Periodic Reporting for period 4 - PREMUS (Preservation and Efficacy of Music and Singing in Ageing, Aphasia, and Alzheimer’s Disease)
Reporting period: 2023-07-01 to 2024-06-30
Music is a highly complex and versatile stimulus for the brain and it is 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 deepens our systems-level understanding of the structural and functional relationship between singing, speech and music in the ageing brain and provides 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 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 deepens our systems-level understanding of the structural and functional relationship between singing, speech and music in the ageing brain and provides 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 comprised 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 mainly carried out by the Music, Ageing and Rehabilitation Team (MART, link: www.helsinki.fi/en/researchgroups/music-ageing-and-rehabilitation-team) at the Cognitive Brain Research Unit (CBRU) in University of Helsinki.
During PREMUS, we successfully collected data from a total of 608 subjects (Study 1: 100 healthy adults, Study 2: 200 healthy older adults, Study 3: 79 persons with chronic aphasia & 55 family caregivers, Study 4: 144 persons with dementia & 30 healthy controls). The collected data were obtained from neuropsychological tests, questionnaires, electroencephalography (EEG) measurements, and structural (sMRI) and functional (fMRI) magnetic resonance imaging measurements implemented using cross-over (Studies 1 & 4), longitudinal (Study 2), and randomized controlled trial (RCT, Study 3) designs. In Study 4, the COVID-19 pandemic unfortunately delayed the onset of data collection, which is still ongoing, and no published results are reported yet from that study. Due to the lockdown period during the pandemic, the work in PREMUS also focused on further data analysis and reporting from a previous RCT focusing on the rehabilitative effects of daily vocal music listening during early stroke recovery, closely linked to the theme of Study 3.
The results of Studies 1-2 showed that in healthy older adults (i) the singing network of the brain undergoes less functional reorganisation (in terms of lateralization and engagement of the prefrontal cortex) in normal ageing compared to the speech network, especially when the task is cognitively demanding, (ii) regular choir singing is associated with better cognitive functioning (executive function, episodic memory) and emotional wellbeing (depression, social integration, quality of life) as well as with enhanced auditory processing of sound features relevant to choir singing (pitch and location) and structural connectivity in multiple left and right hemisphere white matter pathways, and (iii) music-evoked autobiographical memories are strongly linked to the emotional experience of the songs, mediated by same core musical (rhythmic, tonal, timbral) features, as well as to memories of music-related activities (e.g. singing, dancing, listening) from adolescence years.
The RCT results from Study 3 and our previous study on music listening provided novel evidence that (i) stroke patients with chronic aphasia can often retain their ability to produce words by singing, even in severe aphasia, facilitated by the preservation of left temporal lobe regions and structural connectivity in the left ventral stream, (ii) in chronic aphasia, a multicomponent singing intervention using choir singing, melodic intonation therapy, and home training improves communication, speech, social participation, and caregiver wellbeing and increases grey matter volume and structural connectivity in the frontal lobe parts of the language network, and (iii) in subacute aphasia, also daily listening to vocal (sung) music improves the verbal memory and language recovery and induces structural and functional neuroplasticity in the left language network, and (iv) musical deficits caused by stroke (acquired amusia) are linked to damage in right temporal regions and disconnection of the right ventral stream.
The outcomes of PREMUS have been published in 51 journal articles, 3 PhD theses, and 13 Master’s theses and disseminated in 45 conference/workshop presentations, 25 training lectures for professionals and students, 35 lectures for the general public and other stakeholders, and 55 media communications.
During PREMUS, we successfully collected data from a total of 608 subjects (Study 1: 100 healthy adults, Study 2: 200 healthy older adults, Study 3: 79 persons with chronic aphasia & 55 family caregivers, Study 4: 144 persons with dementia & 30 healthy controls). The collected data were obtained from neuropsychological tests, questionnaires, electroencephalography (EEG) measurements, and structural (sMRI) and functional (fMRI) magnetic resonance imaging measurements implemented using cross-over (Studies 1 & 4), longitudinal (Study 2), and randomized controlled trial (RCT, Study 3) designs. In Study 4, the COVID-19 pandemic unfortunately delayed the onset of data collection, which is still ongoing, and no published results are reported yet from that study. Due to the lockdown period during the pandemic, the work in PREMUS also focused on further data analysis and reporting from a previous RCT focusing on the rehabilitative effects of daily vocal music listening during early stroke recovery, closely linked to the theme of Study 3.
The results of Studies 1-2 showed that in healthy older adults (i) the singing network of the brain undergoes less functional reorganisation (in terms of lateralization and engagement of the prefrontal cortex) in normal ageing compared to the speech network, especially when the task is cognitively demanding, (ii) regular choir singing is associated with better cognitive functioning (executive function, episodic memory) and emotional wellbeing (depression, social integration, quality of life) as well as with enhanced auditory processing of sound features relevant to choir singing (pitch and location) and structural connectivity in multiple left and right hemisphere white matter pathways, and (iii) music-evoked autobiographical memories are strongly linked to the emotional experience of the songs, mediated by same core musical (rhythmic, tonal, timbral) features, as well as to memories of music-related activities (e.g. singing, dancing, listening) from adolescence years.
The RCT results from Study 3 and our previous study on music listening provided novel evidence that (i) stroke patients with chronic aphasia can often retain their ability to produce words by singing, even in severe aphasia, facilitated by the preservation of left temporal lobe regions and structural connectivity in the left ventral stream, (ii) in chronic aphasia, a multicomponent singing intervention using choir singing, melodic intonation therapy, and home training improves communication, speech, social participation, and caregiver wellbeing and increases grey matter volume and structural connectivity in the frontal lobe parts of the language network, and (iii) in subacute aphasia, also daily listening to vocal (sung) music improves the verbal memory and language recovery and induces structural and functional neuroplasticity in the left language network, and (iv) musical deficits caused by stroke (acquired amusia) are linked to damage in right temporal regions and disconnection of the right ventral stream.
The outcomes of PREMUS have been published in 51 journal articles, 3 PhD theses, and 13 Master’s theses and disseminated in 45 conference/workshop presentations, 25 training lectures for professionals and students, 35 lectures for the general public and other stakeholders, and 55 media communications.
Going beyond the state of the art, the results of PREMUS have many important scientific and societal implications. From the basic research perspective, they broaden our current understanding of the neural relationship between speech and singing by showing that while these forms of communication overlap in the brain, they also exhibit different structural and functional patterns related to ageing and to the effects of neural damage in aphasia. They also highlight the inherently strong links between emotions and music perception and music-evoked memories in ageing. From the applied research perspective, they show that regular choir singing is beneficial for healthy ageing, in terms of cognitive function, socioemotional wellbeing, and brain function and connectivity and that both vocal music listening and group-based singing rehabilitation can be effective tools in aphasia rehabilitation, enhancing verbal communication and neuroplasticity of the language network, and, in the case of singing, having also added psychosocial benefits.
Societally, these findings on the roles of singing in supporting wellbeing in ageing and enhancing recovery in aphasia are highly important, given the rapid ageing of the population and the enormous societal burden brought about by cognitive decline and neurological disorders, especially aphasia.
Societally, these findings on the roles of singing in supporting wellbeing in ageing and enhancing recovery in aphasia are highly important, given the rapid ageing of the population and the enormous societal burden brought about by cognitive decline and neurological disorders, especially aphasia.