The Extraordinary World of Music and the Mind

The nurse looked at Tomaino in shock. “She said, ‘What just happened?’ ”

Two years later, Tomaino was hired as the music therapist at Beth Abraham Hospital in the Bronx — where Oliver Sacks was a neurologist. He was already famous for his 1973 book Awakenings, which chronicled his use of the experimental drug L-dopa to awaken patients who had been “frozen” for decades in a coma-like state from a virus called encephalitis lethargica. Tomaino saw an obvious parallel with dementia patients. “So I said to Oliver, ‘Did you ever see this?’ He said, ‘No! Show me!’ ” Sacks was floored. “He said, ‘We gotta look at this and figure out what the heck is going on!’ ”

Through the 1980s, with Sacks’ input, Tomaino studied the positive effects of music on the mood and memory of Beth Abraham’s dementia patients. The work drew increasing attention after the 1990 release of the movie adaptation of Awakenings, and reporters descended on Beth Abraham in search of new medical miracles. In a joint interview with The New York Times in 1991, Sacks called music a “neurologic necessity,” and Tomaino said that music could “locate the lost personalities” of dementia patients — a phenomenon she demonstrated that same year on a segment of the TV show 48 Hours when she played a swing tune on her accordion for a near-catatonic dementia patient, who jumped out of his wheelchair and started dancing (he had been in a dance act with his brother in his youth). “The staff got really excited,” Tomaino says, “so the physician assistant would sing to him, the orderly would sing to him as they walked. He eventually went back home to his daughter.”

Two years after that, Tomaino convened the first-ever conference on Clinical Applications of Music in Neurological Rehabilitation. “The scientific and medical community was still on the fence about music and the brain,” she recalls. “We hoped to push the dialogue. We had over 125 people show up, some from outside the country, and we needed to send some away.” This gave Tomaino the momentum (and the funding) to help launch, in 1995, the Institute for Music and Neurologic Function at Beth Abraham. Since then, there has been an explosion of interest in the field of music and memory.

Mysteries remain about how memories are created, stored and retrieved in the brain and how music acts to revivify them in dementia patients, but answers have begun to emerge, thanks to advanced brain scanning technology that did not exist when Tomaino and Sacks did their early research — specifically, fMRI. This technology uses a strong magnetic field and radio waves to track blood flow throughout the brain, showing what areas are active during physical tasks, like moving the fingers (which “lights up” areas of the motor cortex in an fMRI scan), or during cognitive tasks, including decision-making and memory.

A brain scan showing areas stimulated by new,recently heard music (blue) and by long-known tunes (red).

Illustration by Chris O’Riley (Music and Health Science Research Collaborative [MAHRC], University of Toronto; Keenan Research Centre for Biomedical Science, St. Michael’s Hospital)  

All memories, regardless of how vivid and indelible they seem to us, are electric and chemical signals in our brains that travel through a network of neurons. Decades ago, it was believed that there was a dedicated memory module of the brain where the past was stored. fMRI revealed that many areas of the brain are involved with memory, from the brain stem (seat of automatic tasks like breathing and blinking) and the emotion centers (including the amygdala, with its fight-or-flight reflexes) to the seeing and hearing centers; from the executive areas of the brain (where thinking and decision-making occur) to the part where long-term memories are processed. 

None of this should be especially surprising when you consider the layered richness of memory — the distant sights, sounds, smells, feelings and conversations that can be evoked by something as ephemeral as a scent on the breeze.

Memories begin with our five senses, through our experience of the world. The memory that allows you to recognize your mother was first encoded when you were a baby, from seeing, hearing and smelling her — sensory stimuli that resulted in the firing of neurons that wrote the memory “Mom.” 

Through repeated exposure to your mother, that memory grew increasingly durable, owing to actual physical changes in your brain. When specific groups of neurons are repeatedly activated, they strengthen the synaptic connections between them. (“Neurons that fire together wire together” is the saying in neuroscience.) Which is how a memory vital to your continued existence — That’s my mom! — becomes strongly encoded and efficiently accessed.

But even the memory of your mother can be lost if something chokes off the electrochemical signals that flash along those neurons. This is what is thought to occur with Alzheimer’s disease. Certain brain waste products — so-called tau tangles and amyloid plaques — as well as other factors, the theory goes, can disrupt and destroy neurons and their connections, especially in areas of the brain associated with memory — even as strong a memory as Mom. 

Alzheimer’s is progressive. As more brain cells die, more of the past vanishes. Of all the attempts to hold on to memories in the face of this loss — through drugs, diet and exercise — music has proved to be among the most successful. Again, fMRI offers a possible explanation for why.

Listening to music, fMRI reveals, is (like memory itself) a full-brain workout; a wide distribution of brain structures light up, including the:

• Brain stem. Rousing classical music makes the pulse and blood pressure rise; soothing lullabies make them drop.

• Motor centers. These are the source of the irrepressible urge to tap the toe or bob the head in time with music.

• Language centers. They light up to a song with lyrics we remember.

• Auditory cortex. This is where music’s pitches and tones are processed.

• Emotion centers. Here feelings of yearning, joy, exultation, sadness, fear or loss are touched off by changes in the music’s tempo, pitch, volume; in the executive centers, thoughts and memories connected to the music are activated.

• Visual systems. Think of how a dark and stormy passage of Beethoven’s Ninth Symphony can call up images in your mind of black and turbulent skies. Disney did it for us with “Night on Bald Mountain” in Fantasia.

This full-brain workout hints at why melodies and lyrics — particularly those from songs that have personal significance to us — have such a peculiar sticking power in our memories. fMRI scans reveal that such “auto-biographically salient” music is written into many parts of the brain — the movement center, for instance—not touched by Alzheimer’s until the very last stages of the disease. Music, by stimulating these preserved parts of the memory network, seems to reach into those areas of the neocortex, the brain’s wrinkled outer layer, to find those neurons that have not yet died off, thus triggering memories thought to be lost forever.

Part IV “Rocket Man”

Many caregivers and clinicians report that the memory-enhancing, mood-improving benefits of music are temporary, lasting only as long as the music is playing — and for a period of about 15 minutes afterward. 

But experiments Tomaino conducted in the 1990s suggested something different. In a 1993 study, funded by a $250,000 grant from the New York State Department of Health, she was able to hire enough music therapists to administer a lavish amount of music therapy on small, five- to six-person patient groups, in 30-minute sessions, three times a week for 10 months. A battery of cognitive tests conducted before and after the therapy revealed significant improvements in brain function and behavior. Formerly silent patients, Tomaino reported, began addressing staff by name and participating more appropriately in conversations than those who participated in verbal reminiscence groups—“implying,” she wrote, “that there is a potential for improvement in patients with dementia.” In a follow-up study in 1996, 121 dementia patients also showed “significant changes in behavior and affect.”

Tomaino did not have access to an fMRI machine, so her research lacked the hard evidence of physiological brain changes — and her findings failed to gain much traction. But new research has emerged that supports Tomaino’s observations, including fMRI studies published in 2021 from a project led by Michael Thaut, a professor of music and of neuroscience in Toronto.

Thaut had always been fascinated by the power of music. Prior to becoming a neuroscientist, he had been a professional violinist in Europe. In the early 2000s, while working as a neuroscientist at the University of Colorado, he did groundbreaking research involving people with Parkinson’s disease and those recovering from stroke, showing that when rhythmically strong music was played to such patients, they synchronized their walking gait with the music and moved more quickly and with better joint control. The therapy is called rhythmic auditory stimulation. “Stroke patients walk much more symmetrically and faster,” Thaut told me recently over Zoom. “Parkinson’s patients don’t have that shuffle and tendency to fall over.”

For years, Thaut had been hearing anecdotal reports of music’s power to help dementia patients, and he had been eager to study the phenomenon. He got the chance in 2016 when he accepted a professorship at the University of Toronto and helped create a partnership with the Keenan Research Centre for Biomedical Science and geriatric psychiatry at St. Michael’s, one of the city’s largest hospitals. His first experiments in music and memory using fMRI, in 2018, compared the effects of “autobiographically salient” music that Alzheimer’s patients had loved and listened to for 25 years or more with brand-new music created by Thaut and his team. 

Patients first heard the new music an hour before they entered the scanner. When they heard it again during their scans, it had no deep encoding in the brain — it activated the auditory area only. “Basically, a sensory memory,” Thaut calls it. The beloved, familiar music, however, when played to patients in the scanner, lit up a larger network of the brain — including in the frontal lobes, where higher-order reasoning and memory are processed, a clear and objective sign of a musical “memory trigger” for people with dementia.

“They recognized it in terms of ‘that is music I know,’ ” Thaut says. “ ‘I know what that is! That is the music I danced to when I met my wife.’ This activation spreads throughout the entire cortex — and the whole network comes alive.” 

He stresses that hearing autobiographically salient music does not regress patients to an earlier time of life. Quite the reverse. “It actually triggers a cognitive boost to orient them in the immediate reality. One could say, ‘Oh, they remember music from when they were 15 years old, and they feel like a 15-year-old again.’ No. They’re not suddenly acting like a 15-year-old. The music gives them a sense of orientation in the here and now—and an identity: ‘That is part of my life. I know who I am.’ ”

In a different experiment, Thaut also reported a boost in cognitive functioning — a finding similar to what Tomaino had seen in the 1990s. Alzheimer’s patients who listened to personal playlists of favorite music daily and talked about what they could remember with their spouse or caregiver for one hour a day for four weeks showed significant improvement on memory tests, Thaut says. 

“That is extremely unusual. Ordinarily, these patients don’t improve in anything; if you’re lucky, you can slow down the decline ramp.” He hastens to add that he and his colleagues have not found a “cure” for Alzheimer’s or dementia. “We cannot say that we are reversing the disease, because it has a certain biological process. We are not, for instance, destroying, with music, the amyloid plaques or the tau tangles that are believed to be the cause of the memory loss. But in areas of the brain, activating preserved networks gives people at least a cognitive boost that allows them to operate in a more functional way.”

The most eye-popping of Thaut’s findings is that after four weeks of listening to their favorite music daily, patients’ brains had a greater density of white matter. “If you have an increase in white matter density or volume in a certain area of the brain,” Thaut says, “that means there are more highways active between the neurons. There’s more traffic.” A dead neuron cannot be brought back to life, but music appears to bolster connections between preserved neurons. “So we are building as much as we can around destroyed stuff,” Thaut says. 

“It’s a bit like a city that gets bombed. Many houses are gone, but we can emphasize what is still standing. We can figure out how to get a street from here to there. We can rebuild to make that city support as much life as possible.”

All of this raises the question, for those of us not afflicted by dementia, of whether we should be loading up our Spotify Rocking ’70s playlists with the songs we first fell in love with in our teens and early 20s — that period of life when, according to Daniel Levitin, a musician, neuroscientist and author of This Is Your Brain on Music (2006), most people form their musical tastes. 

Says Thaut, “We can assume that active and positive stimulation is good for brain health. Engaging in music you like and enjoy is definitely a great part of it. Can it reduce risk for dementia in the medical sense, like aspirin against stroke? No. There are many factors—genetics, injuries, etc.—that contribute to disease. But it may provide boosts to keep the brain healthy longer.”

And don’t worry about friends or spouses who deride you for engaging in empty nostalgia when you fire up Elton John’s 1972 banger “Rocket Man” for the 20th time that month. It is precisely the familiarity of such music, the memories around it, the goose-bump-inducing pleasure of its soaring chorus and the surge of dopamine that can be released by your brain’s pleasure and reward centers as that crescendo arrives— “I’m a rocket MANNNNN … And I think it’s gonna be a long, long time!” — that can make such beloved songs so therapeutic, according to Thaut. “This is your daily brain exercise,” he says. “As a general principle: If there’s something that’s good for you, do it as much as you can.”

Listening to new music has its own rewards, of course — what better way to bond with a tween than over Taylor Swift? But for revving up the memory centers embedded throughout your brain, science seems to suggest that familiar tunes work best.

Part V “She Loves You”

I learned firsthand about the miraculous power of music for dementia patients in November 2020, when, for this magazine, I was researching a story about Tony Bennett’s previously undisclosed Alzheimer’s disease. 

Visiting him in his apartment on Manhattan’s Central Park South, I saw a man unable to converse, who barely registered my presence and who, I was told by his wife, Susan, had forgotten the use for common objects like a fork or keys. Yet when his longtime piano accompanist began to play, Bennett, at the sound of the first notes, came alive, walked to the piano and proceeded to perform, impeccably, an hour of music from his set, recalling every lyric, crescendo, melody, physical gesture. It was impossible to believe he was in the late stages of a devastating illness that two years later would end his life.

Now, once again writing about music and memory for AARP The Magazine, I am delighted to discover that, like Bennett’s, my own memory is unlocked by musical triggers. I have, for the last couple of years, been writing a memoir and, at age 65, I find that I am getting to it just in time — before certain salient aspects of my past have faded from my synapses forever.

The author with mom Carol, circa 1963.

Courtesy John Colapinto

Recently, I was revising a chapter concerning my earliest memory of my late mother — a memory from when I was 4 years old, in my native Toronto, and we were drawing on sheets of brown packing paper while the radio played a song that had just burst onto the Canadian airwaves and caused a sensation. It was called “She Loves You,” and it was by a new group named the Beatles. 

The date was September 1963, which I can state with accuracy because that is when the song debuted across North America. Though a massive hit in Canada, the song flopped in the United States — the Beatles would have to wait more than four months for a U.S. hit with the release of “I Want to Hold Your Hand” and their epochal appearance on The Ed Sullivan Show.

In any case, in my original draft of this scene, the details were annoyingly hazy. I knew my mom was encouraging my nascent skills as a cartoonist, but all was dim and undefined, lacking the specific detail that makes writing come alive. But thanks to my experience with Tony Bennett, and my more recent encounters with Connie Tomaino, Xiyu Zhang and Michael Thaut, I decided to listen to “She Loves You” as a memory prod.

Reader, I might as well have discovered that someone had secretly filmed and recorded my mother and me that distant afternoon. Now, with the music as spur and prod to my memory, I could “see” that, on that day six decades ago, I was drawing the Beatles’ faces on that packing paper — and that my mother, to aid me, had laid out, open on the floor, a sheet of newspaper that featured photos of the Fab Four.

Pointing to each face in turn and saying their names (“Paul … John … George … Ringo”), my mother was brought back to life, de-aged to a youthful 31, and I could see her nimbus of soft brown curls, her large green eyes, her huge smile — That’s my mom! — as she exclaimed over my attempt (failed, as my revived memory assures me) to capture the Beatles’ individual looks. It was a heart-stopping journey back in time, a resurrection that, frankly, moved me to both smiles and tears.

At least for as long as the music played.