Ask the doctors: Music therapeutic tool for those with dementia

Q: We got an email from a medical center looking for adults with cognitive problems to be in a study about music. What would be the connection? My father-in-law has mild cognitive impairment and may be progressing to dementia. He is very interested in applying.

A: Cognitive impairment refers to a decline in the ability to think, remember, reason, make decisions and learn and retain new information. It is sometimes a precursor to other forms of dementia. Memory loss is perhaps the best-known symptom, but the effects are more far-reaching. People with this diagnosis struggle to concentrate, find it difficult to complete tasks, can be unable to follow instructions and lose the ability to solve problems. The condition can also erode the ability to recognize and express emotions, which adds another layer of separation from the wider world.

The use of music as a therapeutic tool to bridge those mental and emotional barriers has gained support in recent years. Research has found that for some people, music can improve mood, ease anxiety, elicit memories, sharpen cognitive function and encourage participation in daily life. Studies have linked the addition of music to the lives of people living with mild cognitive impairment with an improved ability to learn, retain and recall new information.

Similar studies have been conducted with patients living with Alzheimer's disease. The addition of music was found to be helpful in easing the agitation that often occurs in dementia. It also helped increase alertness and orientation, and sometimes eased symptoms of depression, which led to a decrease in the amount of medication needed.

Exactly how or why music works in these ways is not yet fully understood. However, there is a growing body of evidence showing that, even when other neural pathways are disrupted, those that are associated with listening to music remain intact. The result is that music can engage and activate parts of the brain that, due to disease progression, have otherwise become inaccessible.

Researchers have found that even when patients have progressed to the later stages of Alzheimer's and other forms of dementia, some were able to recognize and respond to music. They could tap out a beat, showed clear enjoyment as they listened and could sometimes accurately remember the lyrics to songs.

Music therapy is increasingly available as part of the management of cognitive impairment and dementia. Therapists use music to get the patient's attention, as background sound to ease anxiety and agitation, as a cue for transitioning between activities and physical spaces and as a shared experience to create an emotional connection. When access to professional help in someone's area is either limited or unavailable, families can add music to their caregiving duties.

Not surprisingly, this is most effective when the songs and melodies are already familiar to the patient. The music of someone's youth has been found to elicit a strong response. It is important to understand that music therapy has not been found to reverse the loss of cognitive function. However, it may preserve or amplify existing function, and it can improve quality of life for patients and caregivers alike.

Black mold should be eradicated by experts

Q: My husband and I bought a lake cabin for our family to use in the summers. We're doing some remodeling and have learned there's black mold in the basement. What are the health risks of black mold? We have already spent a few nights there. Should we be worried?

A: Mold is a fungal growth. It can digest virtually anything that contains carbon, which is why molds are abundant in damp or decaying organic matter. There are an estimated 100,000 different species of mold, which range from harmless to helpful to hazardous. Molds are key to the production of many of the cheeses we enjoy, including Gorgonzola, blue cheeses and brie. And, of course, penicillin, which is also a mold, changed the course of medicine.

Indoor mold is often referred to as mildew. Once established, it spreads easily. Molds reproduce by forming microscopic spores that travel via air currents to new locations. If a spore lands on an area with both nutrients and moisture, it can quickly begin to form its own colony. The sheltered environment and controlled temperatures of enclosed buildings, particularly those with leaky plumbing and drywall, offer molds an ideal environment.

When people talk about black mold, they're referring to a species known as Stachybotrys chartarum. It requires the warm temperatures of an indoor environment to reproduce and spread. In addition to spores, molds can produce something known as microbial volatile organic compounds, or mVOCs. These are chemically diverse compounds that molds use to communicate and interact with each other. They are too small to see, but if you have ever reacted to the dank and musty smell of a room containing mold, it's because you have inhaled mVOCs.

Exposure to black mold can cause a range of adverse effects. On the mild side are typical allergic reactions, such as headache, stuffy nose, itchy eyes or congestion. Prolonged or heavy exposure has been known to cause fatigue, exhaustion, light-headedness, mental fatigue, irritability, difficulty sleeping and problems with concentration. If someone has a weakened immune system, a fungal infection of the airways is possible.

Due to the health risks of black mold, it is important to stay away from the area. And because this type of mold is both challenging to remove and is easily spread, it is important to bring in expert help for eradication. This typically involves sealing off the area to localize spores, removing all damp and damaged building materials, disposing of carpets and textiles in the affected area, disinfecting all exposed surfaces and running an air purifier with a HEPA filter to clean the air. Workers will wear protective suits and N95 masks during the cleanup. If you plan to check on their progress, you should suit up as well.

If you or anyone in your family did experience symptoms from your exposure to the black mold in your home, it may be a sign of a mold allergy. It would be wise for them to check in with their health care provider for an evaluation.

• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.

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