Dr Kevin McCarroll
Medical Matters
Music has been used for millenia to raise our spirits. The ancient Greeks recognised that physical and mental well-being could be enhanced by music. Indeed, music was used to improve performance in athletes at the ancient Olympic games. Pythagorus believed that it could soothe ailments of the spirit, body and soul and used the term “musical medicine” while Aristostle argued that music had cathartic effects. Even further back, about 5,000 years ago the ancient Chinese Book of Changes noted that “music has the power to ease tension within the heart and to lessen and loosen emotions”.
While we can all appreciate the relaxing effects of music, what if any, real and beneficial effects may it have on health?
There are numerous studies investigating the effect of music and music therapy in a variety of clinical settings including dementia, brain injury, neurosurgery, cardiac surgery and in pain management, and palliative care. Some are small, lack a control group or have limited outcome measures though others are well designed and have provided valuable insights.
Pathways
As we listen to music, multiple neural pathways are activated all over both sides of our brain. Modern neuroimaging identifies these as areas associated with emotional, cognitive and memory processing and different types of music also result in activation of different brain regions. Some small studies have found improved cellular immune response and lower cortisol levels after listening to music.
A review of 23 studies with 1,461 subjects where music listening was the main intervention found that it may have a beneficial effect on blood pressure, breathing, heart rate and pain. Other analyses of pooled studies have found a reduction in pain intensity and requirement for opoid analgesia.
There has also been increasing research into the effect of music or music therapy in those with dementia. The most recent, comprehensive and independent review in 2018 of over 22 studies involving 1,000 patients with dementia in nursing homes concluded that five sessions of music probably reduced depression and behavioural problems and may improve emotional well being, quality of life and reduce anxiety.
The well renowned neurosurgeon Dr Oliver Sacks describes in his popular book Musicophilia the powerful and sometimes tranformative effect of music on older people with dementia or brain injuries in longterm care. Music can evoke emotion and with that memories.
In fact, research suggests that music evoked autobiographical memories are often more vivid. Of interest too, is that the ability to play a musical instrument is often maintained until much later into the course of Alzheimer’s as it appears brain areas important for motor and musical memories are spared.
Music therapy is now recognised as an evidenced based profession allied to medicine and encompasses not just listening to music but playing, composing, singing and moving to music. It involves a therapist working individually with a person and can promote better levels of engagement, communication and well-being.
So what type of music is most beneficial? There is no clear answer but some studies point to particular genres of music as well as other factors but ultimately music that one perceives as pleasant and likes is important.
In 1993, the ‘Mozart effect’ was described – and enhancement of reasoning skills solving spatial problems in normal subjects after listening to Mozarts Piano Sonata K448. The effect was small though and may be explained by a heightened arousal. Interestingly, in a small study of middle aged adults, music by Mozart and Strauss but not ABBA resulted in a significant reduction in blood pressure and cortisol levels.
A musical key that is pleasant, a catchy melody, few changes in volume and rhythm and the absence of sung words are factors that are associated with a more favourable response to music. In fact, cheerful music appears to have a greater impact without words whereas vocals may enhance the impact of sad music.
Some studies suggest that music is a strong stimulus to neuroplasticity and playing a musical instrument might promote increased connectivity between the left and right sides of our brain.
Indeed, developing cognitive skills might protect against dementia. For example, in one study of identical twins those who played an instrument were about a third less likely to develop dementia.
In summary, music can evoke positive responses which may have an underlying physiological basis and appears to be beneficial as an adjunct to other therapies in a variety of clinical settings.
Dr Kevin McCarroll is a Consultant Physician in Geriatric Medicine, St James’s Hospital, Dublin.