CAN MUSIC HELP ALZHEIMER’S PATIENTS?                                                      

What is Alzheimer’s disease?

Alzheimer’s disease is a type of irreversible, progressive brain disease that attacks and destroys the brain’s cells, which results in a loss of memory and other essential cognitive functions. The neurodegenerative disease is responsible for causing up to sixty percent of dementia cases. Contrary to popular belief, Alzheimer’s disease should not be considered a normal part of aging as approximately two hundred thousand people under the age of sixty-five have been diagnosed in the United States alone. Symptoms of the disease worsen over the years and are eventually terminal. Here are the seven stages.               

Stage One: No Impaired Behavior

A patient usually does not exhibit symptoms of memory loss or other cognitive impairments during stage one of Alzheimer’s disease. The only way the disease can be detected during this stage is by a positron emission tomography (PET) scan, which is an imaging test that studies how well the brain is working. As the disease progresses into other stages, a patient will experience more changes in their reasoning or thinking.

Stage Two: Very Mild Impairment

Patients with stage two Alzheimer’s disease still may not show symptoms, or they may exhibit very mild cognitive impairment. In most cases, memory loss associated with this stage is difficult to differentiate from the symptoms of normal aging. A patient with stage two Alzheimer’s disease may still do well on memory tests, and symptoms are unlikely to be picked up by medical professionals yet. Stage two is characterized by small changes that do not interfere with a patient’s ability to live on their own.

                   

Stage Three: Mild Decline

By stage three, a patient’s medical doctors and family members may begin to notice memory and cognitive impairments. The three most common areas affected during stage three Alzheimer’s disease are planning and organizing, finding the right word to describe feelings during a conversation, and remembering names of new places or people. A patient with stage three may finally show signs of Alzheimer’s disease on memory and cognitive tests. During this stage, it is common to misplace personal possessions such as keys, money, and other valuables.

Stage Four: Moderate Impairment

During stage four Alzheimer’s disease, the symptoms that began to arise in stage three starts to get worse. A patient will often forget important details about themselves, forget what month or time of year it is, have trouble locating the date on a calendar or perform simple math equations, and can no longer order from a menu or cook for themselves. It is recommended that patients in stage four no longer drive and are protected from being taken advantage of financially. Someone else should handle the patient’s finances.

Stage Five: Moderately Severe Impairment

During stage five, patients often experience significant confusion resulting in the inability to get dressed or recall simple details like their phone number. They may still maintain a moderate amount of functionality and can usually bathe and use the toilet by themselves unassisted. They may also still recall the names of family members and details about their past, such as their youth and childhood. A person with stage five Alzheimer’s disease may repeat themselves or ask the same questions over and over again.

Stage Six: Severe Impairment

Stage six Alzheimer’s disease is characterized by confusion or being unaware of a patient’s surroundings or environment, extreme personality changes and behavioral problems, the inability to recognize faces except for very close friends and relatives, loss of bladder and bowel control, and wandering. A person in stage six will need to be supervised regularly and requires the help of professional care. He or she will need assistance with going to the bathroom, bathing, eating and other daily activities.

 Stage Seven: Very Severe Decline

The final stage of Alzheimer’s disease may be warranted by the inability to swallow, the need for assistance in all life activities, and the failure to speak anything except a few words or phrases. A patient in this stage is considered near death as Alzheimer’s disease is a terminal illness. The patient is not aware of his or her surroundings and can no longer tell when they are hungry or thirsty. They may require complete assistance with eating, walking, and using the bathroom. Patients with stage seven may no longer be able to recognize their loved ones.

A year before my mother died on 2003 at age ninety one, she didn’t recognize anyone she previously knew.  She had suffered from a stoke years earlier. I don’t know if the stroke brought on the Alzheimer’s disease.

Alzheimer's disease is an irreversible, progressive brain disease. It is characterized by the development of amyloid plaques and neurofibrillary, or tau, tangles; the loss of connections between nerve cells (neurons) in the brain; and the death of these nerve cells.

Early-onset Alzheimer’s disease occurs between a person’s 30s to mid-60s and represents less than 10 percent of all people with Alzheimer’s. Some cases are caused by an inherited change in one of three genes, resulting in a type known as early-onset familial Alzheimer’s disease, (FAD). For other cases of early-onset Alzheimer’s, research suggests there may be a genetic component related to factors other than these three genes.

A child whose biological mother or father carries a genetic mutation for early-onset FAD has a 50/50 chance of inheriting that mutation. If the mutation is in fact inherited, the child has a very strong probability of developing early-onset FAD.

Early-onset FAD is caused by any one of a number of different single-gene mutations on chromosomes 21, 14, and 1. Each of these mutations causes abnormal proteins to be formed. Mutations on chromosome 21 cause the formation of abnormal amyloid precursor protein (APP). A mutation on chromosome 14 causes abnormal presenilin 1 to be made, and a mutation on chromosome 1 leads to abnormal presenilin 2.

Critical research findings about early-onset Alzheimer's have helped identify key steps in the formation of brain abnormalities typical of the more common late-onset form of Alzheimer's. Genetics studies have helped explain why the disease develops in people at various ages.

Alzheimer's is not just a disease of old age. About 200,000 of the 5.7 million people with the disease have the young-onset form, meaning they were diagnosed before age 65, according to the Alzheimer's Association. Many people are in their forties and fifties with dependent children and booming careers when the disease strikes. As it does with age-related Alzheimer's disease, the young-onset form also impacts memory, thinking, behavior, and, in later stages, daily activities and functions.

Researchers believe that many genes that affect the risk of Alzheimer's disease are yet to be discovered and that identifying others will prove vital in the development of new ways to treat, or even prevent, the disease. That is why much of current research focuses on understanding what's happening to the brain.

When Mike McGuff was in college at Baylor University in Waco,  Texas, he made a point of calling his mom, Elizabeth, at least once a week. By his senior year, their conversations began to feel a bit “off.” Always known for her wit, vibrancy, and confidence, Elizabeth was now increasingly passive and unsure of herself. In the span of six months, she also had been let go from her longtime job as a fourth-grade teacher because she couldn't keep up.

“I didn't know what was going on,” says McGuff. “Mom thought she was depressed and started seeing a therapist.” The mystery of his mother's rapid mental decline was finally solved in September 1999— about a year after McGuff first started noticing changes in her behavior. At just 53 years old, Elizabeth was diagnosed with young-onset Alzheimer's disease. “I was in total shock. She was so young. I could never imagine someone getting Alzheimer's at 53. In fact, I don't think I even knew such a thing was possible.” She died from complications related to the disease five years later.

Young-onset Alzheimer's disease has a strong genetic component. So far, researchers have linked the condition to mutations in one of three genes: APP, PSEN1, or PSEN2, which account for about 10 percent of all young-onset cases. When any of these genes is altered, the brain produces large amounts of amyloid beta peptide, a toxic protein fragment that clumps together to form amyloid plaques, a key marker of the disease, says Richard Sherva, PhD, research assistant professor at Boston University School of Medicine. These clusters bind themselves to receptors on nerve cells, triggering a process that erodes their synapses with other nerve cells.

Alzheimer's is not just a disease of old age. About 200,000 of the 5.7 million people with the disease have the young-onset form, meaning they were diagnosed before age 65, according to the Alzheimer's Association. Many people are in their forties and fifties with dependent children and booming careers when the disease strikes. As it does with age-related Alzheimer's disease, the young-onset form also impacts memory, thinking, behavior, and, in later stages, daily activities and functions.

For nearly 20 years, John M. Ringman, MD, MS, FAAN, professor of neurology at the Keck School of Medicine at University of Southern California, has studied families who carry the A431E or Jalisco gene mutation and develop Alzheimer's disease in their forties. His research, including an article in the April 2013 issue of Continuum: Lifelong Learning in Neurology, led him to conclude that this strand likely began with a single ancestor who lived in Jalisco, Mexico hundreds of years ago.

Studying families with at least three individuals in two or more generations who develop symptoms between the ages of 30 and 60 led to significant progress in understanding the genetic roots of the disease and the cause and effect of the disease overall. “These genes are inherited in a dominant way, which means you only need one mutated copy of the gene,” explains Dr. Sherva. “If you have the mutation, you are virtually assured of getting the disease.”

Former pastor and registered nurse Renee Perkins, 61, is more than familiar with the genetic component of the disease. She was diagnosed seven years ago when she recognized what looked like a familial genetic predisposition for the disease. She recalls her grandmother's odd behavior on a camping trip when she was in high school, “She was doing strange things like repeatedly asking me if I wanted coffee when I didn't drink coffee and never had,” recalls Perkins. “Then she poured coffee into a saucer instead of a cup.” More than 20 years after her grandmother's diagnosis, Perkins' mother was also diagnosed. In the interim, Perkins discovered that her great-grandmother had died in her fifties and that her death had been attributed to tuberculosis (TB) that had spread to her brain. She is convinced her great-grandmother had Alzheimer's, not TB.

As an aside, in 1937, when I was four years of age, I was diagnosed with having tuberculosis in my left lung. I was hospitalized in a sanitarium for children who suffered from that disease for a year.  When I was released, I was cured.

Music has been known to affect those with dementia and Alzheimer’s, but why it has an effect on these patients has not always been clear that is until now. A recent study shows that dementia and Alzheimer’s patients can recall memories and emotions, and have enhanced mental performance after singing classic hits and show tunes from movies and musicals — a breakthrough in understanding how music affects those with dementia and Alzheimer’s.

Researchers determined the effect music has on dementia patients, by leading half of the participants through selected songs while the other half listened to the music being played. After the musical treatment, all participants took cognitive ability and life satisfaction tests which showed how participants scored significantly better when being lead through songs, rather than only listening. Unfortunately, notwithstanding that when I was young, I had a good voice and sang in concerts, now if I try to sing, everyone will vacate the room real quick.

Here are five reasons why researchers believe that music boosts brain activity:

1. Music evokes emotions that bring memories.

Music can evoke emotion in even the most advanced of Alzheimer’s patients. Neurologist Oliver Sacks says that, “Music evokes emotion, and emotion can bring with it memory.  It brings back the feeling of life when nothing else can.” By pairing music with every day activities, patients can develop a rhythm that helps them to the recall the memory of that activity, improving cognitive ability over time.

2. Musical aptitude and appreciation are two of the last remaining abilities in dementia patients.

Linda Maguire, lead author on the study wrote, “Musical aptitude and music appreciation are two of the last remaining abilities in patients with Alzheimer’s.” Because these two abilities remain long after other abilities have passed, music is an excellent way to reach beyond the disease and reach the person.

3. Music can bring emotional and physical closeness.

In the later stages of dementia, patients often lose the ability to share emotions with caregivers. Through music, as long as they are ambulatory, they can often dance. Dancing can lead to hugs, kisses and touching which brings security and memories.

4. Singing is engaging.

The singing sessions in the study engaged more than just the brain and the area related to singing. As singing activated the left side of the brain, listening to music sparked activity in the right and watching the class activated visual areas of the brain. With so much of the brain being stimulated, the patients were exercising more mind power than usual.

5. Music can shift mood, manage stress and stimulate positive interactions.

The Alzheimer’s Foundation of America has an entire web page dedicated to music therapy in Alzheimer’s patients. They say that, “When used appropriately, music can shift mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function and coordinate motor movements.” This is because music requires little to no mental processing, so singing music does not require the cognitive function that is not present in most dementia patients.

I hope that you have found this article informative. Of course, this comment is directed to those who are not already in stage seven of the Alzheimer’s disease.