Stephen Horenstein
Music, Arts and Society

Alzheimer’s Disease and Music

Photo: Sarah Horenstein, z''l; from the author's personal family archive.
Photo: Sarah Horenstein, z''l; from the author's personal family archive.

When I was fourteen a buddy of mine dragged me to a rock concert to hear a new group. All I heard was screaming girls and saw nothing but confetti. The music was distorted and garbled. When we emerged from what was then Boston Garden, I said to my friend, “This group will last three months!”. Well it turns out that they didn’t. They were called The Beatles and they had just played their first American performance. For years I used this event in my university teaching about the challenges of evaluating musical “quality”and also letting them know in no uncertain terms (but half joking) that this was the END of my career as a music critic!  However, I never forgot this seminal experience; it was central to my life–and you’ll soon see why.

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Seriously speaking, we have come to find out that the music that one HEARD at age fourteen has enormous power and value. Please let me explain. In the years leading up to his death, the late Oliver Sacks discovered that the age of adolescence (specifically age fourteen when the brain becomes developed), was a “sweet spot” of sorts. Sacks explained:

“…the therapeutic role of music in dementia is quite different from what it is in patients with motor or speech disorders. Music that helps patients with parkinsonism, for example, must have a firm rhythmic character, but it need not be familiar or evocative.  With aphasics it is crucial to have songs with lyrics or intoned phrases….The aim of music therapy in people with dementia is far broader than this–it seeks to address the emotions, cognitive powers, thoughts, and memories, the surviving “self” of the patient, to stimulate these and bring them to the fore.  It aims to enrich and enlarge existence, to give freedom, stability, organization, and focus”. (see Musicophilia, by Oliver Sacks, New York: Alfred A. Knopf). 

When Sachs played music for an aged Alzheimer’s patient (who’s name was Woody, a former musician), the patient came “alive” while hearing familiar music of his adolescence (“Certainly Woody looked more ‘present’ when singing than at any other time”).   Sacks later premised that the music somehow impacted on the auditory cortex (located in the more primitive part of the brain), triggering floods of memories, most of them visual and sensual, emanating from that period of the patient’s life. Sacks knew that the Alzheimer’s patient’s auditory cortex was most likely still in tact, and was one of the last parts of the brain to deteriorate, even in advanced stages of the disease.

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For the last three and half years a team of university music and music therapy students have assisted me in continuing Sacks’ research in Israel, through the Jerusalem Institute of Contemporary Music  http://www.jerusalem-institute.com supported by a generous grant from the Abraham and Sonia Rochlin Foundation (USA). We have called this initiative “Enhancing Life for the Aged Through Music.”  Throughout the program, we have engaged with dozens of elderly afflicted with Alzheimer’s disease. We have worked one-to-one and in small groups. We have developed techniques to research personal “playlists” of Israel’s elderly who had unusual life journeys (it often took us weeks, even months, to discover just what elderly listened to at age fourteen!). We did this primarily through interviews with family and friends, and trial and error. We now have succeeded in compiling hundred’s of hours of videos, documenting the gestures and reactions of those elderly; the preliminary findings are astounding!

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If you have seen the film “Alive Inside” you may already know what I am talking about (the movie’s “star” is Henry, a sweet elderly man in a wheelchair, at first sedentary and static, then awaking almost ecstatically to the music of his youth, especially Cab Calloway and “Minnie the Moocher”). Our research is somewhat similar, but we feel that we have succeeded in going deeper into the possibilities of music and memory.

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Of course, our program is not Israel’s first (for instance,  Professor Ayelet Dassa of Bar Ilan University has been a pioneer in this field for many years; she is still doing ground breaking work). However we believe that we have discovered remarkable revealing parameters of non-verbal communication in elderly listeners; we too have seen Alzheimer’s patients “come alive” in countless and miraculous ways! The research is due to be published later this year; we seek to present it in international forums worldwide.

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Meanwhile, I would like to suggest a bit of an online “adventure” for whoever is reading this.  I ask you all to close your eyes and imagine (and try to actually HEAR) the music you heard at age fourteen. While you are doing this, keep your eyes closed and try to trace what you feel in your body and what you see flash before your “eyes” (also with eyes closed). You may be surprised at what is revealed! Later, please take care to write things down, describing what you saw and felt;  then try to expand your list by closing your eyes again. Perhaps even seek out the “original” music as it was sung, played and orchestrated (“re-makes” probably won’t do).  Try to listen to them too (with the internet they are quite easy to find). This exercise may literally one day “save your life”.

Because as new pills, new remedies, new preventative measures are being revealed,  I am utterly convinced that at the end of the day this horrible disease will be treated in multiple dimensions (in case-specific scenarios), dimensions that will include exercise, music, movement and other fine arts. The musical tool we call the “personal playlist” is invaluable. It is not comprised of music that is familiar and one enjoys (for instance Yerushalayim Shel Zahav which is faithfully sung in every nursing home that I know), but that which is embedded deepest in the psyche, in the auditory cortex and has the power to trigger pathways of memories, sensations and even goosebumps.

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A personal note.  I initiated “Enhancing Life for the Elderly through Music”  in memory of my mother, Sarah Horenstein z”l (whose picture is at the top of this post; unfortunately she was inflicted with Alzheimer’s disease along with her mother (my grandmother Esther z”l) and her sister (my aunt Bella z”l).

I leave you with one more confession. I have my playlist, and I carry it around with me! What’s on it? “Herring Boats are Coming with Bagels and Lox” (Micky Katz), Beethoven’s “Pathetique Sonata” (my mother played it constantly), “Cry Me a River” (which I played at fourteen on my alto saxophone, with a singer who was 3 years older than me; it was the first time I fell in love), and (would you believe it?) “Norwegian Wood” by the Beatles!  Who would have known that the group I first detested at their first American concert in the early 60’s would have become such an important part of my own psyche and part of my “saving grace”!

I am confident that as I am writing the human race has come closer to a cure of this miserable disease. I pray every day for our elderly, those afflicted, and those in imminent danger. One day, hopefully, we will totally eliminate this scourge from the earth.  Meanwhile, many of us will sing away, and hope that we can continue to touch lives.

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About the Author
Stephen Horenstein is a composer, researcher and educator. His repertoire of musical works has been performed and recorded worldwide. He has been a recipient of the Israel Prime Minister's Prize for Composers and the National Endowment of the Arts (USA). His teaching has included Bennington College, Brandeis University, Tel Aviv University, Jerusalem Academy of Music and Dance; residencies at Stanford University, York University, California Institute of the Arts, and others. He is Founder and Director of the Jerusalem Institute of Contemporary Music, established in 1988 to bring the music of our time to a wider audience.
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