Piano playing skills in a patient with frontotemporal dementia: A longitudinal case study

Patients with dementia, such as Alzheimer’s disease, can continue to play the piano skillfully despite profound cognitive impairment. It has been suggested that this may be because these skills have been well-rehearsed and become automatic motor movements. Less is known about how these musical skills may be related to the performance of everyday functional abilities and, also, how the ability to play a musical instrument may be affected in other dementia types. Recordings of a patient diagnosed with behavioral-variant frontotemporal dementia, a dementia syndrome clinically characterized by marked behavioral and cognitive changes, playing the piano was taken 12 months apart. Aspects of musical performance (accuracy, tone quality, dynamics, rhythm, tempo, and interpretation) were rated by professional musical teachers. The physical and mental skills required to complete activities of daily living were assessed. Tests of cognitive functioning and brain imaging were also conducted over this period. Results showed that over one year, significant declines were observed in the areas of cognition, the mental abilities required for everyday skills, as well as brain atrophy on imaging. Physical skills for the performance of activities of daily living were relatively preserved, as was the ability to play the piano. These findings confirm previous reports and demonstrate the relative independence of procedural skills in the context of significant cognitive impairment in patients with dementia.