Henry has been a nursing home resident for about ten years. He isn’t able to say his daughter’s name when she asks him who she is. His caregiver explains that Henry tends to sit around with his head down, not talking. Then, as she hands Henry an iPod with his favorite music and puts headphones on him, there’s a transformation. His face lights up, his eyes open wide, he moves his arms and sings along. Afterward, he is able to answer questions and share memories about his youth.

The documentary Alive Inside features Henry’s story and shines a light on the work of Dan Cohen, founder of the nonprofit organization Music & Memory. “Dan Cohen founded the field,” said Tobias Overath of Duke’s Department of Psychology and Neuroscience and the Duke Institute for Brain Sciences. “People with Alzheimer’s who can’t communicate can awaken through music that’s personally meaningful.”

At Duke, School of Medicine students Kelly Ryan Murphy and Daniel Goltz initiated a quality improvement project at the Eno Pointe Assisted Living Center, “Connecting Residents with Dementia to their Autobiographic Soundtrack with Personalized Music,” mentored by Duke geriatrician Heidi White from the Department of Medicine. Their program received a 2016 AMDA Foundation Quality Improvement and Health Outcomes Award.

Faculty and Undergraduates Team Up for a Bass Connections Project

White, Overath and Cassandra M. Germain of the School of Medicine’s Department of Psychiatry and Behavioral Sciences led a related Bass Connections project, Music and Memory in the Aging Brain, with undergraduates Cole Jenson ’18, Amanda Lee ’17 and Megan Snyder ’17.

The study’s objectives were to examine the effectiveness of daily music listening on the behavioral symptoms of patients with dementia, and to examine perceptions of caregiver burden before and after the personalized music intervention.

The team worked with five pairs of patients and caregivers who live together at home in Durham: four couples and one parent-child pair.

Snyder explained the team’s process: “We go out and meet with them and do some baseline measurements, and assess their cognition and their neuropsychiatric behaviors associated with dementia. We also talk with their caregivers. Then we ask them what kind of music they like, and we come back with their favorite music personalized on an iPod. We ask them to listen to their personalized music every day, and we see if there were any changes with their neuropsychiatric symptoms—and also with the caregiver burden associated with caring for someone with dementia.”

The pre- and post-measures included the Caregiver Burden Inventory (CBI) and the Neuropsychiatric Inventory (NPI) to assess participant behavioral symptoms.

Snyder and Lee shared findings at the Society for Post-acute and Long-term Care Medicine conference in March 2016. The team found a reduction in CBI scores in three out of five caregivers. Some caregivers reported that their loved ones were less agitated immediately after listening to the music, and some said they found the music intervention enriching and that it improved quality of life by helping to increase interaction with their loved one.

Mentoring a New Generation

“One of the benefits for School of Medicine faculty is that the program provides a chance for faculty to mentor another generation of students, and also a means of collecting pilot data in an area of interest,” said Germain. “Our students have had a variety of opportunities to be exposed to the science side of medicine and the clinical side, which they wouldn’t have without this project.” White agreed: “It is reassuring to see college students who embrace the needs of the coming decades for our older adult population.”

Germain added that the undergraduates played a key role in shaping the project. “One of the outcomes we were aiming for was a clinical reduction of neuropsychiatric symptoms,” she said. “Based on student interest, we added language and caregiver outcomes to the project. Amanda became very interested in language production and quality; her anthropology background influenced that. Cole had a background in the arts, and his contribution helped to shape the music playlists and provide technical support. Megan did a lot on the caregiver burden piece.”

For Jenson, this experience sparked an interest in further inquiry. “I want to do more research on stuff like why music makes people happy,” he said.

Duke’s involvement in this area of research continues with a summer extension that enrolled three more participant-caregiver pairs and involved one additional undergraduate, Morgan Ferrans, in the study. With direction from White, medical students Vinay Choksi and Kyle Freischlag identified geriatrician Katja Elbert-Avila as a mentor and are bringing personalized music therapy to patients in the long-term care facility at the Durham VA.

Learn More

• Read reflections from Heidi White about this project team.
• Explore Bass Connections in Brain & Society.
• Find out how to get involved in Bass Connections.

Images: still of Henry from Man in Nursing Home Reacts to Hearing Music from His Era; Megan Snyder talks about her Bass Connections team during Brain Week at Duke; Cassandra Germain, Tobias Overath and Heidi White present at the Bass Connections Faculty Team Leader Forum