Music is the rhythm of life. It has transformative powers. It connects us with who we are and who we have been. The 2014 documentary Alive Inside demonstrates how music is intrinsically tied to our emotions and can unlock memories buried deep when played to Alzheimer’s patients.
Connie Tomaino is a music therapist and the director of the Institute of Music and Neurological Function in New York. She said, “Music is an essential bridge to connecting people with dementia and Alzheimer’s Disease to themselves, their loved ones and their personal history”. Renowned neurologist Oliver Sacks reiterates, with years of research encapsulated in the following statement: “Music imprints itself on the brain deeper than any other human experience. Music evokes emotion and emotion can bring with it memory”.
Of course, hearing impairment has direct implications on the efficacy of music therapy programs and, worryingly, many people with dementia are unable to convey that they have hearing loss to nursing staff largely untrained in diagnosing audiological problems.
Although hearing loss requires prompt treatment, hearing screenings are not typically a standard part of medical assessments by doctors and professional carers. Too often patients must present with severe to profound hearing impairment in order for audiology referral to take place. What’s more, hearing tests are not infallible. The pure tone or ‘beep’ test commonly administered does not always pick up early-stage hearing loss. Astonishingly, even when it is picked up, some audiologists dangerously advise patients to wait until things get worse before bothering with hearing aids.
Hearing loss can masquerade as a loss of mental sharpness, and older people with hearing loss appearing disengaged or confused are at times misdiagnosed with cognitive illness. (This can happen to children with undetected hearing loss, except they are misdiagnosed with attention deficit disorders.) It’s easy to see how this can happen, when common dementia screening tests depend on a patient’s ability to hear. Further, hearing loss can lead to depression, which often goes hand in hand with dementia (little wonder when you consider that it’s a barrier to socialising, and to our ability to experience music as intended).
Ironically, research increasingly shows that untreated hearing loss can actually accelerate brain tissue loss and lead to cognitive disease. A recent John Hopkins study found that even mild hearing loss substantially increases the risk of dementia.
Music, on the other hand, is considered a protective factor against dementia in that it has been proven to delay the impact of hearing loss on speech perception. In a study conducted by Samira Anderson and her colleagues, it was found that musicians with hearing loss still hear better than non-musicians without hearing loss when it comes to their ability to distinguish speech from background noise. Further studies by Aniruddh Patel find that, when combined with high quality hearing aids, music training exercises can reactivate the part of the brain that helps people conduct a conversation in a busy restaurant.
Concern has been raised as to the suitability of hearing aids for people with dementia. Fitting hearing aids for a patient with Alzheimer’s is easily done in the earlier stages of the disease, but once the disease has reached a severe stage, some patients may reject their use. Like anything, responses vary.
It has been argued that hearing aids for dementia patients are a wasted expense and will only be lost, unworn or unmaintained, but these fears can be allayed with the use of ear retainers and clips, with appropriate fitting, and by the incorporation of maintenance into carer’s routines.
It is important that every measure is taken to keep dementia patients engaged with their family and environment for as long as possible; relaxed mental activity will only hasten the disease. Moreover, hearing aids can quell anxiety inducing tinnitus, and clinical evidence show that music and environmental sounds have a soothing effect, even after the understanding of speech is gone.