Music Making and Engagement for Older Adults at Risk for Dementia: Examining Neurobiological Relationships and Co-Designing a Music-Based Trial

Abstract

Older adults with mild cognitive impairment (MCI) are at higher risk of developing dementia, making them a key group for secondary prevention. Lifestyle activities that are cognitively stimulating, socially engaging, and emotionally fulfilling may help delay or mitigate decline. Music-making has been proposed as one such activity, with evidence suggesting benefits for cognition and well-being in older adults at risk for dementia. While music-making is thought to promote neuroplasticity, the brain’s ability to reorganise neural pathways, the extent of this effect in MCI remains unclear. Despite recommendations to encourage such activities, robust evidence for their efficacy in this population is lacking. This thesis aimed to examine the effect of music-making on neuroplasticity, cognition, and psychosocial outcomes in older adults at risk for dementia. Across four studies, it revealed that: (a) evidence linking music-making interventions to neuroplasticity is inconclusive, with no studies specifically in MCI; (b) currently playing an instrument is associated with greater grey matter density in the temporal lobe, insula, and cerebellum; (c) the type of music-making has distinct effects on neuropsychological and psychosocial outcomes; and (d) baseline characteristics of participants in the NeuroMusic trial reflect the intended at-risk profile, underscoring the trial’s significance. These findings add to the literature on music-making and brain health in ageing. Music-making shows potential to enhance neuroplasticity, delay cognitive decline, and improve psychosocial outcomes, positioning it as a promising early intervention for older adults at risk for dementia. Understanding its effects on brain structure, cognition, and well-being provides critical insights for developing targeted, evidence-based prevention strategies in MCI