelly urine include
as Barber’s, he cautions against placing too
certain foods, such as asparagus, and some
much hope in music therapy’s long-term
medications including vitamin B6
effects.
supplements. There are some medical
‘‘Clinically we certainly see that people conditions as well that could be causing the
respond to music when they may not be problem, such as diabetes or liver disease, but
generally speaking you would normally be
reachable in other ways. Whether it has any
having some other symptoms as well as
lasting effect beyond the duration of the
strong-smelling urine if one of these was the
music, I don’t think that has ever been
cause, especially after two years. Sometimes a
shown.’’
smell attributed to the urine is, in fact,
He also thinks Barber should introduce
originating from a vaginal discharge. Vaginal
more measures to his study before making infections such as gardnerella or trichomonas
any judgments on whether music improves are commonly associated with an odour —
Alzheimer’s patients’ quality of life. most often fishy-smelling. Once diagnosed
‘‘The Hierarchic dementia scale just meas- they are very treatable.
ures function. You also need to look at
cognition and you also need to measure I am approaching 40 and have started
behaviour and look at quality of life,’’ taking multivitamins. Are these beneficial?
Brodaty says. ‘‘You can’t say whether it will I am generally healthy although I do take
improve quality of life just because we can medication for high blood pressure.
show something clinically. To make those THERE is plenty of evidence that suggests
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
this, many people believe that by taking
supplements of the vitamins and minerals
found in fruits and vegetables they will
receive the same health benefits.
Unfortunately, however, the evidence
meat, chicken, salads and grain-based dishes
doesn’t generally support this. It seems the
rather than using salt and salty sauces and value of a high fruit and vegetable intake is
seasonings can provide flavour as well as
health benefits.
not simply related to particular vitamins and
Cooking with wine or adding a splash of
minerals. Supplements do not appear to be an
adequate substitute. Also, supplementing a
lemon juice can work wonders with fish, while diet that is not nutrient-deficient has not
rosemary is a match for potatoes, tarragon been shown to offer any increased protection
with chicken and curry powder with eggs. against cancer or heart disease. Mind you, if
After so much focus on avoiding fat and sugar, your diet is deficient in certain nutrients —
a positive spin on a negative campaign perhaps the result of a vegan diet, or because
message would be a nice change — as well as you have particular nutritional requirements
advising people to drop the salt we could also for reasons of chronic ill-health — then
suggest they pick up the herbs. supplementation is often worthwhile.
Sharon Natoli is an accredited practising Linda Calabresi is a Sydney GP and
dietitian and director of Food & Nutrition executive editor of www.6minutes.com.au,
Australia. a news service for Australian doctors.
www.foodnut.com.au Send your queries to
lindacalabresi@gmail.com
Health Safety and
Environment Advisor
Exploration and Mining, Brisbane
$63K - $72K plus Superannuation
Ref. No. 2008/71
A CSIRO HSE Officer promotes a positive safety culture,
provides advice to staff, supports the implementation of
CSIRO HSE policies and implements site specific HSE
programs. An opportunity exists to join CSIRO based
at the Queensland Centre for Advanced Technologies
(QCAT) in Brisbane.
If you have:
• A relevant degree/diploma or equivalent experience in
HSE, particularly in the mining, manufacturing or energy
sectors;
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