Does playing a musical instrument prevent dementia?

Abstract

AbstractBackgroundMusical instrument playing provides intellectual stimulation, which is hypothesised to generate cognitive reserve that protects against cognitive impairment.MethodA systematic review and meta‐analysis of all studies with musical instrument playing as the exposure, and cognitive impairment and/or dementia as the outcome. This was followed by a primary analysis drawing on data from the EPIC‐Norfolk population cohort, attesting for a dose‐response relationship between mid‐life musical instrument playing and late‐life cognition, after adjusting for relevant health and social confounders.ResultOf 1211 articles identified from literature searching, three met inclusion criteria. All were of good methodological quality, and reported large protective effects of musical instrument playing. A 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 two cohort studies found a 59% reduction in the risk of developing dementia within the study follow up.In EPIC‐Norfolk, data were available from 5693 participants (745 musicians) on music playing, cognition, and all covariables. Classification of musicianship by frequency of playing demonstrated key differences in socio‐demographic factors. Musicians outperformed non‐musicians in cognition generally. Compared to non‐musicians, frequent musicians had 80% higher odds of being in the top cognitive decile (OR 1.80 [95%CI 1.19‐2.73]), whilst musicians playing at any frequency had 29% higher odds (95% CI 1.03‐1.62), compared to non‐musicians. There was evidence of a threshold effect, rather than a linear dose‐response relationship.ConclusionThe existing evidence base suggests a substantial protective effect of musical instrument playing on cognition, but is limited by size and the risk of reverse causality. Our primary EPIC‐Norfolk analysis also supports a positive association between mid‐life musical instrument playing and late‐life cognition. ‘Musicians’ are a heterogeneous group, and those playing frequently demonstrated the best cognition. Larger, more focused studies are required to further explore this association, with a particular need to consider the cumulative lifetime quantity of music playing. Studies investigating the association between lifestyle factors (e.g. music playing) and cognitive decline should consider the heterogeneous nature of participants, rather than simply adopting a binary classification.