Music and Memory, featuring Dr Jess Jiang

PROFESSOR PHILIP SCHOFIELD (INTRO)

Hello, and welcome to series two of The Greatest Good, a UCL Press podcast. 

Jeremy Bentham, the late 18th and early 19th century philosopher, was the intellectual inspiration for the founding of University College London and is credited with the maxim that actions should be judged by the amount of happiness that each produces. 

I’m your host, Professor Philip Schofield, Director of the Bentham Project here at UCL. Join me as I explore the ways in which Bentham’s thought is still relevant in the 21st century. 

In this series, we focus on the intersection of Bentham’s ideas with current research into how we understand the human mind, in conversation with leading UCL academics.  

PROFESSOR PHILIP SCHOFIELD 

Hello Jess, thanks very much for coming along today. Jess, would you please introduce yourself and say a little bit about your research on dementia and hearing? 

DR JESS JIANG 

Absolutely. So, my name is Jess. I’m postdoctoral research fellow based at the dementia research center at UCL’s Queen Square Institute of Neurology. I have been there for the past five to six years now, I would say, and my research focus for a long time, in regards to my PhD, was on the idea of complex hearing, particularly in dementia and how it can be affected. So it was during my PhD that I read a book about musical illusions. It was by Professor Diana Deutsch and one of the illusions, which you can find online, is called the speech to song illusion and it happens to be her reading out a bit of a section and it was, I think it was, ‘sometimes behave so strangely’. So, once you loop that phrase, which is completely spoken, what happens is your brain slightly tricks you, and if I play it most of the time that person opposite may be like ‘Oh my gosh, it sounds like a song, it sounds like she’s singing’, instead of these multiple repetitions – and the suggestion of that was that it was a form of short-term neuroplasticity so we thought—

PROFESSOR PHILIP SCHOFIELD 

So can you explain that term – neuroplasticity? 

DR JESS JIANG 

Yeah, yeah, yeah, so the idea that that there’s a certain form of plasticity in the brain where you can build new connections and strengthen the brain in that kind of way. That is something known to slightly decrease with dementia.  So the idea is, could we use this as a marker and as a way of telling about this form of short-term neuroplasticity? So we took the stimuli and started playing it. And within what I took as a cognitively healthy comparison individuals around the same age, other demographics as well, and played them this illusion, about 70% of them can hear it. At 70% they’ll be like, oh, I hear this is no longer, you know, this is no longer speech, this is music instead. But in the case of people living with dementia and with the different types of dementia that decreased substantially. It was about more closer to 30% people who would actually hear this illusion.  And that’s a massive drop. Obviously there are a lot of different other factors as to why they can hear the illusion. But in and itself, what you would say is similar in population while just one has the disease versus one doesn’t, it’s quite striking that a much less percentage of people can actually perceive that illusion. And it’s not even a case of they can’t tell the difference between speech or song because as a control condition near the end, I would just play them short phrases of actually, ironically, it’s myself singing really badly or just speaking it. And most people get at least 90% correct on that, on being able to tell if it was spoken or sung.

PROFESSOR PHILIP SCHOFIELD 

And can those experiments tell the people who are working with the drugs anything? The people who are sort of investigating just what’s going on in the brain?

DR JESS JIANG

Yeah, so some of the measures we’ve been developing – and I’m in the lab of Professor Jason Warren, and him as his lab have been developing these really sensitive auditory markers for…two decades now or something – and the idea of them is also to be quite good at disease tracking as well. 

So within clinical trials, in order to develop a drug that’s very suitable, you also throughout the phases need to track the progression of are they improving or are they not decreasing as much as you would expect and things like that. And to be able to deliver that, you need very good disease tracking markers. So the idea is that you can use these and benefit understanding and build the understanding of drug development as well. Really from there, what I’ve really focused on is developing these real world hearing measures that can really track some of these complex hearing scenarios for purposes such as screening tools or diagnostic purposes. So that’s really been a heavy focus of mine alongside other things as well. 

PROFESSOR PHILIP SCHOFIELD 

What are the complex situations you’re talking about?

DR JESS JIANG

Yeah. So the reason why I say complex is the idea of the auditory environments are typically quite dynamic. We’re currently in quite a soundproof room, which is quite rare. But most of the time when we’re engaging in any kind of communication or interaction, it’s always in the context of noise. Our world is just naturally really noisy. And that’s what I mean.  Our brain is so effortlessly filtering out all these external noises all the time, that really you don’t think about, oh, I’m just paying attention to this one person while filtering out all the sounds of closing doors or paper rustling or anything like that, depending on whatever scenario you’re in. And this form of really lots of different sounds coming in your brain working really hard to parse them all out. And that has been shown to be affected in particularly Alzheimer’s disease, but as well as a lot of other forms of dementia as well. So I’m particularly focusing on that kind of idea. So it’s very different from if you were concerned about your hearing, you go to an audiology clinic and have those beeps played to you in a very quiet and controlled environment. My focus has been really how can we take this and apply it to the real world scenarios that we frequently engage with at a busy dinner table or things like that.

PROFESSOR PHILIP SCHOFIELD

Right, so is it that people with dementia have problems hearing, or is it that the hearing problems are a contributory factor to dementia? 

DR JESS JIANG

That’s quite a hot topic at the moment, and there’s lots of discussions about what exactly is the link – so particularly now, we know that there is a link between hearing and dementia, but exactly the mechanisms involved isn’t really fully understood. We have cases where some people say, like, hearing could be a contributing factor, but you have the other side: that the hearing symptoms section early signal and early sign of dementia and its effect on the brain.  And particularly in the environment that I was describing earlier which is these complex… The dinner table scenario is a very good one. We call it auditory scene analysis, where basically it’s the idea that your brain is taking out different segments of whatever’s happening auditorily-wise and trying to make sense of it. And that is incredibly taxing on the brain. And we found that that is particularly a really early and really sensitive marker for Alzheimer’s disease for example so. That’s on my side of research more so, but there’s been lots of other research looking at possibly hearing being more on the other direction so it’s been… I think it’s an open-ended question where a lot of people are trying to figure out exactly what the mechanism is between the relation of hearing and dementia. 

PROFESSOR PHILIP SCHOFIELD

But you’re particularly interested in using music?

DR JESS JIANG

Yeah, and that’s definitely one of the key interests. So, my focus has predominantly been in Alzheimer’s disease and frontotemporal dementia.  Those are two distinct types and in both of them we’ve definitely heard lots of things associated with music before. So I think particularly doing the COVID-19 lockdown we heard lots in the news about people with dementia and then having a retained ability to still be able to play or compose music and things like that. And in the case for frontotemporal dementia we have people who have musicophilia which is a kind of an intense love and partially almost an obsession with music that can manifest in a way or a growing change in musical taste. So previously they might have only liked heavy metal but they suddenly really really only like pop music or ABBA or something like that. You can have that kind of change. You also can have a thing of music aversion. Suddenly they absolutely hate music and they can’t stand being in the room with it. So I think music definitely keys into an aspect of cognition and the brain that other aspects don’t. 

PROFESSOR PHILIP SCHOFIELD

My mother was a singer, not a professional, but that was the thing when she had dementia. The rest of her personality went in some respects, but she always remembered she was a singer. 

DR JESS JIANG

Yeah, it also taps into emotions and feelings and things like that. So musical therapy is potentially a very good way of bypassing, particularly for people who love music, as a way of bringing more a sense of happiness, a sense of more the behavioural symptoms that can come alongside with the diagnosis.  But equally, I think it can definitely bring about a sense of cohesion with the people around them, like the music therapy that we’re currently trialing at the moment is typically between the person living with dementia and their primary caregiver, which tends to be a spouse. And I think you can see that through playing the music together. They talk more, they engage, they turn their heads, they smile together, they might bob together as well. So that’s always really nice. 

PROFESSOR PHILIP SCHOFIELD

Right, so, I mean, it’s not that music’s going to cure anything, but it helps the situation which the person with dementia and their carer are in?

DR JESS JIANG

Yeah. I think again for the earlier point of it being very individualised it has to be in the case that the person really likes music you don’t want to deliver a music therapy to someone who ends up hating music and doing more damage than benefit but you can see an increase in engagement and lots of different things when people are particularly listening to music that they really like. 

PROFESSOR PHILIP SCHOFIELD

Mm-hmm. So I guess you have to then do them their own playlist?

DR JESS JIANG

Yeah, so you would definitely need to have a sense, so the music intervention that we’re really trying right now is completely based on the idea of personalised playlists, because in the past there’s a really key thing about called the reminiscence bump, which is the idea that the songs you listen to in your teens and early adulthood are the most prominent, the ones that you really love and you really remember. And I think there’s a tendency that therefore because of that you would just play the top hits of the time.  But not everybody is a big fan of those kinds of music, you know, they might really like different kinds of music and therefore actually playing generic music actually doesn’t really do them that much benefit. So the idea is exactly giving the personalised playlist, making it so that it can be memorable to them. It might be there, I don’t know, the example a lot of people have given is, oh that was our, you know, our wedding song or something. And that always gives an additional emotional reaction and memory to it.

PROFESSOR PHILIP SCHOFIELD

Is it correct that dementia takes away certain cognitive functions but leaves the emotional side of the brain much more intact? 

DR JESS JIANG

Yeah, so that can definitely happen in certain kinds of dementias, but for example, in frontotemporal dementia, emotion regulation actually gets affected quite early on, and that is quite immediate, which is you would, the most common example is, for example, people have shown people emotional faces of whether they look happy, sad, angry, or anything like that, and they particularly perform worse at that. Now, in comparison to something like Alzheimer’s disease, which you’re exactly right, which is slightly more retained until later on in the later stages that it gets more affected, but the earliest stages, your emotional recognition and things like that are less impaired.  But I think it is complex, because I think one of the things about frontotemporal dementia, for example, is their emotions might be inhibited on other factors. You have people telling us that, for example, in terms of relationships, they’re less emotional about it, but when it comes to music, they suddenly are in floods of tears or things like that, and it’s something specific about music that can bypass certain barriers before, yeah. 

PROFESSOR PHILIP SCHOFIELD

And part of your work is to make treatment, or this sort of treatment, more inclusive.

DR JESS JIANG

Yeah, so I am very focused on the idea of making research more inclusive and more representative of a lot of different populations. So for example, the music intervention one, we’ve recently been awarded an extension of the grant with Grand Challenges, and particularly the focus of that is to deliver it within minoritized ethnic communities.  And I think it’s quite something that is really critical for us to really consider because representation in dementia research has been an issue, and it’s really important for us to learn more about the disease that is not strictly restricted to one type of population rather than it should be inclusive and more representative towards a general public.

PROFESSOR PHILIP SCHOFIELD

So how are you doing that? 

DR JESS JIANG

Um, I haven’t quite directly been able to implement it exactly for this grant yet, because we’ve just gotten funding for it. But for the past two years, I’ve been trialing out a new program that’s kind of like patient and public involvement and engagement aspects of things. So, within within the UK, there’s been fantastic research being done on lots of different minorities ethnic communities for example, but one of the communities that I personally noticed that was largely ignored and underrepresented was the Chinese community. And therefore, with a personal direct insight towards the culture of it I realised it’s quite strange, especially when there’s a growing immigrant population. And therefore, I started running these public engagement events within different community centres in London, trying to increase engagement and things like that and increase understanding of dementia. And overall, I’ve delivered probably now – there’s been about 170 attendees, I would say. It’s been really encouraging; they’re very complimentary – I don’t know if I deserve it or not – but I think with each one of them, they’re showing an increase in learning but also an increase with accepting the necessity of research, for example. So there’s a hesitancy initially, and a lot of them have said something such as – and granted so – of a lack of time caring responsibilities etc, but post delivering the engagement event and describing more about dementia and describing the importance of research and improving our understanding about dementia, it basically was more people saying that they were more willing to engage with research, which is really encouraging and I think that’s one of the first steps that we can take towards trying to make it less scary, I guess, and make it more approachable for more people and therefore hopefully that can bring about a more inclusive research culture as well. 

PROFESSOR PHILIP SCHOFIELD

Right.

DR JESS JIANG

So, one of the things I’m really grateful for, and for the last five or six years of working at Queen Square, is that the families themselves and I think it’s really important that – and it’s always really heartwarming that a lot of them come into our research and they all say something like well I know it’s not going to directly benefit me but I know it’s gonna benefit a lot of people and in years on time. 

And I think the idea of developing these measures is to help people living with these diseases because, you know, these families are absolutely wonderful, and I think that’s why it’s really important to consider dementia in itself as a complex disease but also what each individualised family needs and we were developing these early diagnostic measures because some of them have told us… You know, it’s always based on their direct feedback so if they said something like you know we got the diagnosis way too late and that is particularly prevalent when I whenever I speak to anyone who’s from a minoritized ethnic community they’re like no we got the diagnosis probably three or five years later and stuff. So the idea is to create these more inclusive early detectable measures so that you know they can get the detection early as well, so that they can get all the treatments and care options available for them and for their individualised person. And equally the music intervention, for example, is exactly defined for the people currently living with dementia where you know drugs are on its way but not quite there yet exactly on on and and for the different types of dementias as well, you know, there’s there’s still a lot more to do so therefore this music intervention for the people who also like music could be beneficial in the very moment so, yeah, I think that’s always… it’s really it’s always amazing for myself to work with the families and they’re a reminder of that.

PROFESSOR PHILIP SCHOFIELD

Well I think it’s fantastic what you’re doing because having you know lived through dementia myself, I just know how awful it is – at least it was in my case, it’s not necessarily so – but I wish I’d known what the signs were, like two or three years before I picked up on them. So what you say has been… yeah, I find personally very, very interesting and quite moving, really, that you’re doing this work – and good luck to you. 

DR JESS JIANG

Thank you.