Choir singing may improve cognitive function in older adults
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Choir singing improves verbal flexibility, a domain of executive function and cognition, in older adults, according to research published in PLOS ONE.
“Playing a musical instrument has been shown to be connected to better cognitive functioning in several areas of cognition, for example cognitive flexibility, attention and memory,” Emmi Pentikäinen, a doctoral student at the in the Cognitive Brain Research Unit and the Music, Aging and Rehabilitation Team at the University of Helsinki, Finland, told Healio Primary Care. “There is now evidence that choir singing could perhaps lead to better cognitive flexibility.”
Pentikäinen and colleagues conducted a cross-sectional questionnaire study, with participants recruited through flyers, presentations and e-mail advertisements. The study included a main cohort study of 162 participants and a sub-cohort study that included a randomly selected sample of 74 participants who underwent neuropsychological tests.
Those included in the study sample were aged 60 years and older and did not have neurological or psychiatric disorders.
Among all participants, 106 were choir singers who had been singing in a choir for at least 1 year, and 56 participants were controls who had not sung in a choir during the last 10 years.
For the study, the researchers defined choir singing as regularly participating in a choir led by a professional conductor that rehearsed at least once a week and performed at least twice a year. Participants were considered high-activity choir singers if they had started earlier in life and sung in choirs for more than 10 years. Those who participated in choirs for fewer than 10 years were considered low-activity choir singers.
All participants completed six questionnaires to measure their cognitive function, depression, social well-being, quality of life, and how music affects their everyday life. Those randomly selected for neuropsychological testing also underwent 1.5 hours of testing from trained psychologist to evaluate their general cognition, executive functions, processing speed, working and episodic memory and verbal skills.
According to the researchers, high-activity choir singers were older, on average, compared with low-activity choir singers.
The researchers found that choir singers had significantly higher verbal flexibility than controls.
Additionally, they determined that there were significant differences between groups in Social Integration Scale of the Social Provisions Scale, general health based on the WHO Quality of Life questionnaire, and music engagement questionnaire scores.
When comparing low- and high-activity groups with controls, Pentikäinen and colleagues found that social integration scores were higher in high-activity choir singers compared with low-activity singers and controls, and that there was no significant difference between low-activity singers and control participants.
However, WHO quality of life scores for general health were higher among low-activity choir singers compared with high-activity singers and controls.
According to the researchers, music engagement scores were higher in both choir singer groups compared with controls, but there were not significant differences in scores between the choir singer groups.
“In our study, we noticed that choir singers had better verbal flexibility than controls, but the groups did not differ in any other cognitive measures,” Pentikäinen said. “Thus, more research, and especially longitudinal approaches, are needed to establish the possible cognitive benefits of choir singing.”
Perspective
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The study is interesting because it highlights how complex the brain is, and we know that there are so many activities that help stimulate or keep other parts of our brain going well. For example, a lot of patients tell me they do sudoku and crossword puzzles, and they think that is the key to maintaining brain health. But our brains are actually much more complex. We have known for a while that music is important for the brain, and actually involves a different part of the brain that doesn’t deteriorate in the same way, in terms of memory loss, with dementia.
When we have choir singing — as in this example here — it showed that it helped participants maintain verbal flexibility. Executive function is an important, complex role that’s done in the front of our brain. Our memory is really distributed over many parts of our brain. I think that this is important to know because this is one component of keeping our brain healthy, but it is not the whole picture. The other part that is important about choir singing is that it’s also a social event, and we know that social connections are very important to the brain. It is challenging to measure all these different activities, but in this study, it showed that choir singers did better in terms of verbal flexibility, but not in any other cognitive domains. In terms of my patients, everybody is looking for that one magic thing that keeps our brains functioning well as we get older, and our brains are much too complex to find that one thing helps all domains of our cognitive function. But clearly, this study shows that singing in a choir does help with verbal flexibility.
We have seen other studies that show music can help keep patients engaged, it can reduce agitation, and it is a way of reaching people who have dementia because it involves a different part of the brain than words and general communication. I remember having a patient who could not speak in a single sentence but could sing every stanza of multiple hymns that she had learned in church, and we always found that remarkable. We also know that a lot of long-term care facilities use music to help reduce agitation and help people bring back memories from their youth in ways that they can’t express verbally. If you have somebody who can participate in a choir, it also means that they have some level of physical function to be able to attend rehearsals, stand up and perform, and they must have some degree of lung and cardiac function to be able to sing and breathe. So, these studies are looking at things that are other than just brain function, because by definition, in order to participate in a choir, you have to have some other health measures that are intact and viable. They did say here that the low-activity choir singers had better general health than the high-activity choir singers, and I thought that was interesting, and I’m not sure what to make of that; why would low-activity choir singers have better health? That sounds a little paradoxical, and it highlights the challenge of these studies.
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