Sing to Remember: Defying Dementia
INspired by the power and hold of music on the brain
Jason Lai, Principal Conductor of the Yong Siew Toh Conservatory, has conducted professional musicians around the world. This time he is taking up the herculean task to form a choir with a group of amateurs - 9 individuals living with dementia and their loved ones, singing together in a concert. In UK and US, there are performance choirs that include members living with dementia, so Jason has set out to put together the first Singapore choir that includes people living with dementia.
Under the tutelage of The A Capella Society founder and vocal trainer Angelina Choo, who has experience teaching those who are living with dementia, this unlikely choir undergoes weekly rehearsals designed to prepare them for a Christmas Concert on one of the busiest streets of Singapore - Orchard Road.
In this two-part series by Channel News Asia, they document participants’ three-months journeys as they work towards proving that those living with dementia can shatter the stigma and achieve something truly remarkable.
Dementia is the broad term for the loss of ability to think, remember, and reason, to the extent that it interferes with daily life. While memory loss is a common symptom, there are at least 10 types of dementia that affect different parts of the brain, that control emotion, behaviour and even movement.
1 in 10 Singaporeans above 60 live with dementia. There is no cure to dementia but science is proving that one instrument can make a difference - the human voice. According to Dr Feng Lei, who formed a dementia prevention research choir back in 2015, “Medicine can only slow the progress, but choral singing can help to improve concentration, memory, information processing speed, and psychological well-being.” His research is part of an ongoing study that aims to prevent and alleviate symptoms of depression and dementia. Dr Feng Lei shares, “In choral singing, you need to harmonise with the group, you need to know when to sing your part, you need to coordinate with your director and with your choir members. His study was the very first in the world on how they use music to prevent dementia. People with dementia are losing function, losing memory, and there is not enough intervention available. Choral singing is like a workout; together with medicine and other intellectual activities, the outcome for people living with dementia will be optimised.”
Recent studies have discovered that musical training has impact on the brain. Scientists have found that those with intense musical training has younger brains due to the stronger neural connections. Neural connections are like a network within the brain that controls our sensory, motor and cognitive abilities. To harness the power of music on the brain, all is required is a body of people and a voice.
Before the start of choir rehearsals, the members are put through a battery of tests that assess their level of cognitive function and emotional state of mind. These tests were repeated at the end of three months to find out whether music can make a measurable difference in their lives.
Through these three months, Jason saw through the lens of people living with dementia, how they may feel judged, watched, experience people around being impatient with them, or how they struggle with low self-esteem. He also noticed how they find it difficult to try to keep pitch, sing a phrase, or even just make sounds with their voice. He hopes that the choir will help rebuild their confidence and sense of belief in themselves.
Harnessing VR technology, Dementia Singapore gives a glimpse into the daily struggles of people living with dementia through a VR simulated character, Aunty Lucy. The most common symptoms one will experience are memory loss, increased heart rate due to anxiety, sensory overload (i.e. heightened sensitivity to light and sound), and hallucinations, on top of the stress of being scolded by family members. Another symptom is Sun Downing where there is sudden worsening of confusion, agitation, and aggression, that could begin in the late afternoon, and lasts into the night.
Some common types of dementia are Alzheimer’s Disease (destroys memory and thinking skills), Vascular Dementia (disrupted blood and oxygen flow to the brain), and Dementia with Lewy Bodies (causes hallucinations and movement disorders). Dementia spans from early to late stage of dementia, and is a progressive condition where the person can be bed-ridden as it worsens.
Almost half of this choir group has Young Onset Dementia, where some of them were diagnosed before 60. Individuals with Young Onset Dementia tend to have a rapid decline. Assoc Prof Nagaendran Kandiah, Director of Dementia Research Centre at NTU LKCMedicine, shared that the youngest person with dementia he has seen is 46 years old. About 17 years ago, he used to see about 2 to 3 patients with Young Onset Dementia (ie. between the ages of 35-65) in a week, but in the recent years, he has seen about 15 to 20 patients in a week. The reasons could be an increase in awareness in people, where they take proactive steps to get diagnosed early. The other reason is due to biological factors like White Matter Disease - blood vessels in the brain narrows, reducing blood supply, causing brain cells and the connection between them to die off overtime. White Matter Disease is found to be linked to genetics, diet and lifestyle.
When these disruptions spread, they may damage various parts of the brain such as the temporal lobe (visual processing, memory, emotions), frontal lobe (emotional regulation, planning, reasoning and problem solving), and parietal lobe (sensory information). There is one area that remains relatively untouched until the very last stage of dementia - cerebellum - where musical memory is stored. Music Therapist Evelyn Lee uses the analogy that music is like the Pied Piper, it strings people along to awareness, to a moment of clarity, or is like driving when the fog clears up. During her sessions, she also pairs actions with singing as it activates a different part of the brain. She believes that as the brain is engaged more during the sessions, clients have a higher chance of being able to retain memory. Singing together also releases several chemicals in the brain - dopamine (pleasure hormone), oxytocin (love hormone that strengthens bonds between individuals) - and lowers cortisol levels (stress hormone). In one of the participants, family members observed a steep decline in the condition during the pandemic.
The patients are not the only individuals living with dementia; their loved ones also take on a role as caregivers, bearing a lot of stress, worry and sacrifices. It is also a common concern when their loved ones may go missing. When it happens, it causes anxiety and panic. One of the participants, Peter Estrop, shared that he got lost in a bathroom of a shopping mall and he only found the way out because he had followed someone else out.
In the past, caregivers were the forgotten group. They were not recognised in the community sector, social sector, or healthcare sector. Today, more focus has been shifted to caregivers. Music Therapist Evelyn conducts a guided imagery and music session using a psychotherapeutic approach that reduces stress and anxiety. It is increasingly being used as an intervention for caregivers of those living with dementia.
Towards the end of the three months, the participants enjoyed the camaraderie, felt a sense of oneness and unity, and even bravery. They also went through the same battery of tests and results showed that the overall cognitive state score went up from 20.8 to 21.7. According to Prof Kua Ee Heok, who led a 10-year long study on dementia prevention, affirmed that a one point increase is quite significant. There was also significant improvement on social connectedness, from 38.7 to 44.1, while anxiety scale improved from 5.2 to 2.8.
The days leading up to the big day, some participants experienced apprehension. The opening soloist, Jacqueline Sim, even declared that she will not be singing. Through Jason’s encouragement, she agreed to continue. At the end of the documentary, participants and their caregivers went up on stage in front of a wide audience and sang heartily.