Indian Music: A Future in Dementia Care Indian Music and Dementia

Dear Editor,

Behavioral and Psychological Symptoms of Dementia (BPSD), like anxiety and agitation, leads to social isolation. ¹ They are often managed by pharmacological interventions due to easy availability. However, prolonged use of drugs might worsen the symptoms or produce adverse side effects.^{2, 3} Therefore, alternative non-pharmacological therapies are being researched. ⁴ Here, we briefly review the use of Music Therapy (MT), which is efficacious in BPSD. ⁵ According to the World Federation of Music Therapy (1996), MT aims to meet the physical, emotional, psychological, social, and cognitive needs of individuals with the aid of music and/or elements of music such as rhythm, sound, melody, and harmony, under the guidance of a qualified music therapist. ⁶ We discuss Indian Classical Music (ICM) because of its geographical relevance, socio-cultural relativity, and easy availability.

The emergence of music as a form of therapy dates back to the late twentieth century when it was found that agitated patients with Alzheimer’s Dementia calm down on hearing music they enjoyed before the diagnosis. ⁷ Listening to music for short periods positively affects the cognitive functioning of people with dementia. ⁸ Lin et al. exposed dementia patients to MT for six weeks and found significant improvement in aggressive behaviour. ⁹ Sung et al. found that MT helped to reduce levels of anxiety in individuals with dementia. ¹⁰ In another study, pre-recorded or live music was given as an intervention to two groups of older adults with moderate to severe dementia. Live music was much more beneficial and improved their positive engagement, socializing skills, and mood.^{11, 12}

An imbalanced Autonomic Nervous System (ANS) activity, that is, elevated sympathetic and reduced parasympathetic activity and hyperactive Hypothalamic-Pituitary-Adrenal (HPA) axis with elevation in cortisol levels has been noticed in cases of anxiety and depression associated with dementia (BPSD symptoms).^{13, 14} High cortisol levels have also been found in individuals with mild cognitive impairment and dementia. ¹⁵ Research suggests that MT increases parasympathetic activity and reduces cortisol levels, which in turn provides a relaxing effect. Further, the rhythmic movement with the music decreases sympathetic activity producing a calming effect. ¹⁶

Music has also found a niche in Reminiscence Therapy (RT), which involves discussion of past events and people with the aid of certain prompts like past photographs, voice recordings, familiar items, etc. Music Reminiscence therapy (MRT) has combined the positive implications of both RT and MT, where patients are made to hear familiar music from the past or childhood with the idea that they can re-experience their memories. ¹⁷ So, with the emergence of MRT, a better direction has been identified in providing care to such individuals. Due to its emotional impact, music from the past or childhood stimulates strong memory associations. This is particularly beneficial to patients with Alzheimer’s dementia, especially during phases of sadness due to the inability to communicate or sundowning. ¹⁸

Irregular sleep patterns and depression are major problems in patients with late-stage dementia. ¹⁸ A study that used ICM found that raagas like “Bahar,” “Bihag,” “Mishra Pilu,” and “Malay Marutam” caused sustained improvement in the sleep quality of patients with depressive disorder. ¹⁸ However, the reduction in depressive symptoms was not significant. This could be because these raagas enabled a state of relaxation that might have induced sleep. A study on healthy individuals found that a raaga named “Desi Todi” decreased blood pressure, symptoms of anxiety, and stress while enhancing feelings of satisfaction, hope, and optimism. ¹⁹ The above findings indicate that BPSD (sleep irregularities, anxiety) can be managed with the aid of ICM. ²⁰ However, literature about using different forms of Indian Music is scarce and further studies are required.

MT sessions have also been found to improve the quality of life of caregivers by helping them deal better with caregiver burden and stress-related illnesses and improving the quality of the relationship between the caregiver and care receiver. ²¹ MT, despite its limitations like subjectivity (e.g., preferred and familiar genres of music might be more beneficial in individuals who are exposed to similar kinds of music during an MT session) and cultural and geographical relevance (e.g., an Indian would relate more to ICM than western classicals) is a non-invasive technique without side effects.^{18, 22, 23} Future studies should focus on the implications of music, especially Indian music, on the holistic psychological and physical well-being of dementia patients. The “TALA Sound” project, for example, found that Indian Carnatic music had a calming effect on older adults with or without cognitive impairment. ²⁴

Music, especially ICM, plays an important role in relation to dementia. In addition, MRT also provides us with a promising non-pharmacological alternative treatment. It is cost-effective and can be done by social workers, nurses, and even family members or caregivers without any necessary training in music. ¹⁷ Hence, the scope of ICM as a means of psychotherapy is extensive but the research is still in a nascent stage and further studies are desired.