Music is the temporal art form par excellence. It is meaningful primarily through time. It projects a temporal process by offering aural images of temporality. Yet, surprisingly, music as a primary image of time has been little studied even by specialists in music (among the few exceptions are Greene, 1982; Kramer, 1988; Epstein, 1995).
It is the temporal element of music that is the focus of this chapter. My license to enter an area where few musical specialists dare to tread is the nocturnal delirium referred to as the Sundown Syndrome and its often remarkable response to music.
Since pathology often highlights a phenomenon that otherwise remains seamlessly invisible, this response of Sundowning to music may have something to tell us about the nature and function of music itself. This is the intended thrust of this chapter-not a reductively simplistic contribution to clinical neurology. Since the organization of the central nervous system is hierarchical, when there is damage the resulting impairment depends on the location of the insult, the systems involved, the loss of higher functions, the “release” of lower ones, and the degree of restoration and reintegration. Reductionism is inappropriate.
Sundowning is a general phenomenon of nocturnal delirium most commonly seen in the evenings in elderly persons with nonspecific cerebral damage and resultant dementia. The clinical picture is one of confusion and agitation, reduced ability to maintain attention to external stimuli, and disorganized thinking and speech. Perceptual disturbances such as illusions and hallucinations, and emotional disturbances such as anxiety, fear, anger, and paranoia, are common.
While those affected may demonstrate little or no dementia during the day, the change toward the evening can be dramatic and escalate