Music for People with Dementia: Why Are Old Songs Remembered?

Why does music seem so powerful for people with dementia? Read what research says, how to build a personal playlist and what to watch out for at home.

A woman who describes how her father no longer remembers his grandchildren's names, and sometimes doesn't even recognise his own home, says she was astonished one holiday morning when an old Zeki Müren song came on the radio: although her father no longer formed sentences of the length he used to, he hummed the words of the song from beginning to end without stumbling once. Moments like this are a shared experience for many family carers. Music for people with dementia is a topic that is both hopeful and confusing: why can someone who forgets recent events remember a song from forty years ago? Does music change the course of the illness? In this article we look at these questions, at what research says today and at how music can be used at home.

Why Does Music Seem So Powerful for People with Dementia?

Dementia is the general name for conditions that involve a progressive decline in memory, thinking, language and the ability to manage everyday tasks. Alzheimer's disease is the most widely known example. As the illness progresses, a person may forget recent events, confuse familiar faces and have difficulty speaking.

Even so, many carers observe that their relative still responds to songs they loved in their youth, remembers the words and even keeps time with the rhythm. It is thought that some aspects of music-related memory may be relatively preserved until the later stages of the illness. The reasons for this are still being researched, but a few possible explanations are discussed:

• Repetition: Songs loved in youth have been listened to and sung many times over the years. This intensive repetition may make them very firmly learned.
• Link with emotion: Songs often settle into memory together with emotional moments such as a wedding, a love affair, a parting or a holiday morning. Emotional memories may be more lasting than ordinary information.
• Rhythm and melody: Because song lyrics are learned together with melody and rhythm, they may be remembered differently from information made up of words alone.

These explanations give some idea of why music can work like a "door". But they also come with a warning: remembering a song does not mean that memory in general has come back or that the illness has receded. When the song ends, the person may become confused or restless again. This does not mean that music is worthless, but that its effect is often limited to the moment.

Music cannot reverse dementia; but sometimes it can let you meet the person you love in the same place again, if only for a few minutes.

What Does Research Say About Music in Dementia?

Music-based interventions in dementia are among the topics that Cochrane has examined systematically. The current version of the review looked at 30 studies involving a total of 1,720 people. The findings can be summarised roughly as follows:

• Music-based interventions probably reduce depressive symptoms in people with dementia.
• There may be some improvement in overall behavioural problems.
• On the other hand, no clear effect is expected on agitation, aggression or cognitive function.

In other words, music is not a method that treats dementia itself or brings memory back. However, it can be a valuable tool for supporting a person's mood, creating enjoyable moments and building a bond between the carer and the person. It should also be borne in mind that a significant proportion of these studies were small, that participants knew what they were taking part in and that follow-up periods were short.

It is also important to draw a distinction here. In research, "music therapy" usually describes work carried out with a trained professional, within a defined framework, involving musical interaction with the person. A relative putting on old songs at home is a valuable care practice, but it is not the same thing. We have explained this difference, and how music therapy works in general, in our article on music therapy.

Music at different stages of the illness

Dementia progresses differently in each person, so the way music is used may also change over time. In the early stages of the illness, the person can often still express their own preferences. At this stage, asking them which songs they love, putting a playlist together with them or supporting them to join a choir or music group if they wish can provide both a meaningful activity and a social connection. A list prepared at this stage also serves as a guide later on, when the person finds it hard to express themselves.

In later stages, the person may not be able to choose songs or pay attention for long. At this point, short, familiar and calm pieces may become more meaningful when combined with physical contact such as holding hands or gentle rocking. What matters is adapting to how the person is on that day and not expecting a response "like before".

Making a Personal Playlist at Home

Perhaps the simplest and most personal way of using music with a relative who has dementia is to put together a playlist based on their life story. You can follow these steps:

1. Focus on their youth: Songs that were popular in your relative's young adulthood, the years of first love, marriage, military service or a first job, often evoke the strongest response.
2. Gather information from the family: Ask their siblings, spouse and old friends: Which songs did they love? What was played at their wedding? Which folk song did they hum? Whose records did they listen to?
3. Don't forget cultural and regional ties: Turkish classical music, Turkish folk music, regional folk songs, songs from old Yeşilçam (classic Turkish cinema) films or religious hymns may hold an important place depending on the person's past. The person's beliefs and sensitivities should be respected.
4. Watch their response: Note which songs make them smile, sing along, calm down or, on the contrary, become restless. Over time the list takes shape according to these observations.
5. Keep it short: Short sessions of listening at particular times may be more suitable than long, continuous music.

Let's say a son caring for his mother, a retired teacher, notices that she becomes restless in the evenings and wants to leave the house. By asking his aunt, he finds a few songs his mother loved in her youth. One evening, when he puts these songs on and holds his mother's hand, she stops looking out of the window and starts singing along. It doesn't have the same result every evening; on some days nothing works. But this small ritual becomes a new meeting point between the two of them.

Simple Activities to Do Together with Music

Music doesn't have to be something you only listen to. Here are a few simple activities that can be adapted to the person's condition:

• Singing together: You start and they join in. Singing part of the words and leaving a gap gives the person the chance to finish the line. If they can't, carry on yourself.
• Keeping the rhythm: A tambourine, two wooden spoons or simply clapping is an easy way to take part in a song with the body.
• Seated movement: Gently swaying the arms, tapping a foot in time or moving the shoulders to the music is also suitable for people with limited mobility. If there are balance problems, avoid dancing standing up.
• Photos and songs: Listening to a song from a particular period while looking at old family photographs can make it easier to talk about memories. But avoid testing the person with "Who's this, do you remember?"
• Adding music to daily routines: Always playing the same calm song at breakfast, before a bath or at evening tea may make the flow of the day more predictable for some people.

The aim of these activities is not to teach anything or to "exercise" the memory, but to share an enjoyable moment together. Taking a break when the person gets tired or loses interest is as important as the activity itself.

Music for People with Dementia: What Should You Watch Out For?

Music is usually a safe and enjoyable activity; however, with people who have dementia, some points need care.

• Volume and setting: Busy environments with a television, conversations and music all at the same time in the background can increase confusion. Play music in a calm setting and at a volume that won't be disturbing.
• Using headphones: Some people may enjoy listening to music through headphones; others may find headphones uncomfortable or frightening. Watch the person's reaction and don't leave them alone.
• Don't push: Insisting, "Come on, you know this song," may embarrass or upset the person when they can't remember. If they sing, join in; if they don't, simply listen together.
• It can trigger sadness: Some songs may bring back memories of a spouse who has died, a child who has been lost or a painful period. Tears are not always a bad sign; but if the person becomes clearly distressed, change the music or stop it.
• Avoid constant background music: Music left on all day can lose its meaning and may cause tiredness or restlessness in some people.
• Keep expectations realistic: Music sometimes works and sometimes doesn't. A song that worked one day may not get a response the next. This doesn't mean you have done something wrong.

Music for the Carer Too

Caring for a relative with dementia is a long, exhausting and often isolating process. The carer may put their own needs on hold for a long time. Here, music can be a place of rest not only for the person with dementia, but for the carer as well.

A moment of singing together can also give the carer the feeling that "we still have a connection." Setting aside a few minutes during the day to listen to music you love, joining a choir or music group, or listening to something through headphones while walking can be a small but important break for you.

The burden of care often falls on the shoulders of one person in the family, frequently a daughter or a daughter-in-law. Music can also be a small way of sharing this load. A sibling who lives in another city can sing their mother's favourite folk song to her on a video call; grandchildren can learn their grandfather's favourite songs and sing them together during a holiday visit. Contributions like these do not lighten the main burden of care; but they can help the rest of the family become involved in the process and help the carer feel less alone.

For more information about the psychological burden of caring and how to cope with it, take a look at our article on being a dementia carer. There, feelings that carers often experience, such as grief, guilt, anger and burnout, are discussed in detail.

When Should You Seek Professional Support?

Music can be a valuable tool in life with a relative who has dementia, but it does not replace medical assessment and follow-up. It is important to talk to your doctor or relevant specialists in the following situations:

• If changes in memory, behaviour or personality have recently started in your relative and no assessment has yet been carried out
• If you notice a sudden worsening in behaviour, marked confusion or a rapid disruption of sleep patterns
• If you see depressive symptoms in your relative such as marked withdrawal, constant crying or refusing to eat and drink
• If you feel exhausted, hopeless, constantly angry or guilty while caring

If you are having thoughts of harming yourself or your relative, call 112 (emergency services) in an emergency.

It is important, both for the carer and for the person they care for, that the carer looks after their own mental health. Individual therapy can offer a space to address the grief, guilt and burnout that caring brings, and to learn how to set boundaries and ask for support. Structured approaches such as cognitive behavioural therapy (CBT) can help carers cope with difficult thoughts and plan time for themselves.

Frequently Asked Questions

Does music slow down the progression of dementia?

Current research does not show that music-based interventions have a clear effect on cognitive function. Music can be valuable for supporting mood and creating enjoyable moments; however, it should not be seen as a treatment that slows the progression of the illness.

My relative becomes restless when they hear music. What should I do?

Everyone responds to music differently. You can try lowering the volume, trying a different song or genre, or reducing other sounds in the room. If the restlessness continues, it is best not to force the music and to talk about it with their doctor.

Can I make a playlist for my relative who lives in a care home?

Yes. It can be helpful to share the list you have made, along with your notes on how your relative responds to particular songs, with the care home staff. Listening together during your visits can also make them more meaningful. Loading the list onto an easy-to-use device means staff can also put it on when needed.

My relative can no longer speak. Can they still benefit from music?

People whose speech has declined can still respond to music through facial expressions, hand movements or keeping time with the rhythm. You can continue to connect by holding their hand, swaying gently or simply listening together.

• #dementia
• #alzheimer's
• #music and memory
• #family caregiver

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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