The Neuroscience of Music and Parkinson’s Disease

As anyone who has ever heard “their song” can attest, the right music has the power to make you move. Now, healthcare providers are trying to harness this power to help patients with a disabling neurological motor disorder, Parkinson’s disease (PD).

Over the past three decades, researchers have begun to uncover the neural basis of music’s effect on the brain with an eye toward treating diseases like PD. A growing body of research reveals that the influence of music is far-reaching—shaping connections in the brain, improving the senses and movement, and enhancing mood.

The Many Disharmonies of Parkinson’s Disease

As the second-most common neurodegenerative disease following Alzheimer’s, Parkinson’s disease (PD) affects more than 10 million people worldwide and is projected to impact 1.2 million Americans by 2030.

PD is marked by a host of movement-related problems, including tremors, rigidity of muscles, sluggish movement, and postural instability. As the disease progresses, patients may develop a slow, shuffling gait and experience difficulty maintaining their balance. With less mobility and autonomy, patients find their quality of life can suffer considerably.

Though PD is most often associated with motor impairment, symptoms related to deficits in mood, behavior, and cognition also surface throughout the course of the disease, further complicating treatment and diminishing the quality of life for patients. Approximately 30 percent of PD patients have anxiety, while an average of 35 percent report clinically significant depressive symptoms. These mood disorders often develop years before the onset of PD’s motor symptoms, suggesting that they may be part of the disease process instead of a response to coping with PD.

Imperfect Treatments for a Complex Disease

As a neurodegenerative disease, PD involves the progressive loss of dopamine-producing neurons. This loss leads to irregular activity and connections in the surviving brain cells, impacting movement coordination. It may also account for non-motor symptoms in PD related to emotion and mood.

Traditionally, physicians prescribe medications that target the dopamine system to compensate for the patient’s lost dopamine production; surgical interventions, such as deep brain stimulation, can also help and are believed to mitigate some of the aberrant brain activity caused by the disease.

Unfortunately, these medications and surgeries become increasingly ineffective with extended treatment in most patients. To address PD and all its complexities, healthcare providers are exploring different treatment strategies to complement more traditional interventions.

A Brain Shaped by Music

Music may be uniquely suited to address the different challenges people with PD face in ways more traditional medical interventions cannot.

The brain is not a static object. It is malleable and plastic, able to change its connections and activity based on a person’s experience.

Engaging with music requires a multifaceted set of skills—keeping a rhythm, hitting the correct notes, or coordinating specific body parts, for example—and may make it particularly effective in activating and reshaping many parts of the brain affected by PD.

Getting Back into the Rhythm

Music therapy may be one promising option that can address many symptoms of PD. Therapeutic music performance, such as prescribed dance classes or group drumming sessions, can improve gross and fine motor skills through a process called rhythmic entrainment, which sets body movements to the beat of music.

In a series of seminal studies, researchers provided a rhythmic beat to PD patients and instructed them to walk. Typically, PD makes it difficult to produce and maintain the rhythmic movement required for walking. But the rhythmic beats in these studies provided a metronome to help patients sync their steps, leading to improvements in gait speed and cadence.

A systematic review conducted in 2018 of previous research studies found that rhythmic auditory stimulation improves walking speed and increases the length of each stride in PD patients. Based on these results, the authors recommend “early incorporation of rhythmic auditory cueing for gait performance” in PD patients. In the real world, research-backed programs that take advantage of the rhythm of music, such as Dance for PD, have helped improve movement and quality of life for PD patients in 25 countries worldwide.

Other types of music therapy, such as instrument playing, also show promise for improving movement speeds and rhythm for PD patients. One recent meta-analysis involving almost 600 participants concluded that music-based movement therapy is an effective treatment for motor function, balance, and walking speed of people living with PD.

Music Sets Emotions in Motion

Music is more than just a beat: it can also stir up powerful feelings, which can help PD patients.

Listening to and producing music is associated with increased activity in brain areas involved with reward and emotion and increased release of dopamine. By naturally increasing the brain’s dopamine levels, music may partially counteract the loss of dopamine neurons from the progression of PD. As an added benefit, music is intrinsically motivating, which means music therapy is more effective and easier to keep up with compared to other training regimens, like conventional physical therapy.

Recent studies conducted by neurologist Alexander Pantelyat of Johns Hopkins University found that regular choir, guitar, or drum sessions helped patients with Parkinson’s disease improve their movement and coordination as well as their mood.

The group music sessions also provide a social benefit, establishing a community for PD patients who may otherwise find themselves isolated and lonely. Allowing PD patients to experience camaraderie and develop social bonds likely benefits their mood and quality of life.

By providing these kinds of non-motor benefits, music can help PD patients in areas of life that traditional medicine cannot address.

Filling the Gaps in the Music Therapy

There are still many open questions about how music affects the brain and PD. Pantelyat noted that there are relatively few studies involving large numbers of research subjects that investigate the systematic changes music can have on PD. The studies that have been published “generally lack scientific rigor in terms of clinical studies being appropriately designed and powered to detect meaningful differences,” he said.

As a result, scientists do not have a clear idea about what kinds of music therapy work best for particular subgroups of the PD population. Increasing this knowledge would improve the targeting and efficacy of music therapy in PD patients.

But Pantelyat remains optimistic.

“I am heartened to say, though, when looking at the [systematic reviews of research] on music and arts-based interventions, that the overall level of evidence for diseases like PD is rising,” said Pantelyat. With a growing body of evidence, music may help bring harmony to the brain and life of patients with Parkinson’s disease.

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Written and reported by IAM Lab Communications Specialist Richard Sima. Richard received his Ph.D. in neuroscience from Johns Hopkins and is a science writer living in Baltimore, Maryland.

This post was featured on Psychology Today.

Lead image: Andrea Piacquadio