Medicinal Melodies
Imagine a lifelong loved one responding to your greeting with an expression of unreserved confusion. They withdraw from the sincere hug you offer while demanding, “Who are you?” An embrace that was hoped to steal them from the unforgiving disease that often leaves them puzzled at the reflection in the mirror, for just a brief moment in time you wished to remind them. You share again the depths of your affection and pray, for a fleeting second, that the spoken words will transcend you both to a long awaited reunion of life’s triumphs and challenges. Like a thief, Alzheimer’s disease tiptoes into one’s mind and unapologetically stomps on a beautifully illustrated autobiography leaving vacant chapters, lonely hearts, lost sufferers and frustrated family members. The heartache of Alzheimer’s disease is merciless. The rapid growth and severity of Alzheimer’s disease (AD) has left scientists racing to accurately identify the cause and feverishly working to immediately develop a cure. In absence of a remedy, the medical community and those families who support a diagnosed loved one, join in arms to focus their unremitting efforts on therapies which will slow the progression of the illness, and improve the patient’s quality of life. In the myriad collection of pharmaceutical options, one unmistakable alternative stands above the rest, Music Therapy. Most often, AD symptoms are addressed with a physician’s pen to prescription pad in efforts to pacify a patient’s angry outbursts and ease the memory loss that interrupts their daily life. With the advancement in music therapy and initiating use in the daily life of an Alzheimer patient, immeasurable benefits are being witnessed, and its popularity is growing at a rapid rate. With minimal costs, ease of accessibility, and lack of side effects, music is arguably the best medicine. The Thief
Alzheimer’s disease is the most common type of dementia. The disease was first discovered 100 years ago, but only in the last 30 years has research into the symptoms, causes, risks factors and treatments gained momentum. During the course of AD two abnormal structures called plaques and tangles damage and kill nerve cells in the brain which cause dementia. “Though most people develop some plaques and tangles as they age, persons with Alzheimer’s tend to develop far more. Most experts believe the plaques and tangles play a critical role in blocking communication among nerve cells and disrupting processes that cells need to survive” (Alzheimer’s). As we examine the nature of the illness, discuss the chief concerns and become familiar with the prevalence of the disease, we realize that Alzheimer’s is an illness that exercises no discrimination. It practices equal opportunity among all ethnicities and genders. Marked initially by a decline in cognitive and functional abilities, such as forgetfully misplacing items or getting ‘turned around’ with directions, the disease ultimately progresses to a more severe stage leaving individuals requiring help with basic daily living tasks. Bathing, dressing, eating and using the bathroom become chores that require direction and assistance on an elementary level. In the final stages, Alzheimer’s patients lose their ability to communicate, fail to recognize their surroundings, become bed-bound and rely on around the-clock care. Frequently, pneumonia becomes a reality and triggers a downward spiral in the patient’s health. Ultimately, Alzheimer’s disease is fatal, often in result of pneumonia. Accompanying the cognitive deterioration, behavioral and emotional symptoms present unyielding depression and apathy, consequently crafting an extremely multifaceted illness. Alzheimer’s disease accounts for approximately 60 to 80 percent of dementia cases. In 2012 it was recorded that an estimated 5.4 million Americans of all ages have Alzheimer’s disease. “One in eight people age 65 and older has Alzheimer’s disease and nearly half of people age 85 and older have been diagnosed with the illness” (Alzheimer’s). According to the 2012 Alzheimer’s Disease Fact and Figures, Alzheimer’s disease is the sixth-leading cause of death in the United States. Actively Pursuing Quality of Life
Without a cure it is of utmost importance that the emphasis be placed on the patient’s quality of life. Five behavioral aspects are addressed, social interaction, awareness of self, feelings and mood, enjoyment of activities, and response to surroundings, all lend to a person’s welfare. In efforts to establish an environment that encourages positive behavior and exercises cognitive skills appropriately, a team of healthcare providers are appointed to each patient. These teams typically consist of a primary care physician, a neurologist or geriatrician, a psychiatrist or psychologist, a geriatric nurse, social worker, or care coordinator and engaged family members. An individual care plan is then developed which is tailored to meet the specific needs of each patient. Each of the behavioral aspects plays a critical role in the patient’s overall wellbeing, significantly impacting their quality of life. How is “quality of life” best reached? Which therapy provides the most effective, most efficient, safest course in creating the environment for the desired outcome to be achieved? Many would argue pharmaceuticals, some would recommend natural remedies, but I contend that music therapy is most effective, efficient, and the safest form of treatment. Crowe extensively explored the role of music in dementia stating, “There is an important role for music in fostering quality of life because it strengthens our emotional awareness, installs a sense of agency, fosters belongingness, and provides meaning and coherence in life” (301). Therapeutic Options
At present, the disease is nursed with various prescription drugs currently approved by the U.S. Food and Drug Administration (FDA), along with an assortment of non-pharmaceutical treatments. There are numerous concerns that accompany each therapy, both beneficial as well as unfavorable. Numerous factors are taken into consideration when deciding which treatment is best suited for the individual. Whether pharmaceutical or non-pharmaceutical the influential factors typically discussed address the side effects and safety of each, the monetary implications to the patients, their families, and society as a whole, and the results profited from the therapy, whether immediate or delayed and long term versus short term affects. Each treatment goal is to produce positive results in cognitive and motor functioning as well as favorable psychological improvements. The most common therapies presently being utilized are Cholinesterase inhibitors, Namenda, herbal mixtures and music therapy. Cholinesterase inhibitors and Namenda are two different classes of pharmaceuticals approved by the FDA for treating Alzheimer’s disease. The non-pharmaceutical therapies implemented in various institutions to ease symptoms are herbal and music therapy. Each of these therapies aid in only providing relief to AD symptoms; neither group has proven to slow the rate of progression of the disease. Pharmaceuticals
Let’s first address the pharmaceutical methods. Cholinesterase inhibitors are most often prescribed to treat symptoms of mild to moderate and moderate to severe Alzheimer’s. This drug prevents the breakdown of acetylcholine and stimulates nicotinic receptors to release more acetylcholine in the brain. Increased concentrations of acetylcholine in the brain lead to increased communication between nerve cells, and sometimes temporarily improve or stabilize the symptoms of Alzheimer’s disease. Cholinesterase inhibitors are designed to protect the cholinergic system essential for memory and learning, which is progressively destroyed in Alzheimer’s. The benefits of this drug are far from dramatic but have shown to mildly lessen symptoms such as memory loss, anxiety, poor mood and lack of confidence. A randomized controlled trial suggested that the percentage of people with Alzheimer’s disease who experienced a favorable improvement with treatment varied between 40 and 70 percent. However, once a patient stops taking the drug, their condition typically deteriorates over a period of 4 to 6 weeks until they are at the same point as an individual who has not taken the drug. Frequent side effects are nausea, vomiting, diarrhea, weight loss, loss of appetite and muscle weakness. The monetary requirements present some challenges to family with the costs of medications at an all-time high averaging $2681 annually. Namenda or N-methyl D-aspartate (NMDA) is the second most commonly prescribed medication used to treat the symptoms of AD. NMDA is an antagonist prescribed to treat symptoms of moderate to severe Alzheimer’s. This drug is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work very differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination and often are once a patient reaches a severe stage of Alzheimer’s disease. When glutamate is normalized often cognitive and memory deficits are improved. A number of side effects frequently experienced are dizziness, headache, constipation, and confusion. Again, with the rise in prescription medications and Medicare unable to cover all of the pharmaceuticals regularly prescribed for AD, patients and families may experience fiscal hardship.
To treat the behavioral and emotional symptoms of Alzheimer’s disease Psychotropic medications are used on a regularly basis. These medications address the psychological and emotional aspects of brain functioning. Although these drugs display some effectiveness, they can also potentially cause very severe side effects. For example dry mouth, sexual problems, constipation, bladder problems, nausea, feeling jittery, headaches, forgetfulness, rage, dizziness, drowsiness, weight gain, drooling, tremors and drowsiness. Psychotropic medications include anti-anxiety medications, antidepressants, antipsychotics, and hypnotic medications as well as mood stabilizers. Generally these medications are prescribed to address symptoms such as hallucinations, insomnia, paranoia, depression and anxiety. Unfortunately, it has been recorded that antipsychotic drugs have been linked to an increased risk of death in patients with Alzheimer’s disease.
With the sometimes difficult to meet expense, vastly unwelcomed side effects that could potentially cause more harm, and the synthetic nature of pharmaceuticals, it is no surprise when a patient and their family members choose to exhaust all other therapeutics options first. In addition to the aforementioned concerns, the improvements these drugs present are often gradual and very subtle, often only stabilizing functions. Furthermore, if deterioration in the Alzheimer’s disease patients cognitive function or behavioral mood is noticed despite the use of an appropriate medication, and the patient is taken off of the regiment, it is possible that the deterioration will accelerate, leaving the care team and family scrambling to find another suitable solution.
Natural Remedies
Within the last couple of decades it has become quite popular for patients and family members to explore herbal remedies prior to turning to prescription medications. Natural remedy for illnesses versus prescription drugs has been the subject of medical debates for quite a long time. While a good number of patients swear by the remedies that their physicians prescribe, others have started questioning the risks that typically go with pharmaceutical remedies, and have embarked on the task of looking for safer and more natural alternatives. There are more than a few important reasons to weigh before deciding on a treatment to best address medical problems. Among some common arguments, staying true to the body’s natural chemical constitution resides at the top of the priority list. Synthetic substances can sometimes cause brain chemicals to fluctuate and as a result, the body is made to believe that the symptoms of a certain illness are subsiding because the chemical ingredients in a prescription drug indicate this to the brain (this is especially true of medication for psychiatric conditions). Natural remedies aim to do away with synthetic means of healing, and offer ingredients that enhance the body’s inherent ability to heal itself. Therefore, little to no side effects are experienced by the patient. Since ingredients of natural remedies are mainly composed of plants, herbs, and other organic ingredients, no synthetic elements are present to alter a body’s hormones. In addition to not interrupting the body’s natural chemical makeup, most natural remedies are more affordable than their prescription counterparts. The usual trend of pharmaceutical drugs is higher costs than an alternative natural remedy, largely because of the overhead cost from big-name companies, including the expense of advertising for sales. Holistic remedies gain in popularity and advertisement largely by word of mouth, therefore avoiding advertisement and additional overhead costs. Various herbal mixtures, vitamins and other supplements are widely promoted as preparations that may support cognitive health or delay Alzheimer’s.
The National Institutes of Health convened an expert panel that concluded current evidence does not support any benefit from taking extra vitamin B, vitamin C, vitamin E, folic acid or beta carotene. However, there is strong data that omega-3 fatty acids in fish oil may help prevent cognitive decline. High doses of vitamin E are prescribed by some physicians to help treat Alzheimer’s disease, based on a federally funded study showing that the vitamin delayed the loss of ability to carry out daily activities, consequently postponing placement of the patient into a care facility for a few months. The plant extract Ginkgo is thought to have several substances believed to be of benefit to Alzheimer’s disease patients. Nevertheless a number of supplements promoted for cognitive health can interact with other medications a person may be taking in support of Alzheimer’s disease or other health conditions, and for that reason may be circumvented. Music to My Alzheimer’s
The parent that once consoled your broken spirits and doctored your scraped knees no longer speaks your name in that familiar reassuring voice. They no longer recognize your face nor impart an emotion of intimacy between two people that have composed a lifetime of treasured memories together in a rare sonnet. The individual who once spoke encouraging words at just the precise moment and faithfully placed you time and again travelling confidently in the right direction now needs guidance from you. Assistance with who they are, what day it is, where they are, eventually coaching them how to stand and how to walk along with reminding them when to eat.
Works Cited
Cramer, Luciana. “Music Therapy Enhancing Cognition.” Alz.org. Alzheimer’s Association, n.d. Web. 4 Feb. 2013.
This article emphasizes several ways in which music creates a positive impact on cognitive skills. Memory recall, positive changes in moods and emotional stages, a sense of control over life, along with several other benefits.
Crowe, Barbara J. Music and Soulmaking: Toward a New Theory of Music Therapy. Lanham, MD: Scarecrow, 2004. Print.
This resource explores new avenues in music therapy. The author discusses connections between music therapy and nature. She also shows how everything is interrelated and addresses how music is able to touch people in a deep and consequentially healing way.
Jourdain, Robert. Music, the Brain, and Ecstasy: How Music Captures Our Imagination. New York: W. Morrow, 1997. Print.
Robert Jourdain examines science, psychology, music theory, paleontology, and philosophy in this book. He writes of why music speaks to us in ways that words cannot, and why we for such powerful connection to it.
Larsen, Dana. “Is Music Therapy an Effective Dementia Treatment?” Senior
Living News and Trends. N.p., 30 Oct. 2012. Web. 1 Feb. 2013.
This article details Dan cohen’s, founder and Executive Director of Music & Memory, thoughts on the benefits of personalized music for dementia patients, why music can stir memories, and how nursing homes can initiate and utilize a music therapy program.
Lou, Meei-Fang. “The Use of Music To Decrease Agitated Behaviour Of The Demented Elderly: The State Of The Science.” Scandinavian Journal of Caring Sciences 15.2 (2001): 165-73. Brown UK. Web. 2 Feb. 2013.
The paper reviews the state of the science of interventions using music to decrease the agitated behavior of the demented elderly person.
“Music, Art and Alzheimer’s.” Alzheimer’s Association. Alz.org, n.d. Web. 05 Feb. 2013. Shows that the Alzheimer’s Association is an advocate in instituting music therapy and specifically lists ways to incorporate the therapy into the lives of patients.
Raglio, Alfredo, Giuseppe Bellelli, and Daniela Traficante. “Efficacy of Music Therapy in the Treatment of Behavioral and Psychiatric Symptoms of Dementia.” Alzheimer Disease & Associated Disorders 22.2 (2008): 158-62. National Center for Biotechnology Informaion. Web. 30 Jan. 2013.
This study illustrates that music therapy is an effective tool for reducing behavioral and psychological symptoms of dementia.
Ramsey, Nancy. “10 Questions: For Oliver Sacks.” CBSNews. CBS Interactive, 05 Nov. 2007. Web. 05 Feb. 2013.
Oliver Sacks is a well-known neurologist who has contributed significantly to the music therapy conversation. This article offers great information.
Sacks, Oliver W. Musicophilia: Tales of Music and the Brain. New York: Alfred A. Knopf, 2007. Print.
This book is quite thorough. It not only touches on the effect music has on dementia but several other aspects of how the power of music stirs our
brains. It has been an incredible read.
Schaeffer, Juliann. “Music Therapy in Dementia Treatment – Recollection Through Sound.” Music Therapy in Dementia Treatment. Great Valley Publishing Co., Inc., n.d. Web. 30 Jan. 2013.
This editorial illustrates music therapy making an impact on physical wellbeing as well as improving emotional wellbeing. It brings to light that music help encourage movement and exercise thus generating not only a psychological benefit buy a physiological one as well.
Sung, Huei-chuan, and Anne M. Chang. “Use of Preferred Music to Decrease Agitated Behaviours in Older People with Dementia: A Review of the Literature.” Journal of Clinical Nursing 14.9 (2005): 1133-140. National Center for Biotechnology Information. Web. 31 Jan. 2013.
A chief concern for Alzheimer’s patients and the caretakers is a time referred to as sundowners. Sundowners syndrome typically occurs at the end of the day. It is a time when agitations and anger sometimes present.
Svansdottir, H. B., and J. Snaedal. “Music Therapy in Moderate and Severe Dementia of Alzheimer’s Type: A Case–control Study.” International Psychogeriatrics 18.04 (2006): 613-21. EBSCO. Web. 30 Jan. 2013.
This piece brings evidence that music therapy is effective in treating agitation and anxiety in moderately sever and severe Alzheimer’s patients. Regardless what stage the disease is in, music can play a positive role.
Thaut, Michael, and Gerald McIntosh. “How Music Helps to Heal the Injured Brain.” How Music Helps to Heal the Injured Brain. Dana Press, 24 Mar. 2010. Web. 03 Feb. 2013.
This article takes music therapy from beginning to end. The author writes when and where music therapy began making an impact, the progress that science has made, and what the future holds.
Vink, A. C., M. Zuidersma, and F. Boersma. “The Effect of Music Therapy
Compared with General Recreational Activites in Reducing Agitation in People with Dementia.” International Journal of Geriatric Psychiatry (2012): n. pag. EBSCO. Web. 30 Jan. 2013.
This study brings great information to the conversation by detailing the different outcomes between music therapy and general recreational activities. It identifies that there is truly a benefit to incorporating music therapy over general activities.
The Week Staff. “How Music Improves the Memory of Dementia Patients.” The Week. The Week Publications, 16 Apr. 2012. Web. 02 Feb. 2013.
This article discusses the effects music therapy has had on Henry Dryers life.