Tony Bennett and Lady GaGa in 2015 (Photo/Wikimedia)
Tony Bennett and Lady GaGa in 2015 (Photo/Wikimedia)

Reduce cognitive decline by engaging with music

In August 2021, Tony Bennett (singing alongside Lady Gaga) gave his final performance at the age of 95 for an audience of 6,000 at Radio City Music Hall. Despite his advanced Alzheimer’s dementia, he sang more than a dozen songs and received at least 20 standing ovations.

A few days later, he had absolutely no memory of his performance.

How can music therapy help those like Tony Bennett who already have dementia, and can it help others with neurological and mental health conditions? Taking a step back, can music possibly protect our aging brains from memory loss?

First, let’s start in childhood. A 2019 study of children, reported in Frontiers in Psychology and elsewhere, demonstrated that musical training results in increased language and speech skills, and leads to higher executive functioning.

Now we’ll flash ahead to another study, published in 2020, that looked at community-living older adults over a 12-month period. It found that those who had played a musical instrument demonstrated better cognitive function compared to those who never played a musical instrument. The hypothesis is that playing a musical instrument requires integration of sensory, motor and mental skills that produces a “cognitive reserve,” which protects against cognitive decline.

What happens in the brain anatomically when playing an instrument or listening to music? Research using functional MRIs has validated that processing music stimulates many parts of the brain. Visual, motor and auditory cortexes of the brain are all activated when playing a musical instrument. Listening to music also stimulates the brain widely. In his book “Musicophilia: Tales of Music and the Brain,” neurologist Oliver Sacks wrote: “Listening to music is intensively active, involving a stream of inferences, hypotheses, expectations, and anticipations.”

Portions of the limbic or emotional system of the brain are triggered depending on if music evokes feelings such as happiness, sorrow, fear or tension. When we listen to music the “attachment hormone” oxytocin increases, which socially bonds us. (Maybe this is why it is common for people in every culture to sing and dance with one another.)

Dopamine, the pleasure hormone involved with food and sex, is also released during music listening, not only at the peak of an emotional moment, but shortly beforehand — called the anticipation phase.

Utilizing the knowledge of how music affects the brain can be applied therapeutically to help patients with dementia regain previous memories, improve mood and provide a sense of control. Describing the benefits of music in those with cognitive impairment, Sacks wrote (again in “Musicophilia”): “Music may allow an ability to organize, to follow intricate sequences, or to hold great volumes of information in mind — this is the narrative or mnemonic power of music.”

In addition to helping patients with memory problems, music therapy has benefited those with Parkinson’s disease, bipolar disorder, schizophrenia, Huntington’s disease and those who have lost their speech after a stroke or brain injury.

A poignant example of music therapy is how Gabby Giffords, the former member of Congress from Arizona, recovered after being shot in the head in 2011. By playing the French horn and singing, she was able to regain speech, movement and cognitive function.

The goal in treating dementia patients with music therapy is to find the surviving inner self by awakening emotions, thoughts and memories through music.

Even though having a life filled with singing did not protect him from getting Alzheimer’s, singing was still the best treatment for him, as Bennett’s neurologist explained on “60 Minutes.”

Because musical perception is spread throughout the brain, musical sensibility and awareness can survive even after other memories have disappeared. Through his singing, Tony Bennett’s passion, joyfulness and kindness prevailed. After Bennett’s final performance, Lady Gaga reflected, “He gave a gift to the world. Things can change and you can still be magnificent.”

Dr. Jerry Saliman

Jerry Saliman, MD, retired from Kaiser South San Francisco after a 30-year career and is now a volunteer internist at Samaritan House Medical Clinic in San Mateo.