Sari Laitinen

Music listening enhances cognitive recovery and mood after middle cerebral artery stroke

We know from animal studies that a stimulating and enriched environment can enhance recovery after stroke, but little is known about the effects of an enriched sound environment on recovery from neural damage in humans. In humans, music listening activates a wide-spread bilateral network of brain regions related to attention, semantic processing, memory, motor functions, and emotional processing. Music exposure also enhances emotional and cognitive functioning in healthy subjects and in various clinical patient groups. The potential role of music in neurological rehabilitation, however, has not been systematically investigated. This single-blind, randomized, and controlled trial was designed to determine whether everyday music listening can facilitate the recovery of cognitive functions and mood after stroke. In the acute recovery phase, 60 patients with a left or right hemisphere middle cerebral artery (MCA) stroke were randomly assigned to a music group, a language group, or a control group. During the following two months, the music and language groups listened daily to self-selected music or audio books, respectively, while the control group received no listening material. In addition, all patients received standard medical care and rehabilitation. All patients underwent an extensive neuropsychological assessment, which included a wide range of cognitive tests as well as mood and quality of life questionnaires, one week (baseline), 3 months, and 6 months after the stroke. Fifty-four patients completed the study. Results showed that recovery in the domains of verbal memory and focused attention improved significantly more in the music group than in the language and control groups. The music group also experienced less depressed and confused mood than the control group. These findings demonstrate for the first time that music listening during the early post-stroke stage can enhance cognitive recovery and prevent negative mood. The neural mechanisms potentially underlying these effects are discussed.

Cognitive, Emotional, and Social Benefits of Regular Musical Activities in Early Dementia: Randomized Controlled Study

PURPOSE OF THE STUDY During aging, musical activities can help maintain physical and mental health and cognitive abilities, but their rehabilitative use has not been systematically explored in persons with dementia (PWDs). Our aim was to determine the efficacy of a novel music intervention based on coaching the caregivers of PWDs to use either singing or music listening regularly as a part of everyday care. DESIGN AND METHODS Eighty-nine PWD-caregiver dyads were randomized to a 10-week singing coaching group (n = 30), a 10-week music listening coaching group (n = 29), or a usual care control group (n = 30). The coaching sessions consisted primarily of singing/listening familiar songs coupled occasionally with vocal exercises and rhythmic movements (singing group) and reminiscence and discussions (music listening group). In addition, the intervention included regular musical exercises at home. All PWDs underwent an extensive neuropsychological assessment, which included cognitive tests, as well as mood and quality of life (QOL) scales, before and after the intervention period and 6 months later. In addition, the psychological well-being of family members was repeatedly assessed with questionnaires. RESULTS Compared with usual care, both singing and music listening improved mood, orientation, and remote episodic memory and to a lesser extent, also attention and executive function and general cognition. Singing also enhanced short-term and working memory and caregiver well-being, whereas music listening had a positive effect on QOL. IMPLICATIONS Regular musical leisure activities can have long-term cognitive, emotional, and social benefits in mild/moderate dementia and could therefore be utilized in dementia care and rehabilitation.

Music and speech listening enhance the recovery of early sensory processing after stroke

Our surrounding auditory environment has a dramatic influence on the development of basic auditory and cognitive skills, but little is known about how it influences the recovery of these skills after neural damage. Here, we studied the long-term effects of daily music and speech listening on auditory sensory memory after middle cerebral artery (MCA) stroke. In the acute recovery phase, 60 patients who had middle cerebral artery stroke were randomly assigned to a music listening group, an audio book listening group, or a control group. Auditory sensory memory, as indexed by the magnetic MMN (MMNm) response to changes in sound frequency and duration, was measured 1 week (baseline), 3 months, and 6 months after the stroke with whole-head magnetoencephalography recordings. Fifty-four patients completed the study. Results showed that the amplitude of the frequency MMNm increased significantly more in both music and audio book groups than in the control group during the 6-month poststroke period. In contrast, the duration MMNm amplitude increased more in the audio book group than in the other groups. Moreover, changes in the frequency MMNm amplitude correlated significantly with the behavioral improvement of verbal memory and focused attention induced by music listening. These findings demonstrate that merely listening to music and speech after neural damage can induce long-term plastic changes in early sensory processing, which, in turn, may facilitate the recovery of higher cognitive functions. The neural mechanisms potentially underlying this effect are discussed.

Structural changes induced by daily music listening in the recovering brain after middle cerebral artery stroke: a voxel-based morphometry study

Music is a highly complex and versatile stimulus for the brain that engages many temporal, frontal, parietal, cerebellar, and subcortical areas involved in auditory, cognitive, emotional, and motor processing. Regular musical activities have been shown to effectively enhance the structure and function of many brain areas, making music a potential tool also in neurological rehabilitation. In our previous randomized controlled study, we found that listening to music on a daily basis can improve cognitive recovery and improve mood after an acute middle cerebral artery stroke. Extending this study, a voxel-based morphometry (VBM) analysis utilizing cost function masking was performed on the acute and 6-month post-stroke stage structural magnetic resonance imaging data of the patients (n = 49) who either listened to their favorite music [music group (MG), n = 16] or verbal material [audio book group (ABG), n = 18] or did not receive any listening material [control group (CG), n = 15] during the 6-month recovery period. Although all groups showed significant gray matter volume (GMV) increases from the acute to the 6-month stage, there was a specific network of frontal areas [left and right superior frontal gyrus (SFG), right medial SFG] and limbic areas [left ventral/subgenual anterior cingulate cortex (SACC) and right ventral striatum (VS)] in patients with left hemisphere damage in which the GMV increases were larger in the MG than in the ABG and in the CG. Moreover, the GM reorganization in the frontal areas correlated with enhanced recovery of verbal memory, focused attention, and language skills, whereas the GM reorganization in the SACC correlated with reduced negative mood. This study adds on previous results, showing that music listening after stroke not only enhances behavioral recovery, but also induces fine-grained neuroanatomical changes in the recovering brain.

Therapeutic Role of Music Listening in Stroke Rehabilitation

We performed two parallel interview studies of stroke patients (n= 20) and professional nurses (n= 5) to gain more insight into the therapeutic role of music listening in stroke rehabilitation. Results suggest that music listening can be used to relax, improve mood, and provide both physical and mental activation during the early stages of recovery from stroke. Thus, music listening could provide a useful clinical tool in stroke rehabilitation.

The Effect of Music and Audiobook Listening on People Recovering From Stroke: The Patient’s Point of View

Recent experimental evidence suggests that musical activities can enhance motoric, cognitive, and emotional recovery after a stroke. The authors’ aim was to gain more insight about the emotional and psychological factors underlying the therapeutic effects of listening to music after a stroke, by combining both qualitative and quantitative methods. Thirty-nine patients who had suffered a stroke were interviewed about their subjective experiences when listening, on a daily basis, to either self-selected music (n 1⁄4 20) or audiobooks (n 1⁄4 19) during the first 2 months after the stroke. Results showed that music listening was specifically associated with better relaxation, increased motor activity, and improved mood, whereas both music and audiobook listening provided refreshing stimulation and evoked thoughts and memories about the past. These results highlight the clinical importance of providing stimulating and pleasant leisure activities after a stroke and further encourage the use of music in stroke rehabilitation.

Clinical and Demographic Factors Associated with the Cognitive and Emotional Efficacy of Regular Musical Activities in Dementia

Recent evidence suggests that music-based interventions can be beneficial in maintaining cognitive, emotional, and social functioning in persons with dementia (PWDs). Our aim was to determine how clinical, demographic, and musical background factors influence the cognitive and emotional efficacy of caregiver-implemented musical activities in PWDs. In a randomized controlled trial, 89 PWD-caregiver dyads received a 10-week music coaching intervention involving either singing or music listening or standard care. Extensive neuropsychological testing and mood and quality of life (QoL) measures were performed before and after the intervention (n = 84) and six months later (n = 74). The potential effects of six key background variables (dementia etiology and severity, age, care situation, singing/instrument playing background) on the outcome of the intervention were assessed. Singing was beneficial especially in improving working memory in PWDs with mild dementia and in maintaining executive function and orientation in younger PWDs. Music listening was beneficial in supporting general cognition, working memory, and QoL especially in PWDs with moderate dementia not caused by Alzheimers disease (AD) who were in institutional care. Both music interventions alleviated depression especially in PWDs with mild dementia and AD. The musical background of the PWD did not influence the efficacy of the music interventions. Our findings suggest that clinical and demographic factors can influence the cognitive and emotional efficacy of caregiver-implemented musical activities and are, therefore, recommended to take into account when applying and developing the intervention to achieve the greatest benefit.

Music, Emotion, and Dementia: Insight From Neuroscientific and Clinical Research

Music has an important meaning in the lives of many elderly persons. Its capacity to evoke emotions and influence mood and arousal is often relatively well preserved also in dementia. Neuroscientific and clinical research has increased our understanding about the mechanisms underlying music enjoyment and its therapeutic effects. This article reviews previous studies that address the neural basis of music cognition and emotion. We also introduce the effects of varying music interventions on emotional and cognitive functioning in dementia. Findings suggest that both traditional music therapy and caregiver-implemented music activities may have the capacity to reduce emotional and behavioral disturbances in dementia, although firm conclusions about the long- term effects of music still remain elusive. The rapid growth of dementia warrants study in the rehabilitative effects of everyday musical leisure activities or hobbies, such as music listening and singing, on well-being in dementia, especially in its early stages.

Pattern of Emotional Benefits Induced by Regular Singing and Music Listening in Dementia

To the Editor: Behavioral and psychological symptoms of dementia (BPSDs), such as depression and anxiety, are highly prevalent symptoms in persons with dementia (PWDs) and represent one of the most complex, stressful, and costly aspects of dementia care. Previous studies have demonstrated that the capacity of music to evoke emotions and memories is often preserved even in severe Alzheimer’s disease (AD) and that music therapy or musical activities can enhance mood and social interaction in PWDs, although more evidence is needed. In a recent randomized controlled trial, the cognitive and emotional effectiveness of two types of caregiver-implemented musical activities, singing and music listening, were compared with standard care in individuals with mild to moderate dementia. Singing and music listening improved Mini-Mental State Examination scores and attention and executive function test scores and reduced depression symptoms, as indicated by the Cornell–Brown Scale for Quality of Life in Dementia (CBS) total score. Extending this study, the aim of the current study was to determine whether singing and music listening, which differ motorically, cognitively, and emotionally, would show a distinct pattern of emotional benefits on the subscales of the CBS.

COGNITIVE, EMOTIONAL AND SOCIAL BENEFITS OF REGULAR MUSICAL ACTIVITIES IN EARLY DEMENTIA

• 89 PWD-caregiver dyads comprising family members and nurses from day activity centres and inpatient centres in Helsinki and Espoo, Finland. • Participants were randomised into three groups: Singing Group (SG), Music Listening Group (MLG), and a usual care Control Group (CG). • Caregivers in the SG and MLG were encouraged and taught to either sing or listen to music regularly with their PWDs to “enhance mood, increase reciprocal communication as well as support the cognitive abilities of the PWD”. • Participants were followed for nine months. • Cognitive abilities, moods and quality of life (QOL) of PWDs, and psychological wellbeing of their family members were assessed at three points: Before the intervention (baseline), Immediately after the intervention (Follow-up 1: Three months from baseline), and Six months after the end of the intervention (Follow-up 2: Nine months from baseline).