He softly pounded a slow, steady beat, hoping his grandmother might acknowledge the presence of the soothing sound. Almost miraculously, she lit up, and began repeating his name over and over saying, “Mickey...Mickey” (Szalavitz). The Grateful Dead drummer, Mickey Hart, was experiencing first hand the power and strength that rhythm and music is capable of having on humans. His Grandmother, who is diagnosed with Dementia, a disease that causes individuals to “fade away” from the lives they once had, was his inspiration to further research into the connection that the effect music has on the brain and seemingly hopeless diseases like Dementia have. Hart described this experience saying, “rhythm was reconnecting her to the world that was fading away” (Szalavitz). This idea of rhythm and its swaying effect on people with disabilities and disease is more commonly known as “music therapy”. Music is a natural, affordable way of treatment for people with Alzheimer's, another form of Dementia, and it can and should be implemented at care facilities and given more recognition than it is currently disposed to. The effect of music on the improvement of the lives of people living with Alzheimer's disease are boundless and have been measured for decades. When reviewing studies addressing the impact of music and music therapy interventions with Alzheimer’s patients, many benefits are observed. Individuals see a decrease in problematic behaviors, an increase in social skills, improvement in emotional and cognitive skills, they begin to maintain and improve active involvement, and have improved recall and language skills. Although some trust the older practice of use of a “magic pill”, Alzheimer’s is still an incurable disease and treatment only refers to the relief and improvement of prevailing symptoms. Therefore, the encouragement of music therapy should be integrated through programs within assisted living homes and through the establishment of proper education for caregivers and higher institutions, since it is a more natural, affordable, yet, still effective way of treatment for Alzheimer’s.

The Alzheimer’s Foundation of America defines Alzheimer’s as, “a progressive, degenerative disorder that attacks the brain's nerve cells, or neurons, resulting in loss of memory, thinking and language skills, and behavioral changes” (AFA Website). Alzheimer’s typically acknowledges three stages of patient deterioration. In the “early” (mild) stage of onset Alzheimer's, a patient could be seen to have a tendency to forget words, forget something they just read, or forget where they last placed an object; they can be inclined to ask the same question over and over again, have trouble making plans, or have difficulty remembering names of those they just met. The “middle,” or moderate, stage will be connected to symptoms an increase in confusion and memory loss, trouble with now recognizing close family and friends, the constant reiteration of the same story (or idea, etc.), a decrease in ability to perform complex tasks (including personal hygienic care), and a increased level in need for assistance in completing daily tasks. The worst and most serve phase of Alzheimer's, the “late” (severe) stage, recognizes almost total memory loss, yet the individual may: mistake individuals for another, be able to recognize faces but not the name that goes with it, develop delusions, lose the ability to realize when they need to perform simple tasks required for living (eating, drinking, walking, etc.), and develop an attachment to an object used for companionship, filling the hole that Alzheimer’s has left them with. All of these symptoms are a result of something going wrong biologically. The actual deterioration of the patient's brain is due to the death of neurons in different places of the brain, which are connected to the different motor functions of the persons: “These neurons, which produce the brain chemical, or neurotransmitter, acetylcholine, break connections with other nerve cells and ultimately die” (AFA Website). And so, for example, the ability to hold short-term memory would first fail when neurons are destroyed in the Hippocampus of the brain. While the ability to make good judgement and possess language skills will fail when the cerebral cortex is attacked. Typically, those who are aged 65 or older will be affected by Alzheimer's; however, the disease is not a normal part of aging. Publically, the only type of treatment recognized by the Alzheimer’s Foundation of America is that of drug medication: “Researchers are continually testing the effectiveness of various drug therapies that will control symptoms; slow, reduce and/or reverse mental and behavioral symptoms; and prevent or halt the disease” (AFA Website). However, thanks to the evolved modern society we have today, there are other options that doctors and care officials could be considering.

The American Music Therapy Association defines music therapy as, “an established health profession in which music is used within a therapeutic relationship to address physical, emotional, cognitive, and social needs of individuals”. The art of music therapy has been around since the times of Aristotle; however, the official rudiments of clinical music therapy are identified to have come after World War I and II, when groups of musicians would visit wounded veterans in hospital to play their songs for them. It was then that people realized musicians would need some official training before they were able to really soothe the majority with their music. This began music therapy's emergence into the public scene of medicine and its evolving nature as an official therapy method. Some were pulled in by this “new medicine” thought, and as most people know doctors are always infatuated and intrigued by “the next best thing”. There is a difference between therapeutic music therapy and clinical (therapeutic) music therapy. An example of therapeutic music in general could be a choir singing at a nursing home, celebrities visiting and playing for hospitals, or a piano player playing music in the lobby of a hotel. However, clinical music therapy is a little different, where the one performing or assisting with the music themselves has been officially trained in the art. Some examples of effective uses for clinical music therapists to engage in include: working with children who have Autism, using it to reduce asthma attacks, working with patients who have damaged speech from prior injuries, and working with elders to reduce the effects Dementia can have (AMTA Website).

As stated before, Alzheimer’s is the most common form of Dementia detected by doctors. The effects that music therapy have been discovered to have on the symptoms and effects Alzheimer’s intrudes on an individual are countless and still being tested, but are still proven to be effective. To understand better exactly how music is more effective on Alzheimer’s patients than other treatment regimes, one must first understand biologically what happens in the brain when music is administered to an individual. A brain study was conducted among non-Alzheimer's patients and Alzheimer's patients to better understand the preservation of long-term music memory capabilities in each individual. The case entrusted in the belief that musical memory was separate from other memory, and so one could happen to be damaged while no harm was done to the other. “The researchers wanted to determine what brain regions play a role in long-term musical memory, and then determine how, if at all, these specific areas are affected by Alzheimer’s,” the author explains about the goals of the experiment (Jtrask). Scientifically the process which takes place in the brain pertaining to why music is easily recalled in Alzheimer's patients is understood in the following quote:

They looked at functional magnetic resonance imaging (fMRI) scans of 32 young, healthy people while they heard music that was unknown, recently known, and long-known, to determine which brain regions were associated with the different types of musical memory, and to specifically locate which brain areas were linked with long-term musical memory. fMRI monitors brain activity by measuring changes in blood flow to different brain regions; brain cells consume energy as they fire, and they require additional energy to continue firing, which is brought to the cells by blood. Therefore, increased blood flow to particular brain regions indicates that those regions are active during the specific activity. The researchers found two brain areas that were linked to precise recognition of long-known music: the caudal anterior cingulate gyrus and the ventral pre-supplementary motor area (ventral pre-SMA). The caudal anterior cingulate gyrus is thought to be associated with prediction, expectation, and evaluation of events, and with decision making. It has been suggested that ventral pre-SMA is involved in sequence learning and planning.

Three indications of Alzheimer’s disease in the brain are accumulations of amyloid-beta (a sticky substance that causes plaques and tangles in the brain), reduced glucose metabolism (less energy consumption and therefore, less activity) in brain cells, and cortical atrophy (loss of grey matter/brain mass). The researchers looked at voxel-wise maps that showed the levels of these markers in different brain regions in 20 Alzheimer’s patients and 34 people without the disease. In comparison to the rest of their brain areas, the Alzheimer’s patients had less atrophy and less reduced glucose metabolism in the caudal anterior cingulate gyrus and the ventral pre-supplementary motor area. However, accumulation of amyloid-beta was found in both of these regions. The common pattern of development of Alzheimer’s markers in the brain is amyloid-beta accumulation, then reduced glucose metabolism, than cortical atrophy. The amyloid-beta found in the brain regions associated with long-term musical memory may indicate the beginning of the development of Alzheimer’s markers in these areas.

With that being said, in comparison to the rest of the brain, the areas that the researchers identified as important for long-term musical memory were relatively spared by Alzheimer’s disease. (Jtrask)

With this information understood, with the areas of the brain which control musical memory spared, this evidence explains why Alzheimer’s patients have the ability to remember old school fight-songs or “oldies hits” from the radio, and not what they had eaten for breakfast that morning. And now that the case for why music therapy works biologically, it is critical to understand the rewarding effects music actually has on the patient's emotionally, physically, and mentally. The main target and effectiveness of music is on the memory of the patient; however with the improvement of a patient's memory, other symptoms that are burdened with Alzheimer's have a noticeable improvement and overall happiness is radiated by the individual. A filmed documentary on the degrading effects on Alzheimer's on an individual and the following of their improvement progress was produced and released in 2014 and titled “Alive Inside”. Included in the documentary was a story of an older man named Henry. When the scene opens, we see Henry sitting crouched over in his wheelchair, looking almost asleep. His daughter comes to greet him, and tragically he has no idea to who he is talking to. Henry is given an ipod and headset while talking to his nurse, not able to form complete words and twiddling his arms into a ball.  The music starts playing. Henry begins to sing and dance to his ability to the beat. He comes to life and is reborn from the dark hole Alzheimer’s lingers on (Sundance Film Festival). Patients who participate in some form of therapeutic music treatment have evident boosts in cognitive abilities, decreased agitation levels, increased happiness and mood, improvement in memory, recall, and language skills, increased ability to interact socially and actively, and a decrease in behavior considered problematic. There are a few known methods to enforcing musical therapy on an individual. The method of using a downloaded ipod is proven to work well with all patients, since it requires a more personal touch and the patient is able to connect one on one with the sounds (as seen with Henry in documentary). Another method used is the integration of a “therapy” session in the schedule of patient’s daily lives, to work in groups for a more general improvement in their living environments. Other more general music therapy methods are also used, for example: sing-alongs, background music, exercise with accompanying music, playing instruments, etc. To begin making steps towards introducing these such methods to Alzheimer’s patients, the therapist must first be officially trained and clinically officiated to conduct such sessions with patients.

The first appearances of a professional-clinical environment for music therapy education arrived in the 1940s. Three people and their foundations played a key role in the rudiments of clinical therapeutic music education. Ira Altshuler, psychiatrist and music therapist herself, fought for the use of music therapy in the state of Michigan for decades. Willem Van De Wall, author, wrote the first “how-to” music therapy guide book and pioneered the start of music therapy in state-funded institutions. E. Thayer Gaston, “the father of music therapy”, took the profession to new level in terms of implementation, organization, and education. Soon after these three made their mark in the uprising of the music therapy industry, Michigan State University led the revolution with the establishment of the first college training program in music therapy (1944) (AMTA Website).There are now many foundations in place supporting the practice, such as the National Association for Music Therapy, the American Association for Music Therapy, the Certification Board for Music Therapists, and the American Music Therapy Association, along with 72 AMTA Approved Universities that now educate professionally in the field of clinical music therapy. Now with more official education requirements to be a therapist in the industry there are a certain conditions that must be met to start working. You must attend an AMTA Clinical Music Therapy approved university and receive a bachelor's degree or higher, and you must complete at last 1200 hours of clinical training. In addition to college education, therapists must hold an MT-BC credential that is issued through the Certification Board for Music Therapists. Some states require an additional license to work, but the MT-BC credential certifies that the employee has had official education. Knowledge in music, psychology, and medicine are all required to perform work in Clinical Music Therapy. The profession has become a way of new medicine, and more and more doctors and therapists are becoming involved in improving the education on musical therapy, conducting trials and experiments furthering research in treatment methods, and discovering new elements of the science that have not yet been tapped into. 

On the other hand, some argue against the use of music therapy for logical and feasible reasons, fighting the actual effectiveness and lingering ramifications of the “after” using music therapy. One must be cautious with the actual emotional responses, for example, happiness, that follow right after a therapy session on Alzheimer’s patients, because “that joy can be laced with anxiety or even terror from being awakened by familiar sounds into an unfamiliar world” (Swayne). Because these patients are cognitively and physically disabled to an extent, and argument can be made for the involuntary pressure that music therapy pushes on a patient: “if these gestures are involuntary, we have to remind ourselves continually that some of these individuals are not free agents who can choose to listen or not” (Swayne). An issue of consent and the actual ability for these patients to express the level of “mood” they feel from sessions comes to question under the field of music therapy. The final area of concern with music therapy is that of injury. Not physical injury, but mental degradation. The author explains this type of this possible damage by sharing a personal hypothetical: “I can easily imagine that, should I outlive my husband, songs that bring me joy today might one day bring me pain, because those songs will make me think of him. The same likely holds true for patients who cannot coherently tell caregivers about their musical triggers” (Swayne). These people who strike against the use of music therapy are not completely boycotting the idea, yet warning the public about music and its underestimated powers. Others argue on the side for pill medication. It is an old medicine, which is proven to work, and so it is easier and quite possibly quicker than slowly endorsing music therapy on patients. Some doctors and practitioners also stand strong the the “magic pill” method. People are convinced and argue that with the continuation use of pills, we would not need to harm patients mentality further with the possibility of a harmful musical therapy method.

Although a good case can be made against the integration of music therapy on Alzheimer’s patients, for the sake that instead of an improving lifestyle, therapy actually induces the opposite. But to this day, results only remain positive and concerns with music therapy should be considered, yet should not seriously impact one's decision in implementing programs. “One of the more positive results we’re seeing is a reduction in the need for psychotropic medication. Music soothes the residents to the point where they actually may not need all of the medications that they needed prior to going on [Music & Memory’s] program,” claims a doctor who witnesses daily first hand the effects of music therapy in assisted living homes (Testimonials). Music therapy is essentially more natural, more enjoyable, and more rewarding than pill medication. One could argue quality over quantity. Although an amount of pills would “get the job done” and help soothe effects of Alzheimer’s, the long-term lasting effects music tattoos on patients is more practical, powerful, and potent.

Music therapy is an up and coming medication method for patients with Alzheimer's, and its effects are boundless and rewarding. Clinical music therapy is a big chunk in the future of medicine, and so the encouragement of the practice and implementation of music in different aspects of patients lives. The next steps of understanding music and its miraculous effects on Alzheimer’s disease would be the integration of music therapy programs in all assisted living homes. The future could see the possibility of a the disappearance of pills in medication with the establishment of music therapy programs. Music therapy is a positive and effective method for treatment of Dementia diseases, and it should be integrated within all homes that assist those living with Alzheimer’s disease, for the reason of improving their quality of life.
