Alzheimer's, Music, and Memory

by Rui M. Costa, DVM, PhD

An image showing the charting of brainwave trajectories of individual neurons using the Expansion Selective Plane Illumination Microscope (ExA-SPIM).

The opera Lucidity delves into the fragmented, bewildering world of dementia and Alzheimer's disease, a space where memory dissolves and identity blurs. It confronts a cruel paradox: characters who know that they don't know, those who don’t know that they don’t know, and others who are painfully aware of the knowledge lost by those around them. Amid this narrative of memory loss and fading recollection, one aspect remains untouched—music. Music cuts through the fog of memory loss, reaching into the deepest parts of the human brain, stirring something enduring even when other aspects of cognition fail. 

Neuroscience offers insights into why music, more than many other stimuli, endures in the brains of people grappling with memory disorders. While Alzheimer's disease often ravages regions of the brain like the entorhinal cortex and the hippocampus and other areas of the brain crucial to forming and retrieving episodic memories, the regions tied to musical memory remain surprisingly resilient. 

Music is stored not only in one region of the brain but across a widespread network involving brain areas that process auditory stimuli, like the auditory cortex and subcortical auditory regions; brain areas that process rhythms and timing; areas involved in the production of movements related to playing or dancing; and, importantly, the limbic system, which governs emotion. These overlapping circuits mean that even in the later stages of dementia, patients often retain the ability to recognize and respond to music that has marked significant moments in their lives. For many, a song once played at a wedding or a melody from childhood can evoke vivid memories that are otherwise inaccessible. Studies using brain imaging have shown that musical memory taps into brain regions that are among the last to be affected in Alzheimer’s disease. 

Neurologist Oliver Sacks explored this in his work, noting how Alzheimer's patients might suddenly recall and be brought to life by a familiar song, with a change in facial expression and often the ability to hum along to the tune.

An image showing the charting of brainwave trajectories of individual neurons using the Expansion Selective Plane Illumination Microscope (ExA-SPIM).

Music doesn’t merely provoke passive recognition; rhythm and melody can engage motor circuits in the brain and unlock an individual's ability to participate, engage, and connect with a sense of self that might otherwise seem lost. Music therapy is increasingly being used to reconnect dementia patients with their identities. Patients who may have forgotten their own names can still sing lyrics from songs learned decades ago. Singing or dancing can stimulate motor and cognitive functions and improve the quality of life in dementia patients. Even for those with profound cognitive decline, the act of tapping along to a rhythm or singing in a group can be motivating and provide a sense of connectedness. In a world where memory fades, music remains, providing comfort, connection and a link to the self. It is in this paradox between forgetting and remembering that Lucidity finds its power.

Rui M. Costa is the President and CEO of the Allen Institute and a Professor of Neuroscience and Neurology at Columbia University. He received his PhD from UCLA and completed postdoctoral work at Duke University. He has led research at the National Institutes of Health, the Champalimaud Center for the Unknown, and the Zuckerman Mind Brain Behavior Institute at Columbia University. He has been knighted commander of the Order of Santiago d’Espada and is an elected member of European Molecular Biology Organization, the National Academy of Medicine, and the Washington State of Academy of Sciences.

The Allen Institute was founded by Paul G. Allen in 2003. Its mission is to understand the principles that govern life, and to advance health. At the Allen Institute interdisciplinary teams carry out foundational moonshot research projects in the areas of brain science, immunology and cell science and share the findings openly with the world to have exponential impact in science and health.

Lucidity is on stage November 21–24, 2024 at The Opera Center. Learn more and buy tickets at seattleopera.org/lucidity.