>> SO WELCOME TO CLINICAL CENTER GRAND ROUNDS AND THE GREAT TEACHERS SERIES, I'M BILL THEODORE FROM THE EPILEPSY SECTION AT NINDS AND IT'S A GREAT PLEASURE TO INTERVIEWS DR. BRUST WHO IS PROFESSOR OF CLINICAL NEUROLOGY AT COLUMBIA UNIVERSITY OF PHYSICIANS AND SURGEONS AND JOHN'S A CONSTANT NEUROLOGIST WHO HAS HAD A LONG TIME, INTEREST AND SCHOLARLY ENDEAVOR IN ADDICTION NEUROLOGY AND THE TREATMENT OF STROKE, BUT MORE THAN THAT, HE HAS HAD LIFE LONG INTEREST IN MUSIC, AND HAS TREMENDOUS EXPERTISE AND IS HIMSELF A PERFORMER ON A NUMBER OF INSTRUMENTS AND HE HAS, STUDIED THE NEUROLOGY OF MUSIC FOR MANY YEARS AND HAS BEEN INVOLVED IN A WONDERFUL COURSE AT THE AMERICAN ACADEMY OF NEUROLOGY SO I THINK IT'S A TERRIFIC OPPORTUNITY FOR US TO HAVE HIM HERE TO SPEAKOT NEUROLOGY--SPEAK ON THE NEUROLOGY OF MUSIC. >> [ APPLAUSE ] >> THANK YOU, BILL. HAVING NEVER WRIT KNOW AN NIH GRANT, I AM BOTH HONORED AND STARTLED TO BE HERE. LOUDER? LOUDER. THIS NEED TUBES UPDATED. I AM NO LONGER AT HARLEM HOSPITAL CENTER, BUT BACK AT COLUMBIA UNIVERSITY MEDICAL CENTER FULL-TIME. AND I HAVE NO DISCLOSURES WHATSOEVER. WELL, THAT SKIPPED ONE. HERE WE WE ARE. --TWO QUESTIONS I WANT THE TO ASK THIS MORNING OUR FIRST, DOES THE BRAIN READ AND WRITE MUSIC THE SAME WAY IT READS AND WRITES LANGUAGE? AND SECONDLY, IS MUSIC OR MUSICAL LITERACY GOOD FOR THE BRAIN? SPEECH AND MUSIC ARE BOTH ORGANIZED SOUND, BUT SPEECH IS ORGANIZED IN A PROPOSITIONAL WAY, IT GIVES SIM ANTIC INFORMATION. MUSIC IS NOT. THERE'S VERY LITTLE SYMANTIC INFORMATION IN MUSIC HOWEVER, BOTH SPEECH AND MUSIC ARE SIN TACTIC WHICH IS TO SAY THEY FOLLOW VERY STRICT RULES OF ARRANGEMENT AND EACH OF THEM HAS AN ALMOST INFINITY POSSIBILITY OF PERMUTATIONS. AND I--OKAY, WHAT IS THE SURVIVAL VALUE OF MUSIC, ALMOST ALL CULTURES, HAVE MUSIC, AND NEARLY EVERYBODY WITHIN THOSE CULTURES LIKES MUSIC BUT WHY DO WE HAVE MUSIC. DARWIN THOUGHT THAT MUSICAL CALLS SYSTEMS INVOLVE INTOED SPEECH. HIS COLLEAGUE HERB EXPOSURE TO RADIATION SPENCER ON THE OTHER HAND--HERBERT SPENCER THOUGHT THAT IT HAD AN EVOLVED STYLIZED FORM OF SPEECH. SEVERAL YEARS AGO, THERE THERE WAS NO MUSIC MAN KIND WOULD GO ON THE SAME WAY IT DOES. HE REFERRED TO MUSIC AS AUDITORY CHEESE CAKE. THIS WAS NOT ENDORSED BY MUSICIANS, MUSEICOLOGYST OR MUSICAL PSYCHOLOGY. THE MUSIC IS COMPOSED OF COMPONENTS, PITCH REFERS TO HERTZ, THE FREQUENCY. TAM BERNEA DEET IS WHAT--TAMBER IS WHAT MAKES ONE INSTRUMENT SOUND LIKE ANOTHER, CAN YOU TELL A I HAVEOLIN FROM A TROMBONE AND THEN MUSIC HAS DURATION, LOUDNESS AND RHYTHM. WITH MELODY THE MUSIC IS MOVING SEQUENTIALLY, WITH CORDS THE INFORMATION IS PRESENT SIMULTANEOUSLY. MUSIC ENGAGES EMOTION AND IT ENGAGES INTELLECT AND I THINK WE WOULD AGREE THAT THE BEST MUSIC, SHOULD ENGAGE BOTH. THERE ARE DIFFERENT BRAIN CIRCUITRYS FOR THE DIFFERENT COMPONENTS OF MUSIC AND FOR THEIR INTEGRATION AND THIS SORT OF WORK TRYING TO NARROW DOWN WHAT PART OF THE BRAIN DOES WHAT, GOES BACK MANY DECADES. FOR EXAMPLE, AT COLUMBIA'S OWN DEPARTMENT OF PSYCHOLOGY BEVERLY AND ALEO DESCRIBED LISTENING HOW NAIVE LISTENERS, UNTRAINED APPEARED TO LISTEN TO MUSIC PRETTY MUCH WITH THEIR RIGHT HEMISPHERES WHEREAS MORE SOPHISTICATED LISTENERS, THOSE WHO READ MUSIC TENDED TO LISTEN TO IT WITH THEIR LEFT SEREBERAL HEMISPHERES AND THEY CONCLUDE THAD THIS WAS BECAUSE THE RIGHT HEMISPHERE IS MORE HOLISTIC AND THE EMOTIONAL AND THE LEFT IS ANALYTIC AND AS YOU GOT FAMILIAR WITH WHAT MUSIC WAS DOING YOU TENDED TO ANALYZE IT MORE AS YOU LISTEN TO T. I REMEMBER WHEN I FIRST READ THIS PAPER, I DISCIPLINARYICIDED THAT I PROBABLY LISTEN--DECIDED THAT I PROBABLY LISTEN TO HYDEN AND CHARLIE PARKER WITH MY LEFT BRAIN AND FRANK SINAT RAAND AND CHER COULD HAVE GONEY WITH MY RIGHT BRAIN AND ROCK WITH MY BRAIN STEM. [LAUGHTER] THIS IS SIMPLISTIC AS WE WILL SEE, BUT FUNCTIONAL IMAGING HAS CONTINUED ON WITH INTERESTING FINDINGS BUT MOST RECENTLY, ROBERT SATUR IN MONTE REAL SHOWED PARTICULARLY PLEASURABLE MUSIC, WHAT HE CALLED LISTENING AND GETTING CHILLS ACTIVATES THE VENTRICAL AREA OF THE DEEP BRAIN LIM CIBOL SYSTEM. THIS IS THE SAME REWARD CIRCUIT THAT YOU NEED TO EXPERIENCE, SEX OR COCAINE. BY DISSENNATE MUSIC, IF IT'S SCARY IT ACTIVATES THE AMYGDALA WHERE IF IT'S SIMPLY UNPLEASANT IT ACTIVATES THE PARAHIPPOCAMPAL REGIONS. WHAT ABOUT APTITUDE, TRAINING, LITERACY? WELL, EVERYBODY SPEAKS LANGUAGE WHO HAS NORMAL INTELLIGENCE AND IN FACT I'VE ALWAYS BEEN STRUCK AT HOWmF HAVE TO BE TO NOT LEARN LANGUAGE. THESE ARE PEOPLE WHO ARE SO RECARDED THEY LITERALLY HAVE TO BE BROUGHT IN OUT OF THE RAIN. WHEREAS PEOPLE APTITUDE FOR MUSIC HAS A VAST SPREAD AND A TINY PERCENT OF THE POPULATION WHICH HAS PERFECT PITCH AND THEN AT THE OTHER END FOUR% OF THE POPULATION, WHICH IS SAID TO BETONE DEAF O R WHAT'S CALLED CONGENITAL AMUSIA, AND CANNOT TELL TWO PITCHES IS HIGHER THAN THE OTHER, CHILDREN DO NOT GET TAUGHT HOW TO TACO TO SING. --TALK OR TO SING. THEY JUST HEAR IT AND THEY DO IT. THEY DO HAVE TO BE TAUGHT TO WRITE, EITHER LANGUAGE OR MUSIC. IS MUSIC A SEPARABLE INTELLIGENCE? HOWARD GARDENER HAS THOUGHT SO, HE LISTS MUSIC SEPARABLE FROM MASS, VERBAL, ANOTHER SPACE, GENERATEDET AND I CAN SOCIAL INTELLIGENCE. AND ON IT IS OTHER HAND THERE ARE THOSE WHO BELIEVE EXPERIMENTS G OF SINGLE IQ DEFINES HOW INTELLIGENT YOU ARE IF WE'RE ARROGANT ENOUGH TO SUPPOSE THAT, WE CAN SPECUL THAT WHERE MOS ARD ALIVE TODAY, HE WILL--MOZART ALIVE TODAY WE WOULD BE A STRING THEORIST. NEUROLOGISTS ENCOUNTER MUSICAL PHENOMENA IN A VARIETY OF WAYS AND WE CAN DIVIDE THEM INTO POSITIVE AND NEGATIVE PHENOMENA. POSITIVE PHENOMENA INCLUDE MUSIC EPILEPSY, THESE ARE SEIZURES TRIGGERED BY MUSIC, SOMETIMES A SPECIFIC FORM OF MUSIC, SOME OF THESE SEIZURES OCCUR ONLY WHEN HE HEARD THE SECOND MOVEMENT OF BEETHOVEN'S FIFTH SYMPHONY. MUSICAL PARTIAL SEIZURES ARE MUSICAL AND THESE CONSIST OF HEARING MUSIC AND OFTEN QUITE EX PERMENTORSHIP SKILLIALLY AND A RECORDING OF A SONG, THE PERSON HAD NOT HEARD OR THOUGHT ABOUT FOR MANY, MANY YEARS. MUSICAL RELEASE HA LUGESINATIONS ARE USUALLY--HALLUCINATIONS ARE USUALLY FOUND IN OLDER DEAF PEOPLE AS THEY LOSE THEIR HEARING, THEY START HALLUCINATING MUSIC AND IT MAY BE SOMETHING THAT'S KIND OF FUN OR PLEASURABLE AND SOME OF THEM CAN EVEN CONCENTRATE ON IT AND DIAL IN WHAT THEY WANT TO HEAR. OTHERS IT CAN BE SOMETHING THEY DON'T LIKE AT ALL AND TORMENTORSHIPMENTORSHIPMENTORSHIPMENTORSHI PMENTORSHIP SKILL ING AND THISnw p IS A RESPONSE AND WITH MUSIC THIS IS OFTEN A SOUND AND VISION AND E-FLAT MIGHT PRODUCE HALLUCINATED COLOR OF PURPLE D-SHARP MIGHTf COLOR OF GREEN. NOTHINGATIVE PHENOMENA ARE AMUSIA, AND THIS IS TO MUSIC AS EFFACIA IS TO LANGUAGE, IT IS HIGHER LEVEL PROBLEM OF OF PROCESSING MUSE WHICH IS NOT EXPLAINED BY BAD HEARING OR BY DIFFICULTY ARTICULATING. AND YOU CAN HAVE A MUSIA WITH EPHASIA OR A MUSIA WITHOUT EPHASIA. OR EPHASIA WITHOUT AMUSIA. UNLIKE EPHASIA THERE ARE WIDELY DIFFERENT LESIONS CEREBRAL HEMISPHERES THAT UNDERLIE THE VARIOUS PHENOM THAT WE ENCOUNTER AND PRACTICALLY NO TWO PATIENTS OF THE HUNDREDS IN THE LITERATURE ARE PRECISELY ALIKE. THERE ARE DISORDERS, PITCH INTERVAL AND TONAL STRUCTURE, WHAT'S CALLED CONTOUR, CONTOUR IS THE DIRECTION PITCHES ARE MOVING, THE FIRST LINE OF THE NATIONAL ANTHEM IS I LITTLE BIT DOWN AND A LONGER WAY UP, THAT'S ITS CONTOUR, DESSERTED WOULD BE THE INABILITY TO RECOGNIZE ONE INSTRUMENT FROM ANOTHER. WITH OR WITHOUT A PROBLEM OF IDENTIFYING AND THE RHYTHM AND METER, RHYTHM IS--WHERE METER IS FOUR-FOUR, OR THREE-FOUR, THE DIFFERENCE BETWEEN A MARCH AND A WALTZ, A MEL OFFICE OF DIVERSITYIA IS A--MELODIA, IS THE ABILITY TO RECOGNIZE SONGS OR MELODYS AND THERE'S LOSS OF EMOTIONAL RESPONSE TO MUSIC FOR EXAMPLE, THERE'S A REPORT OF A COMPOSER WHO FOLLOWING THIS STROKE HAD NO LONGER H. I.T EMOTIONAL CONNECTION TO THE MUSIC HE HEARD AND THEREFORE HE COULD NOT COMPOSE AND SEEMINGLY THE CONCEPTION HE COULD STILL COMPONE CONFIDENTLY 12 TONE CEREAL MUSIC. WHICH BRINGS US TO MUSICAL ALEXIA AND EGRAFFIA AND--AGRAFFIA AND THE TWO PATIENTS THAT GOT ME INTEREST INDEED THIS FIELD--INTERESTED IN THIS FIELD MANY YEARS AGO. THE FIRST WAS A 20 YEAR-OLD VOICE STUDENT WHO HAD SEVERAL INFARCT DURING SURGERY FOR A LEFT TEMPORAL MEL ANGIOMA, SHE WAS LEFT WITH TRANSCORTICAL EPHASIA WHICH MEANS SHE HAD DECREASED COMPREHENS OF SPEECH BUT COULD REPEAT PRETERM BIRTH LE AND SHE HAD ALEXIA AND AGRAPHIA FOR WRITTEN LANGUAGE. MUSICALLY SHE WAS NORMAL RECEPTIVELY AND EXPRESSIVELY. INCLUDING TESTING FOR PITCH, MELODY, TEMPORAL, DURATION, RHYTHM AND LOUDNESS. HOWEVER SHE HAD MUSICAL ALEXIA FOR SINGLE NOTE PLACEMENT, FOR INTERVALS AND SHE READ RHYTHM BETTER THAN PITCH. SHE HAD MUSICAL EGRAFFIA SHE COULD COPY OKAY BUT SHE COULD NOT INDICATE PITCH ON A SCORE. THIS IS HER ATTEMPT TO WRITE HAPPY BIRTHDAY. AND YOU'LL SEE THAT HER RHYTHM IS BETTER THAN HER PITCH. 10 MONTHS AFTER THIS, I HEARD HER GIVE A RECITAL IN FIVE LANGUAGES ALTHOUGH STILL APHASIC AND WITH ALEXIA IS AGRAPHIA THROUGH LANGUAGE AND MUSIC. A LITTLE WHILE AFTER THAT, THIS IS HER ATTEMPT TO WRITE HAPPY BIRTHDAY. SHE'S GOTTEN BETTER AND RHYTHM AND STILL BETTER THAN PITCH. THE SECOND PATIENT WAS A 42 YEAR-OLD JAZZ DOUBLE BASIST WHO HAD AN INFARCT IN THE LEFT TEMPORAL PARIETAL LOBE AND HE HAD CONDUCTION EFFACIA WHICH MEANT THAT HIS COMPREHENS OF SPEECH WAS PRETTY GOOD BUT HE HAD A LOT OF TROUBLE REPEATING, HE ALSO HAD ALEXIA AND AGRAPHIA FOR LANGUAGE. MUSICALLY HE HAD RECEPT AND I HAVE EXPRESSIVE EMUSIA, HE RECOGNIZED WELL KNOWN MELODY AND ERRORS AND TAMBER AND WHICH OF TWO NOTES WAS HIGHER BUT HE MISSED INTERVALS IN MAJOR OR MINOR. COULD NOT SING OR WHISTLE AND HIS RHYTHM WAS WORSE THAN HIS PITCH, PARTICULARLY BAD FOR A BASSIST. HE COULD MUSICAL DYSLEXIA, HE COULD NOT IDENTIFY SYMBOLS OR LETTERS AND COULD NOT PLAY OR SING INTERVALS OR RHYTHMS AND HE H. I.T--HE HAD MUSICAL AGRAPHIA, THIS IS HIS ATTEMPT TO WRITE HAPPY BIRTHDAY. THIS IS HIS ATTEMPT TO WRITE C-SHARP F. HE HAD BEEN IN THE BASE CLEFT, HE WOULD BE RIGHT. A MONTH LATER THIS IS HIS HAPPY BIRTHDAY, SO HE'S GOTTEN BETTER. B IS JINGLE BELLS. OT LEFT WAS THE TAPPING OUT OF A RHYTHM THAT I GAVE HIM AND ON THE RIGHT IS HIS ATTEMPT TO WRITE DOWN MUSICALLY, THE RHYTHM THAT HE HEARD. SO TO SUMMARIZE THESE TWO CASES, PATIENT ONE HAD TRANSKORT COLEPHASIA WITH A LEFT SEVERAL INFARCT AND NORMAL FUNCTION ACCEPT FOR MUSICAL AX LEXIA AND AGRAFFIA, WHICH WAS WORSE. PATIENT TWO HAD CONDUCTION EFFACIA WITH SMALLER INFARCT AND ACCEPTIVE RECESSIVE IN MUSIC AND MUSICAL AGRAPH JAY--PITCH AND RHYTHM AFFECTED. THERE WAS NO EXPLANATION WHY THE SMALLER LESION CAUSED AMUSE WAAND THE LARGER--AMUSIA AND THE LARGER DID NOT. THE BACK PART NEAR THOSE PATIENTS IN THE LITERATURE. THERE ARE HOWEVER, MANY REPORTS OF EPHASIA WITH MUSICAL ALEXIA AND AGRAPHIA. MORRIES LIVED FROM--MORES LIVED FROM 1835-TO 1925, AND AT THE AGE OF 52 AT 1927 HE GOT LOST DURING A PERFORMANCE OF A I HAVEOLIN SINOTTA AND MAKING IRREGULAR LINES AND ERAISERS AND HIS HANDS WOULD TREMBLE IN 1928 HE LOST PLACE, PLAYING A SONNA TINA IN MADRID AND FLEW INTO A PASSION WHEN HE COULD NOT FIND THE WORD HE SOUGHT. HE CONTINUED TO WRITE UNTIL 1932, BOLERO WAS IN 1928 AND THE OTHER BY DON KEYOTE WERE COMPLEADED LATER AND HE HAD SUCH DIFFICULTY WRITING BY 1933 THAT HE COULD NO LONGER SIGN HIS NAME. TO ASKER MAY HE DECLARED MY MIND IS FULL OF IDEAS, BUT WHEN I WANT TO WRITE THEM DOWN, THEY VANISH. IN 1933, HE CONDUCTED HIS CONVERT O IN G, HIS BIOGRAPHER DECLARED THE ORCHESTRA MANAGED ON ITS OWN. AROUND THIS TIME, HE SAID, I WILL NEVER WRITE MY OPERA JOAN OF ARC, THE MUSIC IS HERE, IN MY HEAD, I HEAR IT, BUT I WILL NEVER WRITE IT. IT'S OVER. I CAN NO LONGER WRITE MY MUSIC. ONE MIGHT SPECULATE THAT REVEL'S JOAN OF ARC WAS THE SECOND OPERA NEVER WRITTEN. HE WAS SEEN BY A FRENCH NEUROLOGIST WHO FOUND DEFUSE ABOUT MODERATE IMPAIRMENT IN ORAL AND WRITTEN LANGUAGE AND SEVERE MOTOR APRACTICALLIA, COULD NOT PLAY THE PYO, SEE BARS OR NAME OR WRITE NOTES. PERMUSE PERCEPTION WAS IN IN, HE RECOGNIZEDDED MUSIC AND THE SLIGHTY MISTAKES IN THE PLAYING OF WORKS, PREP SERVED AESTHETTIC SENSIBILITY. HIS ABILITY TO RECOGNIZE AND REMEMBER A MINE UT CHANGE IN THE INTERPRETATION OF HIS WORKS WAS PRESERVED UP TO A FEW WEEKS BEFORE HIS DEATH. IN 1937, HE HAD ERECT CRANEIOT ME, SURGEON WAS SUSPECTING HYDROCEPHALOUS, THE BRAIN APPEARED SUNKEN AND NO BIOPSY WAS TAKEN AND REVELDIED 11 DAYS LATER WITHOUT AN OPS. --AUTOPSY. THERE'S BEEN SPECULATION AS TO WHAT HIS DISEASE WAS AND I THINK MOST PEOPLE TODAY THINK THAT HE HAD SORT OF AN OVERLAP BETWEEN WHAT WE CALL PRIMARY PROGRESSIVE EFEASIA AND CORTICALE BASAL DEGENERATION. PART OF A BROAD GROUP OF DEMENTORSHIP SKILLING ILLNESSES, FRONTAL LOBE OR FRONTAL TEMPORAL LOBE OR DEMENTIA. DID ILLNESS INFLUENCE REVEL'S MUSICAL WRITING? LUIGI DMIDUCCI, WROTE A PROVOCATIVE PIECE SUGGESTING THOUGH, HE MAINTAIN TODAY WAS MUSICAL PERSEVERERATION, A MELODY REPEATED 18 TIMES WITHOUT CHANGE. REVEL DESCRIBED HIMSELF AS AN ORCHESTERAL FABRIC WITHOUT MUSIC. AMUDUCCI, CONSIDERED TO TWO PIANO CONCERT O, THE G WAS CONSERVED MUCH--CONCEIVED MUCH LATER AND THE LEFT HAND CONCERT O, AND THE G WAS CONCERT O WAS MORE REGULAR, THE LEFT HAND BY CONTRAST HAD JAZZ ELEMENTS, SHORTER THEMES AND PHRASES, IRREGULAR PULSATING STYLE AND GREATER NUMBER OF TAM BERNEA DEETS AND HE WONDERED IS THE G CONCERT O A LEFT HEMISPHERIC PIECE AND THE LEFT HAND A RIGHT HEMISPHERIC PIECE. WELL, ACTUALLY, THAT MALE POURED IN WHEN THIS PIECE CAME OUT AND IT WAS POINTED OUT THAT BALERO HAS COMPLEX CHORDS, RHYTHM AND TAM BERNEA DEET AND THAT THE G CONCERT O WAS LAID OUT IN 1929, NOT EARLIER AND DON KHIHIGH HOTY DOES NOT SHOW FEATURES OF THE LEFT HAND CONCERT O. THE LITERATURE DESCRIBES TAMBERSMAZE IN THE RIGHT HEMISPHERE AND RHYTHM IN THE LEFT BUT THIS IS REGUARDING PERSPEPGZ, WHICH IS NOT THE SAME THING AS CREATING MUSIC. THERE ARE OVER 30 REPORTS OF MUSICAL ALEXIA. AND SOME OF THEM INVOLVE A AMUSIA AND MUSICAL ALEXIA BUT WITH NEITHER APHASIA OR ALEXIA, THERE ARE REPORTS OF ALEXIA RESTRICTED TO PITCH, THERE'S A SINGLE REPORT OF MUSICAL ALEXIA RESTRICTED TO RHYTHM AND THEN I KNOW OF ONLY TWO CASES OF NEARLY ISOLATED MUSICAL ALEXIA. AN EXAMPLE OF WHICH WAS WRITTEN BY A NEUROLOGIST, IAN McDONALD WHO PUBLISHED HIS OWN--IN THE JOURNAL BRAIN CALLED MUSICAL ALEXIA WITH RECOVERY, A PERSONAL ACCOUNT, DR. McDONALD HAD AN INFARCT IN THE RIGHT AGEULAR AND SUPER MAGGIAL GYRUS. HE HAD SMALL LEFT INFERIOR HORMONE LEVELSONIOUS QUADRANT HARMONIA, VISUAL PROCESS IN THE LEFT SIDE, AND THE ABILITY TO RECOGNIZE PHASES. TOPPOGRAPHICAL DISORIENTATION COULDN'T FIND HIS WAY AROUND OR DRAW MAPS, A DISTURBED PERCEPTION OF VELOCITY OF MOVING OBJECTS AND DIFFICULTY CALCULATING. HE HAD NO EPHASIA OR ALEXIA EGRAFFIA FOR LANGUAGE, FOR MUSIC HE HAD ALEXIA AT THE KEYBOARD. HE COULD NOT FOLLOW FROM ONE CHORD TO THE NEXT PLAYING ABACAHT CORREL. THE MUSIC DID NOT MAKE SENSE HE WROTE. WRITTEN MUSICAL NOTES THAT CONVEYED INFORMATION ABOUT THE PITCH BY PLACEMENT ON THE STAY MEANT LITTLE WHERE LETTERS DESIGNATED TONE DID, A, G, D. EMOTIONAL CONTENT WHICH HE NOTED DETERMINES PHRASING AND EXPRESSION, WAS ABSENT. SURPRISINGLY IT WAS EASIER FOR HIM TO READ POLYPHONIC MUSIC IN WHICH THE PARTS MOVE INDEPENDENTLY. AND THEN HOMOPHONIC MUSIC IN WHICH THE PARTS MOVE WITH THE SAME RHYTHMIC PATTERN, YET HE HAD READING ERRORS OF TIMES AND RHYTHM. SO HE ALSO HAD A MILD MUSICAL AGRAFFIA WITH NOTES BEING PLACED WRONG. HIS MUSIC PERCEPTION WAS NEARLY NORMAL. HE WROTE WHILE LISTENING TO FAMILIAR MUSIC FOR SHORT PERIODS IT WOULD SOMETIME SOUND STRANGE. DUFSUSPICIOUS RHINE GOLD ON THE RADIO PRODUCED A RELATIVE PROMINENCE OF SOME OF THE INNER PARTS. HE GRADUALLY IMPROVE INDEED CITE ARE READING BUT THE EMOTIONAL CONTENT OF THE MUSIC STAYED ABSENT. IT WOULD APPEAR THAT McDONALD'S MUSICAL ALEXIA AND EGRAFFIA WAS PART OF A NONLANGUAGE HEMISPHERIC SPACIAL DISRUPTION. WHAT ABOUT APHASIA WITH RESERVED READING AND WRITING OF MUSIC. DRNCHL THIS IS VESARAIAN SHEB LYNN IN 1982 AND WELL KNOWN IN RUSSIA AS A COMPOSER OF CORAT THE TIME SYMPHONIES AND OPERAS, AT THE AGE, HE HAD A COUPLE STREEKS AND A COUPLE OF SEIZURES AND THEN A STROKE AND MYOCARDIAL INFARCTION AND DIED AND AT AUTOPSY HE HAD A HUGE LEFT HEMISPHERIC HEMORRHAGIC INFARCT. HE WAS STUDIED BY THE GREAT RUSSIAN NEUROLOGIST ALEXANDER LAUREATE WHO DESCRIBED HIM AS HAVING A SEVERE IMPAIRMENT OF BOTH COMPREHENSION OF SPEECH AND REPEATING SPEECH. HIS SPEECH WAS PARAPHASIC AND PARAGRAMMATTIC WHEN KHI IS TO SAY WHEN HE SPOKE IT WAS MUCH OF THE TIME INCOMPREHENSIBLE JARGON OR GIBBERISH. HE WAS NEVER ABLE TO FINISH A PROPOSITION HE BEGAN. HE HAD DIFFICULTY NAMING AND FOLLOWING SIMPLE COMMANDS BUT ONLY FOR A SHORT TIME. HE COULD WRITE ONLY SHORT WORDS, NOT LONG WORRIEDS, SERIES OF WORDS OR PHRASES, HIS READING WAS RELATIVELY PRESERVED BUT WHEN FATIGUED HE BECAME UNABLE TO GRASP WRITTEN PHRASES OR PARAGRAPHS, MUSICALLY HE INDICATED NEW COMPETITIONS WHICH CREATED TO BE UPTO STANDARD AND WHICH DID NOT DIFFER SIGNIFICANTLY FROM THE COMPOSITIONS OF THIS EARLIER YEARS. A SONATA FOR CELLO, PIANO, CHORUSS AND SONGS AND EIGHTH AND NINTH CORAT THE TIME AND A FIFTH SYMPHONY. THEY DECLARED IT WAS A BRILLIANT CREATIVE WORK FILL WIDE HIGHEST EMOTION SYSTEM OPTIMISM AND FULL OF LIFE. THIS IS RANDALL THOMPSON, WHO WAS BORN 1999 AND WHO AT THE AGE--1899 AT THE AGE OF 76 HAD A LEFT HEMERAL LOBE HEMORRHAGE, ANYBODY WHO WENT TO HARVARD KNOWS RANDOMIZED TRIAL OLDER PEOPLE THOMPSON'S HALLELUJAH. IT'S ALWAYS DONE GRADUATION. HE INITIALLY HAD A RIGHT HOME OWN MOUSE HEME I DON'T MEANIA AND GRAFF EPHASIA AND IT WAS SLOW WRITING AND DISTORTIONS AND HE HAD ALEXIA FOR LANGUAGE. HE NAMED LETTERS BUT COULD NOT READ WORDS ALOUD OR COMP REHENCE THEM AND DIFFICULT TO NAME WHEN THEY WERE EMBEDDED IN WORDS. HE HAD NORMAL MUSICAL PERCEPTION, HE HAD POOR NAMING OF MUSICAL NOTES OR SYMBOLS YET POINTED TO THEM AND WHEN SPOKEN AND CONTINUED TO WRITE OR READ MUSIC WITH SOME ERRORS. HIS WRITING WAS COMPLICATED BY A TENDENCY TO NEGLECT THE RIGHT HALF OF SPACE. THE THERE WAS NO DIFFERENCE BETWEEN READING MELODY LINES, CHORDS OR RHYTHMS. HIS COMPOSING SKILLS WERE UN DIMINISHED THOUGH MORE CONSERVATIVE. OTHER EXAMPLES OF PRESERVED MUSICALITY IN THE FACE OF EPHASIA, WELL, THERE'S A REPORT OF A PROFESSIONAL PIANIST WITH THE IFIESIA WHO CONTINUED TO PLAY PUBLICLY, COULD COMPOSE BRIEF MELODY AND RESPONDED PERFECTLY TO WHAT HE HUNG. HE COULD READ NOTE PITCHES OKAY BUT HAD DIFFICULTY WITH ARRHYTHMIC VALUE. THERE'S A DISSCRIPGZ OF A PROFESSOR OF PIANO WITH EPHASIA, WHO HAD MILD ALEXIA AND SEVERE EGRAPHIA, MUSICAL READING AND WRITING WERE PRESERVED. A CONDUCTAR AT LASCALA HAD GLOBAL EPHASIA AND SEVERE MOTOR APRACTICALLIA, THAT'S INABILITY CARRY OUT COMPLEX LEARNED MOVEMENTS. AND HE HAD ALEXIA AND AGRAFFIA FOR LANGUAGE. HE COULD READ BUT NOT WRITE MUSE AND I CAN CONTINUED TO CONDUCT INCLUDING CASELLO'S PARAARCHY WHICH WAS CONSIDERED EXTREMELY DIFFICULT. THERE'S A DESCRIPTION OF A 77 YEAR-OLD MAN WHO WAS BLIND SINCE THE AGE OF TWO, HE LEARNED BRAILLE FOR BOTH LANGUAGE AND MUSIC ULTIMATELY BECOMING A FAMOUS ORGANIST AND COMPOSER, A STROKE LIFT HIM WITH EPHASIA, VERBAL ALEXIA AND EGRAPHIA IN BRAILLE AND HE HAD NO MUSICCA AND CONTINUED TO READ, WRITE, AND COMPOSE IN BRAILLE. AND THEN. STEVE SPAR SHOWED ME A VIDEO WITH PATES HE SAW AND A MUSIC ONCOLOGY WITH SELECTIVE AMODIA. THIS GUY WAS SHOWN A SCORE AND ASKED TO COMMENT ON IT AND HE GOT ALL EXCITEDDED LOOKING AT SCORE, HE SAID, YEAH THIS HE'S GOES, BOP, BOP, BOP, HE'S GOING THROUGH THE SCORE, EVERYTHING ACCURATE, AND THEN SPAR PLAYS A RECORDING OF THE MAIN THEME FROM SWAN LAKE, HE HAS NO IDEA WHAT IT IS. RAMSEY'S NEVER HEARD IT BEFORE. THAT'S A-MEL ODIA. TO SHOW YOU THE DIFFERENT COMPONENTS OF MUSICAL WRITING. THERE ARE REAL WORDS OFTEN ABBREVIATED, ALLEGRO, FORTE, THERE ARE NOTES DESIGNATED BY LETTERS, A, C, G, BUT REPRESENTED SPACIALLY BY VERTICAL POSITION. WITH DURATION, INDICATED BY APPEARANCE WHOLE, HALF, EIGHTH NOTES AND BY INTERVALLIC DISTANCE. THERE ARE PURELY MUSICAL SYMBOLS, SHARPS, FLATS, CLEFTS, STOACCATO, AND THERE ARE SIMULTANEOUS AND SEQUENTIAL AND TO GIVE A LITTLE ADDED PEES OF COMPLEXITY--ADDED PIECE OF COMPLEXITY HE PUT IN THE UPPER RIGHT GUITAR FINGERING. WELL, WHAT HAVE HE LEARN WIDE FUNCTIONAL IMAGING AS FAR AS READING AND WRITING GOES? THE LATE JUSTIN SIR JOHN DID ONE OF THE EARLIER PAPERS ON THIS USING THE COMBINATION OF P. E. T. AND MRI IMAGING, SUBJECTS WERE AND TESTED USING A SCORE OF A LITTLE KNOWN BOCH P A RTITA THERE WERE FIVE TASKS FOR THEM, AND LISTEN TO SCALES, THEN THEY READ THE SCORE SILENTLY, THEN THEY READ THE SCORE AND HEARD IT PLAYED, THEY CITE READ THE SCORE FROM THE PRECEDING TASK WERE SUBTRACTED SO WHEN THEY GOT TO THE LAST TEST, THERE WERE AREAS OF THE BRAIN LIGHTING UP THAT WERE NECESSARY EXCLUSIVELY FOR CITE READING AND QUALIFYING AND LISTENING TO IT AND THIS IS WHAT HAPPENED. WHEN THEY LISTENED TO THE WITH THE SUPERIOR CORTEX LIT UP AS DID THE LEFT SUPERIOR TEMPORAL GYRUS, THESE ARE AUDITORY AREAS, NO SURPRISE, WHEN THEY PLAY AND LISTEN TO THE SCALES, THESE SAME AREAS LIT UP PLUS THE LEFT MOTOR CORTEX, PLAYING WITH THE RIGHT HAND SO THE LEFT MOTOR CORTEX IS FIRING WHEN THEY READ THE SCORE SILENTLY, EXTRA STRIATUAND ATE VARYS LIT UP AND INTERESTINGLY THAT'S NOT WHAT LIGHTS UP WHEN YOU READ WRITTEN LANGUAGE. AND WHEN THEY READ THE SCORE AND HEARD IT PLAY, THESE AREAS LIT UP PLUS THE RIGHT SUPERIOR TEMPORAL GYRUS WERE NOW OVER IN THE AUDITORY AREAS OF THE NONLANGUAGE BRAIN. AND THEN FINALLY WHEN THEY READ AND HEARD, THIS IS WHAT TURNED UP. AND A AND B, A AND B, WAS ORANGE AND THAT WAS THE FRONTAL AREA, AND INVOLVED AREAS SO THESE ARE AREAS HEADING UP TO HERE THAT ARE IN FRONT OF THE ACTUAL MOTOR CORTEX THESE MIGHT BE CONSIDERED READINESS AREAS, AND D AND E, IS THE LEFT SUPERMOTOR GYRUS. THIS IS AN AREA AREA WHICH IS IN BETWEEN HEARING AND VISION. SO SHE SPECULATED WHEN THAT FIRED IT INVOLVED MAPPING BETWEEN MUSICAL NOTATION AND CORRESPONDING SOUNDS OR MELODY. AND SO, IF SHOWS BILATERAL PARIETAL LOBBIAL AND THAT'S WAY UP HERE IN THESE SPOTS. AND THIS IS A PART OF THE BRAIN WHICH IS INVOLVED IN IDENTIFYING WHERE SOMETHING IS AND HOW IT HAPPENS TO BE MOVERRING. SPLITS INTO THE VENTRAL STREAM ISICISM POLITICALLY--SIMPLISTICALLY IDENTIFIES WHERE SOMETHING S&P WHAT SOMETHING IS, THAT'S WHAT'S LIGHTING UP WHEN THE SUBJECTS, READ AND PLAYS, AND LISTEN TO. CITE READING REFLECTS ANALYSIS OF THE SPACIAL LOCATION OF THE NOTES, MAPPING BETWEEN MUSICAL NONAPOPTOTICINATION AND IT'S-CORRESPONDING SOUND AND MAPPING BETWEEN MUSICAL NOTATION AND VISUALLY GUIDED ACTIONS. THERE HAVE BEEN CORROBORATIONS BROADLY OF THESE FINDINGS AND USING MORE MODERN FUNCTIONAL MRI IMAGING. THIS IS THE-9— STROUPE. A NORMAL PERSON WILL FIND IT HARDER TO NAME THE COLOR, IF THE COLOR IS DIFFERENT THAN THE NAME OF THE COLOR. WORD READING IS FASTER THAN COLOR NAMING, THE WRONG COLOR THERE, THE MISMATCH CREATES AN INTERFERENCE AND A DELAY, THAT'S A NORMAL RESPONSE. SUBJECTS WERE GIVEN ON THE LINE HERE, NUMBERS WERE SUPERIMPOSED THEY PLAYED FIVE NOTE SEQUENCES FROM MAPPING FROM THE NUMBERS TO THE FINGERS INSTEAD OF PLAYING THE FINGERS AS THE NOTES. YOU WITH ME ON THIS? AND THE PIANIST REACTION TIMES WERE SIGNIFICANTLY AFFECTED AND IMPAIRED BY WHETHER THERE WAS CONGRUENCE OR NONCONGRUENCE OF THE NOTE NUMBER PAIRING. THEY WERE USED TO READING THE NOTES. SO WHEN THE NOTE HIS THE NUMBERS WRITTEN ON THEM. AND THEY HAD TO FOLLOW THE NUMBERS, WRITTEN, THEIR INSTINCTIVE NEED TO PLAY OUT OF WHAT WAS WRITTEN WAS IMPAIRED AND SLOWED DOWN. FOLLOWED BY THE NONMUSICAL TO HORIZONTAL STIMULUS MAPPING TEST, PIANISTS DID BETTER ACCIDENT--LEARNED RESPONSES OF BETTER NOTES INDICATING MOVEMENT OF THE HANDS COULD BE GENERALIZED INTO SPACIAL TASKS OUTSIDE OF MUSIC. ANOTHER EXAMPLE OF THIS THE NAIVE SUBJECTS TO CITE READ, PRETRAINING, THEY USE THE SAME BASING THE FINGER PLACEMENT ON THE NUMBER, AND THAT'S UP ON TOP HERE. BUT THEN THEY TRAIN THEM HOW TO ACTUALLY READ THE MUSIC AS NOTES. AND INTERESTINGLY, AFTER ONLY 15 WEEKS OF TRAINING, FUNCTIONAL IMAGING SHOWED THAT CITE READING IT FLIPPED INTO THE SUPERIOR PARIETAL AREAS OF THE BRAIN, IN OTHER WORDS SPACE AREA. THIS IS SEVERAL YEARS AGO, THEY LISTEN FOR 10 MINUTES TO A MOS ARD SONATA--MOZ ART SON ATA, THEY HAD SPECIAL READING ABILITIES FOR A WHILE, GOVERNOR ZEL MILLER OF GEORGIA FOR THE TIME WAS SO IMPRESSED BY THIS WORK THAT HE GAVE A MOZART CD TO EVERY NEW BORN IN THE STATE OF GEORGIA. IT TURNED OUT, PROBABLY NOT TO BE SPECIFIC AT ALL, BUT LIKELY JUST BASED ON MOOD OR AROUSAL, NOT MUSIC PER SE, SONBERG USED CONTROL CONDITIONS THAT WERE SOMEWHAT DIFFERENT, THE ORIGINAL CONTROLS WERE REPETITIVE MUSIC SILENCE OR LISTENING TO RELAXATION TAPES. IN OTHER WORDS, BORING. WHEN THEY LISTEN TO A STORY THAT WAS INTERESTING, THE MOZART EFFECT DISAPPEARED. NOW THAT'S NOT READING AND WRITING MUSIC, AND IS IT POSSIBLE THAT READING MUSIC DOES PRODUCE LONG-TERM BENEFITS IN OTHER COGNITIVE DOMAINS? MUSICAL EXPERTISE IS CORRELATED WITH MORPH LOGICAL CHANGES IN THE BRAIN. THE RIGHT HAND SENSORY MOTOR CORTEX IS LARGER IN I HAVEOLINNISTS--VIE--VIEOLINNISTS, THAN TERIOR IS LARGER AND--THAN TERIOR IS LARGER AND THE RIGHT TEMPORALLY, THE PLANE OF TEMPORALLY, IS THE TEMPORAL LOBE AREA RIGHT NEXT TO THE AUDITORY CORTEX, THAT SEEMS TO GET SMALLER IN PATIENTS WHO HAVE ABSOLUTE PITCH. COMPARED TO CONTROLS MUSICIAN VS INCREASED MISMATCHED POTENTIALS ON HEARING UNEXPECTED MUSICAL NOTES, IF YOU PLAY A TUNE IN THE WRONG NOTE IS IN THERE, MOST OF YOU WOULD SAY, YEAH, I RECOGNIZE THAT, AND THEY WOULD DO IT QUICKER AND CONSISTENTLY, AND BACKGROUND THINKING ABOUT SOMETHING ELSE, A MAGNETIC EVOKED RESPONSE TO PAYON O SOUNDS ARE LARGER IN PIANISTS AND LARGER IN TRULL PET SOUNDS--TRUMPET, IN TRUMPET PLAYERS.— EIGHT YEAR-OLD CHILDREN WERE TRAINED TO CITE READ OR PAINT AND AFTER SIX MONTHS THE MUSICAL KIDS HAD ENHANCED READING AND PITCH DISCRIMINATION COMPARED TO THE PAINTERS. AND OTHER REPORTS DESCRIBE MUSICAL TRAINING INCLUDING SPACIAL TEMPORAL ABILITIES VERBAL MEMORY, SECOND LANGUAGE, CHRONOLOGICAL PROFICIENCY AND ON ALL THE SUBTESTS OF GENERAL I. Q. THIS IS THE INFERIOR FRONTAL LOBE, THE FRONTAL CURRICULUM BUT WHAT'S IT FOR? IT TURNS OUT THAT IF YOU TAKE IT OUT, YOU DON'T GET BROCA'S APHASIA, IT'S SEEN AS THE CENTER CENTER OF A BRAIN NETWORK ENCODING HIRE ARCHICAL STRUCTURES REGUARDLESS OF--IF THEIR MODALITY. AS NOTED BOTH HAVE MUSE AND I CAN SIN TEXT AND THEY ARE ACTIVATED BILATERALLY BY SPEECH AND MUSIC WITH LEFT, SYMMETRYS. BOTH SPEECH AND MUSIC ARE TIGHTLY LINKED TO MOTOR ACTIVITY AND BROCA'S AREA HAS MIRROR NEURONS. MIRROR NEURONS ARE IN THIS REGION AND OTHER REGIONS. AND NOW WHEN YOU SEE A MOTOR ACT AND YOU SEE SOMEONE ELSE DOING THE SAME MOTOR ACT, PARENTHETICALLY THESE ARE BEING SPECULATED AS INVOLVED IN AUTISM. BROCA'S AREA IS ACTIVATED DURING LISTENING AND PERFORMING MUSIC. MUSIC LANGUAGE, AND MOTOR PROGRAMS MAY THUS SHARE A COMMON NEURAL ORGANIZATION, THAT INCLUDES BROCA'S AREA IN THE PROCESSING OF STRUCTURED SEQUENTIAL INFORMATION. THIS IS THREE DIMENSIONAL METAL ORIENTATION TASK, YOU PROBABLY--MANY OF YOU HAVE DONE THIS YOU KNOW FOR A, IS A THE SAME AS B? IT'S PRETTY EASY. IS C THE SAME AS D, THAT'S A LITTLE HARDER AND THAT'S CALLED A NONMUSICAL VISUAL SPACIAL THREE DIMENSIONAL ROTATION. BROCA'S AREA IS ACTIVATED IN MUSICIANS PERFORMING THIS TASK BUT NOT IN NONMUSE CISIONS PERFORMING THIS--NONMUSICIANS PERFORM THANKSGIVING TASK. CITE READING INVOLVES THE EXTREMELY RAPID IMPLEMENTATION OF A SERIES OF OPERATIONS THROUGH PERCEPTION, INCLUDING VISUAL, SPACIAL ANALYSIS OF SYMBOLIC INPUT TO THE SEQUENTIAL OUTPUT OF MUSICAL PERFORMANCE. FINALLY, LET'S TURN TO COGNITIVE LEISURE. IS ANY OF THIS RELEVANT TO SOMEBODY MY AGE? WELL, THERE WHAT IS IT AN INTERESTING STUDY A FEW YEARS AGO FROM EINSTEIN THAT WAS IN THE NEW ENGLAND JOURNAL OF MEDICINE WHERE THEY ADDRESS THE QUESTION OF MENTALICAL ESTIMATE--MENTAL CALESTHENTICS, THEY FOLLOWED A GROUP OF 75 YEAR-OLDS FOR 10 YEARS AND NOTED WHICH ONES DEVELOPED COGNITIVE SLIPPAGE DURING THAT TIME AND THEY ALSO KEPT TRACK OF THOSE WHO WERE OR WERE NOT ENGAGE INDEED WHAT THEY CALL COGNITIVE LEISURE AND THIS INVOLVED CROSS WORD PUZZLES, READING, COMPOSITION, WRITING, BOARD GAMES, AND PLAYING A MUSICAL INSTRUMENT. IT DID NOT INCLUDE TENNIS OR MOWING THE LAWN. AND AT THE END OF THE 10 YEARS THEY FOUND THAT THERE WAS INDEED A CORRELATION THAT THOSE WHO ENGAGE IN COGNITIVE LEISURE WERE LESS LIKELY TO BECOME DEMENTED. OF COURSE YOU'RE NOW ALL ASKING WHAT'S THE DIRECTION OF CAUSALITY, DID THEY STOP PLAYING THE FLUTE BECAUSE THEY WERE GETTING COGNITIVE SLIPPAGE? AND THE AUTHORS GOT AROUND THIS ONE BY NOTING EACH YEAR, WHO WAS SLIPPING. AND DURING THE FIRST SEVEN YEARS OF THE STUDY, AND DURING THIS TIME A FEW WERE TOSSED OUT OF THE STUDY, SO THE ONLY ONES WHO MADE IT TO THE FINISH LINE WERE THOSE WHO WERE COGNITIVELY NORMAL UP TO THE LAST THREE YEARS OF THE STUDY. AND THEY CONCLUDED THAT THEY WOULD HAVE THEN IDENTIFIED THOSE WHO MIGHT HAVE STOPPED PLAYING THE FLUTE BECAUSE THEY WERE ALL READY COGNITIVELY IMPAIRED RATHER THAN THE OTHER WAY AROUND. YOU CAN OR NOT AGREE WITH THIS, THAT THE NEW ENGLAND JOURNAL STATISTICIAN THOUGHT IT WAS OKAY. THERE HAVE BEEN A COUPLE OF OTHER STUDIES THAT HAVE SHOWN THE SAME THING, A STUDY FROM CHINA AND THEN A FEW MONTHS AGO, A STUDY FROM THE MAYO CLINIC, BOTH THE CHINESE AND THE MAYO CLINIC STUDY SHOWED THAT THOSE WHO WATCHED TELEVISION DID WORSE THAN THOSE WHO DID NOTHING. [LAUGHTER] SO TOO CONCLUDE OUR INITIAL TWO QUESTIONS: FIRST, JUST AS MUSICAL PROCESSING INVOLVING DIFFERENT AND MORE DISTRIBUTED BRAIN CIRCUITRY THAN LANGUAGE PROCESSING, SO DO READING AND WRITING MUSIC COMPARED TO READING AND WRITING LANGUAGE. AS FOR THE SECOND, IT'S MUSIC OR MUSICAL LIT RASE MODELERACY GOOD FOR THE BRAIN, I WOULD SAY FORGET IT BECAUSE I THINK, IT'S INTERESTING BUT MUSICAL LIT LITERACY HAS ITS OWN REWARDS. THANK YOU. [ APPLAUSE ]