Sound Medicine

Three years ago, at a conference involving traumatic brain injury, Linda Maguire’s two worlds—music and neuroscience—merged in a particularly dramatic fashion.

There was a flurry of urgent text messages: Was she available in a few hours to fill in for a soloist who was ill?

“I had to leave the conference and sing Verdi’s ‘Requiem’ that night at the Strathmore concert hall in North Bethesda, Maryland, and darn if I didn’t pull it off,” recalls Maguire, MA, a Master of Health Science student in Mental Health.

A classically trained vocalist with numerous performances of leading opera roles and classical music recordings to her credit, Maguire is equally devoted to science. Her research into music and the brain, mainly in Alzheimer’s patients, continues to blend her two passions.

What was for years an amateur interest became a serious academic pursuit not long after she visited a friend with Alzheimer’s in a facility for dementia patients. She witnessed behaviors characteristic of the condition—lethargy, aggression, confusion.

Then she began to play the piano.

“Music not only calmed and redirected them, it clearly provided access to brain networks while nothing else could,” recalls Maguire, who cut back her performing schedule to study cognitive and behavioral neuroscience, earning a master’s in psychology last year.

Now she’s working to harness the power of music—using a science-based approach—to improve the lives of Alzheimer’s patients.

Maguire’s focus is on the use of “prescriptive” music to elicit specific physiological changes that, in turn, bring about positive and measurable responses such as decreases in blood pressure, heart rate and stress hormones.

It’s well established that music can powerfully benefit dementia patients. What’s missing from the equation is an understanding of how musical characteristics—including rhythm, structure, tone, instrumentation, melody and vibration intensity—drive behavioral and cognitive changes.

She likens her “prescriptive music model” to a physician’s use of prescription drugs. “There’s a difference between entertainment and prescriptive value,” says Maguire. “I’m working on developing a foundation to use music as a true and legitimate clinical intervention.”

Nancy Hodgson, PhD, RN, an assistant professor at the Johns Hopkins School of Nursing and Maguire’s thesis advisor, says that her research into music as a precisely targeted clinical intervention holds promise as an effective non-pharmacological approach to enhance Alzheimer’s care.

“I think she’s onto something very innovative,” Hodgson says. “Her proposed design is attentive to detail, and she brings the perspective of a well-established, highly regarded musician.”

Maguire is currently conducting a review of the literature on the physiological response to develop a computerized prototype targeted to dementia patients. Her model relies on a comprehensive physiological and psychological assessment to design personalized music prescriptions that “escort” patients to desired outcomes in mood, cognition and activity levels.

One component of her thesis focuses on “sundowning syndrome” in Alzheimer’s patients to mitigate problematic behaviors that typically occur with more frequency in the late afternoon hours.

The music selection might start with a favorite hymn, a selection that often connects with dementia patients in an agitated state.

“You can build from that point to take them to other arenas,” Maguire says.

Continuing to alleviate the anxiety, Bach’s “Air on G” or Josef Rheinberger’s “Cantilena”—pieces that can trigger relaxation responses—might figure in the repertoire.

“It gradually establishes a physiological domain where anxiety can’t happen because it doesn’t have the physiological ingredients to happen,” Maguire explains.

Although her primary focus is on Alzheimer’s disease, Maguire says that the medical music model is applicable to patients with PTSD, depression, schizophrenia, autism and other conditions.

“A lot of vets with PTSD love heavy metal because that’s what they’re living,” she says. “If you play something sweet and classical, they’re going to reject it.”

Looking ahead, Maguire hopes to develop a website of archived clinical music programming that can be accessed by health care providers and delivered on a professional level.

“I’m just putting together a very logical model, based on empirical research,” she says. “It might serve as a turning point in music medicine.”