David: I would say whatever brings a smile to your loved one's face is important in this journey. The happy times need to be sometimes created and music is such a wonderful venue to do that. Allison: That's Dave Chase. He fell in love with his wife, Rena when they were teenagers, and for six decades they danced and sang songs to each other. And after Rena was diagnosed with Alzheimer's disease, they found out that music was the best medicine. And you'll hear their songful story in a moment. Jay: Welcome to Defy Dementia, the podcast for anyone who has a brain. Allison: Defy Dementia is all about living in ways that keep your brain healthy and reduce your risk of dementia because dementia is not predestined by our genes. Jay: Genetics can play a role, but lifestyle risk factors like unhealthy eating, social isolation and loneliness are also crucial. Allison: And according to the very latest evidence, scientists are now saying that if we make healthy changes to those lifestyle risk factors, we could reduce dementia cases worldwide by at least 45%. Jay: Today on the show, the power of music, just how much can it boost our brain health and stave off cognitive decline. Allison: I'm Allison Sekuler, president and chief scientist at the Baycrest Academy for Research and Education, and at the Center for Aging and Brain Health Innovation. Jay: I'm Jay Ingram. I'm a science journalist. I've been writing and talking about dementia for more than a quarter-century. Allison: Join us as we Defy Dementia because you're never too young or too old to take care of your brain. Jay: If you're a regular listener to Defy Dementia, you know that Allison and I are in bands. I play the electric violin, Allison plays the drums. Allison: And we were running joke between us that someday we're going to hold a battle of the bands to hear whose band is best. Jay: Well, my band isn't getting a huge number of gigs these days, so it's probably yours. Allison: That is most gracious of you to concede that. And I agree it probably is mine. But seriously, it doesn't really matter who is best because it turns out that the brain is the real winner. Jay: And today we have the inside scoop on how your brain benefits, whether you're just listening to old favorites or doing something more challenging, like learning new music or learning to play a new instrument. Allison: And we're also going to try to answer the really big question: to what extent does music reduce the risk of dementia? Jay: But first, a story about two lovebirds. Allison: And these two lovebirds were also songbirds. Both of them were members of a dementia friendly choir in Victoria, British Columbia. The choir is called Voices in Motion, and here they are singing Glen Campbell's, Try A Little Kindness. Jay: And joining us now is one of those voices, Dave Chase is 78. He's a retired teacher from British Columbia. Dave's wife, Rena was also a member of the Voices in Motion Choir. Rena and Dave got married at age 20, had four kids and were together for nearly 58 years. At age 72, Rena was diagnosed with Alzheimer's disease. Dave became her caregiver. Rena passed away last January at the age of 78. Dave is here with us to talk about Rena and how music impacted both of them. He joins us from Mayne Island, near Victoria. Dave, thank you very much for joining us on Defy Dementia. David: I'm very happy to be here. Jay: And we are sorry for your loss. Can you tell us a little bit about Rena as a person? David: Well, she was a complex person. She was very much a free spirit, but had high anxiety. A highly sensitive young gal, raised in a very stern household, but I think her safe place was, even at that age, music. She had her own little record player as a young teenager and she developed a wonderful personality. Although she was an introvert, she loved being around people and she loved to laugh, she loved to dance, she loved to sing. And when I first met her at age 16 or 17, she was very engaging. Allison: And before Rena's diagnosis, you mentioned she had a love of music. What role did music play in both of your lives? David: Music was a go-to place for us to be happy. We both enjoyed singing in church choirs and Rena particularly would use music to communicate with her babies one by one and make up little songs for them. We'd sing together in the car, Harmony, You Are My Sunshine, just whatever little song popped into mind. And that carried on throughout Rena's life. Allison: And what was the impact of the diagnosis on the two of you? David: Yeah, I think I sort of accepted it because I was familiar with some memory loss that had been happening over the years. Rena was very sensitive to the testing and she was quite upset, to the point that she never did go back for retesting. So the impact was quite heavy on her and she looked for ways to deal with it, of course. Jay: After the diagnosis, did music continue to be important to the two of you? David: It certainly did. That was one thing that didn't change. I think the wonderful thing about music is the words were full and meaningful and she could draw on a song at any time, and particularly in times of confusion. Or perhaps not quite knowing how to fit in, music was her go-to-place to contribute to a group or wherever we happen to be. Jay: Now you were in choirs, particularly the Voices in Motion choir. Could you paint us a picture of Rena singing in the choir? What was that like for her? David: Yeah, it brings a smile to my face because. The great thing was she herself discovered the Voice in Motion choir when she was doing some searching. She always enjoyed research. And when she came across the Voice of Motion choir, she really did want to see what it was all about. And from day one, walking through the doors of the meeting hall, we were greeted with warm, friendly smiles and a very supportive community. And it felt like a very safe place to be. Allison: So Dave, how do you think taking part in the choir helped Rena in terms of her cognition, her mood, or in any other way? David: I think the keyword is mood. Feelings are so important when it comes to Alzheimer's because of the frustration and sometimes depression. The music would lift her out of that. And I think not just because of the music, but also because of the emotional support of the other musicians or the other singers. Often couples would sing together to support one another or the caregiver would be supportive. But in Rena's case, being an alto when I was a tenor, the altos just came and took her by the arm and said, "Can I sit beside you today?" And so she was welcomed with open arms. It was a socially as well as musically engaging situation. Jay: Dave, could you tell how her experience of music and the choir changed as her Alzheimer's progressed? David: Interestingly, the actual choir experience didn't really seem to change all that much. There's a video that our daughter took of one of the performances. I guess one change would be that she didn't use her music book. Her music book was folded on her chest and she was singing word-perfect throughout the whole performance. So I found it very intriguing that she didn't have memory loss in the choir. In fact, the friends beside her would often help her turn pages. But she really didn't depend on the written music. Allison: Were there any songs that were particularly special to Rena that stayed with her throughout the entire dementia journey? David: Well, there were simple songs that stuck with her. I'm thinking of the ones she would sing in public. We were in a restaurant one day for lunch and when I was paying the bills, she was beside me and without invitation, she started singing Take Me Out to the Ball Game to the cashier. Allison: And that was the tip. David: So that was a go-to song for the day and a couple other tables joined in too. You Are My Sunshine was one. Hey, Good Lookin', what you got cooking also. I mean there was a huge number of songs she could draw on. She would pick on one for a few days at a time though. Jay: Just so I'm clear on this, she had no trouble remembering the lyrics to songs, but that was happening at a time when her memory was declining? David: Absolutely, the day before she passed away, when she was almost comatose, we had the whole family there and our daughter-in-law is a singer. She started singing Amazing Grace and Rena joined in singing. And the words were right there, the voice was not strong, but it was a beautiful, beautiful memory to have. Jay: It's very hard to introspect about this sort of stuff. But do you feel that music has benefited your brain too? David: I really believe so. I found myself the other day not listening to music just because I'm still in a grieving state and it can pull me right in. But definitely, my music with Rena was paramount. We sang Saskatoon Moon quite a bit. I would strum. She would sing and it was a wonderful connection. I still have with her the music that will carry on and it's something I can do by myself now too. Allison: And are you still singing with the choir? David: Yes, I am. I carried on and I think I will. I've joined a musical here on Main Island that will take up a lot of time with a production in November, but I would like to get in as many times [as I can] at the practices with Voices in Motion choir. Allison: If you had one thing that you wanted to share with everybody about what people need to know about music and folks who are living with dementia, what would that be? David: Well, first of all, I would say whatever brings a smile to your loved one's face is important in this journey. The happy times need to be sometimes created and music is such a wonderful venue to do that. Some people might just like listening to music. Rena had, as I mentioned earlier, high anxiety and of course sleep disturbances and occasional delusions and that sort of thing, but to put on some peaceful nature music and just be with her for a while really calmed her. And she would often be grateful. She'd often say, "Oh, thank you. That's beautiful music." So I would say to anyone who hasn't tried this, just do it. Just try it out. It can really be helpful. Jay: Thank you very much for joining us, Dave, and again, our sympathies to you. David: Thank you. Thank you so much. Jay: Dave Chase is a retired teacher and a member of the Voices in Motion Choir. He joined us from Mayne Island in British Columbia. Allison: Our next guest has been listening to Dave Chase. Dr. Debra Sheets is the founder of the Voices in Motion choir. She knows Dave and she knew Dave's wife, Rena. Debra is a gerontologist and professor emeritus in the School of Nursing at the University of Victoria. And her work is all about enriching the lives of people living with dementia through the arts. Debra Sheets joins us from Victoria. Debra, thank you so much for helping us defy dementia. Debra: Thank you, Allison. Allison: First I want to ask, what did you take away from Dave's story? Debra: I knew Dave and Rena for almost six years. They were just an extraordinary couple. And Rena would burst into song whenever she saw me. It would be like Singing in the Rain or You Are My Sunshine. She had favorite songs and just took so much joy in music. It was very calming for her and really a pleasure to know her through her dementia journey, to be there at her bedside when she was just a day or so away from passing on and to sing some songs with her. Jay: When you started the Voices in Motion choir project, what were you actually hoping to achieve? Debra: In 2018, we started the Voices in Motion choir. It was funded by the Alzheimer's Society of Canada. I had heard about intergenerational programs before and about a dementia choir in the US that a friend of mine had started. I really wanted to bring that to Victoria. My dad had dementia and had nothing to do. He would sit on the couch withdrawn. I always believed in the power of music to really make a difference. And so I decided to bring together this notion of intergenerational along with the dementia choirs. And so I was funded to do a research project. I wanted to specifically look at the impact of participation in music on both the care partner and the person living with dementia. And also on the students that we encouraged to volunteer to participate. And that's what made the Voices in Motion choir different, that it was intergenerational and it was so inclusive. Jay: What methods did your team use to study changes in the brain of people who were singing in the choir? Debra: It was the most rigorous study that's been conducted on choirs that include people with dementia. We brought people in every month over the course of a year and a half. We did two hours of testing: gait, cognition, psychosocial measures, looking at the impact on quality of life and wellbeing, on the impact on depression and anxiety. In the end, compared to national samples of people living with memory loss, we found that the rate of cognitive decline was about half of what it would have been. We also found that anxiety and depression were less, and these impacts were very significant. I mean, they were almost better than taking a pill because they had no side effects. And people left our sessions just feeling connected to others, making new friends, feeling joyous. And I'd like to know how long those effects last because with someone with memory loss, it's a little hard a few days later to ask "How are you feeling now?" And “was it related to the choir?” I'm convinced that mood improvement persisted from what we were hearing from caregivers. When we did some EEG, as a pilot test looking at what parts of the brain were activated, we found that different parts of the brain are activated when you sing with other people compared to when you sing alone. You also release oxytocin and other neurochemicals that lead to positive feelings that increase your sense of connection to others. All these things going on can help you function better. The other thing is that when you're anxious and depressed, your memory's not going to work as well either, and even older songs may become more difficult. When we reduce anxiety and depression, people are able to function better. That's why our research findings were so positive. Allison: Dave described to us how much music benefited him and his wife Rena. I wonder if you can share a few more stories around the impact of choir participation on other Voices in Motion members. Debra: We know that people living with memory loss are often isolated and there aren't very many inclusive activities in the community. Our choir was the first that included people with memory loss. Some people participated in other choirs, but then they couldn't continue because they couldn't memorize the music sheet. Other people hadn't sung in a choir before and also found a home because it really became a caring community where people supported one another. The students often would sit next to someone with memory loss and help them find the right page in the music. People really looked forward to it every week. Allison: I wonder, what do you think the intergenerational element did in terms of changing the way that younger folks think about aging and addressing issues of stigma? Debra: Students learn not to be afraid of dementia. I've had a number of students who've gone on now to pursue careers in nursing, in working with older adults. This typically doesn't happen. As a nursing professor, I see lots of students who want to work in pediatrics or in maternal child health, but they don't come in saying, "I want to work with older people." I've even had a student who went into medical school [to work with older adults]. And that is really the goal: to reduce dementia stigma and to increase social connections. It was really the most meaningful work that I've done. You could see the direct impact so clearly on the students, on the care partners and on people living with memory loss. Allison: It's amazing. Your research really has shown that music is good for the body, brain, and soul. And we really appreciate you taking the time with us today. Debra: Thank you Allison and Jay for the work you're doing to defy dementia. Allison: Dr. Debra Sheets is a gerontologist and Professor emeritus in the School of Nursing at the University of Victoria. She joined us from Victoria. Jay: That was the Voices in Motion choir with Count On Me by Bruno Mars. So just how powerful is music when it comes to boosting brain health? That's a question our next guest is seeking to answer. Dr. Julene Johnson is professor of Cognitive Neuroscience at the Institute for Health and Aging at the University of California San Francisco. She's also the leader of the Music and Dementia Research Network, a group of scientists exploring how music impacts the brain and body. Julene Johnson now joins us from San Francisco. Welcome to Defy Dementia, Julene. Julene: Thank you so much for having me. Jay: I'm curious about how you first became interested in this research topic, looking at the impact of music on older adults and people living with dementia? Julene: I actually had just finished my undergraduate degree in music and I was trying to figure out how I could integrate my interest in music and brain. And one day, I was volunteering at an Adult Day Center. I was sitting in a room just observing what was going on. There were a lot of people that were doing pretty much nothing. Many of them were taking a nap. They were sitting in a circle and they were not interacting. One of the individuals in the room, a woman, got up slowly, walked over to the piano, sat down, and suddenly started playing. And I couldn't believe it because this was an older woman who was living with dementia. Five minutes before she was just taking a nap in a seat along with everybody else in the room. And what struck me so much is that the whole room actually woke up and started to move a little to the music. Some of them started singing, some of them got up and were dancing a bit. I was just so struck as a young person and I thought: "This is it. I want to understand what it is about music for people living with dementia that allows them [to reconnect with the identity they had in their younger years]" And that was over 30 years ago. I have since taken my experience in studying music and integrating it with my interest in cognitive neuroscience in the brain. Allison: You heard our earlier conversation with Dave Chase. What struck you about that conversation? Julene: I was so moved by Dave's story. What was really striking to me [was] that he was really open to using music to help his wife, Rena. But importantly, he was incredibly intuitive and intentional about using music. For example, he noticed that he could sing in the car and even at a restaurant, he also noticed that music was a safe place and welcoming for his wife. That music evoked meaningful emotions and feelings for both of them. And that they could share these times together. What's interesting as a researcher is that these are the exact topics that we are investigating. Allison: There are different levels of participation in music. So we want to delve into those separately. So first of all, what are the benefits to the brain from simply listening to music? Julene: Well, your brain is quite active when you're listening to music and listening to music actually engages several networks in the brain. For example, we actively listen to music using our ears. The auditory system then connects with the emotion networks in the brain, such as when you have feelings and emotions. And [then the auditory system also connects] with the attention networks in the brain. This is where we use our cognitive function to pay attention to different sounds and track different musical instruments and things. And finally, very important for music in the context of living with dementia, the auditory system very effectively connects with memories. And as we all know, music can then tap into long-term memory. It can bring you back to different times in your life, [like when you listened to] the wedding song that you danced to with your loved one. So it's not as simple as it sounds. Just listening to music activates lots of different brain networks. Jay: Oh, that's many ways that music can help. But what about actually playing or singing, actually being involved in the production of music? Does that have different effects? Julene: That's a really great question because we do know that when you actively engage in music, such as in singing in a choir either alone or with other people, playing a musical instrument, again by yourself or in a larger group, these also engage different brain networks. For example, if you are in a choir, you also might be engaging your motor system and you might be swaying to the music or tapping your foot or getting into the groove. You might also move with other people. So there's that social aspect when you're creating music in a group setting. And when you're learning new songs or new pieces on your musical instrument, you're also learning new information. And those [involve] different parts, different networks in the brain. Allison: That is really interesting because some of the things you're talking about are actually topics that we've discussed as ways that you can decrease your dementia risk in previous episodes. But how much do we understand about how music benefits people who are living with dementia? Julene: We've known for over 50 years that music is something that remains preserved often, not always, but often in people living with dementia. We only recently have had additional research resources, so now we can start to better understand the question: "Why is music working so well?". We know music can also stay preserved in some people throughout their whole life. So during their dementia journey, whether they're living in a home, whether they're in memory care, they should be able to have access to that music at each step in their dementia journey. And the scientists now are trying to better understand what are the mechanisms, physiological or psychological that allow that to happen. Importantly, in the future, we want to be able to give better, more tailored recommendations to families and communities. For example, if somebody comes to me and asks, "Hey, I'm a little bit worried about my memory here, what should I do with music?" Or, "Hey, I feel like I'm isolated and I don't feel very connected with communities." We know from my community of voices study that older adults that engaged in a choir for six months had reduced feelings of loneliness. This was a large trial, like the other ones that you're talking about on the same podcast. But for example, I might give a different recommendation for somebody who's worried about their memory. Maybe go and learn a new musical instrument. We're not quite yet at the stage where we can tailor our recommendations and optimize those interventions. We all have choices to make in life and how we spend our time, how we use our financial resources, how we connect with our community. We want to help folks do that in a better way. Jay: We've talked a lot about memory already. Dave Chase earlier spoke about how his wife, Rena gradually lost her memory as her dementia progressed. But she remembered song lyrics right up to the end of her life and yet, probably wasn't able to speak those words as speech communication. How is it that sometimes the verbal component of songs is remembered while the verbal component of speech isn't? Julene: Wow, that's a really great question, and scholars over the last 150 years have been asking that question. Most commonly in the context of people who experienced a stroke. [Even back into the 19th century, scholars have noticed that even when the ability to converse and participate in language get severely impaired after a stroke, some individuals can still sing the words.] In some of the therapies for treating and helping rehabilitate individuals who've experienced a stroke, oftentimes, singing with lyrics is one strategy. And most likely those clues from research done with people with strokes carries over to people living with dementia. [But I think in the context of being able to sing words that may be hard to speak, music acts as a cue, and it also has a rhythm. You can rely on those natural cues, which are almost spontaneous, automatic, and rapid.] And then you put emotions behind that, suddenly something like singing the words rather than speaking the words becomes much easier and much more automatic. Allison: We've been talking so far about music in older adults, but are there benefits earlier in young adulthood or even in childhood? Julene: I think we all talk about how important it is to learn music when we're a child and early in life. There's a lot of research supporting [the importance of that period for learning]. Especially because music is [like] learning a new language. I think there are some advantages to learning early in life. However, learning and engaging in music at any point in your life is probably just as good. I currently have a study where we're providing 12 weeks of piano improvisation training to older adults with and without mild cognitive impairment. The idea is that learning a new [instrument] like piano keyboard is a different type of learning demands than learning perhaps how to sing in a choir. We'll hopefully have the results of that study in a couple of years. But the idea is that there's different types of music learning you can do. It's great to start early in life, but if you haven't, don't let that be a barrier. It is a really great opportunity. Jay: So I think people would want to know, does music actually decrease our risk for dementia? Has that been looked at in any detail? Julene: I would say that question is a little bit harder to study. Number one, you need large cohorts of people. You also need a long [period] of time [when] you're studying risk for developing any condition, and dementia can take 20 years to develop or longer. So those studies are more expensive and harder to do. But we have a few cross-sectional studies that have been done suggesting [for example] that people who have music training or musicians are less likely to develop mild cognitive impairment or dementia. There are a few of those studies, but we don't know what caused what. Is it just that people who have more exposure to music in life have a decreased risk [or are there other] factors? [We need longer studies to answer this question.] Jay: This is also fascinating, Julene. Both Allison and I have one final quick question, and because I'm on the mic, I'm going to start. So I know that you play the flute and I have to know. Were you or are you a big Jethro Tull fan? Allison: And I want to know if you're currently a big Lizzo fan. Julene: Okay, Jethro Tull, absolutely. In high school, he was a hero of mine because I was studying classical-style music, right? And here was this flute player that showed up in rock bands. So I found it really fascinating to listen to his sound because he created all these bizarre sounds on the flute, and the fact that he was the lead of the band as a flutist was so cool. Now Lizzo, I don't know about, so that's a new one for me. Please tell me. Allison: She can play the flute and twerk at the same time. Julene: Wow. Allison: So it's music and exercise, I guess. So two things that could decrease your dementia risk. Julene: Well, there you go. That sounds like a next study. Jay: Well, thank you very much for this. It's really been great to talk to you. Julene: Thank you so much. This was really fun. Jay: Dr. Julene Johnson studies the impact of music on the aging brain. She's a professor of cognitive neuroscience at the University of California, San Francisco's Institute for Health and Aging. She joined us from San Francisco. So much interesting stuff, Allison. What struck you the most about what we've heard today? Allison: I think what was most interesting to me was how music can play a role in your brain health, whether you are younger or older, and it can be useful whether you're trying to decrease dementia risk or already living with dementia. So it's useful for your brain health at every age and stage. What stood out for you? Jay: Sort of a part of what you just said, not just all through life, but all through your brain. I mean when you think about it, songs may or may not have lyrics. If they're lyrical, you're using that part of your mind to sort of consider the meaning of the words. Everybody knows that music can be hugely emotional and it's challenging intellectually. What about improvisation versus playing written music? If you could see the brain in action during music, I think it would be lit up all over the place. Allison: Yes, and the social part as well. Jay: Yeah. And speaking of the social part, I really hope that people who are listening to this who think, "Oh, I can't do music," should at least give that a second thought because I think we're all a little more musical than we might think. Allison: I can't agree more. When I was in first grade in our music class, the teacher told me to just whisper the words. She said, "Just mouth the words, honey, you don't need to actually make any noise." And for years and years and years, I thought, "I have no music ability. I can't sing." I just stayed away from music for a really long time. And then I started allowing myself to sing in the shower, and now I'm doing musicals as well as playing the drums. So don't let your grade one teacher keep you from enjoying music. It's in you. It's in everybody. To find out more about how you can boost your brain health to reduce your risk of dementia or slow its progression, please visit us at defydementia.org. There you can check out other episodes of the podcast as well as our videos, infographics, and other resources. Jay: Our podcast production team is Rosanne Aleong, Helen Chen and Sylvain Dubroqua. Our writer and producer is Ben Schaub. Production is by Pod Tech, music by Steve Dodd and our cover art is by Amanda Forbis and Wendy Tilby. Allison: And we'd also like to thank the people who fund the podcast, the Slaight Family Foundation, the Center for Aging and Brain Health Innovation and Baycrest. Jay: And we greatly appreciate your support as well. So hit that subscribe button for Defy Dementia on Spotify, Apple podcasts, or wherever you get your podcasts. And please be sure to leave a like, a comment, and maybe even a five-star review. Allison: Next time on Defy Dementia, we're going to ask provocative questions like, "To what extent does our attitude affect dementia risk? Can a positive attitude help slow progression of a disease like Alzheimer's?" Prepare to be amazed by the answers. I'm Alison Sekuler. Jay: And I'm Jay Ingram. Thank you for listening to Defy Dementia. And don't ever forget, you're never too young or too old to take care of your brain.