Interview: Academic Research Fellow Teppo Särkämö

Academy Research Fellow, Docent Teppo Särkämö has studied the brainstorming of music processing through imaging studies and how the aging brain deals with music.

What does music mean to you?

– ”I’m not a musician myself and I’ve never played any instruments actively. I love music and it has been present in my life on a listening basis ever since I was young, especially as a means to wind down, deal with stress and feel pleasure. From my job’s point of view, music equals fundamentally an interesting subject and a challenge. I want to understand how music is processed in the brain, how it differs from processing speech, for example, and what kind of an effect it has on rehabilitation. Or when different types of music-related processes in the brain are studied, I ponder if music is more than the sum of its parts.”

Is there a memory disease patient in your circle of loved ones?

– ”There aren’t any memory disease patients in my own circle of loved ones at the moment, so I’m lucky in that sense. Personally, I represent the role of a coordinating researcher in our studies. The practical experience we’ve gained has come mostly from music therapists and singing teachers via group activities and also from the participants themselves via questionnaires.”

In 2014, there was a research that studied music’s effect on quality of life in the early stage of dementia. You were in that research group. What made you join it?

– ”Our own research about music and neurological rehabilitation actually began already back in 2004 when we started to study the effects of listening to music in the rehabilitation of acute stage of ischemic stroke and we noticed that it had positive effects. At the point when we were finishing the research in 2008, a new question arose: could music have a similar kind of effect on a memory disease? This isn’t really a new question as music therapy has been used in different forms at special care units for a long time now. However, most often its intended purpose is narrowed to controlling dementia-related neuropsychiatric symptoms in the advanced stage of Alzheimer’s disease, so the main aim of music therapy is to decrease depression and anxiety, aggression and agitation, and other difficulties that are often detected at care units.”

-”We wanted to study this a bit more widely by finding out if also the families and nurses that work with memory disease patients could find their own way to use music in their daily care work that would at the same time be individualised for the memory disease patient. For this, we developed a model that employs music, either listening to it or singing it together, as more like a training model to the families and nurses. With the help of group intervention, we aim to find out what kind of music matters the most in the life of the memory disease patient, what contains the greatest amount of feelings and personal memories, contents of life and importance. In particular, we aimed to find the kind of individualised music that works in different situations: music that helps them to wind down and relax and also to find energy and get active. The goal was to make music a helping tool in the everyday care that a close relative or a nurse would use together with the memory disease patient regularly.”
 

What was the final conclusion of the research?

– ”This was an efficacy study where 89 pairs of a memory disease patient and their close relative participated in the area of Helsinki and Espoo and they were divided in three groups. In one group, we employed familiar music via singing and another one was focused on listening to music and discussing the memories and feelings they brought. In these groups, the intervention lasted 10 weeks and it consisted of both weekly group sessions and exercising at home. The third group was a control group that had no extra music activities. We noticed that compared to the control group, both listening to music and singing it were beneficial when it came to general cognitive ability to function that was measured with the classic MMSE screening, and also when it came to alertness and activities estimated with other neuropsychological tests. Via questionnaires, we found out that the music interventions also decreased the symptoms of depression.”

-”Perhaps the most important and interesting main result was that singing helped to improve the activity of the lingual working memory better than listening to music. The result is sensible to consider because singing is all about an active cognitive process that brings lyrics back to mind and makes you produce them, and the fact that it might have a transfer of learning in the memory activity in general is important. Also the close relatives who were in this singing group found that they were feeling better mentally and their stress decreased which is important considering the fact that the role of a carer is very heavy and burdensome.”

-”The effect that the singing group was noticed to have on working memory was the clearest with the patients whose dementic symptoms were still on a mild level. A similar kind of result has been achieved also in two international studies. It looks like from the cognitive point of view, the most effective thing was music intervention that is targeted as early as possible and where people produce music actively and as a part of a group. In advanced dementia, the benefits that are gained for memory and other cognitive activities are clearly more limited, even though music is a very suitable part of the treatment also at this stage, especially when it comes to emotions and well-being.”

This research of yours has been referred to around the world and Finland is a pioneer in memory knowledge and skills in general. Is there something new coming up?

– ”We have a lot of new research going on. We have just begun a wide 5-years-lasting research project that has been funded by the European Research Council. We study singing and its brain mechanisms in normal aging and neurological diseases, especially with people who have become sick with aphasia as a result of ischemic stroke. We study which brain mechanisms are responsible for keeping the ability to sing and learning new songs in aphasia and if singing in a choir and singing-based speech exercises in a group, aka melodic intonation therapy, could be beneficial in the lingual and cognitive rehabilitation of aphasia patients and also when it comes to mood and social interaction. In addition to that, we study how emotions and memories that music revives stick in the brain in the different stages of Alzheimer’s disease, from the mild stage to the advanced stage.”

Should students that are training for the health and social care field get education on using music in their care work and upbringing work while they’re at school? In what ways?

– ”They definitely should. The latter question is a bit more difficult. Based on what we know about the significancy of music and its effect and its special remaining in Alzheimer’s disease, I recommend people to try it in all care work with memory disease patients whenever it’s possible. The challenge is often the attitudes related to music: either people don’t consider it effective enough or then they think that using it as a part of care work requires being particularly talented or educated in music. In a wide study made in Asia, they asked the nurses about using music in the care of dementia: majority found that music would be beneficial but they hadn’t used it in their work because they thought that they didn’t have the skills required for it.”
 
-”In Finland as well, we’re probably too used to thinking that music is for professionals to play and it can only be put to use when one has an education or a strong background of musical hobbies. I think that kind of thinking takes the idea to the wrong direction and raises the threshold unnecessarily. Listening to music and having simple sessions of mutual singing are needed, they are easily arranged and don’t require being a professional in the field of music in any way. Educated music therapists and musicians have their own important role in putting the more individualised musical rehabilitation into practice, of course – and also in training the nurses to carry it out – which the society should have more resources for. Regardless of who carries out the music therapy, the most important thing is to approach the memory disease patient as an individual, taking their personality and own music background and taste in music into account. If the memory disease patient is incapable of sharing it themselves, it’s worthwhile to map out the patient’s musical history with the help of their close relatives or give it a direct try with, say, old evergreen songs. The practical challenge is the generation gap between the elder memory disease patients and young nurses, of course, who aren’t familiar with the music of the patients’ youth.”

-”We have a project going on in which we collect material of the familiarity of folk songs and songs from the 1950’s-1970’s and their emotional significance, and the personal memories that healthy old people and also dementia patients associate with them. One practical goal is to create a library of old school music which could be used in care work. Music preferences and experiences are very personal, of course, but a music library like that could be a good starting point for making individualised music choices. After finding the right music, another important point would be to recognise which situations it should be used in the everyday life for it to be the most beneficial.”

-”In the discussion that has been going on about medication free treatment of dementia lately, it has been stated that music could be a medicine of sorts, ”a music pill”, that could be used in a way that can be equated to medicinal treatment. It is good to keep in mind that music is no magical cure that could have a long-term effect on the cognition and mood of the memory disease patient. In the same breath, I would say that if music can really be used systematically and repeatedly, in short moments several times a day, we could possibly achieve similar kind of effects with it. This should definitely be studied. In Sweden, for example, they have studied using a care song in the treatment of dementia and it’s been observed that if a nurse sings while, say, washing a patient that is sick with a severe memory disease, it can be carried out in better communication and more calmly. Via the individualised use of music and studying it, we could possibly reach a situation in the future where the patients’ often very heavy symptomatic medication could be gradually lightened by adding music.”

In THL’s study called FINGER, the precautionary effect of music on becoming sick with memory diseases was brought up. How much music should one listen to for it to have an efficient effect, and is live music a better option?

– ”In FINGER, they used a multifactor intervention where music was involved as one of the components in addition to i.a. physical exercise and cognitively stimulating games. We are yet to figure out what the selective effect of music is compared to other activities and how much music should be used with memory disease patients, for example. In our own research, with people rehabilitating from ischemic stroke, we got positive results at the acute stage rehabilitation when music was listened to at least for an hour per day during the first two months. When it comes to deteriorating brain diseases, like dementia, it’s quite a different process also from the brain’s point of view and similar kind of neuroplastic rehabilitation effects cannot be expected. Active group-form music interventions are more effective to the memory disease patients than listening to music, especially in the early stage of memory disease, and it would be good to have them several times a week. I cannot state anything more exact about the amount at the moment.”

-”There have been a few qualitative studies about live music where people have compared the effects of recorded songs and live songs and it has been noted that live music has a greater effect on emotions and state of vigor, especially if the patients can participate. It would be important to have a great amount of music that is used in care work live-based but it doesn’t mean that there should be a professional carrying it out. There is also a lot of developing to do when it comes to hospital musician activity and care culture in Finland. In England, for example, the number of hospital musicians is much greater and there the funding is much more donation-based than in Finland.”

-”From future’s point of view, one of the most pressing questions is how music interventions could be targeted especially to the beginning of the mild stage of the memory diseases, in other words to the phase of mild cognitive impairment when the patient is still living at home with the support of their loved ones before the diagnosis of dementia. At this point, the cognitive reserve, in other words the experience gained in the earlier education and working life and also hobbies that stimulate the brain, play a part in defining how the disease advances and how long they will be able to live at home. Figuring out the role of music in this equation would be one of the Holy Grails in the field of music rehabilitation which we are putting a lot of work into finding. Let’s hope we will.”

How does putting music to good use in the everyday life of the memory disease patient affect the energy levels of the carer?

– ”We noticed in our own study that the people who participated in the singing group had less general stress and mental burden in their role as a close relative or carer. Quality-wise we got a lot of comments that it provided a possibility to a very fun and different kind of communication with the memory disease patient that was missing from the everyday life. It is often a huge challenge to senior couples when the disorder enters their life and changes the dynamics of the relationship and makes it difficult to manage the everyday life and brings financial challenges. For carers it’s often extremely hard and burdening. Singing together – and music in general – provides a possibility to momentarily break that pressure and conflicts and go back to the positive times and mutual memories that are often associated to songs especially in long relationships. Famous neurologist Oliver Sacks has stated beautifully that in a memory disease, music can momentarily take the person back to a time that was a lot richer and hence work like a gateway to the earlier time and personality before the disorder. This way also the loved ones can share feelings and memories with the patient. Music can also be a personal stimulus and spare-time activity to carers, and several of the close relatives who participated in the study told that they had become excited about continuing their own music hobbies and joined a choir, for instance.”  

Does one’s taste in music change when the disorder advances? A person sick with a memory disease often goes back to their youth during the disorder, so does this also show in their taste in music?

– ”This has never been studied very deeply but based on the experience we’ve gained from out studies, it seems like the significance of the familiarity of music is emphasised when the disorder advances, and the patients gravitate toward music that is mainly from their childhood and youth. We’re talking about a retrogenesis phenomenon which means that all the learned skills and gained memories start vanishing in a reversed order when the disorder advances, so the newest ones go first and what we’ve learned in our childhood and youth sticks with us better. Music isn’t an exception in this sense.”

-”When it comes to the social point of view and the music used in the rehabilitation, a very interesting question is what happens in the future when there will be a certain change of generations among the memory disease patients. At the moment, the common music for memory disease patients is especially Finnish post-war schlager music from the 1950’s-1960’s but when it comes to the bigger age groups, the music will be from the 1960’s-1970’s, Beatles etc. The younger the generations are, the more the common musical ”capital” is fragmented containing a wider range of music and different music genres. This will be a challenge of its own in the usage of music in care work when finding significant music on an individual level will be difficult and there is also a need for different kinds of music tools.”

-”In England, for example, there are great innovations and apps, such as Playlist for Life with which it is possible to build playlists of music from different decades on an individualised level. Also the idea of a music will is great. In it a person who believes they’re becoming sick with a memory disease could log the songs that matter to them the most and then it would be delivered to the close relatives and care staff throughout the care chain. Or while the person is listening to the songs, they could documentate and save the personal memories the songs bring to mind and then share them with the younger close relatives. This kind of tools are definitely needed in the future.”

 What was the most recent gig you went to see?

– ”I must have gone to see my most recent gigs at Flow Festival in the summer of 2017. I was impressed by London Grammar in particular while Goldfrapp, which I was a fan of when I was young, was more like a disappointment. Last spring, it was nostalgic to go to see Metallica with my own sons who were pretty much the same age that I was when I went to see them the previous time.”

 What music will be playing in Teppo Särkämö’s player in 30 years?

– ”I think it will play music from my youth again. I was a teenager in the 1990’s so many grunge and heavy bands such as Soundgarden, Nirvana, Alice In Chains, Type O Negative and Rage Against The Machine are my own music capital from my youth. After that, I started listening to more melodic electronic music, such as Massive Attack, Björk and some other bands I’ve listened to during the years. It’s interesting that when I’m listening to the old songs, they don’t quite sound or feel the same as they did when I was young but the memories and old feelings I had back then that they contain come back to mind vividly – and will remain for sure.”

Interview: Marko Mustiala / 2019

Photos: Ville ”Unicorn” Tarhala, Pixabay

Translation: Heidi Malin