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Music Therapy and Cognitive Impairments


This article was originally featured in the September 2019 Issue of OTR, titled 'Music to My Brain', and is reprinted with permission of ON THE RISK, Journal of the Academy of Life Underwriting.

Executive Summary

For centuries, music has been known to have the power to drastically affect our moods and behaviour. By examining the anatomy of the brain, as well as the structures involved when listening to and processing music, we have been able to recognize the relationship between sound frequencies, brainwaves and cognition. These findings have fundamentally augmented our understanding of how music therapy may be utilized to treat or rehabilitate individuals with cognitive impairments, consequently impacting risk associated with underwriting insurance.

If you have ever listened to a song that brought you back to an exact moment in your past, then you may have wondered why and how that happens. What about hearing a melody that reminded you of a distinct smell, taste or emotion? For years researchers have been putting together pieces of the puzzle in an attempt to explain how these complex emotions are triggered. Why does your heart seem to race faster when listening to an upbeat song by Kanye West, and stir slowly when a Celine Dion ballad comes on?

In this article, I will attempt to describe the basic umbrella of subdivisions of the nervous system, as well as the brain structures and chemicals involved when exposed to music. Given my sincere interest in this topic, I feel it’s noteworthy to mention that I have been playing music since age 5, and that I did my undergrad in the Specialist Program in Neuroscience at the University of Toronto. However, being in the insurance industry, I should probably also mention how this could be useful to a Life underwriter.

In Life underwriting, we are generally aware that clients with a history of Alzheimer’s or dementia are typically uninsurable. However, because so much research has been done on the effects of music therapy on patients who exhibit symptoms associated with these diseases, it may be possible to extrapolate these findings to milder cognitive impairments. It has also been demonstrated that music can provide or assist in reducing the need for medication for certain conditions such as anxiety and depression.[1,2] To explain these processes, we must first take a look at the wondrous and elaborate architecture of our nervous system.


Part I: Anatomy 

Our nervous system can be divided into the central nervous system (CNS) and the peripheral nervous systems (PNS). While the CNS is made up of the brain and spinal cord, the PNS consists of the nerves and ganglia. The autonomic nervous system (ANS), regulated by the portion of the brain called the hypothalamus, is a division of the PNS, with two branches of nervous systems: the sympathetic and the parasympathetic. These systems work together harmoniously, providing the mechanism that our bodies use to function in every moment of our lives.[3]

To break it down, the parasympathetic nervous system (PSNS) controls the body at rest, as well as homeostasis, and is responsible for the body’s “rest and digest” functions. It decreases the heart rate, with longer neuron (nerve cell) pathways, referred to as a slower system. On the other hand, the sympathetic nervous system (SNS) controls the body’s responses to a perceived threat, the primary mechanism in the control of the “fight-or-flight” response. Correspondingly, it increases contraction of the heart by way of very short neuron pathways (faster system). Other responses of the SNS include releasing adrenaline, dilatation of the pupils and bronchial tubes, as well as muscle contraction.

In the brain, dopamine functions as a neurotransmitter, a chemical released by neurons to send signals to other nerve cells.[4] This dopamine pathway plays a significant role in our pleasure-reward behaviour. Most types of rewards increase the level of dopamine in the brain. Many addictive drugs can also increase dopamine neuronal activity, which is the same brain chemical responsible for that state you’re in when you feel great after eating chocolate, or from the “runner’s high” after a marathon. And you guessed it, listening to music contributes to this dopamine effect as well.

Another neurotransmitter which is vital to emotions is oxytocin, not to be confused with the painkiller Oxycontin.[5] This is the “bonding” hormone which helps us create a stronger trust, bonds and relation¬ships with the people around us. This is an important factor for why we tend to get closer to people with a good sense of humour. Since humour also helps release oxytocin, you are more likely to bond with people who make you laugh. To understand how a song, let’s say “Dancing Queen” by ABBA, can cause this cascade of events in the brain, let’s take a closer look at the brain.

There are four main sections of the brain involved in listening to music. These are the auditory cortex, the limbic system, cerebellum and the cerebrum.


The cerebrum is the largest part of the brain located at the front and top of the head.[6] This area is associated with recalling memories when remembering lyrics and sounds of a song. This region is stimulated to keep the song in working memory by bringing up images that are associated with the sounds, and to visualize the music when playing it. The motor cortex is also an area of the cerebrum which processes visual and sound cues, helping control the body’s movements, such as when playing guitar.

The cerebellum is the second largest organ in the brain and located in the back of the head.[7] This area is the vital centre for balance, rhythm and coordinating skeletal muscle movement when hearing or playing music. Together with other parts of the brain, the cerebellum affects the rhythmic movement in the body when moving in response to music, as in reading or visualizing music when playing an instrument.

The limbic system includes the amygdala, which is the emotion centre of the brain, responsible for fear conditioning or the associative learning process by which we learn to fear something.[8] The limbic system also includes the hippocampus, which plays an essential role for sending memories out to the appropriate part of the cerebral hemisphere for long-term storage and retrieving when necessary. This works in conjunction with the formation of new memories about past experiences.

The auditory cortex is primarily a part of the temporal lobe which is located at each side of the brain.[9] This area contains brain cells that are organized by sound frequencies, which also help to analyze the information from music such as volume, pitch, speed, melody and rhythm.

While this introduction to brain anatomy involved in listening to music may have totally gone over your head, how they work together will blow your mind. In Part II, I will briefly describe brainwaves and how they are affected based on what we’re doing in our daily lives. Even if it’s just laying back and listening to your favourite Pink Floyd album, or dancing in a club to your favourite Justin Bieber song.

Because the brain is an electrochemical organ, activity originating from it is presented in the form of brain-waves. There are four categories of these brainwaves, varying in frequency. When the brain is aroused and actively engaged in mental activities, such as making a speech or playing piano, it generates beta waves. These have a frequency of 15 to 40 cycles per second (c/s). The next category are the alpha waves, which are slower and higher in amplitude at a range from 9 to 14 c/s. This alpha state usually occurs when a per¬son is taking a long walk on the beach or is meditating. The third state includes the theta brainwaves, which are even slower with a range of 5 to 8 c/s. This is often present when we take a break from a task and wander off to a daydream state, or “la-la land.” This may also occur when engaged in a repetitious activity, such as driving on a highway or taking a shower. Since the task becomes so automatic, we can be mentally dis¬engaged while we perform it. The final state is delta, where the brainwaves are the slowest frequency. This range is typically from 1.5 to 4 c/s. A deep, dreamless sleep would be an example of this state.[10]


Within these brainwave states, music has the potential to alter a person’s state of consciousness. It has the potential of shifting a person’s perception of perceived in the left brain (real-time minutes and seconds), to , which is perceived through memory. If you recall, the right-brain processes information with an intuitive and creative approach, while the left brain is immersed with analytic thinking, such as solving a math equation. The corpus callosum, a structure made of nerve tissue, is involved in the communication between the two sides.[11]

Experimental time is an experience of a tension state followed by resolution. The rate of the experimental time sequence influences the time perception. Since music causes states of tension and resolution cycles, slow moving music can lengthen the perception of time because an individual’s memory has more time to experience those cycle states. This can cause clock time to become distorted and people can lose track of time. Humans keep time to music involuntarily, even when not consciously paying attention to it.

Music may activate the flow of stored memory across the corpus callosum. This allows the right and left brain hemispheres to work in harmony rather than in conflict.[12] Since music is nonverbal in nature, it will trigger the right hemisphere. When used in a therapeutic nature, the verbalization of words will trigger the logical left brain at the same time. There is evidence that music therapy has facilitated the communication between the left and right brain. This is particularly true in individuals with pervasive developmental disorders, autism and brain injury.

Brain imaging techniques discovered by Dr. Robert Zatorre and his colleagues demonstrate that imagining music can activate the auditory cortex almost as strongly as listening to it.[13] They also observed that envisioning music stimulates the motor cortex, while conceptualizing the action of playing music activates the auditory cortex. This means that a person can hear music even if it is not really playing!

Synesthesia, which is thought to be genetic, happens when perception in one sense activates a perception in another sense whereby they anomalously blend together.[14] A person who experiences musical synesthesia may see a color, smell something, experience a taste, or feel a temperature change due to the music he is listening to. This occurs when there is an increase in the “cross-talk” between different cerebral regions, and music clearly aids this cross-talk. A unique ex¬ample of this is chromesthesia, which is a specific form of synesthesia whereby a person sees visual images, such as colors or shapes, when he is listening to music.[15] And this phenomenon is not from having dropped too much acid in the ’70s either.

Highly creative individuals generally have a different pattern of brain waves than “normal” or non-creative people.[16] Music has the ability to stimulate the production of alpha and theta waves in the brain. Big bursts of these alpha waves consequently induce creativity, while the theta waves are associated with the process of dreaming, learning, states of enhanced creativity and relaxation. Additionally, the perception of virtual vs. experimental time allows us to access different areas of stored memories in the brain, affecting our nervous system, and ultimately our disposition.[17]

In Canada, an estimated 65% of music therapists work with elderly who are cognitively impaired.[18] Since music has been found to stimulate various parts of the brain, it has also been demonstrated that it enhances the memory and emotions of Alzheimer’s and dementia patients.[19] It has also been proven that in advanced Alzheimer’s patients, there is an ongoing aptitude to appreciate music. Since it evokes positive emotions, it can help Alzheimer’s patients share positive moments with their loved ones. Furthermore, individuals who participate in singing while listening to music exercise both sides of the brain, while man¬aging stress. As previously noted, this management of stress is prompted by the release of the “happy” chemicals from the brain, such as serotonin, melatonin and prolactin.

Individuals who have been diagnosed with mild cognitive impairment (MCI) may exhibit symptoms of depression, anxiety, irritability, aggression, apathy and trouble remembering things.[20] It should not be surprising to underwriters if they see more of these types of therapies in future Attending Physician Statements as a source of alternative therapy used in conjunction with traditional medications. Although most types of dementia, such as Alzheimer’s, may not be insurable in the Life insurance marketplace, we can see how music can have great potential as an alternative therapy for milder cognitive impairments. Simply put, music has the power to make you feel good! So next time you’re listening to Air Supply’s greatest hits and it reminds you of walking through a beautifully scented floral meadow in the summertime breeze, you’ll know why.

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Written by: Garen Markarian

Garen is a Senior Underwriter at RGAX. He supports the RGAX Underwriting Solution Services team in providing comprehensive life insurance underwriting solutions to help carriers optimize risk management outcomes and better compete now and into the future. In addition to more than a decade of industry experience, Garen has an undergraduate degree in Neuroscience from The University of Toronto, and a post-grad diploma as a CRA from The Michener Institute.