Researchers aim to determine whether the arts can treat Alzheimer’s

From the Washington Post:

Story by Fredrick Kunkle

As rock-and-roll fills a sunny recreation room at Birmingham Green in Manassas, residents of the assisted-living facility seem swept up in the music as if by a powerful wind.

Brett Sigmundsson, 52, belts out the lyrics of a Beatles tune while dancing in place with all the vigor of a middle-aged Mick Jagger. John Archer, 64, rises to his feet in dance. Up front, Norma Felter, 85, a former department store clerk whose eyes are glued to a TV screen showing the lyrics for “Hey Jude,” sings into a microphone, not always in sync with the words but joyfully all the same. Even those whose thoughts appear far away sometimes sway or tap their fingers in time to the beat.

The karaoke session is a popular draw at the facility. But music, art and dance sessions like these are also the subject of intensifying interest among the scientific community.

As the nation’s median age rises and baby boomers retire, the federal government, universities and health-care institutions are seeking to determine whether the arts have a quantifiably therapeutic effect on people with Alzheimer’s disease or other age-related disabilities.

Many researchers agree evidence seems promising that the arts can improve cognitive function and memory, bolster a person’s mood and sense of well-being, and reduce stress, agitation and aggression. But many previous studies have been too limited or poorly designed to say for sure.

Alzheimer's research

George Moseley in front of a mural he painted in an empty room at Birmingham Green, an elder care residence in Manassas, Va., on Nov. 21. Painting “helps me to manage and cope, to have a positive attitude,” he said. (Evelyn Hockstein/For The Washington Post)

The National Endowment for the Arts and the National Institutes of Health and others are pushing for more answers. At Birmingham Green, researchers from George Mason University are conducting a federally subsidized study to examine the impact of the arts on the emotional and cognitive health of older adults.

“There still needs to be a lot of work done,” said Sunil Iyengar, who heads the Office of Research and Analysis at the NEA. Iyengar said research into the effect of art on people with cognitive impairments has suffered from a lack of rigor.

Too many studies lacked proper controls, involved samples that were too small, and were poorly defined. They also may have been looking for the wrong thing, Iyengar said. While searching for hard evidence of biological improvements in memory or cognition, many also overlooked measurable improvements in the mood and well-being of people with Alzheimer’s, and their caregivers, too.

In a paper titled “Shall I Compare Thee to a Dose of Donepezil,” researchers Kate de Medeiros and Anne Basting called for developing research models that would better suit interventions that involve the imagination and meaningful personal experiences, instead of those that have been used to test clinical efficacy of pharmaceuticals.

“I think these are the so-called intangibles that we as a society have tended to underplay,” Iyengar said. “These are really devastating diseases for these people and their families, and anything you can do to reduce that pain is important.”

The National Academy of Sciences, at the request of the NEA and NIH, convened a public workshop in March 2011 to investigate ways to bolster research into arts-related interventions for aging adults. Several studies have hinted at the promise of integrating the arts into therapy for age-related disabilities.

Dance and movement have been shown to help older people avoid falls. Acting sessions can strengthen the sense of social ties and community, a critical need for people whose cognitive impairment can lead to isolation. Interventions using everything from drum circles to poetry have been shown to improve psychological symptoms, such as aggression, in patients with cognitive impairment.

Norma Felter sings “Hey Jude” with activity aide Tina Burhans-Robinson during karaoke at Birmingham Green. (Evelyn Hockstein/For The Washington Post)

Norma Felter sings “Hey Jude” with activity aide Tina Burhans-Robinson during karaoke at Birmingham Green. (Evelyn Hockstein/For The Washington Post)

Music has been found to have a particularly strong effect on cognitive function. Research has shown that musical training can help older people distinguish speech better, particularly amid background noise. People recovering from brain injuries, such as a stroke, have been shown to sing words and phrases that they might not otherwise be able to speak. Performing music also relies heavily on memory and understanding of visual and sound patterns. For these reasons, people with musical training may weather the effects of aging better than non-musicians.

“But outside of these things is sheer joy,” said Gary Glazner, founder and executive director of the Alzheimer’s Poetry Project. Glazner said he was working at an adult day-care center in Northern California and searching for ways to connect with people with Alzheimer’s disease when he discovered the power of poetry to reach people with cognitive impairment.

Having studied poetry in college, Glazner shared Henry Wadsworth Longfellow’s poem “The Arrow and The Song” with a resident and from the first line — “I shot an arrow” — hit the mark. Glazner uses poetry, particularly beloved classics learned by older adults, in call-and-response with older people and guides them in writing poems. Jump-rope rhymes, even military cadences, can evoke responses from people with cognitive impairment that engage them, he said.

Holly C. Matto, a professor of social work at GMU who is conducting the experiment at Birmingham Green, said people with cognitive impairment often feel overwhelmed by their inability to process and integrate information from their surroundings. Using the arts, particularly nonverbal arts such as painting and music, can help restore a sense of organizing their world.

“Those nonverbal ways of communicating are not impaired,” she said.

Her 18-month study, supported in part by a $25,000 grant from the NEA, involves taking groups of 10 randomly assigned people and engaging them in twice-weekly sessions using music, imagery and movement. (There is also a control group.) Those who participate in the study are invited to choose music for the group to listen to and then let their imaginations and memories roam. They also use painting to express what they feel in the music. And they are invited to dance. (Study guidelines forbid observing the study itself, but a reporter was allowed to observe other art programs at the center.)

“The hypothesis is that after folks participate in this study, the people will show an improvement in mood and possibly a change in cognitive function,” Matto said. She said the study subjects and control group are to be evaluated before and after the sessions begin using accepted clinical tools, such as the Profile of Mood States, cognitive assessments and the Geriatric Depression Scale, to evaluate whether the sessions have any lasting impact on the subjects’ mood or well-being.

“It makes me happy,” said Felter, who had been rocking to the Beatles from her wheelchair. She said the music helps her adjust to the stresses of living in a communal setting.

Kathryn Dodd, 65, who lived in Ashburn before moving to Birmingham Green, said listening to tunes by James Taylor and Mary J. Blige allowed her mind to wander to pleasant memories from years ago.

“Music brings memories. I basically try to remember the good times — I don’t like to dwell on the bad times — and music brings those out,” Dodd said. “I got a lot out of it.”

All over Birmingham Green are visual reminders of the relief art can bring.

George D. Moseley, 70, who suffers from paranoid schizophrenia, said his love of painting vivid murals of flowers, birds and landscapes — all showing the influence of Thomas Hart Benton and years of formal training at the Corcoran School of Art — has been instrumental in helping manage a lifelong cognitive disability, instead of medication. He describes his art in almost religious terms, saying the activity delivers him from the bondage of his condition.

“It helps me to manage and cope, to have a positive attitude,” he said. “The paintbrush and the art give me an outlook and a feeling of serenity and peace, love, and joy. The paintbrush is the treatment for all else that has failed.”