Playing a Musical Instrument as a Protective Factor against Dementia and Cognitive Impairment: A Population-Based Twin Study

'Monday's feel calmer when creative practitioners are here': a quality improvement project exploring whether creative-practitioner sessions on adult inpatient mental-health wards reduce levels of violence and aggression

BACKGROUND

Violence and aggression (V&A) are commonplace on mental-health wards and may lead to restrictive practice interventions (RPI), having a detrimental impact on patients and staff. In the 12 months preceding this quality improvement (QI) project, there was a mean V&A incidence of 52.7±113.0 and RPI of 37.6±84.1 per 1000 bed days.

METHODS

Using QI methodology, a project involving creative practitioners was codeveloped to provide a range of activities delivered via a 7-day service, across 13 inpatient mental-health wards in five hospital settings, using levels of V&A and RPI as outcome measures. The creative practices used drew on successful projects arising from a linked charity, Creative Minds. Three plan-do-study-act cycles were completed. (1) Coproduction with ward staff, patients and creative practitioners of 4-week session plans, including an induction training package for creative practitioners. (2) Streamlined and centralised communication between creative practitioners and participating wards using a project coordinator. (3) Implementation of a creative-practitioner Rota to better support ward activity planning, staff and patient expectation setting.

RESULTS

During the 12-month project wards with creative practitioners experienced statistically significant reduction in V&A levels (F (1, 168)=5.72, p=0.017) and RPI (F (1, 168)=8.40, p=0.0042). Wards not involved in the project, V&A levels (F (1, 142) =3.34, p<0.069) and RPI (F (132, 142)=0.99, p=0.52) remained unchanged. Ward length-of-stay was used as a balancing measure with no difference pre 45.0±4.9 days and post 46.9±5.0 days intervention (p=0.18). At the project peak, creative practitioners delivered around 300 hours per week of creative activity, which appears to be associated with reduced number of V&A/RPI incidents.

CONCLUSIONS

Recommendations for the project's next steps are to secure sustained funding for creative practitioners to further enhance patients/staff well-being, as well as the coproduction of a creative-practitioner implementation guide to be tested in other mental-health inpatient settings as a part of a research study to better understand the impact of the type/timing of activities (ie, day/evening/weekends) on important patient outcomes and staff well-being.

Acquisition of musical skills and abilities in older adults-results of 12 months of music training

BACKGROUND

Older adults can acquire new skills across different domains. Practicing a musical instrument has been identified as a promising activity for improving cognition, promoting well-being, and inducing brain plasticity in older individuals. However, the mechanisms of these changes are still poorly understood. This study aims to assess musical skill acquisition in musically naïve older adults over one year of practice, focusing on individual factors influencing this process and the relations between musical skills.

METHODS

One hundred fifty-six healthy older adults (age = 69.5 years ± 3.2) from Hannover and Geneva with no prior musical training participated in weekly piano practice (PP) or 'music culture' (MC) sessions over a one-year period. Baseline assessments included the Cognitive Reserve Index questionnaire (CRIq) and Cognitive Telephone Screening Instrument (CogTel). Musical abilities were measured using piano performance ratings (PP group), music quizzes (MC group), and aptitude tests such as the Beat Alignment Test (BAT), Melodic Discrimination Test (MDT) and Midi Scale Analysis (MSA) at baseline and six-, twelve and 18-month timepoints. The interrelationship between musical abilities was investigated through correlational analyses, and changes impacted through individual characteristics were modeled using Bayesian statistics.

RESULTS

The PP group demonstrated moderate improvements in piano articulation and dynamics, while the MC group achieved higher scores in the music quiz. Modest improvements in MDT and MSA were observed in both groups, with the PP group showing greater progress is MSA. Higher global cognitive functioning and musical sophistication was associated with greater performance in MDT for both groups. We did not identify any links between individual characteristics, like age, CogTel, CRIq, and musical sophistication, and improvement in musical aptitude tests. Changes in different musical aptitude test scores were not correlated, and neither the development of piano skills nor the music quiz correlated with initial performances on the musical aptitude tests.

CONCLUSION

Musically naïve older adults can acquire diverse musical abilities, which progress independently, suggesting a broad spectrum of musical abilities rather than a single general musical aptitude. Future research should also explore genetic and psychosocial factors influencing musical development.

TRIAL REGISTRATION

The Ethikkomission of the Leibniz Universität Hannover approved the protocol on 14.08.17 (no. 3604-2017), the neuroimaging part and blood sampling was approved by the Hannover Medical School on 07.03.18. The full protocol was approved by the Commission cantonale d'éthique de la recherche de Genève (no. 2016-02224) on 27.02.18 and registered at clinicaltrials.gov on 17.09.18 (NCT03674931, no. 81185).

Arts and creativity interventions for improving health and wellbeing in older adults: a systematic literature review of economic evaluation studies

BACKGROUND

As the population ages, older people account for a larger proportion of the health and social care budget. A significant body of evidence suggests that arts and creativity interventions can improve the physical, mental and social wellbeing of older adults, however the value and/or cost-effectiveness of such interventions remains unclear.

METHODS

We systematically reviewed the economic evidence relating to such interventions, reporting our findings according to PRISMA guidelines. We searched bibliographic databases (MEDLINE, EMBASE, Econlit and Web of Science and NHSEED), trial registries and grey literature. No language or temporal restrictions were applied. Two screening rounds were conducted independently by health economists experienced in systematic literature review. Methodological quality was assessed, and key information extracted and tabulated to provide an overview of the published literature. A narrative synthesis without meta-analysis was conducted.

RESULTS

Only six studies were identified which provided evidence relating to the value or cost-effectiveness of arts and creativity interventions to improve health and wellbeing in older adults. The evidence which was identified was encouraging, with five out of the six studies reporting an acceptable probability of cost-effectiveness or positive return on investment (ranging from £1.20 to over £8 for every £1 of expenditure). However, considerable heterogeneity was observed with respect to study participants, design, and outcomes assessed. Of particular concern were potential biases inherent in social value analyses.

CONCLUSIONS

Despite many studies reporting positive health and wellbeing benefits of arts and creativity interventions in this population, we found meagre evidence on their value or cost-effectiveness. Such evidence is costly and time-consuming to generate, but essential if innovative non-pharmacological interventions are to be introduced to minimise the burden of illness in this population and ensure efficient use of public funds. The findings from this review suggests that capturing data on the value and/or cost-effectiveness of such interventions should be prioritised; furthermore, research effort should be directed to developing evaluative methods which move beyond the confines of current health technology assessment frameworks, to capture a broader picture of 'value' more applicable to arts and creativity interventions and public health interventions more generally.

PROSPERO REGISTRATION

CRD42021267944 (14/07/2021).

Hobby engagement and mental wellbeing among people aged 65 years and older in 16 countries

Growing aging populations pose a threat to global health because of the social and psychological challenges they experience. To mitigate this, many countries promote hobby engagement to support and improve mental health. Yet, it remains unclear whether there is consistency in benefits across different national settings. We harmonized measures of hobby engagement and multiple aspects of mental wellbeing across 16 nations represented in five longitudinal studies (N = 93,263). Prevalence of hobby engagement varied substantially across countries, from 51.0% of Spanish respondents to 96.0% of Danish respondents. Fixed effects models and multinational meta-analyses were applied to compare the longitudinal associations between hobbies and mental wellbeing. Independent of confounders, having a hobby was associated with fewer depressive symptoms (pooled coefficient = -0.10; 95% confidence intervals (CI) = -0.13, -0.07), and higher levels of self-reported health (pooled coefficient = 0.06; 95% CI = 0.03, 0.08), happiness (pooled coefficient = 0.09; 95% CI = 0.06, 0.13) and life satisfaction (pooled coefficient = 0.10; 95% CI = 0.08, 0.12). Further analyses suggested a temporal relationship. The strength of these associations, and prevalence of hobby engagement, were correlated with macrolevel factors such as life expectancy and national happiness levels but overall, little variance in findings was explained by country-level factors (<9%). Given the relative universality of findings, ensuring equality in hobby engagement within and between countries should be a priority for promoting healthy aging.

The impact thinking framework: a process for advancing research-to-practice initiatives in neuroaesthetics

Neuroaesthetics research explores brain, body and behavioral responses to engagement with the arts and other aesthetic sensory experiences. Evidence indicates that such experiences can help address various psychological, neurological and physiological disorders, and that they can support mental and physical well-being and learning in the general population. The interdisciplinary nature of this work contributes to its impact and promise; however, it also creates challenges as various disciplines approach and define research and practice in varied ways. Recent field-wide reports have noted that a consensus translational framework is needed to support further neuroaesthetics research that can deliver meaningful knowledge and interventions. The Impact Thinking Framework (ITF) was designed to meet this need. Through a description of the framework's nine iterative steps and a presentation of three case studies, this paper posits that the ITF can support researchers and practitioners in understanding and applying aesthetic experiences and the arts to advance health, well-being, and learning.

Identification and Illustration of Means to a Critical Assessment of Music and Health Research Literature

In 2019, the WHO released a scoping review investigating art therapies in evidence-based healthcare practices to identify and understand the gaps in the literature. However, the studies curated were not evaluated for their quality. To address this limitation, several assessment tools to critically appraise music-based research studies that investigate therapies pertaining to preventative healthcare were investigated. Two critical appraisal tools were selected for their robustness and appropriateness for the studies in question: the Joanna Briggs Institute checklists and the Music-Based Intervention Guidelines. These tools were tested by two assessors on a total of 23 music studies from the Preventative and Prevention Health section of the WHO report. Based on the requirements for each critical appraisal tool, seven studies received a full assessment utilizing both checklists. Of these seven, two studies scored on the higher index, indicating that the studies followed a detailed methodology to provide concrete and accurate results. The findings of the study highlighted the limitations of study designs and music-based interventions. With this information, beneficial recommendations for future research in this domain are provided to improve the quality of research, ensuring its place in evidence-based healthcare practices.

Can chronic therapeutic drug use by the elderly affect Alzheimer’s disease risk and rate of progression?

There is no approved drug capable of halting the progression of the most prevalent neurodegenerative disorders, namely Alzheimer’s disease (AD) and Parkinson’s disease (PD). Current therapeutic strategies focus mainly on the inhibition of the formation of protein aggregates and their deposition in the central nervous system. However, after almost a hundred years, proper management of the disease is still lacking. The fact of not finding effective management tools in the various clinical trials already carried out suggests that new hypotheses and strategies should be explored. Although vast resources have been allocated to the investigation of protein aggregates and the pathophysiology is now better understood, clues to the actual etiology are lacking. It is well known that brain homeostasis is of paramount importance for the survival of neurons. Drugs that target the periphery are often not subject to evaluation for their potential effect on the central nervous system. While acute treatments may be irrelevant, pills used for chronic conditions can be detrimental to neurons, especially in terms of progressive damage leading to a long-term decline in neuronal survival. Due to the lack of advances in the search for a curative treatment for neurodegenerative diseases, and the lack of new hypotheses about their etiology, a novel hypothesis is here proposed. It consists of assuming that the effects of the drugs most commonly used by the elderly, such as antihypertensive, hypoglycemic, and hypocholesterolemic, could have a negative impact on neuronal survival.

Sensogenomics of music and Alzheimer's disease: An interdisciplinary view from neuroscience, transcriptomics, and epigenomics

Introduction

The relationship between music and Alzheimer's disease (AD) has been approached by different disciplines, but most of our outstanding comes from neuroscience.

Methods

First, we systematically reviewed the state-of-the-art of neuroscience and cognitive sciences research on music and AD (>100 studies), and the progress made on the therapeutic impact of music stimuli in memory. Next, we meta-analyzed transcriptomic and epigenomic data of AD patients to search for commonalities with genes and pathways previously connected to music in genome association, epigenetic, and gene expression studies.

Results

Our findings indicate that >93% of the neuroscience/ cognitive sciences studies indicate at least one beneficial effect of music on patients with neurodegenerative diseases, being improvements on memory and cognition the most frequent outcomes; other common benefits were on social behavior, mood and emotion, anxiety and agitation, quality of life, and depression. Out of the 334 music-related genes, 127 (38%) were found to be linked to epigenome/transcriptome analysis in AD (vs. healthy controls); some of them (SNCA, SLC6A4, ASCC2, FTH1, PLAUR and ARHGAP26) have been reported to be associated e.g. with musical aptitude and music effect on the transcriptome. Other music-related genes (GMPR, SELENBP1 and ADIPOR1) associated to neuropsychiatric, neurodegenerative diseases and music performance, emerged as hub genes in consensus co-expression modules detected between AD and music estimulated transcriptomes. In addition, we found connections between music, AD and dopamine related genes, with SCNA being the most remarkable - a gene previously associated with learning and memory, and neurodegenerative disorders (e.g., Parkinson's disease and AD).

Discussion

The present study indicate that the vast majority of neuroscientific studies unambiguously show that music has a beneficial effect on health, being the most common benefits relevant to Alzheimer's disease. These findings illuminate a new roadmap for genetic research in neurosciences, and musical interventions in AD and other neurodegenerative conditions.

Latent Classification Analysis of Leisure Activities and Their Impact on ADL, IADL and Cognitive Ability of Older Adults Based on CLHLS (2008-2018)

This study aimed to research the trajectory of leisure activity and the health status of older adults and analyze the effects of leisure activity on the health status of older adults. Based on the longitudinal data of CLHLS (2008-2018), the latent growth curve model (LGCM) was used; we found that the leisure activities (LA), activities of daily living (ADL) ability, instrumental activities of daily living (IADL) ability, and cognitive ability (COG) of older adults show a nonlinear downward trend over time. Furthermore, the panel binary regression analysis is used to find that leisure activities have significant inhibitory effects on ADL disorder, IADL disorder, and cognitive impairment in the older population. In addition, by using latent profile analysis (LPA), the older population is classified into three groups according to the homogeneity of the older adults' choice of leisure activities, namely the types of relaxation, entertainment, and intellectual-learning, respectively. Based on the classification results, the analysis of one-way ANOVA shows that the rates of ADL disorder, IADL disorder, and cognitive impairment of older adults with different types are significantly different. Moreover, the inhibitory effect of leisure activities on the rate of ADL disorder, IADL disorder, and cognitive impairment of older adults is more significant in the middle-aged and high-aged groups. Therefore, older adults should be encouraged to increase leisure activities, especially those who are middle-aged and high-aged.

Music Engagement as a Source of Cognitive Reserve

Music engagement is a ubiquitous activity that is thought to have cognitive benefits for the rapidly aging population. In the absence of robust treatment approaches for many age-related and neuropathological health issues, interest has emerged surrounding lifestyle-enriching activities, like exercise and music engagement, to build cognitive reserve across the lifespan and preserve neurocognitive function in older adults. The present review evaluates evidence of neurocognitive preservation arising from lifelong music engagement with respect to the cognitive reserve hypothesis. We collated a body of neuroimaging, behavioral and epidemiological evidence to adjudicate the benefits of music engagement for cognitive reserve. The findings suggest that music engagement should be considered in tandem with other well-established cognitive reserve proxies as a contributor to differential clinical outcomes in older populations at risk of age-related and neuropathological cognitive decline.

Playing a musical instrument and the risk of dementia among older adults: a systematic review and meta-analysis of prospective cohort studies

BACKGROUND

Engaging in leisure activities was suggested to protect older adults from dementia. However, the association between playing a musical instrument and the risk of dementia is not well-established. This study aimed to investigate this association in older adults using a systematic review and meta-analysis of prospective cohort studies.

METHODS

Pooled hazard ratio (HR) and 95% confidence interval (CI) of having dementia for older adults playing a musical instrument were calculated using the random-effects model. We performed the I2 statistic to detect heterogeneity across studies and the test for funnel plot asymmetry to assess publication bias. The risk of bias assessment was conducted using the modified Newcastle-Ottawa Scale.

RESULTS

A total of three prospective cohort studies were found eligible: two from the U.S. and one from Japan. Playing a musical instrument, in the meta-analysis, was significantly associated with a decreased risk of dementia (HR = 0.64; 95% CI: 0.41, 0.98) among older adults. No signs of significant heterogeneity across studies (I2 = 23.3% and p-heterogeneity = 0.27) or publication bias (z= -1.3 and p-publication bias = 0.18) were identified.

CONCLUSION

Playing a musical instrument was associated with a decreased risk of dementia among older adults. Older adults should be encouraged to engage in leisure activities, especially playing musical instruments.

Musical Activity During Life Is Associated With Multi-Domain Cognitive and Brain Benefits in Older Adults

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.

Frequency of leisure activity engagement and health functioning over a 4-year period: a population-based study amongst middle-aged adults

RATIONALE

Leisure activities have wide-ranging benefits for physical and mental health. However, previous studies have often focused on "leisure" as a homogeneous group of activities. This study was therefore designed to take a prospective and comparative approach exploring different types of leisure activities, as well as investigating whether frequency of engagement is associated with strength of benefits.

METHOD

Data from the 1970 British Cohort Study Waves 9 (age 42) and 10 (age 46) were analysed (N = 5,639). Eight domains derived from the SF-36 health survey questionnaire were used to measure health functioning (general health, vitality, bodily pain, social functioning, physical functioning, mental health, role limitations due to emotional, and role limitations due to physical problems). Leisure activities included physical activity, culture engagement, arts participation, volunteering or community engagement, and literature activities. Both ordinary least squares and logistic regressions were applied.

RESULTS

Physical activity was associated with greater levels of physical functioning, general health, and vitality at higher frequencies, while cultural engagement was associated with social functioning and physical functioning when engaged in several times a year. Arts participation and literature activities had a general negative association with health functioning. Engagements in volunteering/community groups showed varying associations with health functioning (both positive and negative) depending on the levels of engagements.

CONCLUSION

This research suggests that the types of leisure activities and levels of engagement can have differential associations with health amongst middle-aged adults. This may be helpful for public health initiatives and programmes such as social prescribing schemes when formulating programmes, especially regarding 'dosage' of engagement. Further, the overall benefits of high engagement frequency suggest that increasing leisure engagement could play an important role in supporting improving health and wellbeing at a population level.

Music affects functional brain connectivity and is effective in the treatment of neurological disorders

In a million years, under the pressure of natural selection, hominins have acquired the abilities for vocal learning, music, and language. Music is a relevant human activity, highly effective in enhancing sociality, is a universal experience common to all known human cultures, although it varies in rhythmic and melodic complexity. It has been part of human life since the beginning of our history, or almost, and it strengthens the mother-baby relation even within the mother's womb. Music engages multiple cognitive functions, and promotes attention, concentration, imagination, creativity, elicits memories and emotions, and stimulates imagination, and harmony of movement. It changes the chemistry of the brain, by inducing the release of neurotransmitters and hormones (dopamine, serotonin, and oxytocin) and activates the reward and prosocial systems. In addition, music is also used to develop new therapies necessary to alleviate severe illness, especially neurological disorders, and brain injuries.

Lifetime musical training and cognitive performance in a memory clinic population: A cross-sectional study

BACKGROUND

Music training has been found to be beneficial for young and healthy participants but the associations between musical training and the cognitive functioning of elderly participants have not been reported consistently. We examined whether lifetime musical training is associated with neuropsychological performance in a memory clinic population of older patients.

METHODS

A total of 478 patients (54.2% female, mean age 73.70 ± 6.22, mean Mini Mental State Examination score 25 ± 3) were included in the cross-sectional analyses. All patients were referred to the memory clinic due to cognitive impairments. During the course of diagnosis, all patients underwent neuropsychological tests using the CERAD neuropsychological assessment battery. Patients provided information on whether they ever learned to play an instrument for at least five years in their life.

RESULTS

Neuropsychological test results differed based on musical training (p = .042). Overall, there were no differences in any domains of cognitive functioning, other than that patients with musical training performed worse on word list memory (p = .008). However, this relationship varied based on the extent of cognitive impairments. Patients who were cognitively unimpaired (Mini Mental State Examination score 27-30) and had musical training showed better word list learning, whereas patients with cognitive impairments (Mini Mental State Examination score < 27) and musical training performed worse in word list learning (p = .042) and word list recall (p = .045).

DISCUSSION

Overall, there was little evidence of associations between specific neuropsychological test results and musical training. Only in cognitively unimpaired patients was there evidence that musical training had beneficial associations. In patients with cognitive impairment, there were suggestions of negative associations with verbal memory. Future research should longitudinally investigate the beneficial effects of musical training in people with and without cognitive impairments.

The Relationship Between Hearing Loss and Cognitive Impairment in a Chinese Elderly Population: The Baseline Analysis

Objectives: The objective of the study was to investigate the association between untreated age-related hearing loss and cognitive impairment in Mandarin-speaking older adults living in China. Methods: Older adults (293; 111 males, M = 70.33 ± 4.90 years; 182 females, M = 69.02 ± 4.08 years) were recruited. All participants completed a pure tone audiometric hearing assessment, Hearing Impairment-Montreal Cognitive Assessment Test (HI-MoCA), and a computerized neuropsychology test battery (CANTAB). The Mandarin version of the De Jong Gierveld Loneliness Scale was used to measure the loneliness, and the Mandarin version of the 21-item Depression Anxiety Stress Scale (DASS-21) was used to measure the current severity of a range of symptoms common to depression, stress, and anxiety of the participants. Results: A multiple stepwise regression analysis showed that the average of four mid-frequency thresholds in the better ear was related to CANTAB Paired Associates Learning (β = 0.20, p = 0.002), and the global cognitive function score (HI-MoCA) (β = -0.25, p < 0.001). The average of three high frequencies in the better ear was significantly associated with CANTAB Delayed Matching to Sample (β = -0.16, p = 0.008), and Spatial Working Memory (β = 0.17, p = 0.003). Conclusion: The results revealed a significant relationship between age-related hearing loss and cognitive impairment in Mandarin-speaking older adults. These research outcomes have clinical implications specifically for hearing health care professionals in China and other populations that speak a tonal language, especially when providing hearing rehabilitation.

Choral Singing Enriches Everyday Life for People With Mild to Moderate Dementia and Their Family Caregivers

Dementia causes substantial suffering for affected persons and their family caregivers. Because no cure is available, it is important to investigate how alternative therapies can improve life for these individuals. For the current study, persons with dementia (PwD) were recruited from a specialized Memory Clinic in Sweden to engage in a choral singing intervention for 1 hour per week for four semesters. PwD were encouraged to bring a family caregiver to the sessions; both were interviewed and data were analyzed using qualitative content analysis. The choral singing intervention appeared to become an important social context for PwD and family caregivers and had a positive impact on relationship, mental well-being, mood, and memory. The intervention appeared to act as an enriched environment for all participants. Choral singing interventions for PwD and their family caregivers is a simple means to create a social context and improve general well-being. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].

Loneliness, Sense of Control, and Risk of Dementia in Healthy Older Adults: A Moderated Mediation Analysis

Objectives: Despite the rising prevalence of dementia, little research has been conducted to identify modifiable psychological factors that alleviate the risk of dementia in older adults and the underlying mechanisms. Given that loneliness is, in part, concomitant with a weakened sense of control, we examined whether sense of control would mediate the relation between loneliness and dementia risk. Further, considering that working -memory capacity is a critical cognitive resource that serves as a buffer against age-related cognitive decline, we examined a second-order moderated mediational model whereby working-memory capacity moderates the relation between control beliefs and dementia risk in older adults.

METHODS

We administered a series of measures to older community-dwelling adults (ages 60-93; N = 69), including the participant-rated AD8 to assess the risk of dementia. Using the PROCESS macro, we examined the moderated mediation model for the relation between loneliness, sense of control, and dementia risk.

RESULTS

We found that sense of control significantly mediated the relation between loneliness and risk of dementia. Moreover, the indirect effect of loneliness on dementia risk via lowered sense of control was significant only in individuals with poorer working-memory capacity. Notably, these findings held true when important covariates were controlled for.

CONCLUSIONS

Our findings underscore the critical role of control beliefs and working memory in protecting against dementia risk.

CLINICAL IMPLICATIONS

Our findings have implications for intervention programs that target alleviating dementia risk and promoting healthy aging in older adults by improving socioemotional health and cognitive functioning.

Musical instrument engagement across the life course and episodic memory in late life: An analysis of 60 years of longitudinal data from the Wisconsin Longitudinal Study

BACKGROUND

As the global burden of dementia increases, the absence of treatment underscores the need for identification of factors that may improve cognitive reserve-the ability to stave off cognitive decline in old age. The beneficial association between musical instrument engagement and episodic memory has been identified in children, young adults, and older adults. Yet, previous studies in musical instrument engagement have rarely examined the potential for adolescence and adulthood exposures to independently improve cognition, nor have they been linked with the rate of memory decline over time in older adults. We investigated whether adolescent musical instrument engagement and continued musical instrument engagement over the adult life course were separately associated with higher episodic memory, as well as rate of decline in a large longitudinal cohort.

METHODS

Data were from a prospective cohort of high school graduates from 1957. High school music engagement (HSME) was ascertained through graduate yearbooks and assessed as membership in musical performance groups. A questionnaire was used to assess musical engagement through adulthood (MEA) at ages 35, 55, and 65. The episodic memory score was composed of immediate and delayed recall task scores, and was assessed when participants were aged approximately 65 and 72 years old among 5,718 individuals. Linear mixed models were used to assess the association between music, and memory performance and decline over time.

RESULTS

Of high school graduates who participated in the study, 38.1% played music in high school, and 21.1% played music in adulthood. While musical engagement was more common in those who played in childhood, 40% of those who played continuously as an adult did not play in high school. High HSME (B = 0.348, p = 0.049) and continuous MEA (B = 0.424, p = 0.012) were associated with higher memory scores at age 65 after covariate adjustment. When examining memory decline, the benefits of high HSME decreased over time (B = -0.435, p = 0.048), while the rate of decline did not differ between MEA groups. Exploratory models revealed differential benefits for HSME and immediate recall, and MEA and delayed recall.

CONCLUSION

This study provides further evidence that musical engagement in childhood or adulthood is associated with non-musical cognitive reserve. These two exposures may act differentially in different domains of episodic memory. Further work is needed to determine the relationship between musicianship and the rate of cognitive decline.

Performing arts as a health resource? An umbrella review of the health impacts of music and dance participation

An increasing body of evidence notes the health benefits of arts engagement and participation. However, specific health effects and optimal modes and 'doses' of arts participation remain unclear, limiting evidence-based recommendations and prescriptions. The performing arts are the most popular form of arts participation, presenting substantial scope for established interest to be leveraged into positive health outcomes. Results of a three-component umbrella review (PROSPERO ID #: CRD42020191991) of relevant systematic reviews (33), epidemiologic studies (9) and descriptive studies (87) demonstrate that performing arts participation is broadly health promoting activity. Beneficial effects of performing arts participation were reported in healthy (non-clinical) children, adolescents, adults, and older adults across 17 health domains (9 supported by moderate-high quality evidence (GRADE criteria)). Positive health effects were associated with as little as 30 (acute effects) to 60 minutes (sustained weekly participation) of performing arts participation, with drumming and both expressive (ballroom, social) and exercise-based (aerobic dance, Zumba) modes of dance linked to the broadest health benefits. Links between specific health effects and performing arts modes/doses remain unclear and specific conclusions are limited by a still young and disparate evidence base. Further research is necessary, with this umbrella review providing a critical knowledge foundation.

How leisure activities affect health: a narrative review and multi-level theoretical framework of mechanisms of action

There is a large and growing body of evidence on the health benefits of engagement in leisure activities (voluntary, enjoyable non-work activities, such as hobbies, arts, volunteering, community group membership, sports, and socialising). However, there is no unifying framework explaining how leisure activities affect health: what the mechanisms of action are by which engagement with leisure activities leads to the prevention, management, or treatment of mental and physical illness. In this Review, we identify and map over 600 mechanisms of action. These mechanisms can be categorised as psychological, biological, social, and behavioural processes that operate at individual (micro), group (meso), and societal (macro) levels, and are synthesised into a new theoretical framework: the Multi-level Leisure Mechanisms Framework. This framework situates understanding of leisure activities within the theoretical lens of complex adaptive systems and aims to support the design of more theory-driven, cross-disciplinary studies.

Does playing a musical instrument reduce the incidence of cognitive impairment and dementia? A systematic review and meta-analysis

Objectives: High levels of life course intellectually-stimulating activity are hypothesised to produce a cognitive reserve that mitigates against overt cognitive impairment in the face of neuropathology. Leisure-time musical instrument playing could be a viable source of that stimulation, but to date no systematic review has been undertaken to investigate the effect of musical instrument playing on the incidence of cognitive impairment and dementia.Methods: A systematic review and meta-analysis including any study with musical instrument playing as the exposure, and cognitive impairment and/or dementia as the outcome.Results: 1211 unduplicated articles were identified from literature searching, of which three articles were included: two cohort studies and one twin study. All studies were of good methodological quality, and reported large protective effects of musical instrument playing. The twin study reported that musicians were 64% less likely to develop mild cognitive impairment or dementia, after additionally adjusting for sex, education and physical activity. A meta-analysis of the cohort studies found a 59% reduction in the risk of developing dementia within the study follow up. The evidence base is limited by size, small sample sizes and the risk of reverse causality.Conclusion: The three identified studies that investigated the specific relationship of musical instrument playing and subsequent incidence of cognitive impairment and dementia all reported a large protective association. The results are encouraging but should be interpreted with caution. Larger, more focussed studies are required to further explore this association, with a particular need to consider the cumulative lifetime quantity of music playing.

Is there a dose-response relationship between musical instrument playing and later-life cognition? A cohort study using EPIC-Norfolk data

INTRODUCTION

Musical instrument playing provides intellectual stimulation, which is hypothesised to generate cognitive reserve that protects against cognitive impairment. Studies to date have classified musicianship as a binary entity. This investigation draws on the dataset of the European Prospective Investigation of Cancer Norfolk study to examine the effect of frequency of playing on later-life cognition.

METHODS

We compared three categorisations of self-reported musical playing frequency in late mid-life (12-month period) against cognitive performance measured after a 4-11 year delay, adjusted for relevant health and social confounders. Logistic regression models estimated the adjusted association between frequency of musical playing and the likelihood of being in the top and bottom cognitive deciles.

RESULTS

A total of 5,693 participants (745 musicians) provided data on music playing, cognition and all co-variables. Classification of musicianship by frequency of playing demonstrated key differences in socio-demographic factors. Musicians outperformed non-musicians in cognition generally. Compared with non-musicians, frequent musicians had 80% higher odds of being in the top cognitive decile (OR 1.80 [95% CI 1.19-2.73]), whereas musicians playing at any frequency had 29% higher odds (95% CI 1.03-1.62). There was evidence of a threshold effect, rather than a linear dose-response relationship.

DISCUSSION

This study supports a positive association between late mid-life musical instrument playing and later-life cognition, although causation cannot be assumed. Musicians playing frequently demonstrated the best cognition. 'Musicians' are a heterogeneous group and frequency of music playing seems a more informative measure than binary classification. Ideally, this more nuanced measure would be collected for different life course phases.

Train the brain with music (TBM): brain plasticity and cognitive benefits induced by musical training in elderly people in Germany and Switzerland, a study protocol for an RCT comparing musical instrumental practice to sensitization to music

BACKGROUND

Recent data suggest that musical practice prevents age-related cognitive decline. But experimental evidence remains sparse and no concise information on the neurophysiological bases exists, although cognitive decline represents a major impediment to healthy aging. A challenge in the field of aging is developing training regimens that stimulate neuroplasticity and delay or reverse symptoms of cognitive and cerebral decline. To be successful, these regimens should be easily integrated in daily life and intrinsically motivating. This study combines for the first-time protocolled music practice in elderly with cutting-edge neuroimaging and behavioral approaches, comparing two types of musical education.

METHODS

We conduct a two-site Hannover-Geneva randomized intervention study in altogether 155 retired healthy elderly (64-78) years, (63 in Geneva, 92 in Hannover), offering either piano instruction (experimental group) or musical listening awareness (control group). Over 12 months all participants receive weekly training for 1 hour, and exercise at home for ~ 30 min daily. Both groups study different music styles. Participants are tested at 4 time points (0, 6, and 12 months & post-training (18 months)) on cognitive and perceptual-motor aptitudes as well as via wide-ranging functional and structural neuroimaging and blood sampling.

DISCUSSION

We aim to demonstrate positive transfer effects for faculties traditionally described to decline with age, particularly in the piano group: executive functions, working memory, processing speed, abstract thinking and fine motor skills. Benefits in both groups may show for verbal memory, hearing in noise and subjective well-being. In association with these behavioral benefits we anticipate functional and structural brain plasticity in temporal (medial and lateral), prefrontal and parietal areas and the basal ganglia. We intend exhibiting for the first time that musical activities can provoke important societal impacts by diminishing cognitive and perceptual-motor decline supported by functional and structural brain plasticity.

TRIAL REGISTRATION

The Ethikkomission of the Leibniz Universität Hannover approved the protocol on 14.08.17 (no. 3604-2017), the neuroimaging part and blood sampling was approved by the Hannover Medical School on 07.03.18. The full protocol was approved by the Commission cantonale d'éthique de la recherche de Genève (no. 2016-02224) on 27.02.18 and registered at clinicaltrials.gov on 17.09.18 ( NCT03674931 , no. 81185).

Speech-in-noise detection is related to auditory working memory precision for frequency

Speech-in-noise (SiN) perception is a critical aspect of natural listening, deficits in which are a major contributor to the hearing handicap in cochlear hearing loss. Studies suggest that SiN perception correlates with cognitive skills, particularly phonological working memory: the ability to hold and manipulate phonemes or words in mind. We consider here the idea that SiN perception is linked to a more general ability to hold sound objects in mind, auditory working memory, irrespective of whether the objects are speech sounds. This process might help combine foreground elements, like speech, over seconds to aid their separation from the background of an auditory scene. We investigated the relationship between auditory working memory precision and SiN thresholds in listeners with normal hearing. We used a novel paradigm that tests auditory working memory for non-speech sounds that vary in frequency and amplitude modulation (AM) rate. The paradigm yields measures of precision in frequency and AM domains, based on the distribution of participants’ estimates of the target. Across participants, frequency precision correlated significantly with SiN thresholds. Frequency precision also correlated with the number of years of musical training. Measures of phonological working memory did not correlate with SiN detection ability. Our results demonstrate a specific relationship between working memory for frequency and SiN. We suggest that working memory for frequency facilitates the identification and tracking of foreground objects like speech during natural listening. Working memory performance for frequency also correlated with years of musical instrument experience suggesting that the former is potentially modifiable.

Formal String Instrument Training in a Class Setting Enhances Cognitive and Sensorimotor Development of Primary School Children

This cluster randomized controlled trial provides evidence that focused musical instrumental practice, in comparison to traditional sensitization to music, provokes multiple transfer effects in the cognitive and sensorimotor domain. Over the last 2 years of primary school (10-12 years old), 69 children received group music instruction by professional musicians twice a week as part of the regular school curriculum. The intervention group learned to play string instruments, whereas the control group (i.e., peers in parallel classes) was sensitized to music via listening, theory and some practice. Broad benefits manifested in the intervention group as compared to the control group for working memory, attention, processing speed, cognitive flexibility, matrix reasoning, sensorimotor hand function, and bimanual coordination Apparently, learning to play a complex instrument in a dynamic group setting impacts development much stronger than classical sensitization to music. Our results therefore highlight the added value of intensive musical instrumental training in a group setting within the school curriculum. These results encourage general implementation of such training in public primary schools, thus better preparing children for secondary school and for daily living activities.

Music Making and Neuropsychological Aging: A Review

Aging is associated with a decline in social understanding and general cognition. Both are integral to wellbeing and rely on similar brain regions. Thus, as the population ages, there is a growing need for knowledge on the types of activities that maintain brain health in older adulthood. Active engagement in music making might be one such activity because it places a demand on brain networks tapping into multisensory integration, learning, reward, and cognition. It has been hypothesized that this demand may promote plasticity in the frontal and temporal lobes by taxing cognitive abilities and, hence, increase resistance to age-related neurodegeneration. We examine research relevant to this hypothesis and note that there is a lack of intervention studies with a well-matched control condition and random assignment. Thus, we discuss potential causal mechanisms underlying training-related neuropsychological changes, and provide suggestions for future research. It is argued that although music training might be a valuable tool for supporting healthy neuropsychological aging and mental wellbeing, well-controlled intervention studies are necessary to provide clear evidence.

Music Training, Working Memory, and Neural Oscillations: A Review

This review focuses on reports that link music training to working memory and neural oscillations. Music training is increasingly associated with improvement in working memory, which is strongly related to both localized and distributed patterns of neural oscillations. Importantly, there is a small but growing number of reports of relationships between music training, working memory, and neural oscillations in adults. Taken together, these studies make important contributions to our understanding of the neural mechanisms that support effects of music training on behavioral measures of executive functions. In addition, they reveal gaps in our knowledge that hold promise for further investigation. The current review is divided into the main sections that follow: (1) discussion of behavioral measures of working memory, and effects of music training on working memory in adults; (2) relationships between music training and neural oscillations during temporal stages of working memory; (3) relationships between music training and working memory in children; (4) relationships between music training and working memory in older adults; and (5) effects of entrainment of neural oscillations on cognitive processing. We conclude that the study of neural oscillations is proving useful in elucidating the neural mechanisms of relationships between music training and the temporal stages of working memory. Moreover, a lifespan approach to these studies will likely reveal strategies to improve and maintain executive function during development and aging.

Potential Cognitive Benefits From Playing Music Among Cognitively Intact Older Adults: A Scoping Review

The aging population is growing rapidly, raising rates of cognitive impairment, which makes strategies for protection against cognitive impairment increasingly important. There is little evidence indicating highly effective interventions preventing or slowing onset of cognitive impairment. Music playing influences brain and cognitive function, activating multiple brain areas and using cognitive and motor functions as well as multiple sensory systems, simultaneously. The purpose of this study was to review the current evidence related to playing a musical instrument being a potentially protective mechanism against cognitive decline among older adults. Using scoping review procedures, four databases were searched. Paired reviewers analyzed articles for content, design, and bias. Eleven studies met study criteria and were included in the review. All studies showed that music playing was correlated with positive outcomes on cognitive ability; more high-quality research is needed in this area to understand mechanisms behind potential cognitive protection of music.

Individualized Piano Instruction for Improving Cognition in Breast Cancer Survivors

PURPOSE

To evaluate the use of individualized piano instruction (IPI) for improving cognition among breast cancer survivors.

PARTICIPANTS & SETTING

Six participants were included in an eight-week piano program with three data collection time points at baseline, midpoint, and postintervention. Participants were recruited from the breast cancer clinic of a university cancer center in South Florida.

METHODOLOGIC APPROACH

Neurocognitive, psychosocial, and self-report assessments were conducted to determine potential benefits and program feasibility, including the NIH Toolbox® Cognition Battery, the Functional Assessment of Cancer Therapy (FACT)-Cognitive Function, the FACT-Breast, the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and a participant questionnaire.

FINDINGS

Results related to potential benefits suggest that IPI may significantly improve overall cognition in breast cancer survivors, with fluid cognition showing improvement. In addition, IPI may improve quality of life and self-reported measures of depression and anxiety, with large to moderate effect sizes, respectively.

IMPLICATIONS FOR NURSING

Nurses should explore different treatment options for chemotherapy-related cognitive impairment and consider including IPI in survivorship care plans.

Making DEEP Sense of Lifestyle Risk and Resilience

To effectively promote life-long health and resilience against – for example – neurodegenerative diseases, evidence-based recommendations must acknowledge the complex multidimensionality not only of the diseases but also of personal lifestyle. In a straightforward descriptive and heuristic framework, more than 50 potential lifestyle factors cluster around diet (D), education (E), exercise (E), and purpose (P), unveiling their many relationships across domains and scales. The resulting systematics and its visualization might be a small but helpful step toward the development of more comprehensive, interdisciplinary models of lifestyle-dependent risk and resilience and a means to explain the opportunities and limitations of preventive measures to the public and other stakeholders. Most importantly, this perspective onto the subject implies that not all lifestyle factors are created equal but that there is a hierarchy of values and needs that influences the success of lifestyle-based interventions.

Musical practice as an enhancer of cognitive function in healthy aging - A systematic review and meta-analysis

Aging is accompanied by cognitive decline, although recent research indicates that the rate of decline depends on multiple lifestyle factors. One of such factors is musical practice, an activity that involves several sensory and motor systems and a wide range of high-level cognitive processes. This paper describes the first systematic review and meta-analysis, to our knowledge, of the impact of musical practice on healthy neurocognitive aging. The inclusion criteria for the review required that studies were empirical works in English or Spanish that they explored the effects of musical practice on older people; they included an assessment of cognitive functions and/or an assessment of brain status; and they included a sample of participants aged 59 years or older with no cognitive impairment or brain damage. This review led to the selection of 13 studies: 9 correlational studies involving older musicians and non-musicians and 4 experimental studies involving short-term musical training programs. The results of the meta-analysis showed cognitive and cerebral benefits of musical practice, both in domain-specific functions (auditory perception) and in other rather domain-general functions. Moreover, these benefits seem to protect cognitive domains that usually decline with aging and boost other domains that do not decline with aging. The origin of these benefits may reside, simultaneously, in the specific training of many of these cognitive functions during musical practice (specific training mechanism), in the improvement of compensatory cognitive processes (specific compensatory mechanism), and in the preservation of general functions with a global influence on others, such as perceptual capacity, processing speed, inhibition and attention (general compensatory mechanism). Therefore, musical practice seems to be a promising tool to reduce the impact of cognitive problems associated to aging.

The association between singing and/or playing a musical instrument and cognitive functions in older adults

OBJECTIVES

Cognitive decline happens to everyone when aging, but to some more than others. Studies with children, adults, and professional musicians suggest that making music could be associated with better cognitive functioning. In older adults however, this association is less well investigated, which is therefore the aim of this study.

METHODS

In this cross-sectional study data from 1101 participants aged 64 and older from the Longitudinal Aging Study Amsterdam were used. Multivariable linear regression analyses were performed to test the association between making music and cognitive functioning and time spent making music and cognitive functioning. ANCOVA analyses were performed to differentiate between participants who made no music, only sang, only played an instrument or both sang and played an instrument in terms of cognitive functioning.

RESULTS

Making music was significantly positively associated with letter fluency, learning and attention/short-term memory. Time spent making music yielded no significant results. The ANCOVA analyses showed higher scores for participants who only played an instrument compared to participants who made no music on learning, working memory and processing speed. For processing speed the instrument only group also had a higher score than participants who only sang.

DISCUSSION

Making music at least once every two weeks and especially playing a musical instrument, is associated with better attention, episodic memory and executive functions. The results suggest that making music might be a potential protective factor for cognitive decline; however, to support this notion a longitudinal study design is needed.

Actividad cerebral y métodos de enseñanza: estudio comparativo entre métodos

El conocimiento de los métodos de enseñanza musical como herramienta de diseño educativo efectivo se ha ampliado al debatir las prácticas educativas tradicionales frente a prácticas activas como la enseñanza por indagación. Al mismo tiempo la neurociencia revitaliza la enseñanza y el aprendizaje a partir del estudio funcional del cerebro. Compararemos estos métodos siguiendo unas fases. En este artículo presentamos un esbozo de cómo será la primera fase de validación de tareas de creatividad, memoria y aprendizaje musical con músicos y no músicos en la fMRI revitalizando la enseñanza y aprendizaje en un nuevo contexto de cultura avanzada.

Do Lifestyle Activities Protect Against Cognitive Decline in Aging? A Review

The number of patients suffering from dementia is expected to more than triple by the year 2040, and this represents a major challenge to publicly-funded healthcare systems throughout the world. One of the most effective prevention mechanisms against dementia lies in increasing brain- and cognitive-reserve capacity, which has been found to reduce the behavioral severity of dementia symptoms as neurological degeneration progresses. To date though, most of the factors known to enhance this reserve stem from largely immutable history factors, such as level of education and occupational attainment. Here, we review the potential for basic lifestyle activities, including physical exercise, meditation and musical experience, to contribute to reserve capacity and thus reduce the incidence of dementia in older adults. Relative to other therapies, these activities are low cost, are easily scalable and can be brought to market quickly and easily. Overall, although preliminary evidence is promising at the level of randomized control trials, the state of research on this topic remains underdeveloped. As a result, several important questions remain unanswered, including the amount of training required to receive any cognitive benefit from these activities and the extent to which this benefit continues following cessation. Future research directions are discussed for each lifestyle activity, as well as the potential for these and other lifestyle activities to serve as both a prophylactic and a therapeutic treatment for dementia.

Age-Related Changes in Bimanual Instrument Playing with Rhythmic Cueing

Deficits in bimanual coordination of older adults have been demonstrated to significantly limit their functioning in daily life. As a bimanual sensorimotor task, instrument playing has great potential for motor and cognitive training in advanced age. While the process of matching a person’s repetitive movements to auditory rhythmic cueing during instrument playing was documented to involve motor and attentional control, investigation into whether the level of cognitive functioning influences the ability to rhythmically coordinate movement to an external beat in older populations is relatively limited. Therefore, the current study aimed to examine how timing accuracy during bimanual instrument playing with rhythmic cueing differed depending on the degree of participants’ cognitive aging. Twenty one young adults, 20 healthy older adults, and 17 older adults with mild dementia participated in this study. Each participant tapped an electronic drum in time to the rhythmic cueing provided using both hands simultaneously and in alternation. During bimanual instrument playing with rhythmic cueing, mean and variability of synchronization errors were measured and compared across the groups and the tempo of cueing during each type of tapping task. Correlations of such timing parameters with cognitive measures were also analyzed. The results showed that the group factor resulted in significant differences in the synchronization errors-related parameters. During bimanual tapping tasks, cognitive decline resulted in differences in synchronization errors between younger adults and older adults with mild dimentia. Also, in terms of variability of synchronization errors, younger adults showed significant differences in maintaining timing performance from older adults with and without mild dementia, which may be attributed to decreased processing time for bimanual coordination due to aging. Significant correlations were observed between variability of synchronization errors and performance of cognitive tasks involving executive control and cognitive flexibility when asked for bimanual coordination in response to external timing cues at adjusted tempi. Also, significant correlations with cognitive measures were more prevalent in variability of synchronization errors during alternative tapping compared to simultaneous tapping. The current study supports that bimanual tapping may be predictive of cognitive processing of older adults. Also, tempo and type of movement required for instrument playing both involve cognitive and motor loads at different levels, and such variables could be important factors for determining the complexity of the task and the involved task requirements for interventions using instrument playing.

Participation sociale et personnes ayant des atteintes cognitives et centre communautaire de loisir : une équation possible?

Validating support of social participation for people with cognitive impairment (CI) plays a predominant role in maintaining identity, autonomy, sense of belonging and social bonding. Yet what restricts this participation-intervention methods, cognitive impairment, or other individuals in the participant's environment? This study documents stakeholders', volunteers' and users' perceptions of people with CI in community recreation centres (CRC). Six focus groups (n = 44) in Montreal, Quebec City and Drummondville highlighted some issues concerning this subject. Although sympathetic to a society where people with multiple weaknesses coexist, participants are not convinced of the need to include those whose memory and judgment are failing. The integration of people with CI includes relational and organizational challenges and questions our relationship to cognitive aging and performance values in an inclusive environment.

Cognitive decline in normal aging and its prevention: a review on non-pharmacological lifestyle strategies

The purpose of this study is to examine the effects of the selected non-pharmacological lifestyle activities on the delay of cognitive decline in normal aging. This was done by conducting a literature review in the four acknowledged databases Web of Science, Scopus, MEDLINE, and Springer, and consequently by evaluating the findings of the relevant studies. The findings show that physical activities, such as walking and aerobic exercises, music therapy, adherence to Mediterranean diet, or solving crosswords, seem to be very promising lifestyle intervention tools. The results indicate that non-pharmacological lifestyle intervention activities should be intense and possibly done simultaneously in order to be effective in the prevention of cognitive decline. In addition, more longitudinal randomized controlled trials are needed in order to discover the most effective types and the duration of these intervention activities in the prevention of cognitive decline, typical of aging population groups.

Educational games for brain health: revealing their unexplored potential through a neurocognitive approach

Educational games link the motivational nature of games with learning of knowledge and skills. Here, we go beyond effects on these learning outcomes. We review two lines of evidence which indicate the currently unexplored potential of educational games to promote brain health: First, gaming with specific neurocognitive demands (e.g., executive control), and second, educational learning experiences (e.g., studying foreign languages) improve brain health markers. These markers include cognitive ability, brain function, and brain structure. As educational games allow the combination of specific neurocognitive demands with educational learning experiences, they seem to be optimally suited for promoting brain health. We propose a neurocognitive approach to reveal this unexplored potential of educational games in future research.