Music: Reclaiming the Sense of Self in People Living with Alzheimer's Disease

Introduction: Alzheimer’s disease (AD) is a progressive neurodegenerative disease, characterised by memory and cognitive impairment. Autobiographical memory, or the memory of oneself, consists of episodic, self-defining and semantic components. AD profoundly disrupts autobiographical memory, causing individuals to lose their self-identity. Although previous research has shown that music can facilitate the recall of autobiographical memories, the extent and nature of this effect in AD is unclear. Specifically, it is debated whether music preserves neural networks involved in autobiographical memory or whether its effects reflect the relative sparing of musical pathways in AD. 

Method: A comprehensive review of the current literature was conducted to determine the effect of music on each component of autobiographical memory. 

Results: Both music and autobiographical memory are processed by neural networks located in the anterior cingulate cortex, the ventral medial prefrontal cortex and the hippocampus. Music activates these networks by evoking emotion, reducing anxiety and creating familiarity. This helps patients rebuild their sense of self in mild-moderate AD. Music has a preferential effect on episodic and self-defining memories than semantics due to the latter’s weaker emotional association. In advanced AD, the semantic framework breaks down, leading to a dissociation between autobiographical memory and the sense of self. This means that memories cannot be logically connected to create a coherent sense of self, raising the question of whether identity can ever be reconstructed in severe AD. 

Conclusions: Future functional imaging studies and longitudinal research would help delineate the interplay between music, autobiographical memory and self-identity in AD. However, these studies would be costly and time-consuming. Therefore, despite ambiguity regarding the precise pathway music uses to preserve autobiographical memory, its non-invasive nature, absence of adverse outcomes and positive effect on quality of life support its implementation among people living with AD.