lderly people at risk of developing dementia may benefit from choral singing as an alternative to attending health education programmes. While both aim to retard/prevent age-related cognitive decline, new research by NUS Medicine suggests that choral singing intervention is equally effective in delaying cognitive decline as a structured health education programme targeting known risk factors of dementia such as hypertension, obesity, smoking, depression, physical inactivity, diabetes, and social isolation.

Cognitive decline among the elderly

Cognitive function declines with increasing age. This universal phenomenon affects the majority of Singaporean elders. Impaired cognitive function presents a major obstacle to healthy, functional, productive and successful ageing. With a rapidly-ageing population, effective interventions are critical to maintaining good cognitive function and preventing age-related cognitive decline.

The intervention programmes: Choral singing vs health education programme

In a randomised controlled trial (RCT), Assistant Professor Feng Lei from the Department of Psychological Medicine at NUS Medicine worked with 93 participants who had an average age of 70. One group of these senior citizens was assigned to the choral singing intervention led by professional musicians, while a second group attended the health education programme conducted by family physicians, specialist clinicians and community nurses. This established programme comprised short talks as well as activities that emphasised memory work and the acquisition of certain skills.

For a period of two years from 2015 to 2017, the choral group sang weekly at the Yong Siew Toh Conservatory of Music, NUS. Each session was an hour long and participants were exposed to the musical, social, and physical aspects of choral singing. The focus during the sessions was to educate participants to understand the concept of sound, the mechanics of the singing voice, and differentiate good from bad singing.

Later in the programme, participants learnt to sing in different parts. The parts were taught aurally and slowly, helping each singer to understand how they represent different lines in the musical harmony at any point in a musical piece with two or more parts. Several performances were also included as part of the intervention programme, the purpose of which was to promote motivation and a sense of purpose, pride and accomplishment. The participants also performed at the Victoria Concert Hall for the 2019 Voices of Singapore Festival.

Over the same period of time, the health education programme was also held weekly at the Training and Research Academy in Jurong Point (TaRA@JP). The hour-long sessions consisted of short talks on health-related topics—diabetes, physical activities, healthy eating and depression. Participants also took part in activities that required memory work and the acquisition of certain skills, though none involved singing.

Comparing both intervention programmes, A/Prof Feng Lei and his team found common elements such as social interactions, a sense of belonging and the building of friendships over time.

Photograph taken before implementation of COVID-19 safe distancing measures.

Choral singing as a promising candidate to reduce cognitive decline

Choral singing is a novel and promising candidate that has not yet been assessed by a well-designed clinical trial. Based on existing trials and studies, people engaging in lifelong music-making have been found to have better cognitive outcomes later in life. Both amateur and professional singers and musicians have brain features younger than their chronological age, suggesting that music-making has an age-decelerating effect. Singing may therefore be an engaging and effective way to prevent age-related cognitive decline.

To measure the results of the study, the primary outcome was the change in cognitive function during the intervention period. Additionally, secondary biological outcome variables were also measured, including brain magnetic resonance imaging (MRI) metrics, blood markers of immunosenescence and peripheral markers of oxidative damage.