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Research Paper|Volume 12, Issue 24|pp 24798—24816

Effects of choral singing versus health education on cognitive decline and aging: a randomized controlled trial

Lei Feng1,2,3, Rafael Romero-Garcia4, John Suckling4, Jasmine Tan5, Anis Larbi6, Irwin Cheah7, Glenn Wong6, Maurine Tsakok8, Bernard Lanskey9, Darius Lim10, Jialiang Li11, Joanna Yang1,2, Benjamin Goh1,2, Tristan Gwee Chen Teck12, Allan Ho13, Xiu Wang14, Jin-Tai Yu15, Can Zhang16, Crystal Tan6, Michelle Chua6, Junhua Li17, John J Totman18, Caroline Wong18, Marie Loh19,20, Roger Foo21,22, Chay Hoon Tan1,23, Lee Gan Goh24, Rathi Mahendran1,2,25, Brian K. Kennedy3,26,27,28, Ee-Heok Kua1,2
  • 1Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 2Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 3Centre for Healthy Longevity, National University Health System, Singapore, Singapore
  • 4Department of Psychiatry, University of Cambridge, UK
  • 5Department of Psychology, Goldsmiths, University of London, UK
  • 6Biology of Aging Laboratory, Singapore Immunology Network, Singapore
  • 7Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 8Maurine Tsakok Inc, Singapore
  • 9Yong Siew Toh Conservatory of Music, National University of Singapore, Singapore
  • 10Darius Lim, Voices of Singapore Choral Society, Singapore
  • 11Department of Statistics and Applied Probability, Faculty of Science, National University of Singapore, Singapore
  • 12Presbyterian Community Services, Singapore
  • 13NTUC Health Co-operative Limited, Singapore
  • 14Beijing Chui Yang Liu Hospital, Beijing, PR China
  • 15Department of Neurology and Institute of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
  • 16Genetics and Aging Research Unit, McCance Center for Brain Health, MassGeneral Institute for Neurodegenerative Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
  • 17School of Computer Science and Electronic Engineering, University of Essex, UK
  • 18Clinical Imaging Research Centre, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 19Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
  • 20Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK
  • 21Cardiovascular Research Institute, National University Health Systems, Singapore
  • 22Genome Institute of Singapore, Singapore
  • 23Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 24Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 25Academic Development Department, Duke-NUS Medical School, Singapore
  • 26Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  • 27Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  • 28Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
Received: April 17, 2020Accepted: November 20, 2020Published: December 18, 2020

Copyright: © 2020 Feng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

We conducted a randomized controlled trial to examine choral singing’s effect on cognitive decline in aging. Older Singaporeans who were at high risk of future dementia were recruited: 47 were assigned to choral singing intervention (CSI) and 46 were assigned to health education program (HEP). Participants attended weekly one-hour choral singing or weekly one-hour health education for two years. Change in cognitive function was measured by a composite cognitive test score (CCTS) derived from raw scores of neuropsychological tests; biomarkers included brain magnetic resonance imaging, oxidative damage and immunosenescence. The average age of the participants were 70 years and 73/93 (78.5%) were female. The change of CCTS from baseline to 24 months was 0.05 among participants in the CSI group and -0.1 among participants in the HEP group. The between-group difference (0.15, p=0.042) became smaller (0.12, p=0.09) after adjusting for baseline CCTS. No between-group differences on biomarkers were observed. Our data support the role of choral singing in improving cognitive health in aging. The beneficial effect is at least comparable than that of health education in preventing cognitive decline in a community of elderly people. Biological mechanisms underlying the observed efficacy should be further studied.