Music study investigates communication in people living with dementia

Chelsea Court Place, a residential home for individuals living with dementia, is working with the University of Roehampton in a research project entitled Beyond Words, which uses ‘micro-songs’ to recapture and sustain functional language in people with advanced dementia.

The study aims to investigate the power of music, enabling people living with dementia to retain their speech and help communicate their wishes and needs for a longer period than would be normally be the case in the natural deterioration caused by the disease. 

Researchers, Professor Adam Ockelford, Dr Fiona Costa, Catlin Shanghnessya PhD student and ‘savant’ pianist Derek Paravacini are leading this innovative project with residents from Chelsea Court Place. The weekly, 45 minute sessions include a repertoire of familiar songs (requested by the audience) and proceed into a series of micro- songs; short rhythmic melodies associated with key functional language. Such micro-songs have been successfully used with children and young people with complex needs to scaffold or substitute language but no research has been conducted to understand the extent to which this happens.

The project launched in October 2017 and is proving to be extremely popular with the residents. Key finding from this period through to July 2018 have so far included:

The key findings were as follows:

•    Almost all the participants were able to learn the new songs and sing them following demonstrations by the research team.

•    The songs were recalled initially over a period of a week, a month, and then three months (with no exposure between times).

•    The songs were motivating, providing participants with information that could be interesting and helpful: for example, introducing the name of the person sitting next to them (and in some cases their own name); the day of the week. Other songs encouraged movement and reinforced laterality. Some afforded the opportunity to express how they were feeling, which engendered some tactile responses. Some allowed participants to indicate their wants and needs. For example:

•    Contrary to the initial concerns of the research team, they were not interpreted as patronising, but engaging and fun. It appeared that, once they were familiar, the participants did not distinguish between the songs they had known for many years and the new ones.

Background

There are increasing numbers of people with dementia in the UK. Current estimates by the Alzheimer’s Society suggest that there are as many as 850,000. This number is expected to rise to over one million by 2025 and to two million by 2051.

A cure for dementia is still a long way off. It is therefore imperative to find ways of improving the quality of life of those with the disease. To this end, several health bodies have recommended the development of non-pharmacological approaches to care. One such approach is the use of music. Various research studies have shown that participatory music programmes can regulate symptoms of anxiety and depression, reduce agitation and aggression, facilitate social interaction, retain memory and improve general wellbeing.

One of the most debilitating symptoms of dementia is a decline in the capacity to speak. This leads to social isolation, a loss of a sense of time and place, and a reduced capacity to make choices. However, it appears that many musical abilities and memories remain intact during the course of the disease. This raises the possibility that music can be used to rekindle and sustain verbal communication – an idea that was the main focus of the ‘MIND: Phase 2’ study. 

For 10 months, the research team led weekly music sessions with two groups of people with moderate to severe dementia, all in residential care. Each session was preceded with 45 minutes of singing, using preferred music from the participants’ teens and twenties. This was in itself a positive experience. Almost all joined in the singing and were invariably able to recall at least some of the lyrics, thereby accessing language that was normally unavailable to them. 

Following the large-group session, further, smaller groups were engaged in singing for a further 45 minutes, using, within the preferred pieces, specially composed ‘micro-songs’. These set everyday words and phrases to simple tunes as shown below. 

Conclusion and next steps

These songs, each very simple in content, were relevant to the participant’s lives, and a way for them to navigate their social environments. Taking part raised their confidence in their ability to sing and in their memory, often accessing language that was no longer part of their day-to-day vocabulary. The wider effects, such as improved social interaction with other residents and increased self-awareness were, even if short-term, of benefit to them.

It is hoped to initiate a further project that will embed the materials in the daily lives of participants, enabling them to express their feelings and communicate their wishes and needs for a longer period than would normally be the case in the course of the disease. 

Professor Adam Ockelford comments: "Beyond Words hopes to see successful results showing an improvement in sustained use of language for participants and ultimately offering them an improved quality of life. Evidence has so far suggested that music has a powerful role to play in communication with individuals who have complex needs and we are very proud to be working with the Chelsea Court Place team and residents to investigate and hopefully prove the theory."

Christine Valentine-Bunce, Head of Commissioning and Operations at Chelsea Court Place adds: "Music is very powerful and evocative and the sheer joy experienced by our residents in the Beyond Words sessions is remarkable. We have been very impressed with the way in which our residents have embraced the weekly sessions and are very excited about seeing the results."

About Derek Paravacini

Derek Paravacini is a world-renowned ‘savant’ pianist who is working with the University of Roehampton on a ground-breaking research project “Beyond Words” at Chelsea Court Place.

Derek first shot to fame when he was just nine years old, playing jazz with the Royal Philharmonic Pops Orchestra at the Barbican Centre in London. Numerous television appearances followed in the UK and overseas. In the last few years, Derek featured in the series Extraordinary People (Channel 5, UK), and on BBC1, BBC2 and ITV and he has appeared in documentaries in Japan, Germany, Australia and the USA.

Derek has given concerts in venues across England, in Europe and the USA; among them, Ronnie Scott's renowned jazz club, the Mandalay Bay Arena in Las Vegas, Nevada and in Phoenix, Arizona, for Mohammad Ali. He has performed twice at Buckingham Palace. In 2012, Derek played ‘Rhapsody in Blue’ and a new piano concerto written specially for him with the Orchestra of St John’s in London’s Queen Elizabeth Hall.

There is no doubt that Derek is one of the most extraordinary pianists and musical entertainers of his generation. Yet he is blind, autistic and has severe learning difficulties. Dubbed ‘The Human iPod’ in the USA, Derek has a repertoire of tens of thousands of pieces.

For more information on dementia and music therapy, see roehampton.ac.uk