The Brains Are Alive With the Sound of Music

Last weekend I attended a Sound of Music Singalong at the Music Box Theater in Chicago.  When I walked through the double doors into the theater, I was given a bag of goodies: plastic Edelweiss to hold up during the song, an invitation to the ball, and a popper that we were instructed to pop when Maria and Captain Von Trapp kissed for the first time.  I was struck by the age range of the audience, everyone from graying old ladies to young men to children, with some people even in costume!  With the exception of one sullen teenager in a hoodie slouched down in his seat next to me, everyone seemed to be excited.  I figured only a couple of extra-enthusiastic people would really sing, so I was pleasantly surprised when Maria came running over the beautiful green Austrian mountain and all my neighbors started passionately belting out “the hills are alive!”  Everyone was singing.

I wondered, what is it that compels people of all ages, races and genders to pile into a theater on a Sunday afternoon and sing for over three hours?  What is it about music that so inspires and excites people?  This is a question that has gripped neuroscientists all over the world, and recent research has started to provide some answers.

To process music, the nervous system needs to engage a large number of regions starting with the intricate structures in the inner ear, which translate sounds into electrical activity that can be sent into the brain.  Neuroimaging work has shown that once the signal enters the brain, it creates widespread neural activity (as seen in the diagram below), resulting in strong emotional responses.

brain-and-music

Mysteriously, it has been repeatedly reported that patients with advanced dementia, who may have lost the majority of their long-term memories and even language capabilities, show preserved musical ability and response.  It is possible that because of the widespread effects of music on the brain, including areas that are more spared in Alzheimer’s disease, listening to music may be able to awaken and even preserve cognition by accessing memory through alternate pathways.

Can music help dementia patients?

This is the question that Michael Rossato-Bennett addresses in his award winning documentary Alive Inside (available on Netflix streaming).  He takes us on the journey of social worker Dan Cohen as he fights a broken healthcare system and illustrates music’s unique ability to fight memory loss in dementia patients.  We are told the stories of Henry (see video here) and many other individuals whose responses to music are breathtaking, miraculous transformations from quiet shells into animated characters singing, moving to the beat and tapping into memories going all the way back to early childhood.  It provides a gripping view of the unexpected effects of music on patients that were otherwise considered lost to dementia.

As Alive Inside points out, dementia is no small problem.  There are 5 million people in America with dementia, and 10 million people spend a large part of their life caring for them.  There are maybe a million people in nursing homes, slowly losing their connection to life.

“Music gives us a way to reach someone who may otherwise be unreachable.  It creates spontaneity that you cannot create in an institution.  It takes you to a place where you can leave and go off to a world that you create and connect with on your own terms.  There is no pill that does that.”

And the neuroscience backs this up.  In one study done on Alzheimer’s patients, those that listened to “Big Band” music from the 1920’s and 1930’s had better autobiographical memory recall.  In another study, Vande Winckel and colleagues showed that when exercise was combined with music (polka, folk and country), mental exam test scores increased and having Vivaldi’s Four Seasons played while taking cognitive tests seems to enhance performance.

Listening to music is a low-cost, noninvasive treatment that has been shown effective in study after study, and it has no side-effects!  Yet, this information has not been implemented or utilized on a large scale in nursing homes.

Dan Cohen’s mission is to change that, by bringing personalized music to people suffering from dementia all over the country.  When he embarked on this journey in 2006, Dan found that none of the 16,000 long-term care facilities in the U.S. used iPods for their residents.  Today Dan’s work has helped provide personalized music programs to hundreds of nursing homes throughout the country.  His success demonstrates the power of technology and how it can be used to not only treat symptoms, but deeply connect with a person’s heart and soul to give them back some joy and purpose.

We can still bring life to those people who have been forgotten.  We do have something to give.  All we have to do is ask, “What is your favorite song?”

Brain_Waves

Dedicated to my incredibly talented friend Jennifer Mitchell, whose love for music has always inspired me.

References:

“Brain Music.” Brain Music. N.p., n.d. Web. 09 Dec. 2014. <http://www.newswise.com/articles/brain-music&gt;

Lin, Shuai-Ting, Pinchen Yang, Chien-Yu Lai, Yu-Yun Su, Yi-Chun Yeh, Mei-Feng Huang, and Cheng-Chung Chen. 2011. “Mental Health Implications of Music: Insight from Neuroscientific and Clinical Studies.” Harvard Review Of Psychiatry (Taylor & Francis Ltd) 19, no. 1: 34-46.Academic Search Complete, EBSCOhost (accessed December 9, 2014).

Lord TR, Garner JE. Effects of music on Alzheimer’s patients.  Percept Mot Skills 1993;76:451–5.

“Our Mission and Vision – Music and Memory.” Music and Memory. N.p., n.d. Web. 09 Dec. 2014. <http://musicandmemory.org/&gt;

Thompson RG, Moulin CJ, Hayre S, Jones RW.  Music enhances category fluency in healthy older adults and Alzheimer’s disease patients.  Exp Aging Res 2005; 31:91-9.

Van de Winckel A, Feys H, De Weerdt W, Dom R. Cognitive and behavioural effects of music-based exercises in patients with
dementia. Clin Rehabil 2004;18:253–60.

Sugar Head

In 2003, Dr. Robert Lustig saw a six year old Latino boy in his clinic in Salinas, California.  Juan weighed 100 pounds and was wider than he was tall, but his mother insisted he ate a healthy diet.  When Dr. Lustig began to look more closely, Juan’s diet did seem ok for a growing boy; however, through his directed questions, Dr. Lustig found the somewhat unexpected culprit: orange juice.  Juan had gotten into the habit of drinking an entire gallon of orange juice per day.  This is approximately 1,760 calories and 336 grams of sugar, which is over 1 cup of sugar.  Additionally, the amount of dietary fiber: 0 grams.  Why was Juan doing this?  Because the government provided it to his family for free, and his mother had no idea how harmful it could be to her son’s health.  In fact, she felt that the more he drank, the more nutrients he was getting.

Although obesity has received a lot of media attention in the last few years, I was still floored by some of the statistics in Fed Up, a documentary I recently watched (and highly recommend).  I was surprised that the focus was around the role sugar plays in the growing epidemic, a definite shift from the more common topics of saturated fat and exercise.  The numbers get a little scary:

In the United States, it is estimated that 93 Million Americans are affected by obesity.

Kids watch an average of 4000 food-related ads every year (10/day).

A 20-ounce bottle of soda contains the equivalent of approximately 17 teaspoons of sugar.

It will take a 110-pound child 75 minutes of bike riding to burn off the calories in one 20-ounce bottle of soda.

In 2012, Americans consumed an average of 765 grams of sugar every 5 days, or 130 pounds each year.

We all know that the Western Diet, characterized by high saturated fat and refined sugar, has been implicated in a range of diseases such as type 2 diabetes, cardiovascular disease, and stroke, but do we know whether and how this diet is affecting our brain?

We start the quest for an answer to our question with a small neural structure called the hippocampus, named after the greek words hippos and kampos meaning “horse” and “sea monster” respectively.  This is because of the structure’s unusual shape and appearance.  Do you see the resemblance?

Hippocampus_and_seahorse

Much work has been done to try to understand this structure (and it happens to be the one that Henry Molaison had removed in the 1950’s-see About Gray Matters for more on this story).  It is heavily implicated in memory, and more specifically, important for those memories involving spatial cues such as remembering how to navigate around your house.  Because the hippocampus contains unusually large cells, it is particularly vulnerable to environmental insults, including things such as diet.

What protects the hippocampus from environmental toxins?

The blood brain barrier is a crucial component of the nervous system.  It serves as a gate keeper who “decides” what unwanted components of the blood must stay out and which nutrients will be allowed in, protecting the brain from harmful substances.

bbbcart

If you think about a football stadium with entrances surrounding its periphery, the blood brain barrier would be like the people checking tickets.  Only those with tickets would be allowed in.  Now think about what might happen at the super bowl if many of those ticket checkers were just not there.  People without tickets would start hopping over the barriers and entering the stadium to view the game for free.  This is what happens when there is damage to the blood brain barrier: unwanted substances get into the brain.

football-stadium-colorado_3571_990x742         320-20systems20check1

So how does this answer our question about how Western Diet affects the brain?

Recent research has revealed two important trends:

1.  Western Diets seem to stimulate intestinal production of a protein found in the body called amyloid-β.

2.  Elevated levels of  amyloid-β proteins have been shown to damage the blood brain barrier in rats.

Why does this matter?

One of the hallmark signs of a brain diseased by Alzheimer’s is the presence of plaques, particularly in the hippocampus.  These plaques can be thought of as dangerous junk, cluttering the cell and disrupting normal function, and they are partially caused by the accumulation of amyloid-β proteins.  Starting to see how this story is coming together?

Based on the current evidence, we can start to form a theory:  A Western Diet increases bodily levels of amyloid-β protein, leading to increased amyloid-β levels in the blood.  This elevation could contribute to blood brain barrier damage (equivalent to losing those ticket checkers!), resulting in more amyloid-β (ticketless individuals) being able to get into the brain.   Once in the brain, these proteins can damage the large cells in the hippocampus, which are particularly vulnerable.  The theory is laid out nicely in this diagram:

fnagi-06-00088-g0001

(1) Western Diet results in (2) elevated levels of amyloid-β (Aβ) from the small intestines, (3) thus increasing Aβ levels in the vascular system. (4) High levels of Aβ contribute to blood brain barrier damage, (5) which leaves the hippocampus (HPF) vulnerable to damage by Aβ.

So this leaves us with the possibility that obesity and dementia potentially share a common contributory factor: overconsumption of foods high in saturated fatty acids and simple sugars, or the Western Diet.  Given the statistics about the prevalence of obesity in this country and others, the possibility that these people are also at a higher risk for future dementia is incredibly concerning.

Although not many people drink a gallon of juice every day, I have to admit that before reading Dr. Lustig’s book and watching Fed Up, I went out of my way to drink orange juice because I thought it was healthy for me.  I did not realize how much sugar was in it!  Now I just eat the fruit.  I hope this will be better for my body and my brain in the long run.

For more information about the role sugar plays in the obesity epidemic, I recommend:

1. Fat Chance: The bitter truth about sugar by Robert Lustig

2. Fed Up Documentary (more information found here: http://fedupmovie.com/#/page/about-the-issue?scrollTo=facts)

Citations:

http://www.telegraph.co.uk/foodanddrink/10238549/Is-fruit-juice-bad-for-your-health.html

https://faculty.washington.edu/chudler/cart.html

http://www.ncbi.nlm.nih.gov/pubmed/24847262