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"Memory is reinforced by emotions and attention, and Music and Art can be used to bring back sense of self awareness. It is important for Alzheimer ’s patients to reduce the emotional stress of their condition." Dr. Rudy Tanzi, Professor of Neurology at Harvard University, Director of the Genetics and Aging Research Unit, and Co-Director of the Henry and Allison McCance Center for Brain Health at Massachusetts General Hospital

The Research behind Memory Lane An Integrative Multisensory Approach

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CONTEXT OF THE PROBLEM RESEARCH OVERVIEW: MULTISENSORY STIMULATION, CINEMATIC PERCEPTION, NEUROPLASTICITY AND LONG TERM POTENTIATION THE SENSE OF SMELL THE SENSE OF SIGHT, CINEMATIC PERCEPTION, AND NEUROPLASTICITY THE SENSE OF HEARING THE SENSE OF TOUCH THE SENSE OF TASTE IN SUMMARY…

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1. Context of the problem One of the greatest challenges of our time is the growing crisis of Alzheimer’s disease and other related dementias. Although there has been much learned about the disease, breakthrough medications are still a long time in the future. Of paramount importance now is the need for non-pharmacologic approaches to assist caregivers in the management of the disease and to improve the quality of life for those with the disease.

2. Research overview: Multisensory stimulation, Cinematic Perception, Neuroplasticity and long term potentiation.

Watch the small film about the genesis of Memory Lane Tv The Memory-Lane program is unique in how it answers that need. Based on the findings of over fifty years ofpublished research studies, it offers caregivers at home and at long-term care facilities a psychosocial, non-pharmacologic tool to help reduce patients’ stress, anxiety, temporal confusion, and sun-downing syndrome, the agitation that often accompanies fatigue. The program works through multisensory stimulation, using Guided imagery through media stimulation Sounds and Music stimulation to sooth symptoms Temporal referencing to guide users during the day Education and Touch through our caregiver channel Olfactory stimulation through our olfactory tools Among physicians and medical researchers, there is a growing consensus that, for those with Alzheimer’s disease and related dementias, a multisensory approach produces a better result than drug treatment. (See Appendix for a detailed Bibliography, with full source information for the research studies mentioned in this chapter.) A multisensory experience, involving the patient’s senses of smell, sight, hearing, touch, and taste has been shown to produce immediate positive effects on behavior, mood, alertness, sense of self, and ability to concentrate and experience quality moments. In her 2015 publication, “Assessment and Management of Behavioral and Psychological Symptoms of Dementia,” H.C. Kales et al. noted, “The evidence for non-pharmacologic approaches to the behavior problems often seen in dementia is better than the evidence for antipsychotics and far better than other classes of medication.”

We all learn about the world though our senses, and we create relationships with our environment though sight, taste, smell, hearing, and touch. Any activities that stimulate, in a positive way, one or more of the ﬁve senses—touch, sight, hearing, taste, and smell—aid communication and reduce agitation among those diagnosed with dementia. In accordance with the latest research, the Memory-Lane program does not link its sensory stimulation with a performance outcome, which can create undue stress and pressure. Instead, the program simply creates a setting in which the caregiver can reconnect positively with the patient and vice versa. Through music, visual arts, simple stories, peaceful sounds, and appealing aromas, it establishes conditions in which patients and caregivers can have enhanced, palliative experiences. Our senses connect our minds and bodies with the world around us, and it is important to remember that the many things that bring us pleasure, such as music, art, and scenes of nature, will also bring pleasure to a person diagnosed with Alzheimer’s disease and related dementias.

The science of cinematic perception is a new field of research which brings together filmmakers and cognitive scientists to explore the way viewers process images, events and stories experienced on the silver screen. The science of how movies affect our brain, impact our senses, and how filmmaking has evolved to carefully shape the mental and physical responses of audiences is directly related to neuroplasticity. The evolution of virtual reality and neuro science efforts to explain how we can impact certain aspects of our life and cognitive well-being through technology is currently underway. Memory Lane Tv was at the avant-garde of that technology, coupling multi-sensory stimulation with visual impact to induce a relaxation response in the viewer who is cognitively impaired or stressed out. Talma Hendler, founder and director of the Functional Brain Center at Tel Aviv Sourasky Medical Center, uses brain imaging to study how film elicits emotional and empathetic experiences in viewers and how individual differences can alter the way viewers' brains respond to a movie. We reference several studies in the appendix used in the context of dementia referring specifically to the use of visual media for people living with dementia and the positive impact it has on the patients.

When used with the Life Story, the Memory-Lane program becomes an especially powerful tool: a person-centered approach that will assist in improving the quality of life. Click here

“Dementia sufferers need to have their spirit opened. We need to make them see, hear, and listen. They need to perceive things. What’s good for us is even better for them!” Dr. Agid, Scientiﬁc Director, Brain Institute, Paris, France

3. The Sense of Smell

Watch our film on how Memory Lane engages the sense of smell and how the olfactory stimulation works. Olfactory stimulation can connect us with some of our strongest memories. A smell that you associate with an event or past experience will often bring you vividly back to a past moment in time, allowing you to recover that memory. Smells can be pleasant, strong, relaxing, and comforting. C.G. Ballard, et al., in 2009 wrote that a single trial using plant fragrance as an intervention can, for people with dementia, have positive outcomes. In 72 patients with severe dementia (as diagnosed using the Clinical Dementia Rating Scale), who experienced clinically significant agitation, 35 percent demonstrated an improvement in their agitation, compared with the 11 percent who received a placebo. Another study placed linen bags filled with lavender flowers under the pillow of individuals diagnosed with dementia. The lavender scent was noted to improve sleep patterns. Kilstoff, et al., studied the effects of lavender, geranium, and mandarin essential oils in an almond base, packets of which were applied to the skin of dementia residents. The application of these perfumed oils resulted in an increase in alertness and contentment during the day, improved sleeping at nights, reduced levels of agitation, and less mental withdrawal and wandering. Although there is limited research associated with dementia and aromatherapy, it has been well documented that the inhalation of aromas causes strong effects, both physiological and psychological. The physiological effects act directly on the person, with the smell interacting with our bodies at the molecular level. The psychological effects are triggered less directly, as our minds interpret what we smell in light of our experiences, preferences, and cultural conditioning. These two distinct effects both occur simultaneously in the Alzheimer’s patient. The psychological effect can positively influence mood, pain perception, level of stress, and ability to pay attention, while the physiological effect can positively influence heart rate, blood pressure, brain activity, facial muscles, free radical scavenging activity, and cortisol.

In light of the importance of the sense of smell, the Memory-Lane program includes a dry fragrance diffuser and essential oils, speciﬁcally designed for medical environments. In conjunction with guided imagery, it works to help patients with Alzheimer’s disease, and those with related dementias, evoke long-term memories associated with foods, family traditions, and customs. As part of its multisensory approach to dementia care, the fragrance aspect of the Memory-Lane program increases a patient’s ability to connect with moments in time from his or her life story and to be less locked away alone in a detached world. It has been shown to lessen a patient’s challenging behaviors and increase a patient’s ability to relax and remain calm and content. Please refer to our implementation guide to understand how we pair olfactory stimulation with symptoms and programing.

4. The Sense of Sight Visual aids, especially photos and videos of beautiful or memorable scenes, can help stimulate memories and pleasant feelings for someone with Alzheimer’s disease or other related dementias. This effect holds true for people in the early stages of the disease as well as those with moderate to severe dementia. Image association through photographs and videos can play a key role in allowing those living with dementia to reminisce about pleasant times in their lives, just as it can also help them engage in the present moment. As the common expression puts it, “A picture is worth a thousand words.” Through the presentation of photographs and videos, Memory-Lane makes possible therapeutic reminiscence, a way to engage patients in positive conversations. Reminiscence therapy is a respected and widely used psychosocial intervention in dementia care. Martina Kane of the Alzheimer’s Association, for example, sees reminiscence therapy as a burgeoning part of dementia care (cf Memory-Lane Bibliography). She noted that many deep-seated memories have significant amounts of emotion attached to them, so that if one can tap into a patient’s positive emotions of their past, that experience can have a beneficial effect on the present. She further reminds us that reminiscence is a good way to facilitate a conversation with someone with dementia, for it allows you to see the person beyond their disease. Memory-Lane uses a cinematic, high-definition approach to visualization. As noted above, it is not like regular TV. Content and presentation are developed specifically for someone with memory impairment. For instance, none of the programs created for Memory Lane are plot driven, there is almost no narration, no voice over, and people came come “in and out” of the program at any particular moment. In particular, Memory-Lane’s film methodology employs two key concepts, guided imagery and chronobiology, both drawn from well-researched aspects of complementary medicine (alternative medicines like acupuncture and osteopathy that are not part of scientific medicine per se, but that are often used alongside it, to treat disease).

Guided imagery refers to techniques that use simple visualization and direct suggestion to produce psychophysiological relaxation. The benefits go beyond relaxation, however. Use of guided imagery has been shown to alleviate chronic anxiety and depression, relieve physical and psychological symptoms, and overcome negative health habits. Today guided imagery is a technique that is widely accepted in the healthcare field as beneficial and effective. Memory-Lane is the only product currently available that facilitates guided imagery sessions specifically for patients with Alzheimer’s disease and related dementias, through its presentation of pictures, photographs, videos, simple stories, and suggestions. Using this approach, a facilitator or caregiver typically guides a patient to have mental images that have sensory qualities, to bring an image to the conscious mind—mentally seeing, smelling, touching, or feeling that object—and in the process, to access elements of the unconscious mind in a way that has a soothing, palliative effect. Chronobiology is a field of study that looks at the effect of time and rhythmical phenomena on life processes. Medical research has found that our circadian rhythms are extremely important to optimal physiological function. For caregivers with patients with Alzheimer’s disease and related dementias, chronobiology is an especially important area of inquiry, since these patients often demonstrate marked disruption of normal circadian patterns. It is common, for example, for patients and their caregivers to experience the disruptions of sun-downing syndrome, as well as sleep deprivation. With sun-downing syndrome, the shadows of the late afternoon hours can trigger confusion, agitation, and wandering behaviors in many individuals who have the diagnoses of dementia. Dealing with this symptom can be challenging for caregivers. The Memory-Lane program addresses the common disturbance that occurs in dementia patients’ circadian rhythms, both with sessions designed for and delivered at appropriate times of day, and with temporal references and images that help patients orient themselves more accurately to the time of day. The Memory-Lane program incorporates both guided imagery and chronobiology to assist in reminiscence and to improve patients’ circadian rhythm. Caregivers can easily use the program to help elicit patients’ positive memories, to enhance patient–caregiver interaction, and to give patients a better sense of where they are in the progression of the day.

5. The Sense of Hearing

Sound surrounds us all the time. Listening to sounds is an important aspect of interacting with our environment. Our visual impressions can be influenced by the character of sounds that accompany them. The sound of birds chirping in the morning, children laughing, and coffee being poured into a cup all provide us with cues to our environment and produce the memories that make us who we are. Music is an especially powerful type of sound, which researchers have determined is able to change a person’s mood and improve the ability to recall memories. As we all have experienced, music is closely connected to our personal memories. Songs associated with a first love or with other important events are stored in our long-term memory, able to recreate the feeling of a particular time and place. For a person with Alzheimer’s disease or other related dementias, music can be the key to unlock these lifelong memories. A substantial amount of research supports the beneficial effects of music on people with dementia. Several studies link the positive benefits of music with dementia care, showing patients to experience enhanced quality of life and wellness; reduced stress; better mood; improved memory capacity; and a greater ability to communicate with others and express feelings. Neurologist Oliver Sacks found that, “Music evokes emotion, and emotion can bring with it memory. . .. It brings back the feeling of life when nothing else can.” By pairing music with everyday activities, patients can develop a rhythm that helps them to recall the memory of that activity. This recall can happen even in patients with advanced cases of Alzheimer’s disease. In the documentary Alive Inside, film director Michael Rossato-Bennet portrays the work of Dan Cohen, an inspired and distinguished entrepreneur, who started www.musicandmemory.org, a customized music playlist implementation tool for people living with Alzheimer’s disease and other related dementias. The power of music reminiscence is undeniable.

Distinguished geriatric physician Dr. Jean Claude Broutart, working with his patients in Nice, France, has developed a new therapy using music reminiscence that he calls “Mnemotherapy.” Music reminiscence is different from music therapy, but similarly effective. Based on research begun in 2009, this approach to treating the symptoms of Alzheimer’s disease consists of awakening and letting flourish (in a way that can be reproduced regularly later) a musical memory associated with a moment in one’s life. This revitalization of the memory Dr. Broutart calls “Reviviscence” that could be translated as “Relivingness”, a concept developed in literature through sensory stimulation by Proust and his famous “madeleine”, the smell of the cookie that transported him in the kitchen of his grandmother as a child. With that term, Dr Broutard refers to the act of awakening and reliving memories that are long buried or hidden through the “retrograde amnesia” that characterizes Alzheimer’s disease. In line with this research, the Memory-Lane program uses music and sound to tap into the memories of a person with dementia, engage that person, and reactivate their “joie de vivre” (their happiness to be alive). Through a combination of music, image, and sound, the Memory-Lane program helps to alleviate apathy, sadness, depression, anxiety, and troubling behavioral issues. This type of specific reminiscence activates not only the recall of the memory—the revival of an autobiographical episode that is relived in the present moment—but also the full intensity of its detailed emotion. Its characteristic is the joy associated, most of the time, with the narration of this page of life and with the happiness to finally being able to communicate.

6. The Sense of Touch

Whether it is a handshake, hug, or “high five,” meaningful touch can be an important communication tool. Lydia Denworth is a New York-based science writer who has spent her life studying the sense of touch. She has stated, “Nothing makes us feel the effect of the presence of another human being better than the sense of touch. We are equipped for this with nerve fibers sensitive to the emotional charge of touch—sensors that are the base of our sociality.” Touch also helps us learn about our environment. Every day we recognize a multitude of solid objects all around us and take in their shapes, textures, and temperatures. Our somatosensory system, made up of millions of different receptors throughout our body, provides us with sensory feedback and lets us feel “at home in the world.” As we age, we experience less touch, and this diminishment is true for seniors and especially for individuals with Alzheimer’s and others related dementias. Researchers have demonstrated that, among those diagnosed with dementia, touch, both given and received, can produce a relaxing response and a wide range of other benefits. Direct tactile stimulation can bring about improvement in short-term and long-term memory. In these studies, massage of the hands and therapeutic touch brought an improved mood and level of participation in daily activities. Some of these effects were noted to have lasted even after six weeks. Textured quilts are also used in dementia care to provide tactile stimulation, visual, warmth, familiarity, comfort, and relaxation. Doll therapy, using a baby doll that needs some level of care, provides a sense of responsibility and connection. The doll received hugs and nurturing for some individuals diagnosed with dementia. Similarly, heated teddy bears, as well as other objects that can be heated, provide the patient with beneficial warmth and relaxation. The Memory-Lane program provides you with helpful recommendations on common objects that can be used to supplement the sessions, trigger associations, and revitalize memories. For example, providing the resident with tools of his or her former trade often sparks conversation and memories, thus fostering a positive connection and an enhanced sense of self. We learn about the world using our sense of touch, and Memory-Lane incorporates that valuable truth into the patient’s palliative care and multisensory experience.

7. The Sense of Taste

As we age, our ability to taste tends to diminish, and our eating habits may change. For individuals with a dementia diagnosis, these altered experiences of flavor and food preferences can be pronounced. Sometimes patients may develop an increased craving for sugary foods, or they may lose all interest in eating, creating the dangerous and even life-threatening situations of weight loss and poor nutrition. Although taste is not a sense directly incorporated into the Memory-Lane program, it can easily be brought into the sessions. For instance, a recommendation with the olfactory stimulation films is to follow up with tasteful, relevant food. If in the morning we diffuse scent of coffee or chocolate with a morning film, we will visualize images of morning breakfast, and we suggest caregivers to offer chocolate or coffee to enhance the experience.

8. In Summary… Currently, there is promising evidence on the effects of sensory stimulation as it relates to dementia care, and there is more research being done in this active area of scientific inquiry. Today, the most promising non-pharmacologic treatments work by engaging patients and stimulating memories. In accord with this research, Memory-Lane is: A pioneering program that uses multisensory stimulation and modern technologies to assist people with Alzheimer’s and related dementias, as well as their caregivers A collection of carefully made, selected, and arranged short films, paired with materials that engage the viewers’ senses, to improve the behavior and mood of those with dementia A non-pharmacologic intervention that is useful in addressing the neuropsychological symptoms of dementia A unique and powerful tool that combines the proven benefits of guided imagery and chronobiology, to optimize their mutually reinforcing features. A customizable, person-centered array of content, which can be tailored specifically to a single individual. There are no other available tools on the market that employ Memory-Lane’s multi-dimensional, multi-sensory approach to dementia care. Our caregiver protocols guide the administration of sessions, providing templates for beneficial results and effective patient–caregiver interaction. Structured program delivery can be distributed throughout the day, to improve the quality of life and bring back a sense of self and well-being. The program has also been shown to alleviate some of the mental and physical exhaustion that we, as caregivers, may face on occasion, as we strive to improve the quality of life for our patients and loved ones. _________ For More Information: As noted earlier, referrals and a list of scholarly articles illustrating this section are presented in the Appendix; see Bibliography. Please refer to this Bibliography also to explore dementia care research in greater depth than this brief chapter could provide. For updates on research, contact us. Citations to new articles are added there to the Bibliography.