Cognitive, Functional and Narrative Improvements after Individualized Singing Interventions in Dementia Patients

Loss of cognitive, functional and narrative abilities is a telltale indication of Alzheimer’s disease or dementia in elderly, while the ability to participate in singing and recall of both words and tunes remain viable well into the latest stages of the disease, even as all other memory systems progressively deteriorate. Music aptitude and music appreciation are known to be among the last remaining abilities in dementia sufferers and even remains robust throughout disease-affected elderly life. This study examined changes in cognitive, functional and narrative outcomes in elderly participants with dementia before, during and after a 5-week series of individualized singing sessions. Three local assisted living facilities provided dementia patient participants for the study and two study groups were established. Study Group 1 (N = 25) participants were tested on cognitive measures of Mini-Mental State Examination (MMSE) and a Revised Mini-Mental State Examination (R-MMSE), and functional measures of Clock Drawing (CD) and Revised Clock Drawing (R-CDD), as well as self-report life satisfaction using the Satisfaction with Life Scale (SWLS). Group 1 participants included Singers (n = 9) and Non-Singers (n = 16), that included both low-participatory singers (n = 9) and non-participatory controls (n = 7), the latter of whom were regularly exposed to music in their facility. Group 1 outcomes revealed significant interactions or strong trends in improved outcomes in Singers, compared to Non-Singers, in MMSE, R-MMSE, CD and R-CDD outcomes. SWLS outcomes, however, showed a significant, unexpected decline in Group 1 Singers (whose MMSE had improved post-study). Study Group 2 (N = 18) represented a nested, within-study comparison of narrative outcomes between high-participatory Singers (n = 9) and low-participatory Non-Singers (n = 9). Study Group 2 was a subset taken from Study Group 1, and tested verbal fluency and thematic content using measures of Narrative (NARR) and Complete Sentences (CS) testing, before and after a series of within-treatment study singing conditions. [Study Group 2 did not use non-participatory controls.] NARR and CS measures were collected after conditions of silence (Condition 0, or C0), familiar song verse (Condition 1-2, or C1-2), and less familiar song verses (Condition 5-6, or C5-6) of the patriotic song, “America, the Beautiful” (AtB). Qualitative analysis of singing participation (SingPar) in Group 2 participants used a 0-5 rating scale to delineate high and low participation during singing of 20 treatment songs (over a 5-week intervention period). Narrative data was also gathered from four other narrative treatment songs, matched to themes of Romance, Musical Theater, Folk, Nature and Spiritual-Meditative, that were also tested and measured for NARR and CS outcomes, but not analyzed or reported in this paper. Interestingly, Singers in Group 2 showed significant main effect of singing and immediate narrative improvements only after familiar verse (C1-2) singing, while Non-Singers showed significant main effect of singing on narrative improvements only after singing less familiar song verses (C5-6) (both as compared to the silent, no music condition (C-0)). In summary, music remains useful, yet enigmatic regarding its success as a clinical tool with affected elderly populations with dementia. The findings from this study begin to tease out and demystify how singing influences cognitive, functional and narrative performance outcomes high and low-participatory elderly dementia singers