Finding the right recipe
Improvisation is also incorporated into the music therapy sessions in the Mount Sinai clinical trial, which is trying to drill down into the details of the music itself. Joanne Loewy, a music therapy researcher and director of the Louis Armstrong Center for Music and Medicine, is the co-principal investigator of the privately funded study. “It’s not just singing any old song,” she says. How music is delivered matters. Its personal salience to the person being treated matters. Every technical aspect of the music itself—timbre, tone, pitch, melody, rhythm—is likely to affect results. Loewy likens it to chocolate, which comes in myriad varieties. “The recipe is really important to the people eating it.”
To find the right recipe for each person, Loewy’s team conducts an intensive assessment—a kind of audio Rorschach test, as she puts it, to tune into the types of music each person responds to. (She pans her camera in a Zoom interview to show a vast array of musical instruments from around the world.) The researchers assess which types of instrumentation each patient is attracted to, as well as the time period, artists, and individual songs. They dig deep to understand the patients’ associations with those tunes, the feelings and images they evoke—that’s critical, she says, because people can also have negative associations with music. Based on the assessment, the team creates a personalized playlist of music that is engaging and positively reinforcing, capped at both ends with a particularly meaningful selection that Loewy calls “song of kin.” It might be the person’s wedding song, or a song from their formative years, something that connects with them deeply.
“Music therapy research tells us that patient-preferred music has the most strength for change, but we take that a step further,” she says. “It’s not just throwing together a playlist. It’s actually characterizing the aspects and qualities of the music that will engage the listeners.”
That engagement seems to be key, says Mary Sano, a Mount Sinai neuroscientist who heads the Alzheimer’s Disease Research Center and is co-investigator on the study. “Maybe music or song are ways to stimulate neural activity broadly and that might leave you open to laying down new associations,” she speculates. “That’s a real leap of faith” based on the data we have today, she says, but is a legitimate scientific question worth investigating. “If we knew how external stimulation helped the brain to be more plastic, which we know it is, that could certainly be a path to better interventions.”
‘Earworms’ may explain memory effects
Understanding why music triggers memories so powerfully has been Petr Janata’s life work. Now with funding from the Sound Health initiative, the University of California-Davis neuroscientist is investigating how “earworms,” those bits of music that replay involuntarily and sometimes incessantly in our brain, contribute to the creation and consolidation of memories, and how music serves as a cue for retrieving associated memories even when memory structures of the brain involved in effortful memory retrieval are damaged, as in Alzheimer’s disease. His hypothesis is that earworms, which he calls involuntary repetitive musical imagery (IRMI), help to consolidate memories not only for the music itself, but also for non-musical information associated with the music. The work helps unravel a possible mechanism underlying the sometimes profound effects of music on even advanced dementia.
Music therapists like Connie Tomaino, director of the Institute for Music and Neurological Function, are putting these concepts into practice. Tomaino, who’s been working with Alzheimer’s patients for 40 years and is writing a “best-practices” guidebook on music therapy, suggests linking a particular soundtrack consistently with a particular person, so the music can be used as a cue to help a memory-impaired person remember their loved one.
Janata thinks it’s worth a try– with a caveat. “I love engaging with the music therapy communities because they’re very eager to incorporate what’s known from the science into practice. But I think that there is certainly work to be done. What are the mechanisms by which these memories form? And for what type of information is it most useful? Then one can design and try out interventions that are targeted with these mechanisms in mind.”