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Preservation and Efficacy of Music and Singing in Ageing, Aphasia, and Alzheimer’s Disease

Periodic Reporting for period 2 - PREMUS (Preservation and Efficacy of Music and Singing in Ageing, Aphasia, and Alzheimer’s Disease)

Reporting period: 2020-07-01 to 2021-12-31

Music is a highly complex and versatile stimulus for the brain and closely linked to the neural networks that process verbal, cognitive, motor, and emotional information. In severe ageing-related neurological disorders, such as aphasia after stroke and Alzheimer’s disease dementia, music and singing may provide a valuable alternative route to verbal and emotional expression and to memory and self-awareness, but the brain mechanisms underlying this are still poorly understood. Music-based interventions may also be beneficial in ageing and in neurological rehabilitation, but we still know little about the therapeutic potential of singing, especially group singing, to support healthy neurocognitive ageing and recovery from aphasia.

PREMUS utilizes modern behavioural and neuroimaging methods to deepen our understanding of music in the ageing, recovering, and degenerating brain. The project has three main aims: (i) explore how the neural networks that govern the processing of speech, music, and singing change during normal ageing as well as after neural damage and neurodegeneration, (ii) explain which mechanisms drive the preservation of singing ability in aphasia and of music-evoked emotions and memories in Alzheimer’s disease, and (iii) determine if singing can have long-term positive effects in normal ageing and in aphasia rehabilitation.

PREMUS will deepen our systems-level understanding of the structural and functional relationship between singing, speech and music in the ageing brain and provide new empirical evidence for the therapeutic power of singing in supporting emotional, cognitive, and social well-being and brain health, both in normal ageing and in aphasia. This knowledge is important for optimizing the use of music and developing new music-based rehabilitation methods for age-related neurological disorders, which are becoming increasingly common and burdening, both at individual and societal level, in our ageing population.
PREMUS comprises of four parallel studies exploring (i) the effects of ageing and singing experience on the neural processing of singing, speech, and music (Study 1), (ii) the long-term efficacy of choir singing on neurocognitive ageing (Study 2), the preservation of singing ability and the rehabilitative efficacy of a singing intervention in aphasia (Study 3), and (iv) the preservation of music-evoked emotions and memories in different stages of Alzheimer’s disease dementia (Study 4). Led by the Principal Investigator (Prof. Teppo Särkämö), the work in PREMUS is carried out by the Music, Ageing and Rehabilitation Team (MART, link: www.helsinki.fi/en/researchgroups/music-ageing-and-rehabilitation-team).

During the first half (Months 1-30) of the project, the work has focused on the practical implementation of the four studies. Currently, we have successfully performed data collection cross-sectionally in Studies 1-4 from 450 subjects (355 healthy adults, 79 persons with aphasia, 16 persons with Alzheimer’s disease) and longitudinally in Studies 2-3 from 228 subjects. In Studies 1-3, data collection is now complete and data analyses are ongoing. In Study 4, data collection is still ongoing (delayed due to the COVID pandemic).

Our present results suggest that in healthy ageing (i) singing is associated with less age-related functional reorganization of neural processing than speaking in cognitively demanding verbal production tasks, (ii) regular choir singing is associated with better verbal-cognitive and social functioning and enhanced neural processing of multiple sound features, (iii) the autobiographical memories and emotions evoked by music are closely interrelated and share common musical features, and (iv) music-evoked autobiographical memories are linked to musical actions, such as dancing and singing, earlier in life, especially during adolescence. In aphasia, our current results indicate that (i) the ability to produce words through singing is associated with the structure of the left superior temporal cortex; (ii) group singing can enhance verbal communication, social functioning, and caregiver well-being and induce structural neuroplasticity in the language network at the chronic post-stroke stage, and (iii) daily listening to vocal (sung) music can improve the recovery of language skills and verbal memory at the subacute post-stroke stage.
Despite the current challenges and limitations posed by the COVID pandemic, PREMUS has made great progress in the successful implementation of all the studies included in the project. The unique feature and strength of PREMUS, which goes beyond the current state of the art of the research field, is the inclusion of well-controlled experimental studies which combine modern behavioural and neuroimaging techniques and advanced analysis tools and which are implemented in cross-sectional and longitudinal studies and clinical trials involving large samples of healthy persons and persons with aphasia and Alzheimer’s disease.

The analyses of the behavioural, acoustic, neurophysiological, and neuroimaging data collected in PREMUS are still largely ongoing, and during the second half of the project we aim to provide more novel results on the longitudinal neurocognitive benefits of choir singing in healthy ageing, the functional neural basis for the learning of new songs in healthy ageing and aphasia and for the rehabilitative effect of singing in aphasia, and the neural processing of music-evoked emotions and memories in different stages of Alzheimer’s disease.

Regarding the final outcome, PREMUS is expected to yield novel and important results on (i) how normal ageing and singing experience affects the perception and production of singing, speech, and music in the brain, (ii) how specific facets of music cognition (singing ability, music-evoked emotions and memories) are preserved in aphasia and Alzheimer’s disease, (iii) can regular participation in choir singing prevent or slow down neurocognitive decline in ageing, and (iv) can singing-based rehabilitation enhance recovery from aphasia. These results will have important societal implications as they can help uncovering how and why music affects well-being and brain functioning in normal ageing and in common age-related neurological diseases and in optimizing the use of music and developing new music-based rehabilitation tools to combat the deficits and burden caused by age-related neurological diseases.
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