Individualized Piano Instruction enhances executive functioning and working memory in older adults

Abstract and Figures

This study evaluates transfer from domain-specific, sensorimotor training to cognitive abilities associated with executive function. We examined Individualized Piano Instruction (IPI) as a potential cognitive intervention to mitigate normal age-related cognitive decline in older adults. Thirty-one musically naïve community-dwelling older adults (ages 60-85) were randomly assigned to either the experimental group (n = 16) or control group (n = 15). Neuropsychological assessments were administered at three time points: pre-training, following six months of intervention, and following a three-month delay. The experimental group significantly improved performance on the Trail Making Test and Digit Symbol measures as compared to healthy controls. Results of this study suggest that IPI may serve as an effective cognitive intervention for age-related cognitive decline.
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Aging & Mental Health, July 2007; 11(4): 464–471
Individualized Piano Instruction enhances executive functioning
and working memory in older adults
East Carolina University, USA and
the University of Florida, USA
(Received 14 July 2006; accepted 9 November 2006)
This study evaluates transfer from domain-specific, sensorimotor training to cognitive abilities associated with executive
function. We examined Individualized Piano Instruction (IPI) as a potential cognitive intervention to mitigate normal
age-related cognitive decline in older adults. Thirty-one musically naı
ve community-dwelling older adults (ages 60–85) were
randomly assigned to either the experimental group (n ¼ 16) or control group (n ¼ 15). Neuropsychological assessments
were administered at three time points: pre-training, following six months of intervention, and following a three-month
delay. The experimental group significantly improved performance on the Trail Making Test and Digit Symbol measures
as compared to healthy controls. Results of this study suggest that IPI may serve as an effective cognitive intervention for
age-related cognitive decline.
Age-related cognitive deficits are often associated
with executive dysfunction in working memory,
strategy maintenance, and planning and updating
(Salthouse, 1994). Many studies suggest that age-
related cognitive decline may be associated with
a degree of disconnectivity or loss of the ability to
functionally integrate multiple systems resulting in
cognitive dysfunction (Dixon, Backman, & Nilsson,
2004). Functional imaging studies provide evidence
regarding age-related anatomical differences in the
prefrontal cortex (PFC) during working memory
tasks (Nyberg et al., 2003; Rypma & D’Esposito,
2000). Additionally, the temporal relationship
between PFC activation and activation of the
medial parietal and posterior cingulate cortex
changes in aging (Lustig et al., 2003). Structural
imaging studies have shown that aging affects white
matter in the brain traditionally linked to several
cognitive areas such as executive functioning,
visuospatial skills, motor speed, and processing
speed (Almkvist, Wahlund, Andersson-Lundman,
Basun, & Backman, 1992; Kertez, Polk, & Carr,
1990). A key challenge for successful aging is to
discover cognitive interventions that have the
capacity to integrate multiple neural networks to
mitigate or prevent age-related cognitive decline.
Kramer, Bherer, Colcombe, Dong and Breenough
(2004) recently reviewed the relationship between
lifestyle factors and cognitive vitality in aging.
Studies conducted in the US, Europe and Asia all
conclude that persons with more complex occupa-
tions maintain better cognitive function as they age.
Apart from the workplace, individuals who engage
in new games or skills reduce the potential for
age-related cognitive decline. The protective effect of
mental activity seems to depend upon the variety of
skills and tasks. Skilled typists, for example, learn
strategies that enable them to maintain high typing
performance with age, but they do not appear to
obtain a general protection from cognitive decline
with aging. Aerobic exercise has also been associated
with slower cognitive decline in aging. An increase in
growth factors related to exercise may be associated
with neuro-muscular remodeling, protective effects
of additional muscle mass, cognitive challenges
associated with participation in a sport, completing
an exercise session, and continuing to exercise
regularly over time. One limitation is that the
benefits of exercise are predominantly physical or
domain-specific. Some cognitive training programs
offer a variety of tasks and result in enhanced
cognitive abilities that generalize to other cognitive
Specific cognitive training programs have demon-
strated some benefits including improvements in
primary and secondary working memory, tasks
Correspondence: Jennifer A. Bugos, East Carolina University, A-123, AJ Fletcher Greenville, NC 27858. Tel: 252-328-
5721. Fax: 252-328-6258. E-mail:
ISSN 1360-7863 print/ISSN 1364-6915 online/07/040464–471 ß 2007 Taylor & Francis
DOI: 10.1080/13607860601086504
specific to processing speed, strategy learning, and
interference tendency (Cavallini, Pagnin, & Vecchi,
2003; Gunther, Schafer, Holzner, & Kemmler,
2003; Verhaeghen, Marcoen, & Goosens, 1992).
Cognitive restructuring programs can lead to perso-
nal control over cognitive functions such as focused
attention, cognitive effort, and promote strategy
usage, compared to traditional memory training
programs (Caprio-Prevette & Fry, 1996). While
many approaches to cognitive training have been
developed, there are many limitations associated
with current interventions. Many training programs
have been targeted at identifying age-related changes
in the architecture of cognition, rather than seeking
the optimal overall benefit. These studies
support the view that both younger and older
adults have a cognitive architecture that can be
flexibly redeployed, and that task training particu-
larly helps older adults to learn to use their cognitive
resources to improve their task performance
(Kramer, Hahn, & Gopher, 1999; Verhaeghen,
Cerella, & Basak 2004). A significant limitation of
most cognitive training interventions is the lack of
transferability to everyday situations (Ball et al.,
2002; Edwards et al., 2002). Since participation in a
complex occupation and engagement in mentally
challenging leisure activities appears to produce
generalized protective effects, but rehearsal of a
highly familiar task such as typing does not, there
should be a cognitive training dual of a complex
lifestyle. It should be possible to develop cognitive
training paradigms, which produce enduring, gen-
eralized mitigation of cognitive decline with aging.
We hypothesize that one reason for lack of
transferability to multiple cognitive domains lies
within task complexity. Distributing task demands
among several cognitive domains may contribute to
the facilitation of top-down processing resulting in
multiple cognitive enhancements. Most cognitive
training programs focus on one training task and
engage few cognitive processing systems (Stigsdotter
& Backman, 1989). Engaging many cognitive
information processing systems and learning and
memory capacities is essential to maintaining them
and preventing their decline in normal aging.
The optimal cognitive intervention would include
self-efficacy, progressive difficulty, motivated
practice, novel stimuli/task, and multimodal sensor-
imotor integration. The underlying rationale is that
any progressively difficult cognitive training program
that motivates participants to engage in activities,
which coordinate motor activity with short-term
planning, and long-term cognitive strategies will
strongly contribute to maintaining cognitive skills in
aging. Music education naturally motivates these
interlocking activities with the intrinsic enjoyment
and sense of self-esteem that stem from skilled
musical performance. Musical training is therefore
expected to contain the key attributes necessary to
engage and preserve attention and memory systems
throughout the lifespan.
The goal of this study is to evaluate the role of
musical instruction as a potential cognitive interven-
tion to prevent or maintain cognitive skills in normal
aging. Active music making promotes cognitive
skill and concept development directly influencing
memory formation and retrieval. Music instruction
has improved cognitive abilities among other demo-
graphic populations. Individualized music instruc-
tion has been directly correlated with higher verbal
memory task performance among children and
college students (Chan, Ho, & Cheung, 1998;
Ho, Cheung, & Chan, 2003). Four-year-old children
receiving ten minutes of piano instruction up to
twice a week performed better on spatial-temporal
task performance assessments than children
receiving computer training (Rauscher, Levine,
Shaw, & Wright, 1997). After eight months of
piano instruction, kindergartners displayed greater
improvements in spatial abilities than the control
group (Rauscher & Zupan, 2000; Sarnthein et al.,
1997). Six-year-olds scored significantly higher on a
Short-Term Memory subtest of the Standford-Binet
Intelligence Battery after receiving thirty weeks of
music instruction (Bilharz, Bruhn, & Olson, 2000).
Participants who had five or more years of piano
instruction demonstrated increased activation in the
cerebral cortex and a higher degree of retention one
year later (Altenmuller, 2001). In addition, differ-
entiated tasks required to play an instrument help
strengthen and form new synapses (Rauschecker,
Music therapy has been recognized as a possible
intervention for cognitive rehabilitation. Although
the Older Americans Act was amended in 1992 to
include music therapy, most music therapy programs
have consisted of listening activities, rather than
active music making (Bernstein & Clair, 1990).
Research has shown a significant positive correlation
between music listening and cognitive functions
such as verbal or declarative memory on clinical
populations. Furthermore, research has shown that
participation in leisure activities such as musical
performance may reduce the risk for developing
dementia (Verghese et al., 2003).
This research aimed to extend individualized
piano instruction (IPI) as a cognitive intervention
to the well elderly population (ages 60–85). We
hypothesize that IPI will serve as an effective and
enjoyable intervention to preserve cognitive function
and prevent mild age-related memory loss.
Thirty-nine participants were recruited from an
age-restricted independent residential area,
from large churches with extensive community
Individualized Piano Instruction enhances functioning and memory in older adults 465
outreach and other members of the Gainesville,
Florida community. The University of Florida
Institutional Review Board monitored compliance
with local, state and federal guidelines for human
subjects’ research. A questionnaire excluded partici-
pants with neurological impairments such as
Alzheimer’s disease or other dementia, health
problems affecting hand dexterity, experienced
musicians with five or more years of training, and
those younger or older than the target age range of
60–85 years. Depressed persons, were identified and
excluded by a score414 on the Beck Depression
Inventory (BDI; Beck, Brown, & Steer, 1996).
Individuals that reported neurological abnormalities,
including a history of seizures, stroke, or taking
psychoactive medications were also excluded.
Participants who experienced medication changes
during the study were also excluded as many
medications such as anti-cholinergics for heart
conditions, may adversely affect cognitive
Participants were randomly assigned to an experi-
mental group, which received six months of IPI or an
untreated control group. Initially, 21 (4 male and
17 female) participants were enrolled in the experi-
mental group and 18 (4 male and 14 female)
participants were enrolled in the control group.
Sixteen experimental participants and 15 control
participants completed the study (Table I). Attrition
was due to (A) failure to comply with the IPI
regimen, (B) health problems not related to the
study design, and (C) participants who had a strong
preference for either the experimental group or the
control group chose to voluntarily withdraw upon
group assignment.
Cognitive assessments
The initial assessment battery included both tests of
(A) overall cognitive and music ability and (B)
working memory and executive functions. Measures
of overall cognitive ability were presented to confirm
that the experimental and control groups have
similar mental abilities and to compare possible
IPI-enhanced memory performance with cognitive
or musical ability. All participants were assessed at
the same time points: pre-training, post-training
(six months), and following a three-month delay.
Multiple cognitive assessments were administered at
each time point, and were chosen based upon their
association with cognitive domains thought to be
related to the prefrontal cortex (PFC), an area often
associated with working memory and executive
function (Cohen et al., 1997; Postle, Brush, &
Nick, 2004).
Assessments of musical aptitude and
cognitive functioning
The Advanced Measures of Music Audiation (AMMA;
Gordon, 1989) was administered as a baseline
measure to determine initial music aptitude that
may potentially affect musical learning ability.
AMMA was chosen to assess musical aptitude,
because it has been validated in adults with no
previous musical experience. Participants listened to
a series of 30 taped melodic excerpts and distin-
guished potential rhythmic and melodic alterations
by shading the appropriate answer. Percentile rank
scores were based upon Gordon’s (1989) table for
individuals with a minimum of 12 years of
Ward’s seven subtests of the Weschler Adult
Intelligence Scale III (WAIS III; Weschler, 1997)
were administered to yield a Performance IQ (PIQ),
Verbal IQ (VIQ), and Working Memory Index
(WMI) scores. In addition to Information, Digit
Span, Arithmetic, Similarities, Picture Completion,
Block Design, and Digit Symbol, the Vocabulary and
Letter Number Sequencing subtests were administered
to verify that no significant differences (p50.05)
between group performance on verbal and working
memory tasks were present. Ward’s abbreviated
version of the WAIS III results in 47% to 50%
shorter administration time and provides sufficient
information to estimate VIQ, FSIQ, and WMI. The
abbreviated WAIS III has shown similar psycho-
metric properties that correlate to the full-length
WAIS III assessment ( Joy, Kaplan, & Fein, 2004;
Pilgrim, Meyers, Bayless & Whetstone, 1999). Four
subtests (Digit Symbol, Digit Span, Block Design, and
Letter Number Sequencing) were repeated at all three
time points. These subtests were chosen as repeated
measures based upon their potential sensitivity to
piano instruction with respect to spatial, visual, and
sequential memory.
The Trail Making Tests (TMT Parts A and B;
Reitan & Wolfson, 1985) were also administered at
each of the three time points to assess visual
processing and planning abilities. TMT Part A
Table I. Mean (SD) demographic and baseline data for
controls and experimental participants.
(n ¼ 16)
(n ¼ 15)
No. of males/no. of females 4/13 4/12
Age (years) 71.4 (6.4) 69.6 (4.7)
Education (years) 16.3 16.5
BDI 5.8 (4.6) 3.1 (2.2)
PIQ 33.4 (5.3) 32.8 (5.1)
VIQ 48.3 (6.9) 51.7 (6.2)
WMI 34.8 (5.4) 37.8 (6.7)
AMMA Tonal 24.5 (4.9) 24.4 (4.1)
AMMA Tonal percentile rank 52.4 (24.2) 52.5 (20.9)
AMMA Rhythm 26.1 (4.4) 25.7 (4.9)
AMMA Rhythm percentile rank 45.3 (21.8) 44.4 (22.1)
Notes: BDI: Beck Depression Inventory; PIQ: Performance
Intelligence Quotient; VIQ: Verbal Intelligence Quotient; WMI:
Working Memory Index; AMMA: Advanced Measures of Music
466 J. A. Bugos et al.
examines visual scanning, numeric sequencing, and
visuomotor speed, while TMT Part B assesses
executive functions related to the ability to plan,
execute, and modify a potential plan of action.
Participants alternate between selection of sequential
numeric and alphabetical stimuli.
Six months after the initial testing, (two weeks)
both experimental and control participants were
assessed on measures of executive function thought
to be related to the prefrontal cortex, which are
hypothesized to improve with music instruction. All
follow-up testing sessions were conducted individ-
ually and lasted for approximately 2.5 to 3 hours.
Assessments were varied in order of administration
and were provided during two consecutive sessions,
due to scheduling limitations at participating
Analysis of results will indicate significance levels
(p50.05) by repeated measures Group Time
ANOVA for all repeated assessments; Digit Symbol,
Digit Span, Block Design, Letter Number Sequencing,
and Trail Making Tests (Part A and B). To separately
assess the dependence of TMT performance on
cognitive and motor skills, the results of the TMT
assessment minus the motor aspect, results of
TMT B (alternate between letters and numbers)
minus TMT A (numbers alone) will extract motor
skill level and allow for examination of cognitive skill
Individualized Piano Instruction (IPI)
The IPI program is designed to be a broad-based
music education program, including instruction
with progressive difficulty in musical performance,
technical motor/dexterity exercises, and music
theory. Specifically, the IPI program required
participants to attend a half-hour lesson each week,
and to practice independently for a minimum of
three hours per week. Practice sessions were
recorded on a tape recorder or Superscope PSD
300 CD recorder, and practice-time was logged.
A typical lesson began by correcting errors in the
weekly music theory assignment (Schaum Note
Speller; Schaum, 1996) and explaining new theore-
tical concepts for study. Music literacy was an
important focus as participants were ‘musically
ve’ and unable to read music prior to enrollment.
Topics in music theory consisted of basic note
reading, intervallic and key relationships, and basic
tertian harmony. Participants performed initial
exercises presented in the Alfred All-In-One Basic
Piano Course Level 1 prior to performing their pieces
(Lethco, Manus, & Palmer, 1996). These exercises
are designed to familiarize the student with basic
chord progressions and rhythmic challenges encoun-
tered in their pieces. Once students are familiar with
the lesson’s objective and have practiced a particular
skill in isolation, students are ready to integrate this
knowledge into performance.
Then, the participant’s ability to play a musical
scale, primary triads, and perform dexterity exercises
(The Virtuoso Pianist in Sixty Exercises for the Piano ;
Hanon, 1900) was critiqued. Participants were
taught new scales and arpeggios every two weeks.
Hands separate practice was required for each scale
in the first week, followed by scale completion
with performance hands together the second week.
Participants were taught major and minor scales
using the circle of fifths and the pieces studied as
guidelines. For instance, if they were to learn a new
piece in A minor, their scale assignment included all
three forms of the minor scale as well as performance
of a basic i-iv-i-V-i chord progression. Only one
Hanon exercise was assigned every week and often
these required two weeks to complete at a moderate
tempo. Speed was not a requirement of these
exercises as the purpose was to develop finger
strength and dexterity.
Finally, participants performed selections from
Alfred All-In-One Basic Piano Course Level 1 (Lethco
et al., 1996) and were counseled on strategies to
overcome weaknesses. Each week they received a
new assignment, incrementally building on their
individual cumulative achievements.
Data analysis
Data were analyzed using separate 2-Group
3-Time analyses of variance (ANOVAs) with group
as a between-subjects factor and time as within-
subject factor. Only significant effects in the
ANOVAs are reported. Significant effects were
further examined by planned contrasts to determine
the source of effects. For ANOVAs where there were
more than two levels of a within-subject factor, the
Huynh-Feldt epsilon adjustment (Huynh & Feldt,
1976) was used; uncorrected degrees of freedom
and corrected p-values are reported. Planned and
follow-up contrasts were also employed and, where
appropriate, used the Bonferroni adjustment for
multiple comparisons (Keppel, 1982).
Demographic characteristics
Thirty-one participants (16 experimental and 15
controls) successfully completed the study. The
alpha level was set at 0.05 for all statistical tests.
There were no significant differences between
groups on baseline measures of intelligence
(WAIS-III) and music aptitude (AMMA). Baseline
scores for the experimental group and control group
(Table I) illustrate no significant differences between
group PIQ, VIQ, and WMI. AMMA results are
reported as tonal raw scores (T
), tonal percentile
rank (T
), rhythmic raw scores (R
), and rhythmic
percentile rank (R
Individualized Piano Instruction enhances functioning and memory in older adults 467
Post-training results
The Group Time ANOVA on Digit Symbols
yielded a significant interaction, F(2, 55) ¼ 4.68,
p50.015. As shown in Figure 1, experimental
group scaled scores increased during training and
during the post-training interval, while the control
group did not show such a pattern as a function of
A repeated measures ANOVA showed a signifi-
cant main effect for test time on TMT Card A,
F(2, 58), p50.01. No significant main effects were
found for a Group Time interaction on TMT
Card A indicative of similar performance on
motor-specific tasks. Analysis of the TMT Card B
yielded a significant Group Time interaction,
F(2, 55) ¼ 4.44, p50.03. As can be seen in
Figure 2, the interaction effect reflected the fact
that performance in the experimental group
improved over time, whereas this was not the case
for the control group. There were no significant
main effects for time on TMT Card B. An additional
ANOVA was performed on a ‘delta score’, wherein
scores on TMT Card B were subtracted from
performance on TMT Card A for each participant
over each time point. A repeated measure ANOVA
on ‘delta scores’ indicates no significant main
effects for group or time. A Group Time
ANOVA revealed a trend for TMT ‘delta scores’,
F(2, 56), p50.08.
There were no significant findings on the repeated
WAIS-III subtests of Digit Span Backward, Block
Design, and Letter Number Sequencing (Table II).
A repeated measures Group Time ANOVA for the
total Digit Span Subtest over all three time points
Table II. Mean (þSD) cognitive assessment data for controls and experimental participants.
Controls (n ¼ 16) Experimental (n ¼ 15)
Measures T1 T2 T3 T1 T2 T3
Trail making test
Card A 42.0 (9.0) 36.7 (10.6) 36.8 (9.7) 42.6 (10.2) 37.6 (12.7) 31.3 (10.0)
Card B 87.4 (24.4) 101.3 (35.3) 93.7 (34.5) 98.4 (29.9) 84.9 (27.7) 72.1 (19.3)
Trails delta 46.0 (23.3) 65.5 (29.8) 56.5 (32.7) 55.8 (31.7) 47.3 (24.5) 40.8 (17.5)
WAIS-III subtests
Digit symbol (RS) 53.2 (12.0) 53.9 (15.6) 56.5 (11.9) 50.3 (14.3) 59.9 (18.0) 72.6 (11.8)
Total digit span (RS) 17.4 (3.2) 17.3 (4.2) 17.5 (2.6) 19.1 (3.8) 20.8 (4.2) 19.3 (5.0)
Block design (RS) 31.5 (9.3) 32.5 (7.0) 33.7 (5.3) 30.4 (8.5) 34.0 (11.0) 33.9 (9.0)
LNS (RS) 9.8 (2.9) 9.9 (2.1) 9.5 (2.2) 11.3 (2.7) 11.1 (1.9) 10.8 (2.9)
Note: T1: Pre-training; T2: Post-training; T3: Delay; WAIS-III: Weschler Adult Intelligence Scale; RS: Raw Score; LNS: Letter Number
Figure 2. Results of the Trail Making Test (TMT) (A) Card B
performance and (B) Trails delta scores over all time points.
The box plot contains a range of scores with the median score
represented by the solid line inside the box and outliers
represented by points outside the box.
Figure 1. Results of the Digit Symbol (WAIS III subtest) Scaled
Scores. The box plot contains the range of scores with the median
represented by a solid line inside the box, outliers represented by
points outside the box.
468 J. A. Bugos et al.
yielded no significant interaction effects
F(2, 58) ¼ 2.09, p ¼ 0.13. In addition, there were
no main effects for time or Group Time for any of
these WAIS-subtests. However, a trend was found
for the Digit Span Forward (WAIS-III subtest) after a
repeated measures Group Time ANOVA for
pre- and post-testing time points, F(1, 29) ¼ 3.59,
p ¼ 0.06. Interestingly, the experimental group does
not maintain performance gains when practice is
The primary aim of the present research was to
determine if IPI results in enhanced performance on
cognitive tests of attention and working memory in
healthy older adults. We predicted that IPI would
either reduce the normal age-related decline in
these processes or improve performance in these
processes. Further, we also examined whether or not
the potential cognitive benefits of IPI would be
sustained over time, even after IPI was terminated.
Results were generally supportive of our overall
hypotheses, though not completely so.
IPI may increase cognitive abilities related to
attention and concentration, contributing to overall
working memory. Although the TMT contains a
motor component, the pattern of results support a
consistent trend affecting cognition even after motor
effects are extracted. Both Digit Symbol and TMT
enhancements were shown to significantly contri-
bute to attention, concentration, and planning across
all time points. Improvements in Digit Symbol
performance may indicate that IPI had a beneficial
influence on participants’ perceptual speed, visos-
canning, and memory abilities ( Joy, Fein, & Kaplan,
2003). Thus, the effects of IPI not only transfer to
not specifically musical cognitive domains, but also
were sustained. However, the notion that IPI is a
sustainable cognitive intervention must be tempered
by the results of the Digit Span subtest, in which
cognitive benefits were not sustained when practice
and lessons were discontinued.
TMT Part A is a baseline visual scanning and
motor processing task, while Part B includes
cognitive flexibility through alteration of numeric/
alphabetical stimuli in addition to visual scanning
and motor processing. As in previous studies
(Abbatecola et al., 2004), we subtract performance
on Part A from Part B to isolate the contribution of
cognitive flexibility. Significant decreases in time to
complete the task were found for experimental
participants over each time point as compared to
healthy controls. IPI necessitates high levels of
temporal and spatial processing, thus forcing the
performer to plan, organize, and sequence musical
passages into a cohesive musical event. Recent
imaging research suggests patterns of functional
reorganization of the sensorimotor and temporal
association cortices resulting from six months of
music training in novices (Kim et al., 2004).
This overall pattern of results contrasts with the
achievements of traditional approaches to cognitive
aging. Most cognitive training interventions fail
to generalize beyond task-specific performance
measures. Our findings indicate significant perform-
ance gains in general cognitive assessments that were
not specifically trained in IPI. Transferability of an
intervention to other cognitive domains is extremely
rare in the aging literature (Ball et al., 2002;
Edwards et al., 2005). Memory training paradigms
also demonstrate learning in the trained task with
restricted generalizability (Neely & Backman, 1995).
One potential explanation underlying the transfer-
ability of IPI may be the disparity in the overall
approach to cognitive training. IPI consisted of
training multiple cognitive and motor domains
whereas most cognitive interventions employ a
unimodal training task.
Limitations and alternative interpretations
Three hours of piano practice weekly was required as
part of the IPI regimen. When practice was not
maintained and individual instruction discontinued,
some cognitive benefits were no longer sustained at
the three-month delay time point. Even though all
participants who completed the study practiced a
minimum of three hours per week, quality and
quantity of practice varied on an individual basis.
Although participants were instructed to discontinue
practice during the three-month delay, we did not
independently monitor their compliance beyond the
Most cognitive training research contains a rather
large sample size (Caprio-Prevette & Fry, 1996).
Due to the small sample size (N ¼ 31), more
participants may have been necessary to achieve
more generalizable statistical results. One limitation
of the study design included a lack of an attentional
component for the control group. Individual
attention was given to each participant assigned
to the experimental group during each weekly
30-minute lesson. Providing an attentional compo-
nent for members of the control group would
further isolate the potential impact of the indepen-
dent variable, individualized piano instruction.
Furthermore, the pattern of results cannot be
explained by increases in attention alone.
Significant enhancements were found in multiple
cognitive domains such as planning, information
processing speed, and working memory processes.
Pianists integrate hand movements into an aesthetic
and temporal context while engaging in a visual
Individualized Piano Instruction enhances functioning and memory in older adults 469
spatial process of reading musical notation (Meister
et al., 2004). A musically naı
ve individual will
expend extra time and effort to examine patterns,
regulate rhythmic deficiencies, and correct finger
movements. Rehearsal of musical skills can affect
multiple integrated neural networks that require less
recruitment of attentional components after the skill
becomes implicit. We hypothesize that as the
performer actively allocates attentional resources to
musical passages or music theory exercises; the
integration of multiple networks by repeated practice
(bimanual coordination) is reinforced and trans-
ferred to multiple cognitive domains. This top-down
processing may not be specific to music instruction,
but can serve as a hypothesis for other cognitive
training regimens.
We wish to acknowledge our research assistant,
Adriane Argenio, for her assistance with data
collection, and the Evelyn F. McKnight Brain
Research Foundation for their generous support.
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Individualized Piano Instruction enhances functioning and memory in older adults 471
... In the last 20 years, there has been a surge of research aiming to find ways to mitigate age-related changes in cognition. Research has shown that a healthy diet, 1 engagement in physical activity, 2 bilingualism, 3 volunteering, 4 mindfulness training, 5 "gamified" puzzle training, 6 and playing a music instrument 7,8 or participating in a choir 9 can help older adults maintain their physical and cognitive fitness. Among these various activities, music training shows real promise in mitigating age-related changes in cognitive functions because playing a musical instrument is a rich and complex activity that engages many brain areas. ...
... For instance, Bugos and colleagues showed 6 months of musical training (e.g., piano lessons) can improve executive functioning and working memory. 8,12 Seinfeld and colleagues found enhanced inhibition in older adults after months of group piano training. 12 In a recent, randomized controlled trial, 4 months of piano training enhanced verbal fluency in older adults as compared to computer-assisted cognitive training and controls. ...
... Time-frequency analyses, which take into account differences in phase-locked and nonphase locked activity simultaneously, may be better suited for assessing neuroplastic changes associated with training in older adults. The theta (4-7 Hz) and alpha (8)(9)(10)(11)(12)(13) bands are particularly relevant to the GoNoGo paradigm due to their association with cognitive control. [20][21][22][23][24] Prior studies in young adults have revealed increased theta oscillation (4-7 Hz) power over mid-frontal scalp area, associated with withholding the prepotent response in NoGo trials. ...
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There is growing interest in developing training programs to mitigate cognitive decline associated with normal aging. Here, we assessed the effect of 3‐month music and visual art training programs on the oscillatory brain activity of older adults using a partially randomized intervention design. High‐density electroencephalography (EEG) was measured during the pre‐ and post‐training sessions while participants completed a visual GoNoGo task. Time‐frequency representations were calculated in regions of interest encompassing the visual, parietal, and prefrontal cortices. Before training, NoGo trials generated greater theta power than Go trials from 300 to 500 ms post‐stimulus in mid‐central and frontal brain areas. Theta power indexing response suppression was significantly reduced after music training. There was no significant difference between pre‐ and post‐test for the visual art or the control group. The effect of music training on theta power indexing response suppression was associated with reduced functional connectivity between prefrontal, visual, and auditory regions. These results suggest that theta power indexes executive control mechanisms in older adults. Music training affects theta power and functional connectivity associated with response suppression. These findings contribute to a better understanding of inhibitory control ability in older adults and the neuroplastic effects of music interventions. Here, we assessed the effect of 3‐month music and visual art training programs on the oscillatory brain activity of older adults using a partially randomized intervention design. Our findings contribute to a better understanding of inhibitory control ability in older adults and the neuroplastic effects of music interventions.
... Recognizing the shortcomings of medication in curing cognitive decline, there has been a renewed focus on non-pharmaceutical interventions (e.g., lifestyle, environmental, or acupuncture [9]). Research has supported a variety of factors that may boost cognitive functioning in older adults, including social activity [10], physical activities, aerobic exercise [11][12][13], and music making [14,15]. Each of these has independently shown a benefit in delaying the onset of diagnosis, reducing the risk of developing cognitive impairment or slowing cognitive decline in already diagnosed individuals. ...
... Social activity, or lack of it, has long been supported to decrease cognitive functioning and increase the risk of dementia [21][22][23]. Finally, Bugos (14,15) has found support across studies for the impact of music making on cognitive functions. Our null findings for mood across conditions are not consistent with the previous literature. ...
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Prior research demonstrates that music making, physical exercise, and social activity have unique, positive effects on cognition and mood. One intervention, “Jymmin®”, was developed incorporating these approaches and found effective for decreased pain perception and increased endurance, self-efficacy, mood, and muscle efficiency. Previously, Jymmin was not piloted with older adults with dementia. The current study is a randomized pilot study of the Jymmin® with an older adult population in a long-term care facility (n = 38), evaluated across dementia levels (mild, moderate, or severe). Results found significant improvements in scores on a confrontation naming task across all conditions (p = 0.047) and a significant interaction effect for short-term memory scores (p = 0.046), suggesting higher scores at Time 2 for the experimental group and at Time 3 for the control group. There were no significant changes in mood ratings. Findings are discussed in the context of neural activity and musical agency.
... While most of the existing studies are cross-sectional in nature, presumed cognitive benefits of musical activity in older age are supported by musical intervention/training studies. According to such studies in musically non-experienced OA, learning how to play a musical instrument has a robust positive impact on higherorder cognitive abilities including executive functions, working memory, speech perception and visual memory compared to control conditions (Bugos et al., 2007;Seinfeld et al., 2013;Degé and Kerkovius, 2018;Worschech et al., 2021). ...
... More precisely, participants with musical activity outperformed the matched controls in global cognition and multiple cognitive domains including working memory, executive functions, language and visuospatial abilities. These findings agree with a body of studies, suggesting that active participation in musical activity is associated with higher-order cognitive abilities in OA, based on correlational (Hanna-Pladdy and MacKay, 2011;Hanna-Pladdy and Gajewski, 2012;Mansens et al., 2018;Groussard et al., 2020) and intervention/training (Bugos et al., 2007;Seinfeld et al., 2013;Worschech et al., 2021) studies. A recent meta-analysis of active musical training further demonstrates a small but measurable benefit of this leisure-time activity on cognitive functioning in OA with mild cognitive impairment and dementia (Dorris et al., 2021). ...
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Regular musical activity as a complex multimodal lifestyle activity is proposed to be protective against age-related cognitive decline and Alzheimer’s disease. This cross-sectional study investigated the association and interplay between musical instrument playing during life, multi-domain cognitive abilities and brain morphology in older adults (OA) from the DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE) study. Participants reporting having played a musical instrument across three life periods ( n = 70) were compared to controls without a history of musical instrument playing ( n = 70), well-matched for reserve proxies of education, intelligence, socioeconomic status and physical activity. Participants with musical activity outperformed controls in global cognition, working memory, executive functions, language, and visuospatial abilities, with no effects seen for learning and memory. The musically active group had greater gray matter volume in the somatosensory area, but did not differ from controls in higher-order frontal, temporal, or hippocampal volumes. However, the association between gray matter volume in distributed frontal-to-temporal regions and cognitive abilities was enhanced in participants with musical activity compared to controls. We show that playing a musical instrument during life relates to better late-life cognitive abilities and greater brain capacities in OA. Musical activity may serve as a multimodal enrichment strategy that could help preserve cognitive and brain health in late life. Longitudinal and interventional studies are needed to support this notion.
... While research on music-based interventions for motor rehabilitation of older adults is scarce, there is growing evidence of the effectiveness of short-term musical training for cognitive rehabilitation in this population (Bugos et al., 2007;Seinfeld et al., 2013;Bugos, 2019;MacRitchie et al., 2020). Although a thorough review of the effectiveness of musicbased intervention in cognitive rehabilitation is beyond the scope of this paper (for further discussion, see Hegde, 2014;Sihvonen et al., 2017;Fusar-Poli et al., 2018;Koshimori and Thaut, 2019;Schneider et al., 2019;Mollica et al., 2021), it is of note that recent intervention studies have shown significant improvements in cognitive function in healthy older adults involved in piano training programs (Bugos and Kochar, 2017;Degé and Kerkovius, 2018;Bugos, 2019;Zendel et al., 2019;MacRitchie et al., 2020;Guo et al., 2021;Worschech et al., 2021). ...
... Recent results suggest that musical activities may influence the development of executive functions. Rhythm perception and reproduction are associated with certain components of intelligence that play an important role in learning, such as working memory (Degé et al. 2015), music training, which enhances inhibitory control (Bugos and DeMarie 2017;Frischen et al. 2019;Moreno et al. 2011), and cognitive flexibility (Bugos et al. 2007;Portowitz et al. 2014). These components are executive functions. ...
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Numerous neurological, psychological, and transfer studies confirmed the role of learning music in cognitive development and education. However, exploring the long-term impacts of early musical abilities on academic achievement has gained relatively little attention thus far. In a seven-year longitudinal study, we examined the predictive role of musical abilities in future success in school. The sample consisted of 76 Hungarian students. The independent variables were mothers’ education and the tests administered to Grade-1 students, which included Raven’s Progressive Matrices and tests on word-reading, mathematics, and musical abilities. The dependent variable was GPA in Grade 7. All tests demonstrated adequate reliability. In the regression model with the most significant predictive role, the independent variables explained 46% of GPA in Grade 7 when taken together. We established the long-term predictive role of musical abilities in later success in school. Rhythm perception and reproduction demonstrated the most significant explanatory power (11%) of variance for GPA. Mathematics and mothers’ education each explained 10% of the variance. The findings shed light on the positive impacts that early musical training may play in later academic achievement, even in the long run.
... For this purpose, Gordon developed several music aptitude tests intended to measure the music audiation of individuals from different age groups from pre-school to adolescence (Gordon, 1965(Gordon, , 1979(Gordon, & 1986(Gordon, , 1989. These tests have been widely used for assessing music aptitude in various types of school (Moore, 1995) as well as informing research in the fields of music psychology (e.g., Bugos et al., 2007;Burgoyne et al., 2019;Hayward, 2009), music education (e.g., Degé et al., 2017;Schleuter, 1993), and neuroscience (e.g., Schneider et al., 2002;Schneider et al., 2005). In particular, the Advanced Measures of Music Audiation (AMMA) test procedure (Gordon, 1989) has been used as a reference for cross-validating new inventory tests (Law & Zentner, 2012;Müllensiefen et al., 2014;Wallentin et al., 2010). ...
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Edwin E. Gordon developed the Advanced Measures of Music Audiation (AMMA) test to quantify the extent of an adult's stabilized audiation as a fundamental indicator of musical ability. Although intended to measure audiation exclusively, AMMA is based on a test design similar to the tonal memory subtest of the much older Measures of Musical Talents (SMMT) test developed by Carl Seashore (1919). However, previous studies have shown mixed results regarding AMMA's construct validity. It therefore remains unclear whether AMMA is suitable for measuring audiation exclusively, as intended by Gordon, or whether it additionally measures tonal memory. Accordingly, we tested this hypothesis in two steps. First, responses of 364 participants were used to identify – in terms of the Rasch model – those items of AMMA that could form a “revised” scale showing measurement invariance; second, we used a Bayesian post hoc correlation analysis (N = 83) to measure the construct (discriminant) validity of the revised version of AMMA compared to an equal number of items in the tonal memory subtest of SMMT. Results from both studies revealed that (a) only five out of 30 items of AMMA showed a model fit that was adequate to form a scale which meets the psychometric requirements of invariant measurement, although with a low internal consistency and an increased probability for ceiling effects, and that (b) both measurements showed a strong correlation (Mdn_τ = 0.56, 95% CI [0.42, 0.70], BF_(+0) = 2.67·10^12). We can thus conclude that there is no practical evidence to assume that both test procedures (AMMA and SMMT) are independent.
Prior research has demonstrated beneficial outcomes for learning new skills in older adulthood, including increased cognitive and functional abilities, which help prevent age-related declines and foster healthy aging. However, these studies largely have included participants not typically considered at risk for cognitive and functional decline (i.e., White, highly educated, higher income). Cognitive and functional disparities exist among minoritized racial and ethnic individuals, particularly Black and Latinx populations, because of a lifetime of inequalities associated with low socioeconomic status, low education, and discrimination. This theoretical paper proposes a potential pathway in which such disparities could be mitigated by increasing cognitive and functional abilities via novel skill learning in these at-risk populations in middle and later life to prevent decline. We also discuss indirect barriers (e.g., financial and health issues), direct barriers (e.g., limited learning opportunities), and motivational barriers (e.g., self-beliefs, values) that these adults may encounter. We further highlight that addressing these barriers to novel skill learning by providing appropriate resources is necessary to maximize the feasibility and potential effectiveness of this pathway. Lastly, we encourage future research to test this pathway and help inform policymakers and existing learning programs to implement better ways of promoting lifelong learning in an inclusive and equitable manner to prevent decline.
Executive functions (EFs) are a set of cognitive processes that enable us to control attention and regulate behaviour. Since music training involves these processes to a large extent, positive associations can be assumed. Previous research confirmed this assumption with some studies indicating even causal relationships. However, almost all the research focused on purely analytical processes, so-called cold EFs. By contrast, hot EFs involve processes influenced by emotion and motivation. Therefore, the aim of the present work is to investigate the relationship between music training and hot EFs and to compare these results with the better-studied cold EFs. We conducted two correlative studies with young adults (Study 1) and 9–12-year-old children (Study 2) and collected hot as well as cold executive functions in both age groups. Our results show no clear association between music training and hot EFs. However, we found an association between the age when participants started with music training and decision making. Regarding cold EFs our studies confirm previous research suggesting positive associations with music training. To better investigate the relationship between music training and hot EFs, further reliable and valid measures to capture hot EFs are needed.
Specific tools to measure the cognitive benefits of music therapy and music-rehabilitation training available to music therapists are few and empirically weak: they are mostly psychometrically unrefined or based on unclear tasks and scoring protocols; they do not take into consideration distinct cognitive functions or are based on exclusively observational protocols. To overcome these limitations, we developed a 15-min cognitive screening tool suitable for music therapists, Music Cognitive Test (MCT), which assesses cognitive abilities stimulated by music-making activities (e.g., attentional, verbal, and executive functions, short- and long-term memory) by including music-based items. MCT was validated with 335 participants (aged 18–100 years old) presenting a range of cognitive levels, from healthy cognition to severe impairment. MCT correlated strongly and positively with well-known tests: Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Severe Mini-Mental State Examination (SMMSE). MCT also displayed excellent sensitivity in identifying impaired individuals according to both MMSE and MoCA diagnostic criteria (99.4% and 93.0%, respectively), and excellent specificity in identifying healthy participants based on MMSE (93.5%) and MoCA (97.8%) criteria. Overall, results highlight the reliability of this novel brief music-focused cognitive screening test, to enable music therapists to independently and consistently monitor the effectiveness of their intervention on cognitive functions.
This descriptive overview responds to a rising tide of reviews and RCTs which encourage evidence-based interventions from the first moments of life and across the life course that could increase the Flynn effect and improve global statistics on neurocognitive functioning with a healthspan that approximates longer lifespans. We need to learn more from our centenarians who achieve Healthy Ageing. Evolving neuroscience empowers us to drive neuroplasticity in a positive direction in ways that are associated with enhancing neurocognitive functioning across the entire lifespan for vigorous longevity. Music and Dance could meet these urgent needs in ways that also have physical, emotional, neurobiological, neurochemical, immunological, and social health benefits. Interventions using Music and Dance are likely to have high initial and ongoing use because people are more inclined to do what is fun, easy, free (or low cost), portable, and culturally adaptable.
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Reading of musical notes and playing piano is a very complex motor task which requires years of practice. In addition to motor skills, rapid and effective visuomotor transformation as well as processing of the different components of music like pitch, rhythm and musical texture are involved. The aim of the present study was the investigation of the cortical network which mediates music performance compared to music imagery in 12 music academy students playing the right hand part of a Bartok piece using functional magnetic resonance imaging (fMRI). In both conditions, fMRI activations of a bilateral frontoparietal network comprising the premotor areas, the precuneus and the medial part of Brodmann Area 40 were found. During music performance but not during imagery the contralateral primary motor cortex and posterior parietal cortex (PPC) bilaterally was active. This reflects the role of primary motor cortex for motor execution but not imagery and the higher visuomotor integration requirements during music performance compared to simulation. The notion that the same areas are involved in visuomotor transformation/motor planning and music processing emphasizes the multimodal properties of cortical areas involved in music and motor imagery in musicians. D 2004 Elsevier B.V. All rights reserved. Theme: Neural basis of behavior, Topic: Cognition
Conference Paper
When reviewing the literature on brain substrates of music processing, a puzzling variety of findings can be stated. The traditional view of a left-right dichotomy of brain organization-assuming that in contrast to language, music is primarily processed in the right hemisphere was challenged 20 years ago, when the influence of music education on brain lateralization was demonstrated. Modern concepts emphasize the modular organization of music cognition. According to this viewpoint, different aspects of music are processed in different, although partly overlapping neuronal networks of both hemispheres. However, even when isolating a single "module," such as, for example, the perception of contours, the interindividual variance of brain substrates is enormous. To clarify the factors contributing to this variability, we conducted a longitudinal experiment comparing the effects of procedural versus explicit music teaching on brain networks. We demonstrated that cortical activation during music processing reflects the auditory "learning biography," the personal experiences accumulated over time. Listening to music, learning to play an instrument, formal instruction, and professional training result in multiple, in many instances multisensory, representations of music, which seem to be partly interchangeable and rapidly adaptive. In summary, as soon as we consider "real music" apart from laboratory experiments, we have to expect individually formed and quickly adaptive brain substrates, including widely distributed neuronal networks in both hemispheres.
We used event-related fMRI to investigate age-related differences in PFC activity during separate WM task components (encoding, maintenance, retrieval) with varying memory loads of verbal information. Younger adults showed greater PFC activity than older adults only in dorsolateral PFC, only during memory retrieval. Faster young subjects showed less dorsolateral PFC activation during retrieval than slower young subjects whereas the opposite pattern was observed in older adults. This result was replicated in two additional experiments using verbal and spatial information. Age-related changes in the dorsolateral PFC regions involved in memory retrieval may mediate declines in WM performance. These results suggest a relationship between neural activation and performance that is sigmoid in nature. Age-related differences in performance may be mediated by bias shifts in this sigmoid function.
It has been suggested that when the variance assumptions of a repeated measures ANOVA are not met, the df of the mean square ratio should be adjusted by the sample estimate of the Box correction factor, ?. This procedure works well when ? is low, but the estimate is seriously biased when this is not the case. An alternate estimate is proposed which is shown by Monte Carlo methods to be less biased for moderately large ?.