With the care industry’s resources becoming more and more sparse, it seems that the challenge of supporting older adults with dementia is becoming increasingly more prominent. Thus, it is crucial that we invest in exploring the ways in which we can sustain the well-being of such individuals. In this three-part series of essays, we will detail the cognitive, physical and emotional benefits of dance for those with dementia, thereby making it a holistic, versatile and overall enriching activity.
Firstly, researchers have found evidence for the potential for dance to improve visuospatial abilities in those with dementia. This skill encompasses the act of visually identifying objects, understanding their location in the environment, and perceiving the spatial relationships between objects (Castro-Alonso & Atit, 2019). Most types of dementia are known to cause a regression in this skill and the impairment intensifies as the disorder advances (Pal et al., 2016). This is particularly problematic as visuospatial skills are crucial in everyday life. Tying shoes, buttoning clothes, using stairs, recognising objects, writing and drawing and a myriad of other tasks are made increasingly difficult without an intact visuospatial ability (Tojano & Conson, 2008).
Fortunately, research has illustrated that dance can help prevent visuospatial abilities from regressing in people with dementia. Hokkanen et al. (2008) administered a 30 to 45 minute dance session once a week for nine weeks in a dementia nursing home. Using a standardised drawing test, researchers measured participants’ visuospatial ability before and after the dance program. Results showed a significant improvement in this cognitive function. Congruently, Chan et al. (2020) conducted a meta-analysis of several randomised-controlled trials assessing the effect of dance interventions on those with cognitive impairments. Again, significant improvements were found in visuospatial ability.
There are several possibilities as to how dance stimulates such positive changes. Some have proposed that dancing protects the fornix of the brain from degeneration, and the fornix is associated with information processing speed, which is fundamental to numerous cognitive processes (Burzynska et al., 2017; Salthouse, 1996). Others have speculated that dancing requires the dancer to continuously determine and update the spatial position of their limbs, thereby utilising and strengthening spatial processing (Chan et al., 2020). This is corroborated by studies claiming that dancing activates the parietal lobe, a brain region closely related to spatial processing (Brown and Parsons, 2008). Along similar lines, some researchers suggest that executing movement during dance requires the brain to use path integration, the transformation of one’s sense of motion to a sense of location in the space (Savelli & Knierim, 2019), and visual tracking, the ability to fixate on and follow objects in motion (Maruta et al., 2017). Thus, spatial abilities are again utilised and preserved (Foster, 2013).
There is also a growing body of research suggesting that dance also stimulates attention and learning. It is widely known that symptoms of dementia include impairments to learning and attention, as stated in the latest diagnostic manual of mental disorders (American Psychiatric Association, 2013). The extent of the impairment however, differs between types of dementia. For example, whilst it is widely recognised that attention is impaired in Alzheimer’s disease (Baddeley et al., 2001; Belleville et al., 2007; Collette et al., 1999; Lafleche and Albert, 1995; Perry et al., 2000), the slowing of attention is more dominant in lewy body dementia, whereas people with Alzheimer’s more commonly experience attention fluctuations (Ballard et al., 2001). Thus, dance has the potential to facilitate and strengthen attention and learning.
In Guzmán-García et al.’s (2012) study, researchers conducted a qualitative study assessing the effects of a dance program for 13 residents with dementia in care homes. The feedback revealed that the music and dance provided mental stimulation in the form of residents paying attention, listening to guidance, observing movements and learning dance steps. Likewise, an analysis of videos filmed in dance sessions for those with dementia revealed that dancing tapped into numerous intellectual functions (Palo-Bengtsson et al., 1998). These included participants being conscious of timing, recalling old songs and melodies, keeping awake, showing concentration and alertness to learning dance and decreased distractibility. In addition, they seemed collected whilst executing purposeful and meaningful movements.
Though there is limited research hypothesising the underlying mechanism by which dance generates such improvements in learning and attention, some researchers have theories. For example, although dementia tarnishes various cognitive capacities, skills around musical perception, emotion and memory remain preserved even in advanced stages of dementia. Therefore, dance and music may be a particularly apt tool to facilitate concentration and learning, since it utilises facets of cognition that remain intact (Hamill et al., 2011; Sacks, 2010).
These are just a few of the cognitive benefits of dance that are beginning to be studied. More research is needed to substantiate this initial evidence and it is crucial that we continue to explore such a promising avenue for supporting those with dementia.
By Hoi Ching Leung