Music Listening Helps Treat Cognitive Problems

This podcast is made possible through the support of AstraZeneca. 

Jamie DePolo: Hello. Thanks for listening. Our guest today is Dr. Ashley Henneghan, assistant professor in the School of Nursing at the University of Texas at Austin. Much of Dr. Henneghan’s work focuses on improving cognitive outcomes in people who’ve been treated for cancer, especially breast cancer. Her studies have found that listening to music and practicing Kirtan Kriya, a very melodic meditation, reduced cognitive problems and improved quality of life in women treated for breast cancer. She joins us to discuss her research. Dr. Henneghan, welcome to the podcast.

Dr. Ashley Henneghan: Hi. Thank you so much for having me, I’m delighted to be here.

Jamie DePolo: So, to start could you describe for us some of the cognitive problems that people in your studies experience? What are we talking about?

Dr. Ashley Henneghan: Sure. So, a lot of people when they go through cancer treatment or breast cancer treatment experience cognitive changes, and sometimes these emerge during treatment and sometimes they emerge after treatment is over, and they are pretty unique to the individual who is experiencing the cognitive problems. But most often we see difficulties with remembering words or remembering where you put things, you know. So memory is often a problem. So, focusing and paying attention, and things like executive functioning, which is our ability to prioritize things or multitask or, you know, do these complex kind of higher-order thinking that really gets us through most of the day.

Let’s see. Processing speed is also something that people have problems with. So, a lot of times we hear this term “chemo fog” or, you know, like this fog…

Jamie DePolo: Chemo brain.

Dr. Ashley Henneghan: Chemo brain, yeah, exactly. So, I think what people are usually trying to describe is this like, slowness to process. So, in the cognitive world we call that processing speed.

So, it’s pretty unique to the individuals, but those are kind of the big categories of problems that we see most often.

Jamie DePolo: Okay, and how common are these? Because the studies I’ve looked at there’s this huge range and I know personally people who have had these problems, I know other people who’ve received chemotherapy who haven’t really had the problems. So, do we have a handle on that yet?

Dr. Ashley Henneghan: Sure. Yeah. So, the big range of numbers that you’re seeing a lot of the time is due to how cognition is measured in a study. So, depending on how it’s measured kind of affects what that percentage is of people how are affected. It’s also affected by when was cognition measured. Did it happen before treatment started, during treatment, or after? So, that affects the numbers, too. 

But in general, there’s kind of an understanding or acceptance in the field that there’s this cognitive impairment in about 30% of patients even before treatment starts. So, perhaps it’s not just the treatment, it’s something about the cancer pathology or, you know, the psychological and complex experience of being diagnosed with cancer. And then during treatment, that percentage goes up a lot because of all the treatment, all of the again, complexities of going through treatment so, we can see numbers up to 75% of people experience cognitive problems during treatment. 

And then once treatment’s over, you know, after that first six to 12 months, a lot of that spontaneous healing of the brain happens and a lot of those symptoms resolve for most people. But in approximately a third of our survivors, we still see some cognitive impairment or chemo brain symptoms, whatever you want to call it. Yeah. The number varies quite a bit depending on yes, time of assessment and then how is it measured. 

Just to elaborate a little bit more, in some of our studies…well, most of our studies, we use two different ways of measuring these clinical symptoms. First, we use performance on standardized cognitive tests. If you’ve ever gone through like, an SAT-type test, which a lot of us have, that’s what I mean by standardized test, the same test for all people and there’s usually some comparison to population norms to judge if there’s an impairment or not. 

There’s also people’s perceptions of their cognitive functioning. So, we call that the self-report instrument or patient-reported outcome. So, a lot of times that number is higher if we use those patient-reported outcomes compared to the standardized testing.

Jamie DePolo: Sure, that makes sense. I do want to follow up a little bit about causes because I have seen those studies, too, suggesting that just the sort of the emotional, physical, mental shock of the diagnosis can cause some cognitive impairment. Obviously, you’re going to become preoccupied with everything that goes along with a cancer diagnosis. And I’ve also seen studies showing that hormonal therapy, like tamoxifen and the aromatase inhibitors, can cause this because they’ve seen it in people who take hormonal therapy but haven’t been treated with chemotherapy. 

So, do we have a better handle on that, on some of the causes like, can we estimate X person had hormonal therapy but no chemo, they have this percent risk of cognitive impairment? Or are we not quite there yet?

Dr. Ashley Henneghan: We are not quite there yet, unfortunately. And as you know, breast cancer treatment is so multimodal so, so many different treatments go into breast cancer and even if you haven’t had chemotherapy, you’ve most likely had a surgery, you most likely had some sort of radiation and hormonal therapy, so, it’s really hard to just narrow it down to one single treatment. 

So, when it comes to the hormonal therapies, seems like such a common treatment in breast cancer, there have been some studies, as you mentioned, that have compared people who have had just the hormonal treatment to just those that have chemotherapy, or maybe chemotherapy plus hormonal treatment, and really the findings are mixed so, we don’t really know yet. What we do seem to know is that the more treatments that one has, the higher the risk is for having some sort of cognitive change or symptoms just because of the nature of kind of accumulative effect of, you know, all of these things added together versus just one of those things or two of those things.

So, all of the treatments that people go through for breast cancer are all individually risk factors for cognitive vulnerability and then, of course, synergistically there’s risk factors there.

Jamie DePolo: Okay. Now I want to get into your research because it’s so fascinating to me. How did you decide to study listening to music as a treatment for cognitive issues?

Dr. Ashley Henneghan: Yeah. So, this is actually a happy accident, as I like to describe it. But what we were primarily interested at first was meditation. And you mentioned the meditation at the beginning of the podcast called Kirtan Kriya, and it’s a type of meditation that involves, you know, visualization and also this, you know, mantra, so, saying of different sounds, and some finger movements. 

And we saw in the literature that this type of meditation was really effective in people, older adults who had subjective cognitive decline or mild cognitive impairment, even some people who had some early signs of Alzheimer’s, in addition to their caregivers. 

So, the findings that we were seeing in this other patient population seemed to be very promising, and so, we decided that we wanted to investigate, would this type of meditation be beneficial to our breast cancer survivors who are having chemo brain? And we modeled our study based off of what these other investigators had done, and they had used classical music listening as a kind of control condition and you know, the thinking being we’d be controlling for just kind of general relaxation in terms of the meditation intervention, and also listening to something, so, in our meditation group we had guided meditation, and then the time.

So, each of the groups did about 12 minutes of either the guided meditation or the listening to music. So, we actually had it as what we call in the research world attention control so, controlling for attention in all these other factors of the intervention. And what we found afterwards was that the music group did just as good as the meditation group and even a little bit better in some of the psychological outcomes.

So, at first, we were a little bit disappointed in our choice for our control condition, but ultimately encouraged by the fact that we found two options for people that are low cost, really accessible, and seem to be pretty enjoyable to do. So, they, you know, this was our pilot study and it had some interesting and encouraging results.

And since then, we’ve been looking…you know, we’ve tried to explain why did the music group do so well, and it’s become clearer and clearer why they did well just in terms of how the literature supports how music can be beneficial to people’s brains. And while we don’t know exactly how it’s beneficial, there’s a big initiative by the National Institutes of Health and National Endowment of the Arts to try to understand better why music is so good for our wellness and in, you know, the general population but also in clinical populations. 

Jamie DePolo: So, we don’t really know the mechanism. Like, we don’t know what’s happening physically in the brain that is helping.

Dr. Ashley Henneghan: Right. So, we have some educated guesses but we’re not exactly sure what exactly is causing the music to be beneficial. But some of these educated guesses come from, you know, we’ve started looking at musicians’ brains in terms of the science, and what we found is that people who have had, you know, a history of being, you know, knowing how to play music, engaging with music throughout their lifetime have more robust brains in terms of their brains might be larger, a little bit more what we call neuroplastic, meaning the brain structure is more flexible and adaptive than people who are not musicians. 

So, the neuroscience and music research really kind of started in that place in terms of comparing musicians to non-musicians and some of their brain-related outcomes. 

And since then, we’ve seen music in terms of brain research be applied to the dementia population, so, people who have dementia. There’s been studies that show that they might not be verbal or be that engaging with people in their environments, but if exposed to music from maybe their childhood or, you know, middle adulthood, they’ll kind of brighten up and be more engaged and remember things, and it’s kind of sparking something in their brain. So, there’s a, you know, a good amount of research supporting using music to invoke memories in people who have dementia-related diseases. 

And then in the oncology space there has been an increase of using music and music therapy to enhance people’s emotional and psychology symptoms, mainly during treatment. There’s a good amount of research there and proved that maybe some of their depressive or anxiety symptoms or sleep, and even some pain-related outcomes in terms of going through treatment.

So, music therapy is actually recommended by ASCO, the American Society of Oncology and…

Jamie DePolo: American Society of Clinical Oncology.

Dr. Ashley Henneghan: Yeah. I missed one, where they’re used to looking at it and saying it.

Jamie DePolo: Right. Yeah.

Dr. Ashley Henneghan: So, it’s recommended by ASCO to be used during treatment to manage some of those psychosocial symptoms that patients encounter, but it hasn’t really been used in the cognitive symptoms space, so, either during treatment or after treatment. So, it’s kind of a new avenue of research that we’re excited to be at the beginning of because we have some good results in our study. 

Jamie DePolo: Oh, that’s fascinating, and I’ve so many questions now, but the time seems so short. I mean, 12 minutes really isn’t that long to see a change. So, do you have any thoughts about that? Like, if somebody listened longer could it be more beneficial?

Dr. Ashley Henneghan: Right, yes. So, we really just kind of put our stake in the ground in terms of the starting point to start this research and we are definitely investigating some more into what is the right dosage, you know, and what is the right dosage for each person because it’s likely different. But really if I had to guess, I think that it’d be the regular exposure so, it’s like, that 12 minutes doesn’t sound like very much but maybe that was part of the reason why people could do it every day for…we asked them to do it every day for eight weeks so, that’s 56 days in a row. 

And one of our participants shared at the end of the study -- and we do exit interviews -- that I can do 12 minutes but don’t ask me to do more than 12 minutes. And that’s what we see with some of the other interventions that are available for chemo brain. You know, there’s cognitive training or brain games, those types of things, or cognitive rehab, and a lot of times they ask people to do those for 30 minutes at a time, 45 minutes at a time, five days a week, and that might just be too much time for people that’s not realistic for them to work into their daily lives.

But we’ve seen in the meditation literature that 10 to 12 to 15 minutes is enough time to see changes there in terms of practicing mindfulness. So, again, I think it might be just a little bit often but it’s just as impactful as a lot, you know, less often. But we don’t know. Maybe more is better. We also don’t know maybe, you know, learning a musical instrument, not listening to music, could be even more beneficial ‘cause it engages more parts of the brain.

So, we definitely have a lot of questions now that we’ve got this, you know, preliminary evidence.

Jamie DePolo: Sure. And in your study it was classical music. 

Dr. Ashley Henneghan: Right.

Jamie DePolo: Do you think any kind of music could be helpful or is there something particular about…I know classical music can be more complex than some other types of music so, I didn’t know if that was it or if you think any kind of music could help?

Dr. Ashley Henneghan: Yeah. I think that…I think something in between, probably. It’s probably not classical music, but I do think that there is something about there being no lyrics to the music in terms of, you know, we asked people to sit and listen, and they could have their eyes open or closed, but really just kind of sitting and listening, and really it was kind of like a mindful music listening exercise. If there were lyrics or if it was familiar songs, you know, people’s minds can go other places pretty easily. So, we wanted the…I think the no lyrics is probably important and that there is some element of complexity in terms of multiple instruments or, you know, different characteristics like the different sounds, layering of sounds.

So, music if we think of it as a cognitive stimulation, you know, we want the right amount of stimulation and that is, you know, probably unique to the individual in terms of what type of music is pleasant for them to listen to, and then what type of music is complex enough. So, I would say it’s probably not classical music itself, but that if you like classical music, it’s a good place to start, but perhaps jazz or, you know, something else that’s highly instrumental, or even kind of modern electronic music has a lot of sounds and instruments and other types of non-lyrical stimulation to engage with.

So, I personally use this in my life since seeing these positive results. There’s a lot of free, focused-related playlists on platforms like Apple Music or Spotify or things like that, that offer a nice selection of this type of music. But a long answer to say no, it’s probably not just classical music and that I think that came from maybe a few years back there was…have you heard of the Mozart Effect? 

Jamie DePolo: Yes.

Dr. Ashley Henneghan: Yeah. So, it kind of came from that like, people having their babies listening to Mozart and it makes them smarter. That’s been debunked a little bit so, it’s probably not just classical music.

Jamie DePolo: That’s so interesting, and I have to ask, this is kind of a personal question. Because I don’t play an instrument, I am pretty much tone deaf, I can’t sing, but I’ve always loved music. And so, it’s heartening to me to know that just listening to something can be helpful as opposed to actually being able to play it because when you talked about the brains of musicians, I’m like, oh, that’ll never be me. 

But that’s helpful. You know, so, just the listening, not necessarily the playing is important. 

Dr. Ashley Henneghan: Yes. So, your question about mechanism, we don’t know exactly the mechanism by how that is helpful, but we do know that, you know, we as humans have been exposed to music our whole life and our degree of liking that is different. But when we hear musical sounds and songs, whether we know it or not our brains are trying to predict what the next note or sound is going to be. It’s just a, it’s something that happens whether we’re conscious of it or not. 

So, that’s on a very kind of basic neuroscience level. That’s one of the ways that music interacts with our brain functioning. It’s always trying to predict and make sense of things, and when we look at some of the studies that have people in the MRI or fMRI scanners listening to music, the whole brain lights up. You know, it’s totally engaging. So, I think that there’s something very primal to music and something that has been a part of most people’s lives. So, we’re unaware and subconscious of our brain’s ability to interact with that.

Jamie DePolo: Fascinating. Just fascinating. So, finally, I guess for our audience, if someone’s listening and they feel like maybe they’re having some cognitive issues because either they’re in treatment or they’re left over from treatment, can they just start listening to music, you know, something obviously as you said without lyrics so, maybe ambient, classical, jazz, whatever is best for them, for, you know, 12 minutes a day, and do you think that would help, or does it have to be a really structured thing?

Dr. Ashley Henneghan: No. I think if it sounds appealing to you, it sounds like something you would like to try, then try it and if 12 minutes sounds like too much, start with five. I really do think a little bit often is the best place to start, and you’ll know after, you know, about a month or so if your symptoms are improving or if they’re not, but it’s definitely worth a try. You know, we argue that this doesn’t require any training, that it’s very accessible so, yeah, I would encourage people to give it a try. We have some resources, we made our playlists available publicly after we were finished the study so, those are available for people to try, or just to set a timer on your phone or wherever you’re at for however long you’d like to try to start to practice and just listen to some music.

But I would also just say for people who are having cancer-related cognitive changes that there’s not a one-size-fits-all, there’s not one treatment that’s going to help all people. So, if you try something in terms of what we recommend for people to try and it doesn’t work, then try the next thing, next you maybe meditation. If the music doesn’t work then maybe meditation works for you, or, you know, it’s also recommended exercise and brain games. So, all of these things are known to help some people so, just have to figure out what is the right fit for you, but music is a great place to start.

Jamie DePolo: Yeah, that’s so great. Dr. Henneghan, thank you so much. This is…I feel like this is so simple and usually free that anybody could at least try it and see if it helps.

Dr. Ashley Henneghan: Yeah. Absolutely. 

Jamie DePolo: All right. Thank you so much. We really appreciate you joining us today.

Dr. Ashley Henneghan: Thank you for having me. It’s great to be here.