Music lessons from Tony

Following his family’s break in silence about Tony Bennett’s dementia diagnosis, a recent article allows us a glimpse into the artist’s life with a neuro-degenerative disease. In that article, his wife tells us that Tony’s doctors emphasize how important it is for Tony to go to the recording studio every day.

There’s a growing awareness for music’s power (as a force of good) over dementia (remember my shared post about the ballerina and the power of music over dementia?). There’s more than one reason for this power, and we will explore below. But I see a broader point, which applies to musicians and to painters, accountants, hair stylists, dentists, auto mechanics, teachers, firemen, athletes, and pool hall hustlers – and to everyone who is now and who will be a dementia caregiver. That broader point is, the power of peak cognitive identity in dementia. “What?” you say. “But peak cognitive skill is gone, past.” True, but if we think creatively, we can find a place for that peak identity in the present.

But first, the music-specific piece.

My husband can’t tell you my name but he can still sing and play piano as beautifully as ever.

What causes this “musical muscle memory” and how can caregivers leverage it for everyone’s well-being and quality of life?

Forgetting words and names is one of the first signs of cognitive decline. Linguistic skills – vocabulary (including proper nouns), speech production, and listening comprehension – are the product of the left temporal lobe, and this area of the brain is one of the first to show decline. Word loss, name loss, and losing one’s train of thought mid-sentence is actually normal as we age. Under normal circumstances, we are able to recover. But with cognitive decline the word, or name, or second half of the sentence/thought will never actually surface – the person lacks the ability to recover from that lapse.

Lyrics, poems, songs, prayers, and creeds are stored in the right temporal lobe, which processes sonic and linguistic rhythms. The right temporal lobe is often the last area of the brain to decline. This is why poetry, prayer, song, and music remain so accessible, and for so long, in dementia.

Sonic rhythms have a positive physiological effect on us. Poetry, prayer, and song calm our heart and respiratory rates. As a multi-sensory experience music, in particular, helps us find and feel connections with others through chorus and verse, melody and harmony, sonic tension and resolution. Music connects us to our emotions. And music connects us to our bodies. Regardless of physical or cognitive ability, music affirms our physical and metaphysical existence. We understand this in our being, without having to name or describe it.

Perhaps that is what “music muscle memory” is. One doesn’t have to be Tony Bennett to enjoy it. We carry our “music muscle memories” safe and tight, into eternity, in our right temporal lobes (even if we haven’t said the Lord’s Prayer or the Pledge of Allegiance in quite a while). And this is why your non-musician aunt or sister can sing Amazing Grace or My Country ‘Tis of Thee, long into dementia, although they can no longer carry on “normal” conversation or even remember your name.

CAREGIVER TAKEAWAY #1: Caregivers can use this idea of “music muscle memory” by incorporating music into daily caregiving time. Create an mp3 playlist for phone or tablet or burn a playlist onto a CD. Select a genre and/or era that your loved one especially enjoys. In the background, music improves quality time. In the foreground, music can help diffuse escalated situations or celebrate special big (or little) moments with equal success.

Into the studio, every day.

For people living with dementia, everything that is happening now is unfamiliar, because the way they process visual, auditory, tactile, and emotional data is damaged by dementia, and so nothing seems as it once did. What is familiar to those living with dementia is what was happening, where they were, and who they were with when they were in their cognitive peak – when they had command over their minds, their bodies, and their lives.

Their identity is steeped in who they were in their cognitive peak not who they are now, in dementia. And to the extent that we can draw that identity forward into the present, we can help those in our care feel more connected, valued, and driven.

His doctors weren’t encouraging Tony to continue to build on his musical legacy when they prescribed daily recording studio activities for him. They weren’t proposing more albums. But the doctors were recommending the one activity which would help Tony maintain his sense of identity – the activity that was central in his life when he was in his cognitive peak – music.

The brilliance of Tony’s regular studio schedule is that it allows him to experience the world that is most familiar to him, to be in command, to be connected to his true identity. It also promotes social activity and a sense of purpose. And these things have nothing to do with music per se.

Amplifying identity.

So for me this article provides a less obvious, big takeaway for dementia caregivers.

CAREGIVER TAKEAWAY #2: Find ways to celebrate and bring forward their loved one’s identity when they were at their peak cognitively. This will help those with dementia meet essential universal human needs – such as having a sense of belonging, adding value and having personal drive or inspiration.

What caregivers might consider are (1) what was my loved one great at/inspired by when he or she was in his/her cognitive peak, and (2) how can I modify activities to draw on those skills and talents in a way that is appropriate for my loved one’s current abilities?

A champion bowler may still enjoy the lanes. When that is no longer possible/enjoyable, perhaps tabletop bowling or shuffleboard will be engaging. The weekly bridge player may no longer be able to keep up with bridge, but what about Crazy Eights, Go Fish, or SlapJack? The court reporter may not be able to use her steno machine anymore, but might typing on a regular typewriter still be enjoyable? The writer can still keep a journal. The homemaker may still enjoy dusting or folding laundry. The birder can still look at birds, even if not in the wild.

Whatever the activity you choose, remember that the point for your loved one is the doing, the experiencing, the engaging with his or her true identity , not the results. But that’s not to say you shouldn’t record the karaoke session 🙂

If you would like to know more about cognitive function and how it changes in dementia, or you would like more ideas on dementia caregiving, check out my new caregiver’s manual, The Dementia Field Guide.