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“You Are Watching the Power of Music Changing Brain Chemistry”

Published by Anonymous (not verified) on Fri, 27/05/2022 - 6:00pm in

Tags 

Health, aging, Health, Music

This story originally appeared in Rotary magazine, the official publication of Rotary International, a service organization with 1.4 million members around the world. For more information, visit Rotary.org.

Carol Rosenstein was watching her husband, Irwin, slip away inch by inch. At one time he had been a brilliant lawyer, a lover of Broadway musicals, a world traveler. But after his diagnosis of Parkinson’s disease in 2006, he developed dementia, and slowly everything changed. His gait flattened to a shuffle. The sparkle in his eyes turned into a blank stare. His mood soured. Worsening matters, the medications he took caused hallucinations and extreme agitation. As communication grew more challenging, Carol felt the distance between them growing.

Irwin and Carol Rosenstein

Then, in 2014, something happened. Irwin, who had been a gifted pianist since childhood, sat down at the piano and began to play.  As his fingers floated through American classics like “Fly Me to the Moon,” “What a Wonderful World,” and “Try to Remember,” Carol saw his posture straighten. The sparkle returned to his eyes. The husband she once knew came back, bit by bit, if only briefly. “I could see this human being resurrect and start to reconnect with his environment,” she says, “just like I had given him a dose of medication.” 

Mystified, she called his neurologist and asked what was happening. “He said, ‘Carol, you are watching the power of music, changing brain chemistry.’” 

That statement would go on to change not only their lives but the lives of countless others.

Music, it turns out, is medicine for the mind.

While it’s tempting to search for a woo-woo reason why music resonates with us so deeply, it’s not necessary. For people like Concetta Tomaino, the effects can be explained by science and logic — even if there’s still a lot to learn. “I think I went past that magical, mysterious piece a long time ago,” she laughs. Tomaino is one of the pioneers in this area; she has been researching how music affects all aspects of neurologic function for more than 40 years. To her, the impact of music on the mind and body demonstrates how much of our makeup as human beings is based on rhythm, resonance, and perception, all of which connect us in a fundamental way to who we are. “Everything in the world is a vibration of some kind,” she says. “Music is an extension of who we are, and that’s why it helps us reach people who seem to be disconnected because of illness or a traumatic brain injury.”

oliver sacksOliver Sacks in 2009. Credit: Steve Jurvetson / Flickr

Tomaino spent decades as a music therapist, pursuing evidence-based research around music and the brain before volumes of such literature existed. In 1980, she began working at Beth Abraham Hospital (now Beth Abraham Center) in the Bronx, New York, where she first met the consulting neurologist Oliver Sacks. By then Sacks had already written Awakenings, an autobiographical book (and later a movie) about a group of encephalitis lethargica patients frozen in trancelike states, whom he “awakened” using a new drug, along with music.

Like Tomaino, Sacks was extremely interested in understanding more about the potential impact of music on patients. In 1995, the two co-founded the Institute for Music and Neurologic Function, where Tomaino remains the executive director, to better understand the ways that music helps people with neurological problems to move better and remember more.

Sacks, a legend who wrote many books on his patients’ neurological experiences, including Musicophilia, which delves into the effects of music, passed away in 2015. His words on the topic remain as evocative and poetic today as when he spoke them in 1991 before the U.S. Senate’s Special Committee on Aging: “Though the nervous system is sometimes compared to a computer, I think it is much more like an orchestra or a symphony. I think we are musical through and through, from the lowest levels of rhythm in our nerve cells to the highest levels. There is a vast range of neurological disorders in which this inner music is impaired, and all of these can be transformed by the healing power of music.”

“Though the nervous system is sometimes compared to a computer, I think it is much more like an orchestra or a symphony.”

Music has a way of worming into the brain, whether it’s jingles you can’t forget or songs that really resonate. They’re tied to strong, emotional moments and experiences in your own autobiography. And they’re not just stored in one area of the brain. Rather, Tomaino says they’re ingrained in the more fundamental mechanisms of brain processing. In other words, the music that we love actually becomes a part of who we are. 

Because of that, when we hear those old, meaningful tunes even a half-century later, they stimulate multiple areas and networks of the brain — including areas that are relatively unharmed by a disease like dementia — and those long-ago memories resurface. That’s why a person with memory impairment may not recall their daughter’s name but may remember all the lyrics to her favorite lullaby. “It’s pulling from emotions, it’s pulling from feelings, it’s pulling from interpersonal associations, it’s pulling from a date or time or period of one’s life — historical things,” Tomaino says. Music serves as a clue, coaxing the brain to fill in the blanks. 

After her call with the neurologist, Carol Rosenstein began to wonder: If music could help her husband return to himself, even briefly, what could it do for others? She grabbed her Rolodex, told Irwin’s story to her friends in L.A., and invited other “like-minded” people to a night of making music together at a studio space in a private school.

About 30 people showed up. While most of them made small talk, Irwin and three other men, all of whom had neurological conditions, made a beeline for different instruments. A man with Parkinson’s sat at the drums. Another, with Alzheimer’s, settled in at the piano. A third, who no longer spoke, pulled a harmonica out of the breast pocket of his jacket. Irwin gravitated toward the saxophone, an instrument he had played in his college marching band. They didn’t converse, and they didn’t need to. As they started to play, music became their shared language.

“These four strangers became like soulmates in a sandbox,” Carol recalls. “Instead of buckets, shovels, and spades, they had musical instruments, and this was their second childhood. They found each other, they used the music, they bonded.”

Credit: Music Mends Minds

Since its humble beginnings in 2014, Music Mends Minds has expanded with more than 20 bands around the globe.

Carol was so eager to keep the quartet’s energy going that she formed a band, called The 5th Dementia, and launched a nonprofit called Music Mends Minds. The band’s “core four” grew to more than two dozen members and met regularly at Brentwood Presbyterian Church. Local and then national media got wind of it, and, in 2015, a story about The 5th Dementia aired on PBS NewsHour. 

Since its humble beginnings in 2014, Music Mends Minds has expanded with more than 20 bands around the globe. (Most of the bands are now meeting virtually because of the pandemic, and are led by a music therapist.) In 2018, CNN named Carol one of its CNN Heroes. 

A band student participates in The 5th Dementia flagship band’s intergenerational platform. Credit: Music Mends Minds

Carol Rosenstein saw more and more scenes that reinforced the power of music: people who couldn’t remember their own names crooning Frank Sinatra; men and women who barely talked, playing instruments; older adults pushing aside their walkers to dance. She also learned more about the science behind it, thanks to such academics as Michael Thaut, a professor of music and neuroscience at the University of Toronto who is now on the advisory board of Music Mends Minds. Thaut has been researching how music affects the brains of people with Alzheimer’s in hopes of pinpointing ways to improve their lives. He says that scientists aren’t sure what causes Alzheimer’s, which is the most common type of dementia, and that while medications may treat some symptoms, there is no cure.

When a person has Alzheimer’s, the proteins in their brain don’t function normally, and that leads to the death of brain cells. A person in the early stages of Alzheimer’s may forget words or repeat questions. In the end stages, they may experience delusions and forget how to do even the most basic tasks, like eating or walking. According to the U.S. Centers for Disease Control and Prevention, as many as 5.8 million Americans have Alzheimer’s. By 2060, that number is expected to nearly triple. 

In a study published in the Journal of Alzheimer’s Disease in 2021, Thaut and other researchers set out to see what happens in the brain when a person with mild cognitive impairment or early Alzheimer’s disease listens to their favorite playlist for an hour every day for three weeks. At the beginning and end of the study, the 14 participants had brain scans and took neuropsychological tests that involved memory exercises.

“When you drive these networks on a regular basis, you exercise those networks, and then the connectivity within these networks becomes stronger again.”

To Thaut’s surprise, at the end of the trial the participants showed a small but statistically significant improvement in memory — something that is extremely unusual in people with Alzheimer’s or any type of dementia. Close examination of the brain scans revealed visible changes. Most notably, Thaut saw that measurable new connections had formed between different regions of the brain — highways, if you will, that actually changed brain plasticity and also improved function in relaying information. Thaut says the research shows that while music is in no way a cure for Alzheimer’s, it can provide a “cognitive boost.” 

But not all music has the same impact. In another study published in 2020, Thaut and his colleagues compared brain activation when study participants listened to two different types of music: music that dated back at least 25 years, and music that was new to them. What they found was that the different types of music activated different parts of the brain. With new music, brain activity appears limited to mostly auditory processing, but not deep processing. Familiar music, however, stimulated more regions more significantly in a way that is deeply encoded in the brain. Those regions are associated with emotion, cognition, and autobiographical memory, and are minimally affected by early-stage Alzheimer’s. “This is one of the reasons, possibly, that some musical memories are preserved, because they’re encoded in such widely distributed regions,” Thaut says. “So the chance that some of the regions associated with music-based memories are preserved is just higher.”

While the “why” of it all isn’t yet fully known, Thaut says that mood and memory are closely connected, and networks of memories can become connected to mood “nodes.” He describes it as a kind of classical conditioning: You hear a certain song that was important in your past and you automatically think of a certain time or event connected to the music. When you listen to that music more frequently, it’s like a cognitive workout for the brain. “When you drive these networks on a regular basis,” Thaut says, “you exercise those networks, and then the connectivity within these networks becomes stronger again.” 

He was like a corpse under his blankets. Then his arms would start to come out of the covers, his knees would start to lift, and before you knew it, he was dancing with me.

When those who live with and care for people with diseases such as Alzheimer’s and Parkinson’s seek out music and musical groups to help their loved ones, they often find the experience benefits them, too. And there’s research to support that. 

For decades, Mary Mittelman, an epidemiologist who works at New York University as a researcher in the department of psychiatry, has been developing and studying social and psychological methods to help people with cognitive impairment and their family members. In 2011, curious about the impact of music, she started her own chorus, called The Unforgettables, to investigate what rehearsing and performing in a concert could do for participants. The initial chorus consisted of 22 people — 11 had memory impairment and 11 were their family caregivers. Mittelman’s published findings documented improvements in quality of life and communication not just for those with memory impairment but also for caregivers, who reported improved social support and self-esteem thanks to the chorus.

Anecdotes shared by the choral conductors stand out in Mittelman’s report. They saw couples holding hands and looking into each other’s eyes, “as though they were first dating.” They would joke around. Song lyrics would bring back memories and spark conversations. Beyond those observations, Mittelman remembers watching transformations among participants: Some would arrive grunting, agitated. They would leave speaking in full sentences, calm.

Irwin Rosenstein passed away in January 2021, 15 years after his diagnosis and seven years after rediscovering music. In those final days, Carol recalls, he could no longer speak and could not leave his bed or a wheelchair. His smile was a memory. He would look at his wife with a gaze that she refers to as the “Parkinson’s stare.” 

Unless, that is, there was music. 

All the way until the end, Carol made rhythm a part of their lives. As Irwin lay in bed, she would pick up two little egg-shaped shakers and play music and dance in front of him. “He was like a corpse under his blankets. Then his arms would start to come out of the covers, his knees would start to lift, and before you knew it, he was dancing with me,” she says, smiling through her tears. “That’s how we said goodbye, because his brain was so connected to the rhythm of the music when everything else was gone.”

Music could bring Irwin back to the moment, back to himself. It also brought him back to Carol. “It is painful to watch your beloved slip away inch by inch,” she says. “And if it weren’t for the music, I wouldn’t be sitting here today. As a caregiver and first responder, I can tell you, I would have never survived the journey.”

The post “You Are Watching the Power of Music Changing Brain Chemistry” appeared first on Reasons to be Cheerful.

In Holland People With Dementia Can Work on a Farm

Published by Anonymous (not verified) on Mon, 07/03/2022 - 7:00pm in

Four days a week, Kees Oranje’s 81-year-old mother Paula gets up and goes off to work on a farm in the neighboring village of Brielle, just west of Rotterdam. 

Depending on the day, Paula might feed the chickens, assist with chores, or help prepare hot lunches. The farm raises pigs for meat, and grows pumpkins, beans, kale and more in a large vegetable garden. In many ways, Boerderij Op Aarde — “Farm On Earth” — resembles a typical Dutch working farm, but with one key difference: Paula and most of her fellow farm workers have dementia.

Boerderij Op Aarde is one of hundreds of Dutch “care farms” operated by people facing an array of illnesses or challenges, either physical or mental. They provide meaningful work in agricultural settings with a simple philosophy: rather than design care around what people are no longer able to do, design it to leverage and emphasize what they can accomplish.

care farmCare farm participants a responsible for an array of daily tasks. “They’re focused on what needs to get done that day, which is what takes them out of their current disease process.” Credit: Boerderij Op Aarde

It’s an approach that research has shown holds many benefits. For people with dementia, who are often less physically active and more isolated, farm settings promote movement and social interaction. And care farms can have emotional benefits, too, giving participants a sense of purpose and of making a meaningful contribution. 

“We don’t focus on what’s missing, but what is still left,” says Arjan Monteny, cofounder of Boerderij Op Aarde, “what is still possible to develop in everybody.”

Care farming started growing in popularity in the Netherlands in the late 1990s. According to Wageningen University researcher Jan Hassink, farms, squeezed financially as agricultural costs increased and food prices fell, were looking for ways to become more multifunctional. At the same time, a movement was emerging in the Netherlands to reduce the use of institutions, part of a growing recognition that people with disabilities had a right to be active in society.

A few decades on, care farming is well established in the Netherlands, and interest in the model for people with all kinds of disabilities is growing across Europe, in the U.S., and in many other countries, Hassink says. As an option for dementia care, it is a solution that grows more relevant with each passing year. Rates of dementia are projected to more than double worldwide by 2050. Yet how to best care for those people remains a question many countries are still grappling with.

Credit: Boerderij Op Aarde

“We don't focus on what's missing, but what is still left –– what is still possible to develop in everybody.”

In traditional dementia care settings, says Hassink, the focus tends to be on preventing risk. There’s often a fixed schedule of simple activities, like games or movies, and the only choice attendees are given is whether to participate or not. In the course of his research, Hassink has spoken to countless people with dementia. Common to many of them is a desire to not only participate in society, but contribute to it.

At Boerderij Op Aarde, participants start every weekday morning discussing the day’s work. There’s no shortage of tasks: goats and pigs need feeding, gardens need tending, hot lunches need to be prepared. A weathered bench in the workshop might need to be repainted. The workers get to choose which duties they’ll take on — that’s important, Monteny says, because people with dementia don’t have many opportunities to make decisions in their lives.

“It’s a small question,” he says, “but it has a great meaning for the people.”

Common to many people with dementia is a desire to not only participate in society, but contribute to it.

Even bigger, more consequential decisions are made with everyone’s input. Recently, participants were involved in discussions about how last year’s bad pumpkin crop should impact plans for what to plant in 2022. Almost everything the farm produces is used on the farm; lunches include vegetables from the farm’s gardens and sausage and ham from the pigs.

Among the benefits of care farms, according to Hassink, is that participants work alongside the farmers, which creates a more equitable power dynamic than found in many institutions. “They have a joint responsibility for taking care of the activities on the farm, so this makes it like one equal relationship,” he says.

Monteny co-founded the 16-hectare farm with his partner Ronald van de Vliet in 2012. Each day, they work with two staff members from a local care institution, which the farm partners with, plus four volunteers. Almost all of their 40 participants — 18 come per day — have dementia, and all are of advanced age. They chose to focus on this group, Monteny says, because at the time most dementia care they came across tended to be “one size fits all,” without much physical and mental stimulation. 

This is changing quickly. Today, there are roughly 1,350 care farms in the Netherlands, serving a diverse range of people, according to Maarten Fischer, director of the Federation of Agriculture and Care. About 400 of these farms offer care for older people with dementia, he said, many in settings that also include participants with other needs. 

care farmInterest in the care farming model is growing across Europe, in the U.S., and in many other countries. Credit: Boerderij Op Aarde

“They’re focused on what needs to get done that day, which is what takes them out of their current disease process,” Fischer says. 

The model is borne out by research. Studies in Norway and the Netherlands found that people with dementia at care farms tended to move more and participate in higher-intensity activities than those in traditional care, which can help with mobility in daily life and have a positive impact on cognition. Dementia is often linked to social isolation, and care farms were found to boost social involvement, especially among those who wouldn’t opt for traditional assistance options. Spending time outdoors in nature, often part of a day on a care farm, can also improve well-being among people with dementia. Farms are not only good for individuals, their families also benefit: studies find caregivers experience less guilt when their loved ones are supported by services they consider to be nurturing and fulfilling.

“What the person needs is not only care. A person needs emotions, too.”

Hassink says that even institutional care facilities could replicate some of these benefits by incorporating elements common to care farms into their programs. Instead of a fitness class, for instance, they could offer more productive activities that build in movement. Institutions could also empower their attendees with more opportunities to decide which activities they’d like to do. 

“I think the realization that people still like to do useful things, useful work, and to be valued and contribute is really important,” he says.

Before Kees Oranje’s mother started coming to Boerderij Op Aarde in 2018, she was largely isolated, he says, living alone in the family’s farmhouse a few kilometers from the nearest village. Oranje noticed she seemed to “bounce back” after she started at the farm when she was 77. He believes part of what makes her days fulfilling is that, just like in life, they involve activities that inspire a range of emotional responses: frustration, joy, surprise, even anger.

“What the person needs is not only care,” Oranje says. “A person needs emotions, too.” 

At other farms, people with dementia are grouped with people of other ages who have different conditions. That’s the case at the nonprofit care farm launched by Ronald de Vré in Badhoeve, near Amsterdam. Six days a week, the farm hosts groups that mix children and adults of all ages with a range of different conditions, including some dealing with substance abuse issues, and others with conditions like Parkinson’s Disease or dementia. They look after gardens and animals, including ponies, donkeys, swans, sheep and some 60 chickens. With conditions like dementia, he says, “Your world is getting smaller, but here, you feel that your life’s still in the real world.”

Credit: Boerderij Op Aarde

“I think the realization that people still like to do useful things, useful work, and to be valued and contribute is really important.”

The model has its challenges, and it isn’t for everyone. Care farms generally aren’t a good fit for people with advanced dementia, whose condition makes it difficult to participate. As a small organization, Monteny said, keeping up with health regulations designed for larger institutions can be difficult, and funding, which the farm gets from the municipality and a regional care institute, is tight. Farm environments also have the potential for injuries. Monteny acknowledges that accidents happen, though they’ve only ever had minor incidents, like a hammer dropped on a toe. 

“We make it as safe as possible,” he says, “but risk is part of life. That’s one of our mottos.” 

Oranje says he doesn’t worry about such risks at Boerderij Op Aarde. As his mother’s dementia has progressed, she has lost the ability to tell him at the end of the day what she did at the farm. But she continues to live independently in her own house, which Oranje believes is possible because her work at the farm keeps her active. 

“She has to be alert all day long, and it’s the best environment. She can maintain the best mental condition as possible in her situation now,” he says. “And that’s very, very, very, very important because that gives her a reason to live.”

The post In Holland People With Dementia Can Work on a Farm appeared first on Reasons to be Cheerful.