The Impact of Music and Performance-Based Activities on Cognitive Function and Well-Being
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Abstract
Active music-making and performance activities may provide cognitively, emotionally, motorically, and socially demanding experiences in later life, but previous studies rarely separate component effects from attention, expectancy, and group contact. This study estimated the independent effects of music-making and theatre- and movement-based performance, and the uncertainty surrounding their interaction, among adults aged 60–75 years with subjective cognitive decline but no dementia. In a multicentre, assessor-blinded 2×2 factorial randomized trial, 480 participants received music only, performance only, combined delivery, or an attention- and time-matched social-learning program for 16 weeks. Week 16 was the confirmatory endpoint; assessments also occurred at week 8 and at 3, 6, and 12 months. Co-primary outcomes were the NIH Toolbox Fluid Cognition Composite and WEMWBS. Intention-to-treat multiple-membership multilevel models accounted for repeated measures, delivery groups, centers, and exposure-weighted facilitators. Holm correction controlled the four confirmatory tests; multiple imputation, practice-effect sensitivity analyses, and standardized effects assessed robustness. At week 16, music improved fluid cognition by 2.6 points (95% CI 1.1–4.1; Holm-adjusted p=.003) and performance by 2.1 points (95% CI 0.6–3.6; p=.006). Music and performance improved WEMWBS by 2.2 and 2.8 points, respectively. Interaction estimates were imprecise and did not show clear departure from additivity. Effects attenuated after delivery and were uncertain at 12 months. Secondary differences were selective, and longitudinal process analyses remained exploratory and underpowered. Music and performance therefore produced modest short-term cognitive and well-being effects without establishing synergy, durable cognitive protection, or unique causal mechanisms.
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