Music-Based Medical Interventions with Borna Bonakdarpour, MD

Erin Spain, MS [00:00:00] This is Breakthroughs, a podcast from Northwestern University Feinberg School of Medicine. I'm Erin Spain, host of the show. Music-based medical interventions can have remarkable therapeutic benefits for patients diagnosed with cognitive impairments such as Alzheimer's disease, dementia and aphasia. Research has shown that the simple act of listening to music or singing a song cannot only retrieve lost memories, it can also build bridges to increase motor and language function. Dr. Borna Bonakdarpour, a neurologist who treats patients with cognitive disorders, is an expert in the area of music and medicine. He is here today to discuss his recent findings on this topic. He is the director of the Northwestern Music and Medicine Program and an assistant professor of Neurology in the Division of Behavioral Neurology here at Feinberg. Welcome to the show.  

Borna Bonakdarpour, MD [00:00:47] Hello, Erin. Thank you so much for having me. 

Erin Spain, MS [00:00:49] You are a cognitive neurologist. Tell me about your work at Northwestern. Your relationship and background with music and how you became interested in music interventions for your patients. 

Borna Bonakdarpour, MD [00:01:01] My interest in music really grew with my interest with neurology, so they really always kind of work together. As a trained musician, I really wanted to use music to help patients. And one of the great areas of music in terms of interventions is in neurologic patients. And I started with individuals who had aphasia or language impairment due to stroke and with individuals who really couldn't talk much and had expressive aphasia. All they could say was one syllable. I had a patient. She could understand everything very well. Couldn't talk much, but she could actually sing old songs, nursery rhymes, poetry, prayers, which was mind boggling. It was very interesting. At the time, research had shown that you can actually use this ability to rehabilitate persons, speech and language. So the method that I worked with was called Melodic Intonation Therapy and then learned a lot through research and showed that this can be helpful for certain individuals with aphasia. Now, mostly the population I see in my clinic includes people who have some kind of cognitive disorder, including mostly memory problems, language issues, visual processing difficulties, trouble with being able to get activities done, what we call executive function difficulty. The most common cause that we see is, of course, Alzheimer disease, where we see people with frontotemporal degeneration, with Lewy body disease, stroke or medical conditions that can affect cognition. So, we see a wide variety of patients in our clinic. You know, we collaborate with a lot of people and entities. We collaborate with churches, for example, in the Southside for brain health initiatives. 

Erin Spain, MS [00:02:49] You just mentioned that you're a classically trained musician. Tell me about that. 

Borna Bonakdarpour, MD [00:02:52] I started playing piano at a very early age. And, you know, while in in school, middle school, high school, and then in college, I, I never let it go. I continued to play the piano. I was a minor in music in college, so I took a lot of courses and music theory and harmony and its history and analysis. My medical training kind of grew with the musical training. I really wanted to combine them. 

Erin Spain, MS [00:03:18] So explain to me what is actually happening in the brain when it hears music. How does the brain process music to produce these positive outcomes that you're talking about? 

Borna Bonakdarpour, MD [00:03:28] Music and like anything else in the brain, is very complicated. As you listen to the sound, it enters your ear through the brain stem. It gets relayed and processed further and further until it gets to the surface of the brain, what we call the cortex or the hearing cortex or auditory cortex. And then from there, of course, it taps into emotions right away, very close in terms of proximity, anatomical proximity. And as it gets more and more processed, music can tap into different modalities in the brain, different networks of the brain that are involved in motor planning. Of course, when you, you know, hear a rhythmic music involuntarily, sometimes you just start tapping and dancing and moving. So it's very wired. Our brain is wired to do that. And it also taps into different other things. It can help you with sometimes directionality and spatial navigation with two ears. It helps us understand where we are in the space as well. It taps into memory. It brings back memory and imagery. It taps into language, of course, singing, and then also visual memory and visual processing. Now, there are people who actually see colors when they listen to music that's called synesthesia. Not everybody has that ability, but some people do. It also, you know, through the motor planning and motor communication, music can tap into the executive function. So as you see, it taps into every single modality in the brain. And that's why we can use music as an intervention to help other individuals who have some difficulties when different modalities. 

Erin Spain, MS [00:05:00] Are you able to use neuroimaging and these studies with music to see what's really happening? 

Borna Bonakdarpour, MD [00:05:05] We've been able to take pictures of the brain as it's processing things. It was first done with the PET scans and then with functional MRI. And I've been very involved in in imaging brain networks primarily first in language. But my research, which has been, you know, very much involved in both language and music, which have a lot of similarities. And you can actually see these networks and see what happens to the brain when somebody is listening to the music or they are doing a certain task while listening to the music. So, now we can actually see how people think. Using imaging for any intervention can help us with many aspects. First, you know, we want to know who would respond to treatment, but there might be people due to their brain lesions or diseases who may not actually respond very well to certain treatments. For example, if somebody has aphasia with language impairment and I want to use music for rehabilitation, I want to make sure they can actually process music. They are people, for example, with primary progressive aphasia or primary progressive of speech where they have motor problem that and what we do with with language is usually located in right handers in the left side of the brain. And music uses a lot of the right side. So that's why it works, right? Because right side is intact. We try to help the left side using the right side of the brain. So if the pathology is on the right side, then it may not work. So, using structural imaging and functional imaging, we want to get an idea about how the brain works and then who is the best candidate for an intervention. The other thing we can do is to see actually whether our hypothesis is correct. What we call target engagement. Does the music that we are playing for the person actually effects those areas that we are predicting? If it's language, if it's visual, if it's emotions? So, that kind of it validates that this is actually something that's working scientifically because as you may know, any type of intervention can have what's called the placebo effect. If it's just placebo, it's a psychological effect rather than really affecting a certain target. We need more of this type of research for music interventions and music therapy because the effect has been there. We know that. But it also has a lot to do with emotions. So we want to make sure that we are offering it in a scientific way. And then that's why they're music therapist who are board certified. Now, not everybody can play music, can have an effect on the patient. So we are trying to answer these kind of questions and then see how the networks change with music before and after.  

Erin Spain, MS [00:07:44] You just mentioned the disorder aphasia. The actor Bruce Willis was recently diagnosed with this. There's been a lot of news about this condition in the media. You have a music program for this disorder, too, that incorporates singing with patients. Tell me about aphasia. What is it and how are you able to use this program? 

Borna Bonakdarpour, MD [00:08:02] Aphasia is a cluster of symptoms that are related to production or understanding of language or reading or writing. You know, in terms of reading and writing, they call it dyslexia or dysgraphia or alexia or agraphia. With aphasia it's most of the oral communication and understanding of words and sentences. Aphasia can be caused by different diseases. The most common cause, which is usually acute, is a stroke. And that's what I worked with. I mentioned earlier we work with stroke patients who had, you know, damage to mostly the left side of the brain where language or speech sets. And they are not able to process language either production or understanding of language. There are other causes for aphasia as well, tumors, inflammatory diseases. They can cause aphasia and also degenerative diseases of the brain like Alzheimer disease and frontotemporal degeneration. What happened to Bruce Willis? Sounds like it's a primary progressive of aphasia. It's the first time the family shared the news. We didn't know all the details, but sounds like it's a primary progressive aphasia for certain types of aphasia that are expressive and severe, as I mentioned earlier, we can use music and singing to help people talk again. We can't cure it. We can fix it completely. But if somebody can't say anything and then you're able to help them say a few words and make sentences, that's a huge difference you can make in their lives. And that's what we did. The initial study came out of Boston University in 70s melodic intonation therapy and you know, it's been replicated in many languages. I replicate it in the Persian language and we presented it earlier in 2000s and there are colleagues at Harvard University are still working on it. So that's been actually a very promising and an effective intervention when you use it and very well selected individuals with aphasia. 

Erin Spain, MS [00:09:58] You recently started the. Northwestern Music and Medicine program as a project out of your lab at Feinberg. Tell me about this program. 

Borna Bonakdarpour, MD [00:10:06] About last year in June, we had enough support and interest and collaboration with musicians and music therapists, some music practitioners to be able to really start the program with the support from the department. We had a three month pilot program and also a program for it to help with individuals admitted in the hospital and the general neurology and general neurosurgery units to decrease the stress during the pandemic lockdown. The beginning, the as you remember, family members or friends, they couldn't come in. But there's research that shows that music actually can function as a person. We listen to the music not to feel lonely because it activates those areas of the brain that we use for communication and socialization. We do that all the time. People are walking along in the street, they're listening to music or they're at home and working. They always have the music in the background so that actually it's like you have someone else with you. Clara Takarobe was the music practitioner who played for patients through Face Time. She played the viola. We also worked with music therapist Alyssa McFadden and amazing group of nurses and and social workers who actually would take the paperwork and the questionnaire to the patients in their rooms. They were amazing to be able to do that. This is, again, the time that patients were already tested for COVID, so they were negative, but still going to the hospital while people could have worked from home. That was an amazing effort from their side. So, patients would go through a questionnaire telling us what type of music they would like to listen to. The music practitioner would look at that and then would play for them what they liked in a calm fashion. So it wasn't like a recorded music. The music was also altered to help them calm and feel at ease.  

Erin Spain, MS [00:12:01] So the results of this survey, they were published in Frontiers in Neurology. What was the reaction? 

Borna Bonakdarpour, MD [00:12:08] People admitted in the hospital, in the neurology unit. How do they like it? They told us they felt less stressed. They felt like it helped with their mood to feel less anxious and less less lonely. 98% of people said, you know, they would recommend it, really help them. When we did the intervention in the hospital, we were actually lucky that we had about five patients or so connected to electroencephalogram. That measures brainwaves and we could actually see the how these brains calmed down during the music intervention. And they actually continued to be calm after music stopped. We presented at the Academy of Neurology last month. So, this is very fascinating. You can actually measure brainwave changes that happened during music interventions. 

Erin Spain, MS [00:12:58] The role of music preference does play a part here. Tell me about that. Music taste is so subjective. 

Borna Bonakdarpour, MD [00:13:05] Music has a lot to do with emotions and with our memory. So, we may hear a piece of music at a very horrible time of our life. So, we don't necessarily want to re-experience that time in our life. So, it's important to know what type of music the person does not like to hear, what type of instrument they may not want to hear. Otherwise, music like any other intervention, can have adverse reactions. So, you have to be very careful. So, that's why we do the questionnaire beforehand so that they, you know, individualize it to the person who's listening. 

Erin Spain, MS [00:13:39] I want to ask you about these musicians that you work with. These are pretty special musicians. Tell me how integral they are to making your programming work. 

Borna Bonakdarpour, MD [00:13:48] Of course, the programs wouldn't exist without the musicians and music therapists and music practitioners. Over the years, I've been able to develop a close relationship with musicians and music practitioners, music therapists, and be very lucky to be able to work with the best in the field. In Chicago, we have very great musicians. I've been working with a few of the symphony musicians. Clara Takarabe, who is a violist and a music practitioner, co-directs the Northwest Music and Medicine Program with me. And she's been involved for years now with different efforts we've been having and programs we've been offering patients. Also work with Civitas Ensemble musicians, the Chicago Symphony Orchestra. And they've been really working with with patient populations and in hospitals and even around the world. Sometimes when the orchestra goes on tour, they would go to hospitals in Paris. They went to a hospital to play for patients. So, they are they're attuned to patient's needs. And then the idea of how can you use music in settings outside a concert hall, that's very interesting. How can you care for people through music? That's something that I think it's not thought of as much, you know, during the pandemic, you could see that that they were musicians who went out a job, who could do a lot, actually, because our patients needed them. 

Erin Spain, MS [00:15:06] Is there anything else you want to add that you think is important? 

Borna Bonakdarpour, MD [00:15:10] Yeah, I think use of music in clinical settings is still underused. There's a lot of room to work on that and development at Northwestern. I'm happy that now we can do this in collaboration with clinicians and musicians. Of course, we need to have more research. National Institute for Health in 2017, they started this initiative, Sound Health, and they have now funding available to do research, very serious research on sound and music processing and how it can be used for health and for brain health. And I think that will change the field very much with as more very well controlled research will come out. 

Erin Spain, MS [00:15:53] Thank you so much for coming on the podcast and sharing your research. 

Borna Bonakdarpour, MD [00:15:58] Thank you so much for having me.