When music compensates language: a case study of severe aphasia in dementia and the use of music by a spousal caregiver

Abstract

ABSTRACT Background: There is accumulating evidence of the preservation of music skills in people with Alzheimer’s dementia (AD), including spared memory for familiar music and the ability to produce music by singing or playing an instrument. Music can also be used to alleviate symptoms of dementia, leading to reduced agitation, improved positive mood, memory, and expressive language functions. Aims: We evaluated the rate of decline of expressive language and music skills in TC, a 77 year old woman with aphasia in the context of severe AD, and her husband’s use of music in caregiving. Neither TC nor her husband had any formal music training. We also explored whether the preservation of music skills had implications for treating a symptom of her dementia, specifically her misidentification delusion. Methods & Procedures: A retrospective comparison of the progressive decline in TC’s expressive music and language skills was obtained through interviews with her husband. He also completed a purposefully developed questionnaire regarding his use of music during caregiving. Assessment of TC’s language skills was attempted using the Sydney Language Battery, and her music engagement skills were evaluated with the Music Engagement Questionnaire (MusEQ, informant version). Her behaviour and verbal communication was observed during four different conditions, presented by her husband; (1) reading a newspaper article, (2) reading familiar song lyrics, (3) singing familiar song lyrics, and (4) listening to the original version of the familiar song. Outcomes & Results: TC exhibited a gradual deterioration of her expressive language abilities, whereas her music skills (singing and music engagement), were relatively preserved. Her overall score on the MusEQ was in keeping with age matched healthy controls (50–55 percentile) and she had a high average (80–85 percentile) score on the “emotion” subscale. The impact of preserved music engagement was powerfully demonstrated when TC developed a transient misidentification delusion and believed that her husband was an intruder. Her delusion was only resolved after her husband repeatedly sang a significant song that they had shared as a couple for close to 60 years. By singing this special song (“Unchained Melody”), TC eventually “came back” and recognised him. During behavioural observations under different language and music conditions, TC’s verbal communication did not appear to change. Conclusions: This case study illustrates that when language skills deteriorate in AD, music functions may persist, providing a vital tool in coping with the symptoms of severe dementia.