Singing the blues away : reduction of depression in dementia by recreational choir singing

Non peer reviewe

Musiikki toipuvissa aivoissa

Listening to music involves a widely distributed bilateral network of brain regions that controls many auditory perceptual, cognitive, emotional, and motor functions. Exposure to music can also temporarily improve mood, reduce stress, and enhance cognitive performance as well as promote neural plasticity. However, very little is currently known about the relationship between music perception and auditory and cognitive processes or about the potential therapeutic effects of listening to music after neural damage. This thesis explores the interplay of auditory, cognitive, and emotional factors related to music processing after a middle cerebral artery (MCA) stroke. In the acute recovery phase, 60 MCA stroke patients were randomly assigned to a music listening group, an audio book listening group, or a control group. All patients underwent neuropsychological assessments, magnetoencephalography (MEG) measurements, and magnetic resonance imaging (MRI) scans repeatedly during a six-month post-stroke period. The results revealed that amusia, a deficit of music perception, is a common and persistent deficit after a stroke, especially if the stroke affects the frontal and temporal brain areas in the right hemisphere. Amusia is clearly associated with deficits in both auditory encoding, as indicated by the magnetic mismatch negativity (MMNm) response, and domain-general cognitive processes, such as attention, working memory, and executive functions. Furthermore, both music and audio book listening increased the MMNm, whereas only music listening improved the recovery of verbal memory and focused attention as well as prevented a depressed and confused mood during the first post-stroke months. These findings indicate a close link between musical, auditory, and cognitive processes in the brain. Importantly, they also encourage the use of listening to music as a rehabilitative leisure activity after a stroke and suggest that the auditory environment can induce long-term plastic changes in the recovering brain.Musiikin kuuntelu aktivoi aivoissa laajaa, molemmille aivopuoliskoille ulottuvaa hermoverkkoa, joka säätelee useita auditiivisia, kognitiivisia, emotionaalisia sekä motorisia toimintoja. Musiikki voi hetkellisesti kohentaa mielialaa, vähentää stressiä ja tehostaa kognitiivista suoriutumista sekä myös saada aivoissa aikaan neuroplastisia muutoksia. Vielä ei kuitenkaan tiedetä, miten musiikin havaitseminen liittyy muihin auditiivisiin ja kognitiivisiin toimintoihin ja voiko musiikin kuuntelulla olla positiivisia vaikutuksia kuntoutumiseen aivovaurion jälkeen. Tässä väitöskirjassa tutkittiin auditiivisten, kognitiivisten ja emotionaalisten tekijöiden yhteyttä musiikin käsittelyyn keskimmäisen aivovaltimon (MCA) akuutin aivoinfarktin jälkeen. Tutkimukseen osallistui 60 aivoinfarktiin sairastunutta potilasta, jotka jaettiin satunnaistetusti musiikin kuunteluryhmään, äänikirjojen kuunteluryhmään ja verrokkiryhmään. Kaikille potilaille tehtiin neuropsykologiset tutkimukset sekä aivojen magnetoenkefalografiamittaukset (MEG) ja magneettikuvaukset (MRI) toistetusti kuuden kuukauden seuranta-ajan kuluessa. Tulokset osoittivat, että amusia, musiikin havaitsemisen vaikeus, on yleinen ja usein pysyvä häiriö aivoinfarktin jälkeen, erityisesti jos vaurio on oikean aivopuoliskon ohimo- tai otsalohkolla. Amusia on myös selvästi yhteydessä häiriöihin varhaisessa kuuloinformaation käsittelyssä, jota mitattiin ns. poikkeavuusvasteella (MMNm), sekä yleisissä kognitiivisissa toiminnoissa, kuten tarkkaavaisuuden säätelyssä, työmuistissa ja toiminnanohjauksessa. Sekä musiikin että äänikirjojen päivittäinen kuuntelu voimisti MMNm-vastetta, kun taas ainoastaan musiikin kuuntelu paransi kielellisen muistin ja tarkkaavaisuuden suuntaamisen toipumista sekä ehkäisi masentuneisuutta ja sekavuutta ensimmäisten aivoinfarktin jälkeisten kuukausien aikana. Tulokset viittaavat siihen, että musiikilliset, auditiiviset ja kognitiiviset toiminnot ovat aivoissa läheisesti kytköksissä toisiinsa. Mikä tärkeintä, tulokset myös kannustavat musiikin kuuntelun käyttöön kuntouttavana vapaa-ajantoimintona aivoinfarktin jälkeen sekä osoittavat, että ääniympäristön virikkeet voivat saada aikaan pitkäkestoisia plastisia muutoksia toipuvissa aivoissa

Clinical and Neural Predictors of Treatment Response to Music Listening Intervention after Stroke

Patients with post-stroke impairments present often significant variation in response to therapeutic interventions. Recent studies have shown that daily music listening can aid post-stroke recovery of language and memory, but reliable predictors of treatment response are unknown. Utilizing data from the music intervention arms of a single-blind randomized controlled trial (RCT) on stroke patients (N = 31), we built regression models to predict the treatment response of a two-month music listening intervention on language skills and verbal memory with baseline demographic, clinical and musical data as well as fMRI data from a music listening task. Clinically, greater improvement in verbal memory and language skills after the music listening intervention were predicted by the severity of the initial deficit and educational level. Neurally, greater baseline fMRI activation during vocal music listening in the left parietal cortical and medial frontal areas predicted greater treatment-induced improvement in language skills and greater baseline engagement of the auditory network during instrumental music listening predicted improvement in both verbal memory and language skills. Our results suggest that clinical, demographic, and neuroimaging data predicts music listening treatment response. This data could be used clinically to target music-based treatments.Peer reviewe

Cognitive efficacy and neural mechanisms of music-based neurological rehabilitation for traumatic brain injury

Traumatic brain injury (TBI) causes lifelong cognitive deficits, most often in executive function (EF). Both musical training and music-based rehabilitation have been shown to enhance EF and neuroplasticity. Thus far, however, there is little evidence for the potential rehabilitative effects of music for TBI. Here, we review the core findings from our recent cross-over randomized controlled trial in which a 10-week music-based neurological rehabilitation (MBNR) protocol was administered to 40 patients with moderate-to-severe TBI. Neuropsychological testing and structural/functional magnetic resonance imaging were collected at three time points (baseline, 3 months, and 6 months); one group received the MBNR between time points 1 and 2, while a second group received it between time points 2 and 3. We found that both general EF and set shifting improved after the intervention, and this effect was maintained long term. Morphometric analyses revealed therapy-induced gray matter volume changes most consistently in the right inferior frontal gyrus, changes that correlated with better outcomes in set shifting. Finally, we found changes in the between- and within-network functional connectivity of large-scale resting-state networks after MBNR, which also correlated with measures of EF. Taken together, the data provide evidence for concluding that MBNR improves EF in TBI; also, the data show that morphometric and resting-state functional connectivity are sensitive markers with which to monitor the neuroplasticity induced by the MBNR intervention.Peer reviewe

Resting-state language network neuroplasticity in post-stroke music listening: A randomized controlled trial

Recent evidence suggests that post-stroke vocal music listening can aid language recovery, but the network-level functional neuroplasticity mechanisms of this effect are unknown. Here, we sought to determine if improved language recovery observed after post-stroke listening to vocal music is driven by changes in longitudinal resting-state functional connectivity within the language network. Using data from a single-blind randomized controlled trial on stroke patients (N = 38), we compared the effects of daily listening to self-selected vocal music, instrumental music and audio books on changes of the resting-state functional connectivity within the language network and their correlation to improved language skills and verbal memory during the first 3 months post-stroke. From acute to 3-month stage, the vocal music and instrumental music groups increased functional connectivity between a cluster comprising the left inferior parietal areas and the language network more than the audio book group. However, the functional connectivity increase correlated with improved verbal memory only in the vocal music group cluster. This study shows that listening to vocal music post-stroke promotes recovery of verbal memory by inducing changes in longitudinal functional connectivity in the language network. Our results conform to the variable neurodisplacement theory underpinning aphasia recovery.Peer reviewe

Musiikillinen häiriö aivovaurion jälkeen - yleinen mutta harvoin tunnistettu oire?

Musiikin havaitsemisen ja tuottamisen häiriö (amusia) ei ole tavanomaisessa kliinisessä työssä arvioitu oire, vaikka sitä esiintyy jopa puolella akuutin aivoverenkiertohäiriön sairastaneista potilaista. Amusiaa esiintyy yleisimmin oikean ohimo- ja otsalohkon sekä aivosaaren (insula) vaurioiden jälkeen, mutta sitä tavataan myös vasemman aivopuoliskon vaurion yhteydessä, joskin usein lievempänä ja ohimenevänä. Amusiaan liittyvät oikean aivopuoliskon valkean aineen ratojen, etenkin ventraalisen radaston, vaurio sekä ohimo- ja otsalohkon harmaan aineen atrofia ja toiminnalliset muutokset. Amusiassa myös puheen prosodisten piirteiden käsittely häiriintyy, mikä heikentää potilaiden arkipäivän kommunikointia ja sosiaalista kanssakäymistä. Laulaminen vaikuttaa lupaavalta amusian kuntoutusmuodolta, mutta aivovauriopotilaita käsitteleviä interventiotutkimuksia ei ole vielä julkaistu

Longitudinal effects of choir singing on aging cognition and wellbeing: a two-year follow-up study

IntroductionWhile increasing evidence points toward the benefits of musical activities in promoting cognitive and emotional well-being in older adults, more longitudinal studies are needed to establish their long-term effects and uncover the mechanisms through which musical activities affect well-being. Most previous research has focused on instrumental musical activities, but little is currently known about the long-term effects of singing, even though neuroimaging evidence suggests that it is a versatile activity for the brain, involving a multitude of neural processes that are potentially beneficial for well-being.MethodsWe conducted a 2-year follow-up study to assess aging-related changes in cognitive functioning and emotional and social well-being with self-report questionnaires and standardized tests in 107 older adult choir singers and 62 demographically matched non-singers. Data were collected at baseline (T1), and at 1-year (T2) and 2-year (T3) follow-ups using questionnaires on subjective cognitive functioning, depression, social engagement, and quality of life (QOL) in all participants and neuropsychological tests in a subgroup of participants (45 choir singers and 41 non-singers).ResultsThe results of linear mixed model analysis showed that in verbal flexibility (phonemic fluency task), the choir singers had higher scores already at T1 and showed no change over time, whereas the non-singers showed enhancement from T1 to T3. Furthermore, active retrieval of word knowledge (WAIS-IV Vocabulary task) showed significantly different changes from T1 to T2 between the groups (enhancement in choir singers and decline in non-singers), however lacking significant change within groups. Similar opposite trajectories of QOL related to social inclusion and safety of the environment (WHOQOL-Bref Environmental subscale) were significant from T1 to T3, but these changes were not significant within groups or at each timepoint. Within the choir singers, shorter experience in choir singing was associated with greater improvement in the vocabulary task over the follow-up period, suggesting that initiation of choir singing at older age induces some verbal benefits. There were no group differences in any other questionnaire or neuropsychological measure over time.DiscussionIn conclusion, our results suggest that choir singing at older age is associated with a sustained enhancement of phonemic fluency, while the effects on other verbal skills and quality of life are less clear

Miten toiminnanohjausta tulisi arvioida aivovamman jälkeen? Katsaus keskeisiin psykologisiin kyselymittareihin

Traumaattinen aivovamma on aivovaurio, joka syntyy tapaturmaisesti päähän kohdistuvan ulkoisen voiman vaikutuksesta. Yleisenä aivovammoihin liittyvänä tiedonkäsittelyn oireena ovat toiminnanohjauksen vaikeudet, kuten aloitekyvyn ja suunnittelu- ja organisointikyvyn heikentyminen, toiminnan juuttuvuus ja vaikeudet arvioida omaa toimintaa. Nämä vaikeudet hankaloittavat usein huomattavasti esimerkiksi vammautuneen työhön paluuta ja arjessa osallistumista. Aivovammojen tuottamien toiminnanohjauksen vaikeuksien tunnistaminen ja kuntouttaminen onkin sekä yksilön että yhteiskunnan näkökulmasta tärkeää. Toiminnanohjauksen arviointiin sekä kuntoutuksen kohdentamiseen ja vaikuttavuuden arviointiin liittyy kuitenkin haasteita, johtuen toiminnanohjauksen fysiologisen paikantamisen sekä neuropsykologisen mittaamisen rajoitteista. Näiden rajoitteiden kompensoimiseksi on kehitetty toiminnanohjauksen kyselymittareita, joiden avulla voidaan ajatella saatavan validia tietoa yksilön toiminnanohjauksen vaikeuksista arjen tilanteissa. Tässä katsauksessa tarkastellaan kahta keskeistä mittaria: Dysexecutive Questionnaire (DEX) ja Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A). Katsauksen tarkoituksena on koota ja arvioida olemassa olevaa tutkimustietoa kyseisistä mittareista ja pohtia tulosten valossa mittareiden käytettävyyttä neuropsykologin työssä Suomessa. Kirjallisuusanalyysin perusteella molemmat mittarit näyttäytyvät lupaavina työkaluina toiminnanohjauksen arvioinnissa aivovamman jälkeen. Lisää tutkimustietoa tarvittaisiin kuitenkin muun muassa niiden kyvystä erotella erilaisia vamman sijainteja ja erityisesti mittareiden käytettävyydestä toiminnanohjauksen muutosten arvioinnissa kuntoutuksen edetessä. AbstractTraumatic brain injury (TBI) is an alteration in brain function caused by an external force. A common cognitive deficit following TBI is executive dysfunction such as problems in initiating, planning, organizing and monitoring actions. Problems in executive function often set a significant barrier in returning to work and participating in daily life. Identifying and rehabilitating the executive dysfunction is thus an important issue from the individual’s as well as from the society’s point of view. There are however challenges in assessing executive dysfunction and in directing and evaluating the rehabilitation interventions due to the difficulties in physiologically locating and neuropsychologically measuring the executive function. Questionnaires of executivefunction have been developed in order to compensate these difficulties and to quantify the impact of executive dysfunctionin everyday life. This review focuses on two common questionnaires: the Dysexecutive Questionnaire (DEX) and the Behavior Rating Inventory of Executive Function -Adult Version (BRIEF-A). The aim of the review is to collect and evaluate the existing research and to consider the application of these questionnaires in Finland. Both questionnaires appear to be promising tools in measuring the executive dysfunction after traumatic brain injury. More research is needed especially in evaluating whether these questionnaires can be used in assessing the outcome of rehabilitation. Keywords: traumatic brain injury (TBI), executive dysfunction, rehabilitation, Dysexecutive Questionnaire, Behavior Rating Inventory of Executive Function &nbsp

Musiikillinen häiriö aivovaurion jälkeen - yleinen mutta harvoin tunnistettu oire?

Vertaisarvioitu.Musiikin havaitsemisen ja tuottamisen häiriö (amusia) ei ole tavanomaisessa kliinisessä työssä arvioitu oire, vaikka sitä esiintyy jopa puolella akuutin aivoverenkiertohäiriön sairastaneista potilaista. Amusiaa esiintyy yleisimmin oikean ohimo- ja otsalohkon sekä aivosaaren (insula) vaurioiden jälkeen, mutta sitä tavataan myös vasemman aivopuoliskon vaurion yhteydessä, joskin usein lievempänä ja ohimenevänä. Amusiaan liittyvät oikean aivopuoliskon valkean aineen ratojen, etenkin ventraalisen radaston, vaurio sekä ohimo- ja otsalohkon harmaan aineen atrofia ja toiminnalliset muutokset. Amusiassa myös puheen prosodisten piirteiden käsittely häiriintyy, mikä heikentää potilaiden arkipäivän kommunikointia ja sosiaalista kanssakäymistä. Laulaminen vaikuttaa lupaavalta amusian kuntoutusmuodolta, mutta aivovauriopotilaita käsitteleviä interventiotutkimuksia ei ole vielä julkaistu.Peer reviewe

Time course of motor gains induced by Music-Supported Therapy after stroke : An exploratory case study

OBJECTIVE: Previous studies have shown that Music-Supported Therapy (MST) can improve the motor function and promote functional neuroplastic changes in motor areas; however, the time course of motor gains across MST sessions and treatment periods remain unknown. The aim of this study was to explore the progression of the rehabilitation of motor deficits in a chronic stroke patient for a period of 7 months. METHOD: A reversal design (ABAB) was implemented in a chronic stroke patient where no treatment was provided in the A periods and MST was applied in the B periods. Each period comprised of 4 weeks and an extensive evaluation of the motor function using clinical motor tests and 3D movement analysis was performed weekly. During the MST periods, a keyboard task was recorded daily. A follow-up evaluation was performed 3 months after the second MST treatment. RESULTS: Improvements were observed during the first sessions in the keyboard task but clinical gains were noticeable only at the end of the first treatment and during the second treatment period. These gains were maintained in the follow-up evaluation. CONCLUSIONS: This is the first study examining the pattern of motor recovery progression in MST, evidencing that gradual and continuous motor improvements are possible with the repeated application of MST training. Fast-acquisition in specific motor abilities was observed at the beginning of the MST training but generalization of these improvements to other motor tasks took place at the end or when another treatment period was provided.Peer reviewe