Anthony Brandt smiles as he reflects on one of his favorite moments from an earlier pilot program.
“One of the participants walked up to me and said, ‘I’m 82 years old and I never thought I would say this, but I’m a composer,’” Brandt recalled.
The older adult had just spent the previous six weeks learning to compose music for the first time.
“For people at that stage of life to all of a sudden be able to tackle something new, enjoy it, get a lot of satisfaction out of it, it’s very powerful to witness,” Brandt said.
That moment gets at the heart of a collaboration between Brandt, professor and chair of composition and theory at Rice University’s Shepherd School of Music, and Christopher Fagundes, professor of psychological sciences and director of the Institute of Health Resilience and Innovation. For years, the two have been exploring a deceptively simple question: Can creative activities like making music help strengthen the aging brain?
Now they have $3.9 million from the National Institute on Aging, part of the National Institutes of Health, to test that question on a much larger scale.
The five-year randomized clinical trial will examine whether actively creating music can improve cognition and mental health-related quality of life in adults 65 and older with mild cognitive impairment, a condition associated with an increased risk of developing dementia.
For Fagundes, the study is part of a broader shift in how researchers think about brain health.
He compares it to the evolution in thinking about cardiovascular health. People now understand that exercise, diet and other behaviors can influence heart health long before a problem develops and can continue to matter after a heart attack. Increasingly, researchers are asking whether some of the same principles apply to the brain.
“We’re learning, especially over the last 10 years, that that same principle can be applied really well to brain health,” Fagundes said.
Why creativity? And why music?
When Fagundes first began thinking about a possible intervention, the idea was creativity, not necessarily music. He considered other creative activities, including painting.
Then he looked across the Rice campus.
At a university known for both its research and its world-class music program, Fagundes saw an opportunity to bring those strengths together. He turned to Rice’s Shepherd School of Music, where he was connected with Brandt, whose interests extend beyond creating music to understanding how creativity engages the mind.
For Fagundes, Brandt offered something particularly valuable: a collaborator who could think about music not only as an art form but also through a scientific lens.
“I’ve always felt that, in a sense, the arts are a science of the mind, just functioning in a different way than laboratory science,” Brandt said.
That shared curiosity became the foundation of a collaboration that brings two very different disciplines together at their highest levels. Brandt could design an experience that genuinely challenged participants to create something new, while Fagundes and the investigators he assembled across four institutions could build the rigorous scientific framework needed to measure what was happening in the brain and body along the way.
“There’s a lot of fantastic work that’s done in music as medicine, where the music’s role is mood control or it’s palliative to soothe people,” Brandt said. “One of the things that excites me about our study is it’s really about music’s cognitive benefits.”
The program is intentionally designed for people without extensive musical training. Participants do not need to read music or know how to play an instrument. Instead, they use their voices and simple instruments to experiment with sound. They might create a soundscape inspired by a favorite place or memory, turn the rhythm of their name into music or improvise a soundtrack to a silent film.
They even create their own forms of musical notation, so others can perform what they have composed.
At the end of the six-week program, participants perform selections of their original work for family and friends.
Composer Karl Blench, a lecturer in music at the Shepherd School, helped design the curriculum and taught the initial workshops, working directly with participants as they learned to create music.
“Karl was the heart and soul of working with the older adults, and our study wouldn’t have succeeded without him,” Brandt said.
The result was a program that Brandt said worked as an authentic music class as well as a research intervention.
“If science wasn’t involved, you could run these workshops anyway,” he said. “It’s exactly what you might do if you were trying to do a wonderful class for seniors on how to compose music.”
What makes the study different is that researchers can carefully measure what happens as participants take on that creative challenge.
Is it the music, the creativity or the connection?
The new trial will enroll 210 adults with mild cognitive impairment and randomly assign them to three groups.
One group will take the music creativity course. Another will participate in a music appreciation class, where participants spend time together listening to and discussing music but do not compose. A third group will listen at home to music selected according to their own preferences.
The comparison groups are designed to help researchers determine whether any benefit comes specifically from creating music, from engaging with music more generally or from the social connection of taking part in a group.
“We want to know, overall, does this intervention slow impairment or improve cognition over and above a music appreciation kind of class?” Fagundes said.
Researchers will assess participants before and after the program and again in the months that follow, measuring cognition and mental health-related quality of life.
They will also use brain imaging to examine neural networks and collect blood samples to study inflammation and cellular energy metabolism, allowing researchers to look beyond whether participants improve and begin asking how the intervention might be working.
Another key question is whether researchers can predict who is most likely to benefit.
An earlier pilot study offered an intriguing clue. Participants whose brains showed greater neural flexibility before taking the course appeared to experience greater cognitive benefits afterward.
Brandt said that finding would have seemed far less plausible several decades ago, when the prevailing view was that the adult brain was largely fixed.
“It’s the discovery that neuroplasticity lasts throughout your lifetime that makes creativity as an intervention for a 65- or a 70-year-old plausible,” Brandt said.
Fagundes cautioned that the earlier study was small and its findings preliminary. The larger trial is designed to determine whether those signals hold up in a much larger group.
“We want to know not just is it having a global effect, but who is it having the biggest impact for?” Fagundes said.
Fagundes is the principal investigator on the trial with Brandt serving as one of five co-investigators. Bryan Denny, associate professor of psychological sciences at Rice, leads the neuroscience component, while Luis Medina, associate professor of psychology at the University of Houston and a clinical neuropsychologist, will direct the neuropsychological assessment. Paul Schulz, professor of neurology at UTHealth Houston and director of the Neurocognitive Disorders Center, is the neurologist overseeing the study, and George Kypriotakis, associate professor of behavioral science at The University of Texas MD Anderson Cancer Center, will lead the statistical analysis.
The grant is administered through Rice’s Institute of Health Resilience and Innovation.
The collaboration between Fagundes and Brandt began in 2018 with support from the National Endowment for the Arts and has grown from a small pilot into a large NIH-funded clinical trial.
If the larger study confirms their early findings, the implications could extend well beyond the music classroom. The researchers say they hope the work could contribute to a growing understanding of brain health that includes behavioral interventions alongside traditional medical treatments.
For Fagundes, that is part of the promise of the research. Just as exercise and diet have become important tools for protecting cardiovascular health, activities that challenge the brain may one day become another way to help people maintain cognitive health as they age.
“The bigger principle that I’m trying to articulate here is there are preventive processes and processes that impact decline that are not just pharmacological,” Fagundes said.
If creativity proves to be one of them, something as simple as learning to make music could eventually offer older adults another way to actively invest in the health of their brains.