The music project helping to transform dementia care

There are parts of the brain that still respond to familiar tunes, even after cognitive decline. One particular scheme is producing astonishing results.

Research has found that music may help to arrest the progress of dementia in its early stages, and help to improve people’s quality of life in later stages. Picture: istock

Geoff Crabtree stands stern, austere and a little forbidding. He stares into the next room, stock still. I say hello. He twitches with what feels like mild disgust. It is the sort of response I’d imagine you would get if you told a Victorian sergeant major he might have to converse with the French.

Then, a guitar plays the opening notes of The Grand Old Duke of York and it all changes. Sound vibrations in the air become physical vibrations in Crabtree’s eardrum. Vibrations in his eardrum become electrical signals. Electrical signals travel to his brain.

There, they meet tangles and clumps. They meet the damaged neurons that now encode just fragments of Crabtree’s memories. Inside his brain, 88 years of life are fracturing and crumbling, lost to a slow recession of the self. But the signals themselves keep on going, hopeful electrical pulses in search of a destination.

Until, somewhere inside his brain, they find something pure – something so deep, so intrinsic to what it is to be human, that even dementia cannot destroy it. And when they do, it turns out Crabtree is not austere at all. He begins to bob and dance. He bashes a tambourine. He lifts his trousers up to reveal his ankles and waltzes in time in a circle. It will be 30 minutes before he stops. The music has found him – just as Hannah Merchant, the musician, expected.

Research has found that music may help to arrest the progress of dementia in its early stages, and help to improve people’s quality of life in later stages. It can reduce depressive symptoms, and increase motivation. “We see there are parts of the brain that still respond to music, that links from the past can be brought out in the music,” she says.

Merchant works with Anchor, a care provider, to run short sessions across its homes. She does so as part of a new research project, run by Anglia Ruskin University, to see whether such sessions really can improve the quality of life of people with dementia – and the people who care for them.

Others at Oakleigh Care Home in Godstone, Surrey, arrive to join in. Pam Marsh, who likes to tell everyone she loves them, sits down to listen. “I love you,” she tells Merchant. Sam Keeble picks out Fly Me to the Moon – as, apparently, he does most weeks, although he doesn’t remember. Proust had his madeleine cakes, Keeble has Sinatra. Agnes Aitken doesn’t want a maraca, but is happy to listen.

When Merchant finished her music degree, she didn’t know what to do. Then she came across music therapy and, “It was a light bulb moment. It is where music is meaningful; it is what it should be.” As she plays My Bonnie Lies over the Ocean, Aitken whispers to me, “At school we used to sing, ‘My daddy lies over my mummy.’ ”

More residents arrive and I make to stand up, to offer my seat. Aitken makes it politely clear that the person I’m about to offer it to is not her preferred companion. “Don’t get up or I’ll kick your arse.”

Asa Johnson, the dementia services improvement manager at Anchor, says that since the program began they are looking for ways to integrate music into residents’ experiences more. “The group of people there today in that room might not have anything in common apart from that they live in the same care home,” he says, “but for half an hour the music brings them together.” Or, it does, provided that you’re not on Aitken’s enemies list.

Professor Helen Odell-Miller, the director of the Cambridge Institute for Music Therapy Research, leads the project. She says there are good neuroscientific reasons to believe that music can help – more even than other activities. “When people’s brains atrophy, they decline in the way that they can talk and use spoken language,” she says. Some of the brain holds out, though. “If you sing the beginning of a song, procedural memory kicks in. And people can sing to the end of that whole song. And that’s to do with the part of the brain that deals with a sort of reflexive, active aspect.”

It is impossible to sit in a room like this and not think about the nature of humanity, about what it is to be a person. The last time I experienced something similar was at a toddler music session.

There, through music, you could see the emergence of character and personality, the songs a child likes and doesn’t like, the songs he or she dances to, the shy one who is just watching, the outgoing one who is shaking castanets. The magic of those sessions, which I attended with my sons, was that you could peer through the fog of babyhood and begin to see an individual come into focus.

The same is true here in this room in Godstone. Except, it’s bittersweet. With a toddler, you know that the person you see flashes of is the person they will become, on their journey into the future. With a dementia patient, it is someone they were, someone they are losing.

It is no coincidence, though, that the sessions are so similar. “If you sit for a long time with a baby and parent, that’s the way they communicate: through rhythm, pitch, contour – all the qualities of music are there in the way that they communicate,” Odell-Miller says. “At the end of the dementia pathway, when the brain atrophies, these reflexive ways of reacting and responding kick in.”

This is the reaction that, for the musicians, makes it worthwhile. Anna Tilbrook is one of the country’s leading pianists, working as accompanist for singers including Lucy Crowe and James Gilchrist. She is a regular on Radio 3, a regular at Wigmore Hall and, also, a regular at care homes.

In the past 20 years, she estimates, she has carried out a thousand care home concerts, working with a charity called Lost Chord, separate to the Anglia Ruskin and Anchor research. And it is, she says, “the most fulfilling thing I’ve ever done musically”.

“Dementia is such a horrific thing, utterly horrific. You never know how much is going on in that brain, and for how long someone is, say, aware of the fact that, ‘No, I don’t know what my name is any more,’ ” she says. Sometimes, she adds, she arrives in care homes and they are horrible. People with unbrushed hair, slumped in chairs, in soiled clothes, with no sign of who they once were.

But when she plays – particularly when she plays well – she finds a way to the bit of the brain that remembers.

“We had one chap who I’ll never forget. He’d been in his home for three years, just sat in the corner. The carers had absolutely no reaction from him at all, to anything. He was fed, he was washed, he was dressed, he just sat in the corner doing nothing.

“And towards the end of this concert, we played Moon River. Moon River is an absolute classic for getting reactions. He just lifted his head and looked at us and started mouthing the words. The carers were flabbergasted.”

The research project, backed by the Utley Foundation, will look for tangible improvements in patient and carer welfare, gathering the data that could justify more such programmes.

It will always be hard, though, to gather data on the most important effects. How do you put a number on dancing to Frank Sinatra? How do you construct a set of statistics about temporarily regaining a sense of your own self?

In Godstone, the session is coming to an end. Keeble gets up to leave. A nurse comes round to collect the instruments. “I love you,” says Pam Marsh.

Crabtree hands over his tambourine and, suddenly, he is stern, austere, impassive once more. In his past, one of the carers says, she thinks he used to dance. The music is over, but it is not his last session: he will dance again.

The Times