At 101, Frank Iacono still plays the violin. The concertmaster for the Providence Civic Orchestra of Senior Citizens in Rhode Island, he particularly enjoys playing polkas and jigs.
"It keeps my mind active, and it gives me a lot of pleasure," Iacono said.
The orchestra's executive director and co-founder, Vito Saritelli, said Iacono is extremely sharp for his age.
"Music has played a good part of his longevity," said his wife, Mary Iacono, 94. "We're blessed that we're both in good health."
As scientists race to figure out how to promote healthy aging of the brain, and prevent dementia, their preliminary advice for senior citizens has become a chorus of voices: "Stay active! Have hobbies! Be socially engaged!"
Playing music, for some people, is a natural answer to all of those recommendations. Frank Iacono, for instance, has been playing violin since he was 13 -- just because he loves it.
But does music playing in particular stave off dementia? What about just listening to music? How many years do you need to engage in music before it benefits your brain?
Researchers are exploring these questions in the face of staggering statistics about the aging population. The number of Americans 65 and older with Alzheimer's is expected to triple nearly by 2050 -- 13.8 million from 5 million now. The annual cost of dementia in the United States in 2050 will be $1.2 trillion, according to the Alzheimer's Association.
Early research suggests keeping the brain active -- such as by speaking two languages -- may hold back dementia symptoms by up to five years. Scientists are hoping to find that the same is true for music playing, said Brenda Hanna-Pladdy, assistant professor of neurology at Emory University, who studies cognitive functioning among musicians.
"If you can delay the presentation (of dementia) by five years, then you add an extra five years of functioning to an individual at the end of the life span," she said. "In terms of fiscal cost and everything, that's actually quite a lot."
A large study using Sweden's twin registry is looking at intellectually and physically stimulating lifestyle factors that could help stave off cognitive decline. One component of this effort is exploring whether playing music protects against dementia. The results, discussed at the Interdisciplinary Society for Quantitative Research in Music and Medicine meeting in July, are not yet published.
Twin studies carry special importance in science. Usually, when people participate in a study, they each carry a different set of genetics and may have had different upbringings. Those factors could influence whatever researchers want to investigate. Fraternal twins, however, share about 50% of genes, and identical twins share almost all. Twins also likely grew up in the same environment.
"To me, the most intriguing aspect is, in a twin pair, if one becomes demented and the other doesn't, what did (one not do)? Or what did the one who did become demented do that might give you some clues about ways that other people can mitigate their risk?" asked Margaret Gatz, director of the Study of Dementia in Swedish Twins, and professor at the University of Southern California.
Researchers examining the broader twin data have found that, for women specifically, participating in intellectual and cultural activities was linked to lower dementia risk in one study. Activities such as exercise at midlife for both sexes are also protective against dementia, the study suggests.
"All of these kind of add up in suggesting that a more engaged lifestyle is a good thing for the aging brain," Gatz said.
Why would an "engaged lifestyle" help prevent dementia? The idea is that brain stimulation may counteract brain changes that occur because of cognitive decline so that a person can function for longer, Gatz said.
Music playing in particular is something that people can continue to enjoy for longer than their occupations, or strenuous physical activity, Gatz said. It also has cognitive, physical and potentially socially components, so it engages many brain networks.
Unfortunately the twin study has so far only looked at associations between lifestyle factors and dementia; it doesn't prove that music can protect you against cognitive decline. The study also doesn't include brain imaging or autopsies, so the precise mechanism -- how engagement in activities would prevent dementia -- is unknown.
The brain's backup
There is other emerging evidence that playing music could help prevent dementia.
Hanna-Pladdy, the Emory neurologist, is interested in exploring the biological underpinnings further. Her theory agrees with Gatz's: Brain networks that have been strengthened by musical engagement compensate to delay the detrimental effects of aging, a process called cognitive reserve.
So far her research has demonstrated that extensive musical instrumental training, even in amateur musicians, provides a cognitive benefit that can last throughout a person's life. Her studies were published in 2011 in the journal Neuropsychology and in 2012 in the journal Frontiers in Human Neuroscience; they included instrumentalists, not singers.
Hanna-Pladdy and her colleagues found in their first study that even if participants did not continue playing music as they aged, they still performed better at tasks of object-naming, visuospatial memory and rapid mental processing and flexibility than those who didn't play at all -- as long as they had played for at least 10 years. That's critical because as they age, people may lose motor skills or eyesight that prevents them from playing their instruments.
The study also suggests the cognitive benefits of instrumental training can last a lifetime.