Singing and Dementia
Recently I did a blog about music and dementia, and predictably some people were cross because they thought that I was raining on their parade. You might wonder why I pursue this?
It’s because in spite of having an arts degree, singing in a church choir, loving heavy metal, playing the double bass as a teenager, seeing more opera than I can afford and trying to learn the concertina, I’m a scientist at heart and I do respect research evidence.
In 2017 a respected professor of Liaison psychiatry asked me what I thought of “Singing for the Brain.” He asked if I thought it was interesting enough to be funded from the public purse. He wondered how many millions should be spent on evaluating it.
At that time, seven years ago, I said,
“I do not think there is evidence that it reduces dementia. I am glad if it gets evaluated properly because huge amounts of time and money are spent on it and it trumps all other unpopular topics like continence management. Depends what you mean by dementia (which of the many symptoms does it ameliorate, and to what extent and for how long?) Depends what you mean by singing (singalong, new songs, old songs, hymns or other songs with "spiritual" overtones, highly personalised/individualised song books, live music and singers, karaoke etc?)Depends if you are measuring benefit to the family/carer unit as carer burden reduction, socialising, information sharing (does it help reduce carer burden, e.g. I get to talk to other families when taking my mum to the singing?) How does it work compared with other social activities (e.g. cake baking for dementia, dancing for dementia, massage, and cuddles for dementia...?) Depends if the benefit is collateral e.g. reduction in loneliness, increase in exercise (you have to walk to the choir) reduction in boredom, breathing exercises increasing oxygenation, hydration....cake?”
That was just my take. A published study the previous year, which evaluated a Singing for the Brain pilot reported strong support for the activity and high levels of enjoyment, but it said that “further evidence is required to understand the potential impact on participant’s well-being from attending these sessions.”
In other words, great fun, but the jury’s out in terms of other benefits.
So, what since then? A paper published in 2021 outlined a pilot for a randomised evaluation. It said,
Community group singing has received attention for its potential to support people with dementia and their carers. It is postulated that singing can improve cognitive function, strengthen the bonds between care partners and help to establish social support networks. However, there is a lack of rigorous evidence of singing’s benefits for this population.
For me, if something lacks rigorous evidence and it is harmless, then anyone can take part in it. BUT if they make unjustified claims about it, it’s a form of abuse. Abuse of funds, abuse of trust. Claiming it improves cognitive function for people with dementia is a big claim. Anecdotal accounts are interesting, but they are not evidence. Putting in the word “can” begs questions including - Which dementia? What stage? Which cognitive function? How much? And for how long?
I think it is disrespectful if someone says without evidence that an intervention is somehow reversing pathology in a serious illness. It was not OK when people were saying that you could reverse cancer with aromatherapy and a Hallelujah diet. Unlike the Gerson claimed therapy for cancer, singing isn’t going to hurt you. But is there something about dementia that makes it OK to tell people that folksy remedies make a difference to the pathology?
Please keep singing. But don’t pretend there is evidence (yet) that it reverses dementia. That’s patronising and unfair. You might think I’m mean to insist on this, but lots of readers are mean to me for telling it like I see it.
I’m not mean. I’m just refusing to back down in the face of populist bullying.
References:
Dowson, B. et al. (2021) Pilot randomised evaluation of singing in Dementia (preside): Protocol for a two-arm, parallel-group randomised controlled feasibility study with waiting-list control - pilot and feasibility studies, BioMed Central. Available at: https://pilotfeasibilitystudies.biomedcentral.com/articles/10.1186/s40814-020-00759-y (Accessed: 06 March 2024).
Ward, A. (2016) An evaluation of a singing for the brain pilot with people with a learning disability and memory problems or a dementia, Dementia (London, England). Available at: https://pubmed.ncbi.nlm.nih.gov/26160277/ (Accessed: 06 March 2024).
