State of the Science

Effect of Music Interventions on Cognitive Function in

Older Adults With Mild Cognitive Impairment
A Systematic Review
Jeeyeon Kim, BS, RN; Heather Cuevas, PhD, RN, ACNS-BC, FCNS; and Shenell Tiara Wood, BS, RN

ABSTRACT
The purpose of the current systematic review was to examine the effects of music interventions on cog-
nitive function in older adults with mild cognitive impairment (MCI). A systematic search of CINAHL,
PubMed, PsycINFO, and Web of Science databases was performed. Studies examining the effects of mu-
sic interventions on cognitive function in older adults with MCI were included. Narrative synthesis for
cognitive outcomes postintervention was performed. A total of 11 articles met inclusion criteria. Music
interventions significantly improved global cognitive function, verbal fluency, executive function, and
spatial function in older adults with MCI. Included studies were heterogeneous in terms of the type of
intervention, cognitive assessment tool, and intervention duration. Six studies were at risk of bias due to
missing data and confounding factors. Our findings suggest that music interventions can be an effective
strategy to improve cognitive function for older adults with MCI. However, findings should be interpreted
with caution. More rigorous studies with various types of music interventions investigating cognitive
domain–specific effects are needed. [Research in Gerontological Nursing, xx(x), xx-xx.]

In an aging society with increased life expectancy, a sig- Cognitive impairment ranges from mild to severe. Mild
nificant number of people have cognitive impairment, with cognitive impairment (MCI) is the stage of transition be-
a 19% average prevalence worldwide (Pais et al., 2020). A tween a normal cognitive state for age and a state of de-
recent study identified that two of three American individ- mentia (Domínguez-Chávez et al., 2019). Two subtypes of
uals experience cognitive problems by age 70 years (Hale et MCI are amnestic (aMCI) and nonamnestic MCI (naMCI).
al., 2020). Cognitive impairment is a serious public health Although memory impairment is prominent in aMCI, in
concern, given that medical costs are 44% higher for pa- naMCI, memory remains intact, but one (single-domain)
tients with cognitive impairment than for those without or more other cognitive domains (multiple-domain) are
cognitive impairment (Zhu et al., 2013), and the average impaired (Csukly et al., 2016; Dunn et al., 2014). For ex-
cost burdens related to patients with cognitive impair- ample, the cognitive domains impacted by naMCI include
ment were estimated to be $280,000 per person in 2021 attention, language ability, executive function, and visuo-
(Favreault & Johnson, 2021). spatial function (Taler & Phillips, 2008). People with aMCI

From School of Nursing, University of Texas at Austin, Austin, Texas.

Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.
Address correspondence to Jeeyeon Kim, BS, RN, School of Nursing, University of Texas at Austin, 1710 Red River Street, Austin, TX 78712; email:
[email protected].
Received: December 14, 2022. Accepted: March 23, 2023. Posted online: June 16, 2023.
doi:10.3928/19404921-20230609-01

Research in Gerontological Nursing • Vol. XX, No. X, 2023 1

are more likely to progress toward Alzheimer’s disease some reviews examined only global cognitive function or
(AD), with a 17% to 18% conversion rate, and those with memory as targets of the music interventions (Moreno-
naMCI are more likely to develop other forms of dementia Morales et al., 2020; Xu et al., 2017). However, music in-
(Ferman et al., 2013; Michaud et al., 2017). At the same terventions are more likely to be effective for protecting
time, with either type of MCI, patients may recover cog- cognitive function in the early stages of dementia because
nitive function to the normal level for age, with reversion it is hard for people with severe dementia to cooperate with
rates of 58% (Overton et al., 2019). Therefore, early inter- intervention providers and sustain the intervention due to
ventions for cognitive improvement are imperative to pre- physical or cognitive problems (Fang et al., 2017). Thus,
vent progression of MCI to dementia. it is essential to explore their effects on people with MCI
However, there are no pharmacological solutions so that they can recover cognitive function to the normal
available to prevent or significantly delay the progres- level for age. In addition, the most common MCI subtype
sion of dementia, and some medications can increase the is impairment in nonmemory single domains (Palmer et
risks for serious outcomes, such as stroke and embolism al., 2008), so a more comprehensive review should be done
(Fink et al., 2018). On the other hand, using music as a to examine the beneficial effects of music interventions
therapeutic intervention has received attention as an on subdomains of cognitive function affected in naMCI.
easily accessible and cost-effective intervention (Amor Therefore, the purpose of the current review was to exam-
Gaviola et al., 2022) to improve cognitive function and ine the effects of music interventions on global cognitive
has shown positive effects in various populations, includ- function as well as on each subdomain of cognitive func-
ing older adults with and without dementia (Cheung et tion in older adults with MCI.
al., 2018; Diaz Abrahan et al., 2019). These beneficial ef-
fects of the interventions may stem from the impact of METHOD
music on neural reorganization (Altenmüller et al., 2009) Search Strategies
and structural brain changes (Habibi et al., 2018; Hyde A systematic review was performed using the Pre-
et al., 2009). Facilitated social interaction through music ferred Reporting Items for Systematic Reviews and Meta-
interventions (Waters et al., 2022) may also contribute to Analyses (PRISMA) guidelines (Moher et al., 2009). Broad
improving cognitive function as daily social interactions search terms (e.g., music, music therapy, listening to mu-
are related to better cognitive function in older adults sic, cognition, cognitive dysfunction, memory) were used
(Zhaoyang et al., 2021). in consultation with a health-research librarian to allow
Music interventions are categorized as music medicine for a comprehensive review without missing available data;
and music therapy. Music medicine is passive listening and we used medical subject headings (MeSH) for music
to music offered by clinicians, whereas music therapy in- and music therapy (Appendix A, available in the online
volves a therapeutic relationship between participants and version of this article). Keywords were searched through
trained music therapists during the music intervention CINAHL, PubMed, PsycINFO, and Web of Science data-
(Bradt & Dileo, 2014). Music interventions include a va- bases through May 2021.
riety of methods, such as listening to music, singing, mu-
sic with movement, dancing, and playing musical instru- Eligibility Criteria
ments. Evidence for which types of music interventions, Inclusion criteria were as follows: studies that (a) inves-
active or passive, are more effective is limited, as results of tigated effects of music interventions (music medicine and/
previous systematic reviews on dementia are inconsistent: or music therapy) on global cognitive function or at least
Fusar-Poli et al. (2018) found only active music interven- one cognitive subdomain (e.g., verbal fluency, memory,
tion to be effective, whereas passive music intervention had attention), (b) included participants aged >50 years with
the greatest effect in Moreno-Morales et al.’s (2020) study. MCI, and (c) were peer-reviewed and written in English.
Although music interventions have been widely used Publication date was not limited so we could fully under-
for patients with cognitive impairment, the beneficial ef- stand the state of the science. We excluded studies that (a)
fect of the interventions on global and subdomains of did not focus on music interventions (e.g., focused on art
cognitive function for older adults with MCI is not well therapy), (b) included participants who had AD, dementia,
established. Prior reviews have focused on people with de- or other neurological problems (e.g., stroke, Parkinson’s
mentia and excluded those with MCI (Fang et al., 2017; disease, multiple sclerosis), or (c) included only cognitively
Fusar-Poli et al., 2018; Moreno-Morales et al., 2020), and intact participants.

2 Copyright © SLACK Incorporated

Data Extraction and Risk-of-Bias Assessment
Covidence (Veritas Health Innovation, n.d.) was used
to manage the search, remove duplicate studies, and screen
studies. With the identified publications, data extraction
and risk-of-bias assessment were performed by two re-
viewers (J.Y.K., S.T.W.), and any disagreement was resolved
through discussion with another reviewer (H.C.). The
main variables of interest were sample characteristics, in-
tervention characteristics, cognitive assessment tools used,
and cognitive outcomes. Data from included studies were
organized using a structured template (Table A, available
in the online version of this article).
Risk-of-bias assessment was done using the revised
Cochrane risk-of-bias tool for randomized trials (RoB 2)
for the randomized controlled trial (RCT) studies (Sterne et
al., 2019), evaluating “low risk of bias,” “some concerns,” and
“high risk of bias” according to judgment on five domains of
RoB 2. Risk of Bias in Non-randomized Studies–of Interven-
tions (ROBINS-I) criteria were used for quasi-experimental
studies (Sterne et al., 2016), appraising the overall risk-of-bias Figure 1. Study selection process.
judgments based on the seven domains of the ROBINS-I.
Considering the risk of bias in the included studies and Study Participants
variability of cognitive outcome assessment tools and in- A total of 695 older adults with MCI and 42 cogni-
tervention duration among studies, integrating the data tively intact older adults (as a part of control groups) were
with meta-analysis was unnecessary and could generate included in the current review. Three studies (Lake &
misleading results (Trkulja & Hrabač, 2020). Therefore, Goldstein, 2011; Lazarou et al., 2017; Zhu et al., 2018) in-
narrative synthesis for cognitive outcomes after interven- cluded patients with aMCI only. Sample sizes ranged from
tions was performed. 16 (Domínguez-Chávez et al., 2019) to 201 (Doi et al.,
2017), and mean ages ranged from 66.9 years to 83.6 years.
RESULTS Participants’ baseline cognitive function was assessed and
Study Selection identified as MCI before the initiation of interventions.
We identified 4,636 articles through database searches Participants’ chronic conditions (e.g., hypertension, diabe-
and six additional records from the reference lists of re- tes, arthritis) were reported in only two studies (Doi et al.,
viewed articles. After removing duplicates, 3,824 articles 2017; Domínguez-Chávez et al., 2019). No studies report-
were screened by title and abstract, resulting in 48 articles ed adverse events during the music interventions. Table A
for full-text review. Thirty-seven articles were excluded as provides details of participants’ characteristics.
they did not meet inclusion/exclusion criteria; therefore,
a total of 11 articles were included in the final review. Intervention Characteristics
Figure 1 shows the study selection process. Music Medicine. Two included studies (Cacciafesta et al.,
Of the 11 articles, five studies were RCTs with two par- 2010; Lake & Goldstein, 2011) used music listening as an in-
allel arms except for one study with three parallel arms tervention. In Cacciafesta et al. (2010), different types of mu-
(Doi et al., 2017); and six were quasi-experimental stud- sic (Mozart’s K448 and Beethoven’s Für Elise) were provided,
ies. Studies were conducted in various countries, including and cognitive function was examined before and after one-
China (Wang et al., 2020; Zhu et al., 2018), Japan (Doi et time listening to the specific music. In Lake and Goldstein
al., 2017; Shimizu et al., 2018), Greece (Douka et al., 2019; (2011), participants listened to the “Spring” movement of
Lazarou et al., 2017), Italy (Biasutti & Mangiacotti, 2018; Vivaldi’s Four Seasons via headphones for 10 minutes, and
Cacciafesta et al., 2010), Malaysia (Adam et al., 2016), the same participants sat in silence for 10 minutes.
Mexico (Domínguez-Chávez et al., 2019), and the United Music Therapy. Various types of music therapy were
States (Lake & Goldstein, 2011). implemented, including dancing (Adam et al., 2016; Doi et

Research in Gerontological Nursing • Vol. XX, No. X, 2023 3

al., 2017; Douka et al., 2019; Lazarou et al., 2017; Wang et playing percussion instruments (Doi et al., 2017), musical
al., 2020; Zhu et al., 2018), musical improvisation (Biasutti improvisation (Biasutti & Mangiacotti, 2018), and music
& Mangiacotti, 2018), playing musical instruments (Doi with movement (Domínguez-Chávez et al., 2019). Global
et al., 2017), and movement with a musical instrument cognitive function was improved in all seven studies after
(Shimizu et al., 2018). In one study (Domínguez-Chávez the music interventions. Global cognitive function of the
et al., 2019), participants took part in five music interven- control groups did not change or significantly worsened,
tions, such as movement with music, reading of rhythmic which led to significant differences between the music in-
patterns, music listening, playing instruments, and sing- tervention and control groups (Adam et al., 2016; Biasutti
ing, one after another. Seven studies had a control group, & Mangiacotti, 2018; Doi et al., 2017; Lazarou et al., 2017;
and four (Adam et al., 2016; Biasutti & Mangiacotti, 2018; Wang et al., 2020), but Zhu et al. (2018) did not demon-
Doi et al., 2017; Shimizu et al., 2018) used active control strate that the aerobic dance intervention was significantly
groups, which included relaxation therapy, gymnastic ac- effective compared to usual care, as global cognitive func-
tivities, health education, and the same exercises as those tion was improved in both groups. However, the improve-
used in the intervention group but performed without mu- ment was substantially greater for participants in the inter-
sic, whereas three control groups participated in usual care vention group.
or no intervention (Lazarou et al., 2017; Wang et al., 2020; Changes in Specific Cognitive Domains. Specific cog-
Zhu et al., 2018). nitive domains were tested in nine studies (Biasutti &
The duration of interventions varied from 12 to 48 Mangiacotti, 2018; Cacciafesta et al., 2010; Doi et al., 2017;
sessions, but Lazarou et al. (2017) conducted dancing Domínguez-Chávez et al., 2019; Douka et al., 2019; Lake
interventions for 80 sessions over 10 months. The most & Goldstein, 2011; Lazarou et al., 2017; Shimizu et al.,
common therapy duration was 3 months with an average 2018; Zhu et al., 2018). Eight studies showed significant
of 28 sessions (Biasutti & Mangiacotti, 2018; Domínguez- improvement in more than one specific cognitive domain
Chávez et al., 2019; Shimizu et al., 2018; Wang et al., 2020; after the music intervention, except for one study (Lake &
Zhu et al., 2018). All interventions were carried out one Goldstein, 2011) evaluating the effect of music listening on
to three times per week, whereas the duration of each attention.
intervention session ranged from 35 minutes (Zhu et al., Memory. Four of five studies that included memory as
2018) to 70 minutes (Biasutti & Mangiacotti, 2018). Six an outcome showed memory improvement after the music
studies (Biasutti & Mangiacotti, 2018; Cacciafesta et al., interventions (Doi et al., 2017; Domínguez-Chávez et al.,
2010; Domínguez-Chávez et al., 2019; Lake & Goldstein, 2019; Lazarou et al., 2017; Zhu et al., 2018). In Domínguez-
2011; Lazarou et al., 2017; Shimizu et al., 2018]) identified Chávez et al. (2019), participants engaged in music with
the specific music used for the music interventions (e.g., movement. After 3 months, their immediate and delayed
classical music, songs from Mexican folklore, Italian mu- memory was improved compared to their baseline assess-
sic), whereas the other studies did not provide informa- ment. In addition, Doi et al. (2017) demonstrated that
tion about the type of music used. Moreover, Domínguez- memory was significantly improved after 10 months of a
Chávez et al. (2019) took patients’ music preferences into dancing intervention (p = 0.011). Interestingly, this im-
account when designing the intervention program. More provement in memory was seen only in people with aMCI
information about the intervention characteristics is pro- but not in those with naMCI. In the same vein, memory
vided in Table A. was significantly improved after dancing interventions in
the studies that included only people with aMCI (Lazarou
Cognitive Outcomes After Interventions et al., 2017; Zhu et al., 2018).
Changes in Global Cognitive Function. Seven studies However, one study (Douka et al., 2019), which did not
(Adam et al., 2016; Biasutti & Mangiacotti, 2018; Doi et al., differentiate the type of MCI, differed from the previous stud-
2017; Domínguez-Chávez et al., 2019; Lazarou et al., 2017; ies in that memory was significantly decreased (p < 0.001) af-
Wang et al., 2020; Zhu et al., 2018) assessed global cog- ter the dancing intervention compared to baseline.
nitive function with either the Mini-Mental State Exami- Attention. Four of eight studies demonstrated a better
nation or Montreal Cognitive Assessment as an outcome. outcome in attention after the music intervention. Signifi-
These studies implemented various music interventions, cant improvement in attention was shown after 3 months
including dancing (Adam et al., 2016, Doi et al., 2017; of music with movement (p = 0.007; Domínguez-Chávez
Lazarou et al., 2017; Wang et al., 2020; Zhu et al., 2018), et al., 2019), a 6-month dance program (p < 0.001; Douka

4 Copyright © SLACK Incorporated

et al., 2019), 10 months of ballroom dancing with music Shimizu et al., 2018) found that music with movement
(p = 0.002; Lazarou et al., 2017), and 3 months of aero- intervention significantly improved MCI participants’
bic dance (p < 0.05; Zhu et al., 2018). These studies used executive functioning measured by FAB after 3 months
various tools, such as the Digit Span subtest (Domínguez- of intervention (p = 0.002 and p = 0.008, respectively). In
Chávez et al., 2019), Test of Everyday Attention (Douka et addition, dancing interventions significantly enhanced ex-
al., 2019; Lazarou et al., 2017), and Symbol Digit Modali- ecutive function (Douka et al., 2019; Lazarou et al., 2017).
ties Test (Zhu et al., 2018), to assess attention. Douka et al. (2019) provided traditional dancing interven-
However, there were inconsistent results in that no tions for 6 months, whereas Lazarou et al. (2017) imple-
significant improvement in attention was found in four mented ballroom dancing for 10 months, both of which
other studies (Biasutti & Mangiacotti, 2018; Cacciafesta et improved executive functioning (p = 0.03 and p = 0.004,
al., 2010; Doi et al., 2017; Lake & Goldstein, 2011). Two respectively).
studies (Cacciafesta et al., 2010; Lake & Goldstein, 2011) Spatial Function. Spatial abilities were assessed in two
did not show the beneficial effects of music listening on studies (Biasutti & Mangiacotti, 2018; Cacciafesta et al.,
attention when assessed with Trail Making Test A and B 2010), both of which showed significant improvement in
(TMT-A and B) and Repeatable Battery for the Assess- spatial functioning after music interventions compared
ment of Neuropsychological Status, respectively. Doi et al. to baseline. In Biasutti and Mangiacotti (2018), partici-
(2017) demonstrated that attention score (TMT-A and B) pants who received musical improvisation intervention
improved only in 10 months of the dancing group, where- scored better on the Clock-Drawing Test, which is used
as the score worsened in playing percussion instruments to assess visual-spatial function, than their baseline scores
and the health education control group, but the difference (p < 0.001), whereas the gymnastic activities group showed
in scores failed to reach statistical significance. Similarly, no difference in test scores.
in Biasutti and Mangiacotti (2018), although the TMT-A Cacciafesta et al. (2010) was the only study that investi-
score improved after 3 months of musical improvisa- gated the effectiveness of specific musical pieces and tested
tion (e.g., singing, percussion) compared to baseline, this the effects of two different kinds of music on cognitive
change did not reach statistical significance. function. In their study, although participants listening to
Verbal Fluency. Verbal fluency improved after the mu- Beethoven’s Für Elise did not improve in any tested cogni-
sic interventions in all studies that assessed verbal fluency tive domains, those listening to Mozart’s K448 significantly
(Biasutti & Mangiacotti, 2018; Douka et al., 2019; Lazarou improved their spatial-temporal abilities. The improve-
et al., 2017; Shimizu et al., 2018). Biasutti and Mangiacotti ment in spatial-temporal abilities was seen constantly over
(2018) and Douka et al. (2019) assessed lexical retrieval 6 months when stimulation was maintained. The study
with a verbal fluency test (VFT), and participants had bet- authors assumed that certain pieces of music may activate
ter VFT scores compared to their baseline scores after a areas of the brain used for spatial reasoning (Cacciafesta
3-month musical improvisation and 6-month dancing in- et al., 2010).
tervention. In Lazarou et al. (2017), dancing significantly
improved verbal fluency assessed with the F-A-S Test Risk-of-Bias Assessment
compared to baseline, which led to significant differences Using RoB 2 for RCT studies, three studies (Doi
between the dancing group and no intervention group et al., 2017; Shimizu et al., 2018; Zhu et al., 2018) were
(p < 0.01). Shimizu et al. (2018), which implemented rhyth- found to have a low risk of bias, whereas two studies (Bi-
mic movements with music, demonstrated significant im- asutti & Mangiacotti, 2018; Lazarou et al., 2017) were
provement in the Frontal Assessment Battery (FAB) score, categorized as “having some concerns” due to missing
which assesses frontal lobe functions, including lexical flu- outcome data as participants were lost to follow up or
ency, compared to baseline score; however, no significant withdrew from the study. As evaluated by ROBINS-I,
difference was shown between the intervention group and two quasi-experimental studies (Domínguez-Chávez
control group (same exercises without music). et al., 2019; Wang et al., 2020) were assessed as having
Executive Functioning. All studies that assessed ex- a low risk of bias, and the other four studies (Adam et
ecutive functioning demonstrated that music interven- al., 2016; Cacciafesta et al., 2010; Douka et al., 2019; Lake
tions had positive effects (Domínguez-Chávez et al., & Goldstein, 2011) had a moderate risk. The lower-bias
2019; Douka et al., 2019; Lazarou et al., 2017; Shimizu et scores in those four studies were due to confounding fac-
al., 2018). Two studies (Domínguez-Chávez et al., 2019; tors and outcome measurement.

Research in Gerontological Nursing • Vol. XX, No. X, 2023 5

DISCUSSION review (Ito et al., 2022), which had only two studies in the
Main Findings analysis for the effects on memory, included people with
The current review examined the effects of music in- AD. The current review found that older adults with aMCI,
terventions on global cognitive function and each subdo- characterized by memory impairment, are more likely to
main of cognitive function in older adults with MCI. The benefit from music interventions than those with naMCI.
result of our review provides the potential beneficial ef- Further research is necessary to support the idea that mu-
fects of music intervention on global cognitive function. sic interventions have different effects depending on the
Furthermore, the use of music interventions is promising subtypes of MCI and the severity of impairment, which
to improve verbal fluency, executive function, and spatial will contribute to designing music interventions to prevent
function, but evidence of its effect on memory and atten- the progression of aMCI to AD.
tion is limited. However, this finding should be interpreted Verbal fluency improved after musical improvisation
cautiously due to the heterogeneity of intervention types (e.g., singing, percussion), dancing, and music with move-
and the risk of bias of the included studies. ment (Biasutti & Mangiacotti, 2018; Douka et al., 2019;
Lazarou et al., 2017; Shimizu et al., 2018). However, in
Global Cognitive Function Shimizu et al.’s (2018) study, there were no significant dif-
The current review’s finding is consistent with previ- ferences in FAB scores between the music with movement
ous reviews regarding the cognitive benefits of music in- group and control group, who were involved in the same
terventions on global cognitive function (Bian et al., 2021; exercises without music, which implies that this positive
Moreno-Morales et al., 2020). However, those reviews are effect may come from physical movement, as higher physi-
on people with dementia, focusing on global cognitive cal activity is associated with better verbal fluency (Cheval
function, whereas the current review further examined et al., 2021).
subdomains of cognitive function in addition to global Similarly, studies that demonstrated an enhancing ef-
cognitive function and focused on older adults with MCI. fect on executive function used music interventions that
In this review, global cognitive function improvement was involve physical movement, such as music with movement
shown after dancing, musical improvisation, and music (Domínguez-Chávez et al., 2019; Shimizu et al., 2018) and
with movement, which are all active music therapy. These dancing interventions (Douka et al., 2019; Lazarou et al.,
findings are supported by a previous meta-analysis dem- 2017). Physical activity, which was shown to be benefi-
onstrating that active music therapy improved global cog- cial in improving executive function in patients with AD
nitive function in people with dementia (Fusar-Poli et al., (Zhu et al., 2020), might be behind this improvement.
2018). However, the studies included in our review, which Thus, more studies with different types of music interven-
used passive music interventions (i.e., listening to music), tions without physical activity, such as singing, listening to
did not assess global cognitive function. Thus, more inves- music, and playing instruments, or dancing interventions
tigation is needed to evaluate the effectiveness of passive with active control groups (e.g., same physical movement
music interventions on global cognitive function among without music), with a focus on verbal fluency and execu-
people with MCI. tive function in older adults with MCI, should be done.
Spatial function was improved after musical improvisa-
Specific Cognitive Domains tion (Biasutti & Mangiacotti, 2018) and listening to specific
Subdomains of cognitive function, such as verbal flu- pieces of music (Cacciafesta et al., 2010), whereas it was not
ency, executive function, and spatial function, were also changed after gymnastic activity in the study by Biasutti
improved in all included studies, if assessed, after each and Mangiacotti (2018). The positive emotion evoked by
music intervention. This finding is similar to prior system- listening to music may contribute to the improvement, as
atic reviews in which music interventions had significant pleasant music listening arouses a positive mood and has a
effects on verbal fluency (Lam et al., 2020) and executive therapeutic effect in improving spatial attention in patients
function (Ito et al., 2022) in people with dementia/MCI. with unilateral spatial neglect (Tsai et al., 2013). However,
However, Ito et al. (2022) also demonstrated a signifi- evidence for the effects of music interventions on spatial
cant improvement in memory after music interventions, function is still limited. Previous research findings are in-
whereas our review showed inconsistent findings. This dis- consistent regarding the relationship between music inter-
crepancy may be due to differences in participants’ severity ventions and spatial function (Miendlarzewska & Trost,
of memory deficits in the included studies, as the previous 2014). In the current review, only two included studies

6 Copyright © SLACK Incorporated

examined spatial function as an outcome with a moder- outcome data, which can affect results of the review. Third,
ate risk of bias, which represents limited evidence. Further we believe that the systematic search in four databases fol-
music intervention studies with a rigorous research design lowing PRISMA reporting guidelines found all available
should include spatial function as a cognitive outcome. studies related to this field, but there is a possibility that
The inconsistent outcomes in attention in the current studies from other databases were not included.
review may stem from the differences in the intensity of
music interventions. The music interventions that were IMPLICATIONS FOR PRACTICE AND RESEARCH
implemented one time or once per week did not have posi- Findings of the current review have important implica-
tive effects on attention, whereas those that were conduct- tions for future research and practice to improve cognitive
ed twice or three times per week showed favorable effects function in older adults with MCI. Albeit with limited evi-
on attention. Another possible explanation is that the dif- dence, our review provides the promising effects of music
ferences in the types of music used in the included stud- interventions on cognitive function, especially on global
ies affected the outcomes of attention. Indeed, the type of cognitive function, verbal fluency, executive function,
music influenced the outcome of cognitive function in one and spatial function. Considering the potential benefits
study (Cacciafesta et al., 2010) that showed improvement of music interventions with minimal risk of an adverse
in spatial-temporal abilities after listening to Mozart’s K448 event, music interventions may be one nonpharmacologi-
but not after different pieces of music. More research on cal strategy to manage cognitive function and prevent the
the effects of different types of music on each subdomain progression of MCI to dementia, further contributing to
of cognitive function is needed, as the influence of the type recovering normal cognitive function. The type of music
of music differs by cognitive subdomains (Bottiroli et al., interventions, the subtype of MCI, and participants’ mu-
2014). In addition, the effect of physical movement cannot sic preferences could be considered when implementing
be excluded, as evidence has shown that physical activity is music interventions. However, more research is required
beneficial for cognitive function (Mandolesi et al., 2018). to strengthen the evidence of music interventions’ effects
Music interventions that contain physical movement were before they can be implemented in the primary care or
more likely to improve attention scores than passive music outpatient setting.
listening and playing a musical instrument. Thus, music The current review highlights the need for rigorous
interventions without physical activity should be further studies using various types of music interventions without
explored to clarify the unique effect of music itself. physical activity, such as music listening, singing, and play-
ing musical instruments, to clarify the effects of musical
LIMITATIONS experiences themselves without physical movement. In
Although music interventions showed promising ef- addition, future research investigating cognitive domain–
fects on cognitive function in older adults with MCI, find- specific effects with respect to the subtype of MCI should
ings from the current review should be interpreted with be done to identify optimal treatment strategies. Moreover,
caution due to several limitations. First, included studies individualized music selection should be further investi-
were heterogeneous in terms of the types of implemented gated to establish robust evidence of its effectiveness on
music interventions, frequency and duration of the inter- cognitive function and use in practice. Using preferred
ventions, domains of cognitive function assessed, and cog- music for each participant may be more beneficial to their
nitive assessment tools. In addition, this review included cognitive function given that preferred music listening is
studies with all types of music interventions, but dancing effective in managing emotional and cognitive symptoms
accounted for more than one half of the included studies. in older adults with dementia (Eggert et al., 2015; Pérez-
As a result, it was difficult to compare the included studies Ros et al., 2019). In the current review, only one study
and to describe which intervention affects each cognitive (Domínguez-Chávez et al., 2019) considered participants’
domain the most. Therefore, future studies of diverse mu- music preferences, demonstrating significant improve-
sic interventions should use standardized cognitive assess- ment in all five cognitive subdomains assessed in the study.
ments, such as the NIH Toolbox for Assessment of Neuro- None of the included studies examined the effects of
logical and Behavioral Function (Weintraub et al., 2014) music interventions on people with MCI with consider-
to improve the analysis of music interventions’ cognitive ation given to their specific chronic conditions. Only two
domain–specific effects. Second, many of the included studies (Doi et al., 2017; Domínguez-Chávez et al., 2019)
studies had small sample sizes and were limited by missing reported participants’ histories of chronic disease (e.g.,

Research in Gerontological Nursing • Vol. XX, No. X, 2023 7

hypertension, diabetes, arthritis), but these studies did e1397 PMID:35673896
Bian, X., Wang, Y., Zhao, X., Zhang, Z., & Ding, C. (2021). Does mu-
not examine the effects of music related to certain disease-
sic therapy affect the global cognitive function of patients with
induced cognitive impairment. Music interventions may dementia? A meta-analysis. NeuroRehabilitation, 48(4), 553–562.
have different effects on different chronic conditions as https://doi.org/10.3233/NRE-210018 PMID:33967069
each chronic disease increases the risk of cognitive impair- Biasutti, M., & Mangiacotti, A. (2018). Assessing a cognitive music
training for older participants: A randomised controlled trial.
ment in a particular mechanism (Hill et al., 2021). More
International Journal of Geriatric Psychiatry, 33(2), 271–278.
research examining the effects of music interventions on https://doi.org/10.1002/gps.4721 PMID:28401595
disease-related cognitive decline is recommended to ex- Bottiroli, S., Rosi, A., Russo, R., Vecchi, T., & Cavallini, E. (2014).
plore and introduce optimal music interventions for pa- The cognitive effects of listening to background music on old-
er adults: Processing speed improves with upbeat music, while
tients with cognitive impairment in combination with
memory seems to benefit from both upbeat and downbeat music.
chronic diseases. Frontiers in Aging Neuroscience, 6, 284. https://doi.org/10.3389/
Of note, only one study (Lake & Goldstein, 2011) in- fnagi.2014.00284 PMID:25360112
vestigated or controlled participants’ exposure to music Bradt, J., & Dileo, C. (2014). Music interventions for mechani-
cally ventilated patients. Cochrane Database of Systematic Re-
in their daily lives (e.g., listening to music while driving)
views, 2014(12), CD006902. https://doi.org/10.1002/14651858.
apart from the music interventions provided, which may CD006902.pub3 PMID:25490233
impact study results. Listening to music while doing an- Cacciafesta, M., Ettorre, E., Amici, A., Cicconetti, P., Martinelli, V.,
other task or activity influences cognitive performance Linguanti, A., Baratta, A., Verrusio, W., & Marigliano, V. (2010).
New frontiers of cognitive rehabilitation in geriatric age: The
(Angel et al., 2010; Bottiroli et al., 2014) and brain acti-
Mozart Effect (ME). Archives of Gerontology and Geriatrics,
vation (Leggieri et al., 2018). Therefore, researchers may 51(3), e79–e82. https://doi.org/10.1016/j.archger.2010.01.001
also consider background music exposure when designing PMID:20138674
music intervention studies and further investigate how it Cheung, D. S. K., Lai, C. K. Y., Wong, F. K. Y., & Leung, M. C. P.
(2018). The effects of the music-with-movement intervention
influences cognitive function among people with MCI,
on the cognitive functions of people with moderate dementia:
which may advance the knowledge in this field and provide A randomized controlled trial. Aging & Mental Health, 22(3),
useful implications for practice. 306–315. https://doi.org/10.1080/13607863.2016.1251571
PMID:27819483
Cheval, B., Csajbók, Z., Formánek, T., Sieber, S., Boisgontier, M. P.,
CONCLUSION
Cullati, S., & Cermakova, P. (2021). Association between physical-
The current systematic review suggests that music in- activity trajectories and cognitive decline in adults 50 years of age
terventions significantly improve global cognitive func- or older. Epidemiology and Psychiatric Sciences, 30, E79. https://
tion, verbal fluency, executive function, and spatial func- doi.org/10.1017/S2045796021000688 PMID:35035880
Csukly, G., Sirály, E., Fodor, Z., Horváth, A., Salacz, P., Hidasi, Z.,
tion in older adults with MCI. However, findings should
Csibri, É., Rudas, G., & Szabó, Á. (2016). The differentiation
be interpreted cautiously because of the heterogeneity and of amnestic type MCI from the non-amnestic types by struc-
risk of bias of the included studies. More rigorous stud- tural MRI. Frontiers in Aging Neuroscience, 8, 52. https://doi.
ies with various types of music interventions investigat- org/10.3389/fnagi.2016.00052 PMID:27065855
Diaz Abrahan, V., Shifres, F., & Justel, N. (2019). Cognitive benefits
ing cognitive domain–specific effects are needed to better
from a musical activity in older adults. Frontiers in Psychology, 10,
understand the effects of music interventions on cognitive 652. https://doi.org/10.3389/fpsyg.2019.00652 PMID:30984074
function among older adults with MCI. Doi, T., Verghese, J., Makizako, H., Tsutsumimoto, K., Hotta, R.,
Nakakubo, S., Suzuki, T., & Shimada, H. (2017). Effects of cogni-
tive leisure activity on cognition in mild cognitive impairment:
REFERENCES
Results of a randomized controlled trial. Journal of the Ameri-
Adam, D., Ramli, A., & Shahar, S. (2016). Effectiveness of a com-
can Medical Directors Association, 18(8), 686–691. https://doi.
bined dance and relaxation intervention on reducing anxiety
org/10.1016/j.jamda.2017.02.013 PMID:28396179
and depression and improving quality of life among the cogni-
tively impaired elderly. Sultan Qaboos University Medical Journal, Domínguez-Chávez, C. J., Murrock, C. J., & Salazar-González, B. C.
16(1), e47–e53. https://doi.org/10.18295/squmj.2016.16.01.009 (2019). Mild cognitive impairment: A concept analysis. Nurs-
PMID:26909213 ing Forum, 54(1), 68–76. https://doi.org/10.1111/nuf.12299
PMID:30261109
Altenmüller, E., Marco-Pallares, J., Münte, T. F., & Schneider, S.
(2009). Neural reorganization underlies improvement in stroke- Douka, S., Zilidou, V. I., Lilou, O., & Tsolaki, M. (2019). Greek tradi-
induced motor dysfunction by music-supported therapy. Annals tional dances: A way to support intellectual, psychological, and
of the New York Academy of Sciences, 1169, 395–405. https://doi. motor functions in senior citizens at risk of neurodegeneration.
org/10.1111/j.1749-6632.2009.04580.x PMID:19673814 Frontiers in Aging Neuroscience, 11, 6. https://doi.org/10.3389/
fnagi.2019.00006 PMID:30740051
Amor Gaviola, M., Searles, A., Dilworth, S., Higgins, I., Holliday, E.,
& Jill Inder, K. (2022). Estimating the cost of an individualised Dunn, C. J., Duffy, S. L., Hickie, I. B., Lagopoulos, J., Lewis, S. J.,
music intervention for aged care residents with dementia. Nurs- Naismith, S. L., & Shine, J. M. (2014). Deficits in episodic
ing Older People, 34(4), 13–19. https://doi.org/10.7748/nop.2022. memory retrieval reveal impaired default mode network con-

8 Copyright © SLACK Incorporated

 nectivity in amnestic mild cognitive impairment. NeuroImage (Basel), 10(8), 1462. https://doi.org/10.3390/healthcare10081462
Clinical, 4, 473–480. https://doi.org/10.1016/j.nicl.2014.02.010 PMID:36011119
PMID:24634833 Lake, J. I., & Goldstein, F. C. (2011). An examination of an enhanc-
Eggert, J., Dye, C. J., Vincent, E., Parker, V., Daily, S. B., Pham, H., ing effect of music on attentional abilities in older persons with
Watson, A. T., Summey, H., & Roy, T. (2015). Effects of view- mild cognitive impairment. Perceptual and Motor Skills, 112(1),
ing a preferred nature image and hearing preferred music on 267–278. https://doi.org/10.2466/04.10.15.PMS.112.1.267-278
engagement, agitation, and mental status in persons with de- PMID:21466100
mentia. SAGE Open Medicine, 3, 2050312115602579. https://doi. Lam, H. L., Li, W. T. V., Laher, I., & Wong, R. Y. (2020). Effects of
org/10.1177/2050312115602579 PMID:26770801 music therapy on patients with dementia: A systematic review.
Fang, R., Ye, S., Huangfu, J., & Calimag, D. P. (2017). Music therapy Geriatrics (Basel, Switzerland), 5(4), 62. https://doi.org/10.3390/
is a potential intervention for cognition of Alzheimer’s disease: geriatrics5040062 PMID:32992767
A mini-review. Translational Neurodegeneration, 6(1), 2. https:// Lazarou, I., Parastatidis, T., Tsolaki, A., Gkioka, M., Karakostas, A.,
doi.org/10.1186/s40035-017-0073-9 PMID:28149509 Douka, S., & Tsolaki, M. (2017). International ballroom danc-
Favreault, M., & Johnson, R. W. (2021, January 31). The risk and costs ing against neurodegeneration: A randomized controlled trial in
of severe cognitive impairment at older ages: Literature review Greek community-dwelling elders with mild cognitive impair-
and projection analyses. https://aspe.hhs.gov/reports/risk-costs- ment. American Journal of Alzheimer’s Disease and Other Demen-
severe-cognitive-impairment-older-ages-literature-review- tias, 32(8), 489–499. https://doi.org/10.1177/1533317517725813
projection-analyses-0 PMID:28840742
Ferman, T. J., Smith, G. E., Kantarci, K., Boeve, B. F., Pankratz, V. Leggieri, M., Fornazzari, L., Thaut, M., Barfett, J., Munoz, D. G.,
S., Dickson, D. W., Graff-Radford, N. R., Wszolek, Z., Van Schweizer, T. A., & Fischer, C. (2018). Determining the impact of
Gerpen, J., Uitti, R., Pedraza, O., Murray, M. E., Aakre, J., Parisi, passive music exposure on brain activation and functional con-
J., Knopman, D. S., & Petersen, R. C. (2013). Nonamnestic mild nectivity using FMRI in patients with early Alzheimer’s disease.
cognitive impairment progresses to dementia with Lewy bod- The American Journal of Geriatric Psychiatry, 26, S135. https://
ies. Neurology, 81(23), 2032–2038. https://doi.org/10.1212/01. doi.org/10.1016/j.jagp.2018.01.164
wnl.0000436942.55281.47 PMID:24212390 Mandolesi, L., Polverino, A., Montuori, S., Foti, F., Ferraioli, G.,
Fink, H. A., Jutkowitz, E., McCarten, J. R., Hemmy, L. S., Butler, M., Sorrentino, P., & Sorrentino, G. (2018). Effects of physical ex-
Davila, H., Ratner, E., Calvert, C., Barclay, T. R., Brasure, M., ercise on cognitive functioning and wellbeing: Biological and
Nelson, V. A., & Kane, R. L. (2018). Pharmacologic interventions psychological benefits. Frontiers in Psychology, 9, 509. https://doi.
to prevent cognitive decline, mild cognitive impairment, and org/10.3389/fpsyg.2018.00509 PMID:29755380
clinical Alzheimer-type dementia: A systematic review. Annals of Michaud, T. L., Su, D., Siahpush, M., & Murman, D. L. (2017). The
Internal Medicine, 168(1), 39–51. https://doi.org/10.7326/M17- risk of incident mild cognitive impairment and progression to
1529 PMID:29255847 dementia considering mild cognitive impairment subtypes.
Fusar-Poli, L., Bieleninik, Ł., Brondino, N., Chen, X.-J., & Gold, C. Dementia and Geriatric Cognitive Disorders Extra, 7(1), 15–29.
(2018). The effect of music therapy on cognitive functions in pa- https://doi.org/10.1159/000452486 PMID:28413413
tients with dementia: A systematic review and meta-analysis. Ag- Miendlarzewska, E. A., & Trost, W. J. (2014). How musical training
ing & Mental Health, 22(9), 1097–1106. https://doi.org/10.1080/ affects cognitive development: Rhythm, reward and other modu-
13607863.2017.1348474 PMID:28691506 lating variables. Frontiers in Neuroscience, 7, 279. https://doi.
Habibi, A., Damasio, A., Ilari, B., Veiga, R., Joshi, A. A., Leahy, R. org/10.3389/fnins.2013.00279 PMID:24672420
M., Haldar, J. P., Varadarajan, D., Bhushan, C., & Damasio, H. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & the PRISMA
(2018). Childhood music training induces change in micro and Group. (2009). Preferred reporting items for systematic reviews
macroscopic brain structure: Results from a longitudinal study. and meta-analyses: The PRISMA statement. PLoS Medicine,
Cerebral Cortex (New York, N.Y.), 28(12), 4336–4347. https://doi. 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
org/10.1093/cercor/bhx286 PMID:29126181 PMID:19621072
Hale, J. M., Schneider, D. C., Mehta, N. K., & Myrskylä, M. (2020). Moreno-Morales, C., Calero, R., Moreno-Morales, P., & Pintado, C.
Cognitive impairment in the U.S.: Lifetime risk, age at onset, and (2020). Music therapy in the treatment of dementia: A systematic
years impaired. SSM - Population Health, 11, 100577. https://doi. review and meta-analysis. Frontiers in Medicine, 7, 160. https://
org/10.1016/j.ssmph.2020.100577 PMID:32300635 doi.org/10.3389/fmed.2020.00160 PMID:32509790
Hill, N. L., Bhargava, S., Brown, M. J., Kim, H., Bhang, I., Mullin, Overton, M., Pihlsgård, M., & Elmståhl, S. (2019). Diagnostic stabil-
K., Phillips, K., & Mogle, J. (2021). Cognitive complaints in ity of mild cognitive impairment, and predictors of reversion to
age-related chronic conditions: A systematic review. PLoS One, normal cognitive functioning. Dementia and Geriatric Cognitive
16(7), e0253795. https://doi.org/10.1371/journal.pone.0253795 Disorders, 48(5-6), 317–329. https://doi.org/10.1159/000506255
PMID:34234373 PMID:32224608
Hyde, K. L., Lerch, J., Norton, A., Forgeard, M., Winner, E., Evans, Pais, R., Ruano, L., P Carvalho, O., & Barros, H. (2020). Global cog-
A. C., & Schlaug, G. (2009). Musical training shapes struc- nitive impairment prevalence and incidence in community
tural brain development. The Journal of Neuroscience, 29(10), dwelling older adults: A systematic review. Geriatrics (Basel,
3019–3025. https://doi.org/10.1523/JNEUROSCI.5118-08.2009 Switzerland), 5(4), 84. https://doi.org/10.3390/geriatrics5040084
PMID:19279238 PMID:33121002
Ito, E., Nouchi, R., Dinet, J., Cheng, C. H., & Husebø, B. S. (2022). Palmer, K., Bäckman, L., Winblad, B., & Fratiglioni, L. (2008). Mild
The effect of music-based intervention on general cognitive and cognitive impairment in the general population: Occurrence
executive functions, and episodic memory in people with mild and progression to Alzheimer disease. The American Journal of
cognitive impairment and dementia: A systematic review and Geriatric Psychiatry, 16(7), 603–611. https://doi.org/10.1097/
meta-analysis of recent randomized controlled trials. Healthcare JGP.0b013e3181753a64 PMID:18591580

Research in Gerontological Nursing • Vol. XX, No. X, 2023 9

Pérez-Ros, P., Cubero-Plazas, L., Mejías-Serrano, T., Cunha, C., & L., & Chen, L. (2020). Effects of Chinese square dancing on
Martínez-Arnau, F. M. (2019). Preferred music listening in- older adults with mild cognitive impairment. Geriatric Nurs-
tervention in nursing home residents with cognitive impair- ing (New York, N.Y.), 41(3), 290–296. https://doi.org/10.1016/j.
ment: A randomized intervention study. Journal of Alzheimer’s gerinurse.2019.10.009 PMID:31727347
Disease, 70(2), 433–442. https://doi.org/10.3233/JAD-190361 Waters, B., Sousa, L., Orrell, M., & McDermott, O. (2022). Ana-
PMID:31177232 lysing the use of music to facilitate social interaction in care
Shimizu, N., Umemura, T., Matsunaga, M., & Hirai, T. (2018). Ef- home residents with dementia: Narrative synthesis system-
fects of movement music therapy with a percussion instrument atic review. Dementia (London), 21(6), 2072–2094. https://doi.
on physical and frontal lobe function in older adults with mild org/10.1177/14713012221100625 PMID:35593422
cognitive impairment: A randomized controlled trial. Aging & Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P.
Mental Health, 22(12), 1614–1626. https://doi.org/10.1080/1360 D., Slotkin, J., Carlozzi, N. E., Bauer, P. J., Wallner-Allen, K., Fox,
7863.2017.1379048 PMID:28937272 N., Havlik, R., Beaumont, J. L., Mungas, D., Manly, J. J., Moy,
Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. C., Conway, K., Edwards, E., Nowinski, C. J., & Gershon, R.
D., Viswanathan, M., Henry, D., Altman, D. G., Ansari, M. T., (2014). The cognition battery of the NIH toolbox for assessment
Boutron, I., Carpenter, J. R., Chan, A. W., Churchill, R., Deeks, of neurological and behavioral function: Validation in an adult
J. J., Hróbjartsson, A., Kirkham, J., Jüni, P., Loke, Y. K., Pigott, T. sample. Journal of the International Neuropsychological Society,
D., . . . Higgins, J. P. (2016). ROBINS-I: A tool for assessing risk 20(6), 567–578. https://doi.org/10.1017/S1355617714000320
of bias in non-randomised studies of interventions. BMJ (Clini- PMID:24959840
cal Research Ed.), 355, i4919. https://doi.org/10.1136/bmj.i4919 Xu, B., Sui, Y., Zhu, C., Yang, X., Zhou, J., Li, L., Ren, L., & Wang, X.
PMID:27733354 (2017). Music intervention on cognitive dysfunction in healthy
Sterne, J. A. C., Savović, J., Page, M. J., Elbers, R. G., Blencowe, N. S., older adults: A systematic review and meta-analysis. Neurologi-
Boutron, I., Cates, C. J., Cheng, H. Y., Corbett, M. S., Eldridge, S. cal Sciences, 38(6), 983–992. https://doi.org/10.1007/s10072-017-
M., Emberson, J. R., Hernán, M. A., Hopewell, S., Hróbjartsson, 2878-9 PMID:28275872
A., Junqueira, D. R., Jüni, P., Kirkham, J. J., Lasserson, T., Li, T., Zhaoyang, R., Scott, S. B., Martire, L. M., & Sliwinski, M. J. (2021).
. . . Higgins, J. P. T. (2019). RoB 2: A revised tool for assessing Daily social interactions related to daily performance on mobile
risk of bias in randomised trials. BMJ (Clinical Research Ed.), 366, cognitive tests among older adults. PLoS One, 16(8), e0256583.
l4898. https://doi.org/10.1136/bmj.l4898 PMID:31462531 https://doi.org/10.1371/journal.pone.0256583 PMID:34437609
Taler, V., & Phillips, N. A. (2008). Language performance in Zhu, C. W., Sano, M., Ferris, S. H., Whitehouse, P. J., Patterson, M. B.,
Alzheimer’s disease and mild cognitive impairment: A compara- & Aisen, P. S. (2013). Health-related resource use and costs in
tive review. Journal of Clinical and Experimental Neuropsycholo- elderly adults with and without mild cognitive impairment. Jour-
gy, 30(5), 501–556. https://doi.org/10.1080/13803390701550128 nal of the American Geriatrics Society, 61(3), 396–402. https://doi.
PMID:18569251 org/10.1111/jgs.12132 PMID:23414481
Trkulja, V., & Hrabač, P. (2020). Meta-analysis is not always the best Zhu, L., Li, L., Wang, L., Jin, X., & Zhang, H. (2020). Physical activ-
way to round out a systematic review: A few thoughts prompted ity for executive function and activities of daily living in AD pa-
by the COVID-19 pandemic and “spiced-up” with an earth- tients: A systematic review and meta-analysis. Frontiers in Psy-
quake. Croatian Medical Journal, 61(2), 198–200. https://doi. chology, 11, 560461. https://doi.org/10.3389/fpsyg.2020.560461
org/10.3325/cmj.2020.61.198 PMID:32378390 PMID:33343442
Tsai, P. L., Chen, M. C., Huang, Y. T., & Lin, K. C. (2013). Effects Zhu, Y., Wu, H., Qi, M., Wang, S., Zhang, Q., Zhou, L., Wang, S.,
of listening to pleasant music on chronic unilateral neglect: A Wang, W., Wu, T., Xiao, M., Yang, S., Chen, H., Zhang, L., Zhang,
single-subject study. NeuroRehabilitation, 32(1), 33–42. https:// K. C., Ma, J., & Wang, T. (2018). Effects of a specially designed
doi.org/10.3233/NRE-130821 PMID:23422457 aerobic dance routine on mild cognitive impairment. Clinical In-
Veritas Health Innovation. (n.d.). Covidence systematic review soft- terventions in Aging, 13, 1691–1700. https://doi.org/10.2147/CIA.
ware. http://www.covidence.org S163067 PMID:30237705
Wang, S., Yin, H., Meng, X., Shang, B., Meng, Q., Zheng, L., Wang,

10 Copyright © SLACK Incorporated

Table A. Data Extraction of Included Studies
Authors, Groups Age Diagnostic tool Type of music Music Duration of Cognitive outcome Result
year, (analyze (mea for mild intervention selection/Meth music assessment
country d sample n) cognitive od of delivery intervention
size) impairment
1 Adam et 1) 70.9 Mild-moderate 1) Poco-poco dance Not detailed 60 minutes Cognitive function The intervention group
al. Experim cognitive + relaxation twice a week (MMSE) significantly improved
2016 ental impairment for 6 weeks compared to the control
Peninsular group identified via 2) Relaxation only at 6 weeks on the MMSE
Malaysia (n=44) MMSE (p < .001).

2)
Control
group
(n=40)
2 Biasutti & 1) 83.6 Mild-moderate 1) Music training Modern music 70 minutes General cognitive The intervention group
Mangiaco Experim cognitive program: (top-ten hits twice a week function (MMSE) significantly improved
tti ental impairment imitation, creation, from the period for 12 weeks Access skills and compared to the baseline
2018 group identified via and executive of training), lexical retrieval at 12 weeks on the MMSE
Italy (n=18) MMSE and rhythm – body & famous Italian (VFT) (p < .001); VFT (p < .013);
healthy aging instrument music Spatial planning, and CDT (p < .001).
2) percussion/scat (belonging to selective attention,
Control singing the participants’ psychomotor speed There was a significant
group youth) (TMT A) reduction in AMT in the
(n=17) 2) Gymnastic Visual selective control group (p < .05).
activities attention (AMT)
Praxis skills, mental
representation,
planning, logical
skills (CDT)
3 Cacciafest 1) N=12 Age MCI identified Listening to music 1) K448 by 1) once Spatial-temporal Significant improvement
a et al. range via MMSE or Mozart and Für abilities (PFC) in
2010 2) N=10 66– subjective Elise by 2) 6 months Episodic learning (3
Italy 77 memory Beethoven daily objects, 3 places) 1) Mozart’s K448:
3) N=11 disorder 2) K448 by Ideational-praxis PFC test – all 12 patients
(another Mozart 3) once abilities (Clock test) Rey’s 15 words test — 10
group) 3) Other Immediate recall out of 12 patients
compositions (Rey’s 15 words Other tests did not show
with a different test) significant improvement.
index of Attention (TMT
periodicity than A&B) Beethoven’s Für Elise:
K448 Memory for All tests did not show
numbers (Digit significant improvement.
span)
2) Mozart’s K448:
After 6 months, 10 of all
remaining patients
showed improvement in
the PFC test.

3) Other compositions
with a different index of
periodicity with K448: No
significant variation.
4 Doi et al. 1) Dance 76 MCI identified 1) Dancing with an Not detailed 60 minutes Memory (Story The dance intervention
2017 (n=67) via subjective instructor (ballroom once a week memory and word group significantly
Japan 2) cognitive dance, including for 40 weeks list memory tests) improved compared to
Playing complaints, salsa, rumba, waltz, General cognitive the control at 10 months
musical objective cha-cha, blues, function (MMSE) on the story memory test
instrume cognitive jitterbug, and Attention & (p = .011) and the MMSE
nts impairment tango) executive function (p = .026)
(n=67) assessed by (TMT A &TMT B)
tests of memory 2) Playing The playing instruments
3) Health and nonmemory percussion intervention group
educatio domains instruments (e.g., significantly improved
n control conga), improvised compared to the control
 group on the musical at 10 months on the
(n=67) scores MMSE (p = .008)

The dance intervention

aMCI subgroup
significantly improved
compared to the control
aMCI (amnestic) group at
10 months on the story
memory test (p = .001)
but not in the naMCI
(nonamnestic) subgroup.
5 Domíngue N=16 71.3 MCI identified Music with Songs from 60 minutes Global cognition The intervention group
z-Chávez via MoCA movement Mexican folklore three times state (MoCA) significantly improved
et al. intervention (patients’ a week for Attention (digit compared to the baseline
2019 (walking with musical 12 weeks span subset) at 12 weeks on the
Mexico rhythmic preferences Immediate memory MoCA (p = .001); digit
schemes/reading of were taken into (Texts I from the span subset (p = .007);
rhythmic account) Wechsler Memory Wechsler Memory Scale
patterns/listening to Scale) Texts I (p < .001); Texts II
music while doing Delayed memory (p = .001); FAB (p = .002).
activities and (Texts II from the
movement/playing Wechsler Memory
instruments/singing Scale)
) Executive function
(FAB)
6 Douka et 1) 1) MCI identified Traditional dances Not detailed 60 minutes Six domains of The intervention group of
al. Cognitive medi via MMSE selected from all two times a cognitive and MCI significantly improved
2019 ly intact an: over Greece week for 24 functional compared to baseline at
Greece group 65.5 weeks performance (CRD) 24 weeks on the TEA
(n=30) Executive (S4viac) (p < .001); TEA
2) functioning (FUCAS, (S4viti) (p < .001); FUCAS
2) MCI medi TMT) (p = .03); VFT (Verflx:
group an: Attention (TEA) p = .023; Verfls: p = .001;
(n=30) 67.5 Memory (ROCF, and Verfmo: p = .003).
RAVLT, RBMT)
 Verbal fluency (VFT) However, a significant
decrease at 24 weeks was
found on the RBMT 1&2
(p’s < .001).

7 Lake & 1) MCI 70.2 Amnestic MCI Listening to music “Spring” 10 minutes Attention (RBANS: There was no significant
Goldstein group diagnosed by via headphones movement of for one time Digit Span & difference between the
2011 (n=12) experienced Four Seasons by Coding; DRS) music listening and the
USA neurologists and Vivaldi silence condition.
2) neuropsychologi
Cognitive sts
ly intact (subjective
group memory
(n=12) complaint/objec
tive memory
impairment)
8 Lazarou et 1) 66.9 Amnestic MCI 1) International Special music 60-minute Global cognition The intervention group
al. Ballroom based on Ballroom Dancing depending on sessions (MMSE, MoCA) significantly improved
2017 dancing Petersen with special music the type of twice a week Daily function compared to the control
Greece group criteria: (1) (tango, waltz, dance for 10 (FUCAS) at 10 months on the
(n=66) memory Viennese waltz, fox months Memory (RBMT) MMSE (p < .01); MoCA (p
complaint, (2) trot, rumba, cha- Verbal fluency (FAS) = .03); TEA (p = .002);
2) normal activities cha, swing, salsa, Executive function RAVLT (p = .003); FAS (p
Control of daily living, merengue, (ROCFT-copy and = .005); RBMT (p’s < .005);
group (3) normal disco–hustle, Greek delayed recall; TMT and ROCFT (p’s < 0.01).
(n=63) general traditional ballroom B)
cognitive dancing) Learning (RAVLT) The intervention group
function, (4) Attention (TEA) significantly improved
abnormal compared to the baseline
memory for age, 2) No intervention at 10 months on the FAS
and (5) not (p < .01); ROCFT (p
demented; = .004); RAVLT (p = .001);
stage 3 of the TEA (p = .03); and RAVLTI
disease (p = .002).
according to
Global
 Deterioration The control group
Scale significantly worsened at
10 months on the MMSE,
FUCAS, ROCFT delay
recall, RBMT delay recall,
FRSSD, RAVLT, and TEA
map.
9 Shimizu et 1) 74.6 MCI defined by 1) Repetitive Various songs 60 minutes Frontal lobe function The intervention group
al. Moveme Pertersen rhythmic (e.g., Astro Boy, once a week (FAB) significantly improved
2018 nt music criteria; movements with Samba of for 12 weeks compared to the baseline
Japan therapy memory music and the use ladybug, Yosakoi at 12 weeks on the FAB (p
(MMT; impairment of the Naruko Icchorai Ondo, = .008).
n= 30) checklist ≥ 1 clapper Kiyoshi’s
Zundoko)
item
2) 2) Same exercises
Exercise performed in the
group MMT group without
(n=9) background music
10 Wang et 1) 81.1 MCI identified 1) Stepping exercise Not detailed 40 minutes Global cognition (MMSE, There was no significant
al. Square based on four and following the three times MoCA) difference after the
2020 dancing criteria: (1) rhythm of the music a week for intervention at 6 weeks
China group subjective 12 weeks on the MoCA or MMSE.
(n=33) cognition 2) Usual lifestyle
decline; (2) The intervention group
2) MMSE>24; (3) significantly improved
Control MoCA<26; (4) compared to the baseline
group activities of at 12 weeks on the MoCA
(n=33) daily living < 26 (p = .001) and MMSE (p
< .001).

The intervention group

significantly improved
compared to the control
at 12 weeks on MMSE
(p = .006).
11 Zhu et al. 1) 69.6 (1) Diagnosed Dance in Not detailed 35 minutes Logical memory The intervention group
2018 Aerobic with amnestic synchronization three times (WMS-RLM) significantly improved
China dance + MCI according with a musical a week for Overall cognitive compared to the baseline
usual to NIA-AA; (2) phrase of eight 12 weeks function (MoCA) at 3 months on the MoCA
care MMSE≥25; (3) rhythmical meters Attention, (p < .001); WMSR-LR
group processing speed, (p < .05); SDMT (p < .05);
MoCA≤26
(n=29) working memory and P300 latency (p < .05);
(SDMT) and at 6 months on the
2) Visual perception, MoCA (p < .001); WMSR-
Control motor speed, speed LR (p < .05); SDMT (p
group processing, mental < .05); and TMT-A (p
(usual flexibility (TMT < .05).
care; A&B)
n=31) Short-term verbal The intervention group
memory (DST-F&B) significantly improved
Processing speed compared to the control
(P300 latency) at 3 months on the
Attention (P300 WMSR-LR (p < .001); TMT
amplitude) B (p < .05); and at 6
months on the P300
latency (p < .05).
Note. MMSE: Mini-Mental State Examination; VFT: Verbal Fluency Test; TMT A & B: Trail Making Test A and B; AMT: Attentional Matrices Test; CDT: Clock-
Drawing Test; MCI: mild cognitive impairment; PFC: Paper-Folding And Cutting Test; MoCA: Montreal Cognitive Assessment; FAB: Frontal Assessment Battery;
CRD: Clinical Dementia Rating; FUCAS: Functional and Cognitive Assessment Test; FRSSD: Functional Rating Scale for Symptoms of Dementia; TEA: Test of
Everyday Attention; ROCF: Rey–Osterrieth Complex Figure Test; RAVLT: Rey Auditory Verbal Learning Test; RBMT: Rivermead Behavioral Memory Test; RBANS:
Repeatable Battery for the Assessment of Neuropsychological Status; DRS: Mattis Dementia Rating Scale; FAS: the Verbal Fluency F-A-S test; ROCFT-copy and
delayed recall: Rey–Osterrieth Complex Figure Test copy and delay recall; NIA-AA: National Institute on Aging and Alzheimer’s Association; WMS-RLM:
Wechsler Memory Scale-Revised Logical Memory; SDMT: symbol digit modalities test; DST-F & B: Digit Span Test-forward and backward.
Reproduced with permission of copyright owner. Further reproduction
prohibited without permission.