Research Findings from Voices in Motion May Help Shape Dementia Policy

By Stuart W.S. MacDonald, PhD |  Co-Principal Investigator |  Voices in Motion

Many members of the Voices in Motion (VIM) research team have been touched by dementia in some fashion – through our scientific training, engaging with research volunteers, and based upon personal family experiences. A primary motivation of the VIM project was to engage in basic research that not only improves our understanding of dementia, but more importantly, to establish a movement that provides immediate support for persons with lived experience and their caregivers who are navigating the challenges of dementia.

The choir itself is designed to incorporate social and cognitive elements. At the outset of each meeting, choir participants engage in social conversation with other members as well as individuals from younger generations (e.g., children, high school students, and most recently University students). This intergenerational component is intended to destigmatize dementia – the purpose is to educate the next generation that those with dementia are individuals facing a life challenge to be sure, but a challenge that doesn’t singularly define them – members of the VIM community with lived experience laugh, sing with amazing fervor, and share their stories – they continue to live their lives.

Cognition – a term deriving from the latin word cognoscere (getting to know) – encompasses memory, perception, language, and comprehension. The musical repertoire for each choir was expertly selected by Choral Director Erica Phare-Bergh. Erica incorporates songs into the VIM repertoire that draw upon multiple memory systems including both procedural and emotional systems that include brain regions that are relatively unaffected by progressive changes associated with subtypes of dementia such as Alzheimer’s disease. Why is this important? By selecting songs that have been overlearned from a chorister’s past (e.g., think about how many times in your life you’ve heard the Beatles “Let it Be”, or the positive emotions associated with hearing this song), individual’s with dementia can draw upon relatively unaffected brain systems to make amazing contributions to the choir. Notably, despite damage to regions of the brain such as the hippocampus that are central to the formation of new memories, even those with Alzheimer’s Disease in VIM exhibited an adeptness for singing contemporary pieces that required new learning and the formation of new memories. In part, such accomplishments likely reflect the simple power of music in general and of choir in particular – a definitively social experience – that draws upon various neural systems. The integration of these multiple neural systems associated with music, in part, explains its potential therapeutic benefit for those with Alzheimer’s Disease. Specifically, music and the act of singing together socially in a choir is both multisensory and multicortical – music incorporates numerous brain centers spanning motor function to emotional processes to basic memory. Further, this multisystemic nature of music may very well explain why memory for music (particularly well-learned songs from one’s past) is more resistant to forgetting even in the face of dementia-related brain damage (see work by Dr. Marco Iacoboni, UCLA).

Based upon the dedicated research participation of VIM choristers, preliminary analyses have demonstrated the positive benefits of choir. During active data collection, participants completed assessments approximately once per month, permitting the research team to closely examine change in numerous functions including cognition (e.g., memory), psychosocial function (e.g., stress, affect, depressive symptoms), and health. In designing the study, our initial hope was that individuals with dementia might be able to make better use of their existing abilities if we could lessen specific symptoms commonly associated with dementia or caregiver distress including anxiety, agitation, depression, and social isolation. Consistent with this expectation, across the 4-month period of the study for the initial VIM cohort, significant improvements in episodic memory were observed for both individuals with dementia as well as caregivers. The distress experienced by caregivers in providing for a loved one with dementia is well known – our anecdotal and focus group discussions with this cohort identified the importance of the choir for helping caregivers to reduce feelings of stress, anxiety, and isolation. Although preliminary, these observed improvements in memory and reductions in depressive symptoms may reflect the social benefits of the choir intervention (e.g., meeting others experiencing similar challenges, having a social outlet, overcoming the tendency to withdraw socially).

The next 6 months represents a particularly exciting period for VIM research. As many as 10 research projects will be ongoing simultaneously, with plans to share these findings locally with the VIM community, as well as nationally and internationally at scientific research conferences. The principal investigators of VIM are planning to submit several large grant applications within the next year that will focus upon the specific mechanisms by which choir can benefit those with dementia, as well as on championing arguments in support of socially prescribing choir to benefit those with dementia and their caregivers.