Musical Structural Determinants of Emotional Judgments in Dementiaof the Alzheimer Type

Lise GagnonUniversite de Sherbrooke

Isabelle PeretzUniversite de Montreal

Tamas FulopUniversite de Sherbrooke

People with dementia of the Alzheimer type (DAT) may well be emotionally soothed by listening tomusic. However, very few systematic studies have been conducted to support the anecdotal evidence.DAT does damage certain cerebral structures that subsume emotional processing, and some studies havedemonstrated deficits affecting emotional judgments of facial expression and prosody in DAT. Accord-ingly, this study addressed the question of whether DAT might leave musical emotional judgment intact.Twelve early DAT participants and 12 healthy elderly participants took part in this study. Emotionaljudgments were examined in relation to mode and tempo, two important structural properties thatcontribute to the happy-sad distinction in music. Their respective contributions were assessed in fourdifferent experimental conditions. The DAT participants’ responses were similar to those of healthyelderly participants, showing spared ability to employ tempo and mode as cues for emotional interpre-tation. The DAT participants’ performance was not correlated with their global cognitive functioning.These results constitute a preliminary empirical demonstration that, in early DAT, musical emotionaljudgments appear to be based on normal structural analysis of musical input.

Keywords: dementia, music, emotion, recognition

The use of music as a clinical tool with people who havedementia of the Alzheimer type (DAT) has grown impressively inthe last two decades. Many anecdotal reports describe music ashaving the power to release DAT patients’ emotions and also tocognitively stimulate even severe cases of DAT. Accordingly,systematic reviews have been published on music therapy forpeople with dementia (Gibbons, 1988; Kneafsey, 1997; Koger &Brotons, 2000; Sherratt, Thornton, & Hatton, 2004; Vink, Birks,Bruinsma, & Scholten, 2004, 2006), with many reference works onthe subject appearing since 1996 (see, e.g., Aldridge, 2000; Clair,1996; Hanser, 1999). Although musical interventions really doseem to be beneficial for DAT patients, systematic proof of theirefficacy is still lacking. The very few studies that have beenconducted on this topic have used poor experimental methodolo-gies (Vink et al., 2006).

Music as a medium for communication with DAT patients isinteresting because its nonverbal nature bypasses the language andsemantic deficits that characterize DAT. However, many othercognitive deficits occur during the course of DAT. Accordingly,one important question arises in relation to music: how might DATaffect the emotional judgment of music?

In its early stages, Alzheimer’s disease damages some of themost important cerebral structures that subserve emotional pro-cessing, such as the hippocampus and the posterior associationareas (Kemper, 1984). Most systematic studies that have examinedemotional judgments in this disease have concluded that there issome evidence of impairment for emotional judgments of facialexpression and prosody (Allen & Brosgole, 1993; Allender &Kaszniak, 1989; Hargrave, Maddock, & Stone, 2002; Kohler et al.,2005; Roudier et al., 1998; Shimokawa et al., 2000, 2001; Testa,Beatty, Gleason, Orbelo, & Ross, 2001; see Kohler et al., 2005 fora review). However, those studies included groups of mixed early(or mild) and moderate DAT participants.

Studies that clearly distinguished early and moderate DAT partic-ipants did not find such impairment. Lavenu, Pasquier, Lebert, Petit,& Van der Linden (1999) found preserved emotional recognitionfor facial expressions of happiness, sadness, surprise, disgust,anger, and contempt, with a limited deficit for the recognition offear. However, when the same participants reached a moderatelevel of DAT (3 years later) and were assigned the same tests, theyshowed a decline in the recognition of all emotions except forhappiness, sadness, and contempt (Lavenu & Pasquier, 2005).Roberts, Ingram, Lamar, and Green (1996) compared early andmoderate DAT participants for comprehension of emotional pros-ody, and found a significant impairment only with the moderateDAT participants (for surprise, sadness, anger, or neutral—the

Lise Gagnon and Tamas Fulop, Research Center on Aging, Universite deSherbrooke; Isabelle Peretz, Department of Psychology, Universite deMontreal.

We are grateful to all the participants, to Stephanie Louveaux for herhelp in testing them, and to Lise Trottier for her help with the statisticalanalysis. We are also grateful to Francine Fontaine, Brigitte Gilbert, andMarie Robitaille for their clinical advice, and to Zofia Laubitz and LindaBergeron for copy-editing this article. We particularly wish to acknowl-edge the insightful and constructive comments of Nathalie Gosselin. Thisresearch was supported by a fellowship from the Fonds de la Recherche enSante du Quebec and from the Reseau provincial de recherche en adap-tation-readaptation (REPAR) to the first author.

Correspondence concerning this article should be addressed to LiseGagnon, Research Center on Aging, 1036 Belvedere Sud, Sherbrooke,Quebec J1H 4C4, Canada. E-mail: lise.gagnon@usherbrooke.ca

Neuropsychology © 2009 American Psychological Association2009, Vol. 23, No. 1, 90–97 0894-4105/09/$12.00 DOI:10.1037/a0013790

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only emotional intonations to identify). Kohler et al. (2005) didfind impairment for the recognition of happy and sad facial ex-pressions with early DAT participants. However, the task was toidentify intensity of facial expressions by ranging them on a7-point Likert scale, ranging from Very Happy to Neutral to VerySad; this is quite a difficult procedure even for early DAT patients.

Only one study has systematically examined emotional judg-ments of music in patients suffering from dementia (Allen &Brosgole, 1993). Participants were asked to listen to 18 popularmusical excerpts lasting 10 seconds each and expressing happy,sad, or angry emotions. They had to point to a picture of the happy,sad, or angry face of an animal, in association with each musicalselection. In a second condition, participants had to listen to eachexcerpt and say whether it was happy, sad, or angry. Dementedpatients’ overall performance showed deficits affecting the recog-nition of happy, sad, and angry musical expressions. However, theclinical descriptions of patients were unclear, and no specific typeor severity of dementia was mentioned.

Most of the experimental studies of music and DAT haveexamined music perception and memory or musical performanceby musicians. Some studies of music perception and memory haveconcluded that those abilities are relatively spared in DAT (Bier,Provencher, Gagnon, Van der Linden, & Desrosiers, 2008; Cowleset al., 2003; Cuddy & Duffin, 2005; White & Murphy, 1998). Aswell, the preservation of instrumental playing of music in DAT hasbeen demonstrated in some case studies (Beatty, Brumback, &Vonsattel, 1997; Beatty et al., 1999, 1988; Crystal, Grober, &Masur, 1989). However, long-term recognition of familiar or un-familiar melodies may be compromised (Bartlett, Halpern, &Dowling, 1995; Crystal et al., 1989; Halpern & O’Connor, 2000),even implicitly, through emotional ratings of pleasantness (Halpern& O’Connor, 2000). Contradictory results were obtained byQuoniam et al. (2003), however, who demonstrated normal prim-ing effects on preference judgments for unfamiliar melodies witha group of 10 DAT participants, even though the participants’explicit recognition of the same melodies was severely impaired.

In conclusion, it is still not exactly clear how DAT affects musicperception and memory. More studies, with a similar methodol-ogy, are needed to answer that question. Besides, even thoughmusic recognition may deteriorate in DAT, it might be dissociatedfrom emotional judgments of music.

The system for the analysis of emotional expression by music isisolable from music memory (Peretz & Gagnon, 1999; Peretz,Gagnon, & Bouchard, 1998). The study of a case of amusiademonstrated that the ability to distinguish between happy and sadmusic may be spared by brain damage, even when the recognitionof specific pieces of music is impaired (Peretz & Gagnon, 1999).Accordingly, even though DAT may affect music memory, mightit leave emotional judgments of music intact? This is the questionaddressed in the present study, which constitutes the first system-atic exploration of musical emotional judgments in early DAT.

Since it has previously been demonstrated that instrumentationand interpretation are not major determinants of emotional judg-ments (Peretz et al., 1998), such judgments were examined inrelation to structural characteristics that are relevant in this respect.Two structural properties that are known to convey importantinformation with regard to the happy-sad distinction are the tempoand the mode of a piece (e.g., Gagnon & Peretz, 2003; Hevner,1935, 1937). Slow tempi, or few beats per minute, tend to evoke

sad moods, whereas fast tempi, or many beats per minute, tend toevoke happy moods. Mode is related to the subset of pitchesselected in a given musical segment: the minor mode is associatedwith a sad tone, whereas the major mode is associated with a happytone. To assess the respective contributions of tempo and mode tothe emotional evaluation of musical stimuli, we manipulated thesecharacteristics orthogonally, in three different experimental con-ditions, in our earlier study of an amusic patient, I.R. (Peretz et al.,1998). Normal controls and I.R. all proved to be sensitive tocharacteristics of mode and tempo. Those results were generalizedto a sample of 24 university students (Dalla Bella, Peretz, Rous-seau, & Gosselin, 2001). In the present study, we aimed to use thesame materials as Peretz et al. (1998) and Dalla Bella et al. (2001)to investigate whether early DAT patients and normal elderlypersons would also be sensitive to mode and tempo as determi-nants of musical emotional judgments.

Method

Participants

A group of 12 participants who met the NINCDS-ADRDA(McKhann et al., 1984) or DSM–IV criteria (American PsychiatricAssociation, 1994) for probable Alzheimer’s disease participatedin this study. Their characteristics are presented in Table 1. Theywere recruited either by the multidisciplinary team of the memoryclinic of the Sherbrooke Geriatric University Institute (SGUI),from the SGUI archives, or by the Eastern Townships AlzheimerSociety in Sherbrooke. They had received a diagnosis of DATbased on complete geriatric and neuropsychological investigationsconducted at the SGUI memory clinic. The exclusion criteria were:(1) cognitive deficits that could interfere with the course of theprocedure (such as comprehension deficits) and major auditorydeficits; (2) major depression or anxiety; (3) behavior problems;and (4) any other dementia (vascular, semantic, alcoholic, etc.).

A comparison group of 12 healthy elderly participants also tookpart in this study. All were Canadian. They were recruited by wordof mouth and by advertisements distributed via the SGUI ResearchCenter on Aging’s newsletter sent to Sherbrooke seniors. Exclu-sion criteria included dementia of all kinds, memory complaints,history of head injury, depression, or a Mini Mental State Evalu-ation (MMSE; Folstein, Folstein, & McHugh, 1975) score abnor-mal for the age and level of education.

The two groups did not differ according to age or years ofeducation. As expected, they differed significantly in general cog-nitive functioning, as assessed by the MMSE (see Table 1).

Table 1Demographic Characteristics of Participants and Level ofGeneral Cognitive Functioning

CharacteristicsDAT

participants

Healthyelderly

participants

Differencesbetween groups

(level ofsignificance)a

Age 74.3 (56–85) 71.3 (64–84) 0.132Sex (number of women) 7 11 —Years of education 9 (6–18) 8.83 (5–15) 0.555MMSE (/30) 23.08 (16–27) 27.75 (25–30) �0.001

a Mann-Whitney U-tests.

91MUSIC, EMOTION, AND DEMENTIA OF THE ALZHEIMER TYPE

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Eleven of the 12 DAT participants also received a standardizedneuropsychological evaluation. This was done so that only earlyDAT participants would be included. The results are shown inTable 2. The DAT group as a whole presented mainly episodicmemory, semantic memory, and inhibition deficits, in accordancewith the general cognitive profile of early DAT (Collette, Van derLinden, Juillerat, & Meulemans, 2003; Hodges & Patterson, 1995).Also, as a group, they obtained a mean score of 23.08 on theMMSE, which is defined as minimal to mild DAT (Hodges,2000).1

Musical experience was assessed through a brief questionnaire,to include only nonmusicians. Among both healthy elderly andDAT participants, if anyone had received a musical education, itcould be for no more than 5 years and on an instrument that theyhad not played for at least 15 years. All participants were given$15 compensation for their participation.

The project was approved by the Research Ethics Committee ofthe Research Center on Aging (SGUI). Informed consent wasobtained from the participants, and the consent form was signed bythe participants, the researcher in charge of the project, and awitness. Participants were tested at the Research Center on Agingor at home.

Materials and Procedure

Materials. The same set of 32 musical excerpts was usedthroughout the experiments. This set, which was previously usedin one of our studies done with an amusic patient (Peretz et al.,1998, which presents the set of musical selections in the Appendix)and in a developmental study including young adults (Dalla Bellaet al., 2001), very effectively assessed the effect of tempo andmode manipulation regarding the happy-sad distinction.

All the excerpts were instrumental in that they were not origi-nally sung with lyrics; as well, the excerpts were drawn from thecorpus of Western music and were composed for purposes otherthan experimentation. The excerpts were chosen from the classicalcorpus because it was considered important to use musical materialthat is sufficiently complex and engaging to guarantee its process-ing as a meaningful structure rather than as a simple sequence oftones. The selections were drawn from the baroque (e.g., Bach,Albinoni), classical (e.g., Mozart), romantic (e.g., Verdi), andcontemporary (e.g., Ravel) periods. These excerpts were selected sothat half evoked a sense of happiness and the other half, a sense ofsadness. The original instrumentation was generally orchestral (22excerpts) or for solo piano (8 excerpts). The excerpts lasted from 7seconds to 33 seconds (mean: 15.8 seconds). The computer-gen-erated versions were created on a microcomputer running a MIDIsequencing program (Sequencer Plus Gold) and controlling asample playback digital synthesizer (Roland Sound Canvas SC 50)by entering the original scores manually. Each tone occupied itsprecise value in terms of pitch and duration, keeping intensity andvelocity constant. The pedal was used in the piano renditions.

The excerpts contained structural characteristics that determineemotional judgments. Two structural properties known to conveyimportant information regarding the happy-sad distinction are thetempo and mode of the piece (e.g., Hevner, 1935, 1937). Asmentioned above, slow tempi tend to evoke sad moods, whereasfast tempi evoke happy moods. Moreover, minor mode is associ-

ated with sadness, whereas major mode is associated with happi-ness (see Crowder, 1984; Gagnon & Peretz, 2003).

The musical excerpts used in the present study generally fol-lowed these principles: the happy excerpts were mostly played ina fast tempo (the quarter note value varied from 80 to 255,conventionally written as M.M. for Metronome Marking) and wereall in a major mode; most of the sad excerpts were played at a slowtempo (between 20 and 100 M.M.) and were in the minor mode.Therefore, it is likely that both tempo and mode are structuralcharacteristics of the pieces that contributed to the happy-saddiscrimination. The piano-synthesized version was used, mainlybecause such a version is easier to manipulate with a computerprogram.

A baseline condition, referred to as the original condition,included the 32 original piano-synthesized excerpts. To assess therespective contributions of tempo and mode to the emotionalevaluation of the musical stimuli, we manipulated these character-istics orthogonally, in three different conditions. In the tempochange condition, all tempi were set to a single neutralized value(with the quarter note � 84 M.M.) that corresponded to the medianof the original tempi (because inversions from fast to slow, or fromslow to fast tempi were too drastic and resulted in excerpts thatsounded unnatural or ill-formed). In the mode change condition,the pieces were transcribed in the opposite mode to the original.The procedure used for the mode transcription was conventionaland identical to that used by Hevner (1935). Finally, to examinethe joint influence of mode and tempo, the two modificationsapplied in isolation in the mode and tempo change conditions werecombined in the mode � tempo change condition. Sample stimulican be heard at www.brams.umontreal.ca/plab in relation to theDalla Bella et al. (2001) publication.

Procedure. All stimuli were recorded on compact disks andplayed on a CD player in free field at a loudness level that wascomfortable and customary for the listener. Each participant wastested individually.

The four conditions were always presented in the same order:(1) Original, (2) Mode change, (3) Tempo change, and (4) Mode �tempo change. The sequence was designed to respect the fact thattempo is generally a more salient determinant of happy-sad judg-ments (Gagnon & Peretz, 2003; Peretz et al., 1998, for the samestimuli); thus, the experiment was made easier as participantscould move on from the second to the fourth conditions, thusbypassing any fatigue effect. (Although Dalla Bella et al., 2001,controlled for potential biases because of order of presentation,they found no effect of this variable.) Participants were neverinformed of the nature of the changes applied to the stimuli.

1 Participant 1’s cognitive profile requires further clarification. Hescored 27 on the MMSE but showed significant episodic memory deficits.He had a university degree, the highest educational level of all participants.He had received a diagnosis of dementia based on three complete geriatricand neuropsychological investigations (from 2002 to 2005; for details, seeBier et al., 2008). His isolated memory problems and functional difficultiessuggested a diagnosis of a possible, slowly isolated progressive memorydisorder (Della Salla & Spinnler, 1999) or possible Alzheimer’s disease(McKhann et al., 1984). It is worth noting that Participant 1’s very higheducational level made the neuropsychological tests less sensitive, therebymaking a more specific diagnosis hazardous.

92 GAGNON, PERETZ, AND FULOP

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93MUSIC, EMOTION, AND DEMENTIA OF THE ALZHEIMER TYPE

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To keep the procedure used in our previous experiment (Peretzet al., 1998), participants were asked to judge, on a 10-point scale,whether each excerpt sounded happy or sad, with 1 meaning verysad and 10 meaning very happy. However, this procedure was toodifficult for the DAT participants. For example, they frequentlygave a rating of 10 and said “very sad.” They seemed to find it verydifficult to conceptualize a score of 1 as indicating maximumintensity. A pilot group of five DAT participants confirmed theneed to adapt the procedure to their cognitive functional level. Thechosen procedure was to ask participants (1) to judge whether eachexcerpt sounded happy or sad, and (2) to judge the intensity of theidentified emotion on a 5-point scale where 1 meant not muchand 5 meant very much.

Results and Comments

The ratings provided by the DAT participants were converted tocorrespond to the original 10-point scale. Accordingly, “happy”ratings of 1, 2, 3, 4, and 5 were converted into ratings of 6, 7, 8,9, and 10, respectively, and “sad” ratings of 1, 2, 3, 4, and 5 wereconverted into ratings of 5, 4, 3, 2, and 1, respectively.

The mean ratings given by DAT participants and by healthyelderly participants, in each condition for the “happy” and “sad”excerpts, are presented in Table 3. The mean ratings obtained foreach excerpt were evaluated with an analysis of variance(ANOVA), with participants as the random variable, Group (DATvs. healthy elderly) as the between-participants variable, and Emo-tional Category (happy vs. sad) and Condition (original vs. tempovs. mode vs. tempo � mode) as the within-participants variables.The analyses revealed a tendency toward a three-way interactionwith the Group, Condition, and Emotional Category variables withF(3, 20) � 2.79, p � .067.

Because this interaction was almost significant, a comparisonbetween the two groups was performed using separate ANOVAsfor each condition, considering Group (DAT vs. healthy elderly) asthe between-participants variable, and Emotional Category (happyvs. sad) as a within-participant variable. The analyses did notreveal an interaction of the Group and Emotional Category vari-ables (F(1, 22) � 2.63 for original, 1.17 for mode, 3.43 for tempo,and .54 for tempo � mode, ns) nor any effect of Group. Thoseanalyses confirm the absence of significant differences in sensitiv-ity to mode and tempo between our groups for the emotionalclassification of musical excerpts. As can be seen in Figure 1,means were relatively homogeneous from one subject to another.The mean ratings obtained from DAT participants for excerpts oftempo � mode condition seemed to differ from the one of healthyelderly participants, moreover indicating a change of categoryfrom sad to happy judgments. However, this appears to be theresult of one subject’s extreme happy ratings for sad excerpts. Infact, this participant, in his statements, clearly judged the sadexcerpts as being relaxing and, accordingly, happy.2

To examine each group’s sensitivity to the structural manipula-tions, separate ANOVAs on the ratings were performed. ANOVAsstill considered Emotional Category (happy vs. sad) and Condition(original vs. tempo vs. mode vs. mode � tempo) as the within-participants variables. The ratings given by each group were sig-nificantly influenced by the condition presented; the EmotionalCategory by Condition interaction is significant in both DAT andhealthy elderly participants’ data, with F(3, 9) � 105.98 and 41.14,

respectively, ps � .001. Comparisons between conditions wereperformed two by two, with separate ANOVAs, considering thesame factors as in the overall ANOVAs. These subsequent anal-yses indicate that each modification of the original version signif-icantly affects the response pattern. When compared to the originalversion, the tempo condition yields a significant interaction be-tween Condition and Emotional Category (with F(1, 11) � 33.94and 49.58, ps � .001, for DAT and healthy elderly, respectively),as does the mode condition (with F(1, 11) � 7.71, p � .05,and 10.44, p � .01, for DAT and healthy elderly, respectively) andthe mode � tempo condition (with F(1, 11) � 281.04 and 124.88,ps � .001, for DAT and healthy elderly, respectively). Note that inthe latter condition, where the manipulation has the greatest im-pact, ratings are still significantly higher for the happy than the sadexcerpts, t(11) � 2.54, p � .027 and 3.67, p � .004 by bilateraltests, for DAT and healthy elderly, respectively. Thus, despitethe change of both mode and tempo applied to the stimuli, evenDAT participants were still able to discriminate happy from sadexcerpts.

Correlation Between AD Participants’ Performance andTheir Cognitive Profile

The purpose of this analysis was to explore a possible relation-ship between DAT severity and performance on musical emotionrecognition. Bivariate Spearman correlations were carried out be-tween the following general cognitive measures and the DATgroup’s mean ratings obtained on the mode condition (this beingthe most difficult experimental condition): (1) global functioning,measured by the Dementia Rating Scale (DRS); and (2) the MiniMental State Examination (MMSE).

The mean ratings obtained in the mode condition by DATparticipants were not correlated with global cognitive functioningas measured by the DRS (rs(9) of .07 and .32 for happy and sadcategories, respectively, ns); nor were they correlated with theMMSE (rs(12) of .46 and .07 for happy and sad categories,respectively, ns).

Discussion

The objective of this study was to examine the perceptual basisof emotional judgments of music in early DAT. Accordingly, weinvestigated whether early DAT patients and healthy elderly par-ticipants showed the same sensitivity to the principal determinantsof musical emotional judgments—mode and tempo—in four dif-

2 The mean differences obtained as a change in ratings from original tomode, from mode to tempo, and from tempo to mode � tempo were alsoevaluated with an analysis of variance (ANOVA), with participants as therandom variable, Group (DAT vs. healthy elderly) as the between-partic-ipants variable, and Emotional Category (happy vs. sad) and Change inmean ratings (original to mode, mode to tempo, and tempo to mode �tempo) as the within-participants variables. These analyses revealed nointeraction between Group, Change, and Emotional Category variables( p � .1). They revealed a main group effect, with F(1, 22) � 8.023, withp � .01. Simple comparisons between groups revealed a tendency towarda significant difference for the Change from tempo to mode � tempo, butonly for the Happy excerpts, t(22) � 1.88, p � .07 by bilateral tests, withDAT showing the largest difference.

94 GAGNON, PERETZ, AND FULOP

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ferent experimental conditions previously used in two studies byour group (Dalla Bella et al., 2001; Peretz et al., 1998).

For both DAT and healthy elderly participants, mode and tempomodifications changed participants’ performances, particularlywhen the musical excerpts presented incorporated both kinds ofmodifications. Moreover, DAT participants’ responses were sim-ilar to those of healthy elderly, showing spared ability to employtempo and mode as cues for emotional interpretation. These resultsconstitute a preliminary empirical demonstration that early DATpatients’ musical emotional judgments appear to reveal normalstructural analysis of musical input.

In other respects, DAT ratings for the Original condition happyexcerpts were higher than healthy elderly ratings (despite theabsence of a significant interaction between Groups and EmotionalCategory for the Original condition). This could be the result of thedifferent procedure used by DAT participants. They had to ratefrom a simpler 5-point scale, and conversions of their ratings to theoriginal 10-point scale may have resulted in an apparent betterrecognition of happiness.

It is also interesting to note that DAT participants’ ratingsseemed to suggest less sensitivity to mode than those of healthy

elderly (at least for the happy excerpts). However, the analysesperformed on differences obtained as a change in ratings fromoriginal to mode did not confirm such a conclusion. Instead, theyrevealed that DAT participants were really sensitive to mode,inasmuch as they showed, for happy excerpts, the largest meandifference of ratings from tempo to mode � tempo conditions.

Besides, despite the changes of both mode and tempo applied to thestimuli in mode � tempo condition, even DAT participants were stillable to discriminate happy from sad excerpts. This suggests that,like healthy elderly and young adults (Dalla Bella et al., 2001;Peretz et al., 1998), early DAT patients are sensitive to determi-nants other than tempo and mode that play a role in the emotionalclassification of the stimuli (such as pitch level; Gabrielsson &Juslin, 2003).

Another determinant of performance in DAT might be the level ofcognitive decline. The longitudinal study of Lavenu and Pasquier(2005), which demonstrated a specific decrease in the recognitionof facial emotional expressions in DAT as dementia progressed,concluded that the results might be related to the progressivedegeneration of the structures involved in emotional processing.Such a conclusion is also supported by the results obtained in the

Figure 1. Mean ratings obtained for the happy and sad excerpts in each experimental condition as presentedfor each participant from the DAT and healthy elderly groups.

Table 3Mean Ratings (and Standard Errors) for DAT and Healthy Elderly Participants in the DifferentConditions as Defined by the Type of Modification Applied to the Musical Excerpts

Condition

DAT participantsHealthy elderly

participants

Happy Sad Happy Sad �Effect sizes

Original 8.8 (0.5) 4.4 (1) 8.2 (0.9) 4.4 (0.8) .60 (�0.20, 1.60)Mode change 8.3 (0.9) 4.7 (1.1) 7.6 (1.1) 4.5 (0.9) .44 (�0.51, 1.62)Tempo change 7.9 (0.8) 5.2 (1.2) 7.0 (1.1) 5.1 (1) .67 (�0.09, 1.61)Mode � tempo change 6.7 (1.1) 6.1 (1.2) 6.3 (0.9) 5.4 (1) .30 (�0.99, 0.47)

�Effect sizes for the comparisons between groups for each condition (with Confidence Intervals at 95%).

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study of Roberts et al. (1996), which examined the comprehensionof emotional prosody by early and moderate DAT participants.Even if the present study specifically included early DAT partic-ipants, there might be some variability between subjects of thesame cognitive level (e.g., Bier, Gagnon, & Desrosiers, 2005;Joanette, Ska, Poissant, Belleville, Bellavance, et al., 1995). Ac-cordingly, we addressed the question of whether the DAT partic-ipants’ performance in our study might be correlated with theseverity of the general cognitive decline. In fact, the DAT partic-ipants’ performance in the mode condition (the most difficultcondition) was not correlated with their global cognitive function-ing, as measured by either the MMSE or the DRS. In fact, theseresults may be simply consistent with our description of DATparticipants as constituting a homogeneous group with a generalcognitive profile of early DAT. It would therefore be of greatinterest to explore sensitivity to mode and tempo in moderate tosevere forms of DAT.

Contradictory results obtained by Allen and Brosgole (1993)may also be explained by severity of cognitive decline. In theirstudy, demented participants showed deficits affecting the recog-nition of happy, sad, and angry musical expressions. Although theauthors did not provide measures of cognitive level, they describeddemented participants as nursing home residents; thus, the partic-ipants were probably showing moderate to severe cognitive defi-cits. Participants in the present study were clearly showing a mildlevel of deficit, for they were all still living at home (with minimalassistance). Finally, the Allen and Brosgole (1993) study may alsohave included other types of dementia, such as frontotemporaldementia, that also involve emotional recognition deficits, evenearlier than DAT (Lavenu et al., 1999).

Because the majority of studies on the emotional judgment offacial expressions and prosody include more than two categories ofemotions, the negative findings in our study may be partly due tothe fact that we examined the emotional judgment of music foronly happiness and sadness. Alzheimer’s disease, even in its earlystages, damages the amygdala (Chow & Cummings, 2000). This isin accordance with results from the study of Lavenu et al. (1999)that found deficits in emotional recognition only for facial expres-sion of fear in early DAT. Moreover, the amygdala has alreadybeen demonstrated to be necessary for the emotional processing offear in music (Gosselin, Peretz, Johnsen, & Adolphs, 2007). Ac-cordingly, further studies of the emotional judgment of music inDAT should also include fearful music.

Finally, the negative findings obtained in the present study—mainly the absence of any differences between healthy elderly andDAT participants’ performances—may also be the result of a lim-ited statistical power because of the small sample sizes. This is alsosuggested by some effect sizes obtained for the comparisonsbetween groups for each condition (see Table 3). However, resultsregarding emotional recognition were relatively homogeneous, ascan be seen in Figure 1.

Nonetheless, the present study suggests that early DAT doesspare some aspects of the emotional appreciation of music. Thisconclusion suggests that further studies should be done toprovide more empirical support for the use of music as anemotional medium to improve the quality of life of people whosuffer from DAT.

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Received January 17, 2008Revision received July 10, 2008

Accepted July 16, 2008 �

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