JMIR Publications

ABSTRACT

Background:

Subjective cognitive decline (SCD) affects almost one quarter of older people and increases dementia risk. Yet, evidence on remotely delivered, facilitator-led group programs for older adults with SCD remains limited. The aim of this study was to evaluate the effects on cognition of online piano improvisation training compared to online traditional piano replication training (active control) and a waitlist group (passive control), in older adults with and without SCD.

Objective:

This study aimed to determine whether an 8-week online group piano improvisation training program (IMP) improves cognitive function, creative self-efficacy, and quality of life in community-dwelling older adults with and without subjective cognitive decline (SCD), relative to traditional replication piano training (TRT; active control) and a non-active waitlist control (CTL).

Methods:

Older adults (>60 years; N = 105) were randomised 1:1:1 to either piano improvisation, traditional replication, or waitlist control groups. Co-primary outcomes were global cognitive function (MoCA) and visuospatial working memory (CANTAB Spatial Working Memory Test). Secondary outcomes were creative thinking self-efficacy and quality of life. Bayesian regression models reported posterior probabilities (PP), and interviews generated qualitative data for mixed-methods integration.

Results:

Across the entire sample of older adults with and without SCD, traditional replication training showed moderate evidence on the MoCA (PP=0.93). Importantly, for those with lower MoCA baseline scores, improvisation and traditional replication training both showed strong evidence on the MoCA (PP=1.00) relative to waitlist control. Within the SCD group, traditional replication training showed strong MoCA (PP=1.00) and quality of life (PP=0.97) evidence, where improvisation training showed moderate QoL (PP=0.93) evidence. Improvisation showed lower attrition than traditional replication training (2.5% vs. 19.5%), and qualitative data suggested that this was due to creative growth and sustained engagement.

Conclusions:

Traditional piano replication training may support global cognitive function in older adults with and without SCD. Participants with lower MoCA scores may show the most benefit on cognitive function and quality of life from an online piano intervention, whether it is traditional replication or improvisation based. Improvisation training may offer an advantage in participant retention and engagement. The trial used online delivery, but digital access and usability were not systematically assessed. Clinical Trial: The trial was registered with the Australia New Zealand Clinical Trials Registry (ACTRN12626000286347).