A Conversation with Expert Borna Bonakdarpour, MD
By Hrayr Attarian, MD
Little was known about the impact of music on dementia, especially of the Alzheimer’s type, until the beginning of the 21st century. Even then, this knowledge did not seep into the public consciousness until the 2014 documentary Alive Inside: A Story of Music and Memory. Michael Rossato-Bennet’s brilliant film highlighted the benefits of music therapy in a group of nursing home inhabitants with cognitive impairment due to a variety of neurological illnesses. This award-winning film also kickstarted the charitable foundation of the same name, raising money to make music available to a wide variety of individuals suffering from dementia.
Alzheimer’s disease (AD) is the most common cause of dementia, accounting for about 60–70% of cases (1). The risk of AD increases with age and about 42% of those over 85 years of age are at risk of developing AD (2).
To elucidate the role of music therapy in AD we approached Dr. Borna Bonakdarpour at Northwestern University’s Mesulam Center for Cognitive Neurology and Alzheimer’s Disease. Bonakdarpour is an assistant professor of neurology, a renowned scientist, and an accomplished pianist. He gave us his take on the role of music therapy in AD and he discussed with us his research, his clinical work, and his passion for music.
HA: One of your main research areas is music therapy in Alzheimer’s dementia. What constitutes music therapy?
BB: I am currently leading two projects that focus on therapeutic effects of music in moderate to severe dementia. One is in collaboration with Institute for Therapy through the Arts for an intervention called Musical Bridges to Memory (MBM ®) and the other with Northwestern Bienen School of Music professor Nancy Gustafson using a singing intervention called Songs by Heart (SBH).
Music therapy is when music is used for therapeutic benefits and it is administered by a board-certified music therapist. Music therapy in dementia has a goal to decrease symptoms of depression, agitation, and irritability, and also to improve quality of life for patients and their family members. If well designed, it can also help with some memory-based retraining methods.
HA: How do the different types of music therapy compare with one another in helping with symptoms of dementia?
BB: I’ll give you the example of the two projects I am involved in. One (MBM) uses once-per-week concerts for a group of individuals with dementia and their care partners (a dyadic approach). This intervention is administered for 3 months. It also includes care partner training before and after the intervention. That way the effect of the intervention can go beyond the music session as it has an educational element as well. Rhythmic and dance music, popular songs, and pleasurable songs are used in this method.
The other intervention (SBH) uses only singing to engage patients with dementia, however, at a higher dose of daily programs and for a month. So the difference is in the type of music used, dose of music administration, and inclusion or lack of inclusion of care partners.
HA: What changes in your assessment of the patients do you see after music therapy?
BB: Our studies so far have shown improvement in neuropsychiatric symptoms (agitation, irritability, depression, etc.), better social engagement, and decreased caregiver distress.
HA: What structural and functional changes, if any, do you see in the brains of people with dementia with music therapy?
BB: One study has shown increased global connectivity in the brain with areas involved in processing of music. This means through regions of the brain that are intact for processing of music in dementia we can tap in to other regions of the brain and help with their function.
HA: What other projects looking at music therapy do you have?
BB: Other music-based interventions that I am working on are tele-music intervention for patients in the neurology unit at NMH, tele-music performances for mild dementia, and music for NM staff to help with mental well-being. During the COVID-19 pandemic I also joined many fundraising events to fund raise for COVID-19 efforts to support essential workers, posted on social media under #SongsOfComfort. Music is a psychological “first aid” at the time of disasters. Based on the same idea I joined forces with Northwestern Medical Orchestra and faculty and students of Northwestern Bienen School of Music to form a virtual orchestra to support health care and essential workers. We called the orchestra the Northwestern Virtual Orchestra. We also plan to have music programs for underrepresented groups in Chicago combined with educational lectures to increase awareness about different neurologic disease and to bring music to patients who may not have access to it easily.
HA: What is the role of a music therapist in your research and treatment models?
BB: Music therapists have spent years to specialize in work in clinical settings. I refer patients to music therapists if I feel it is an appropriate intervention for them. For research, administration of music is usually with the help of music therapists and music practitioners.
HA: In addition to being a neurologist specializing in cognitive and memory disorders you are also a pianist. Tell us please about your musical journey?
BB: I grew up in a very musical and scientific environment. I chose to have both in my future career and to combine both passions both clinically and in my research. My doctoral dissertation evaluated the effect of Melodic Intonation Therapy in patients with strokes who have difficulty with speaking (so called non-fluent aphasia). Now I collaborate with many music therapists and top Chicago musicians who have interest in patient care through music.
HA: Who are some of the professional musicians with whom you have collaborated?
BB: I have collaborated and performed with Clara Takarabe, violist, who plays with Chicago Symphony Orchestra (CSO) and Los Angeles Philharmonic Orchestra; and Frank Babbitt, Lyric Opera of Chicago violist. I am also collaborating with Civitas Ensemble (members of the CSO) and members of the Lincoln Trio. All world-class musicians.
HA: Do you perform and record outside of your research or do you plan to do so?
BB: I regularly perform and record piano or collaborative pieces and post them on social media. I have also been performing for fundraising and scientific events that are focused on neurology and music. Last year, for example, I performed and gave a lecture at our Alzheimer Day Conference at Northwestern.
References
1. Burns A, Iliffe S, Alzheimer's disease BMJ. 2009;338:b158.
2. Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer Disease in the US Population: Prevalence Estimates Using the 2000 Census. Arch Neurol. 2003;60(8):1119–1122.