Background: Executive functions are a key target of cognitive interventions for older adults due to their central role in daily functioning and maintaining a good quality of life. Piano training has been proposed as an ecologically valid method of improving cognition and brain structure in older adults. The primary aims of this study were to (i) evaluate the feasibility and acceptability of Piano Instruction for Adult Novices as an Online Cognitive Intervention (PIANO-Cog), a novel bespoke 8-week self-guided piano training programme for adults over 50 years of age, and (ii) assess the feasibility of conducting a fully-powered randomised controlled trial (RCT), including recruitment, retention, and adherence. Secondary aims explored effects of PIANO-Cog on executive functions and brain microstructure using advanced diffusion-weighted imaging (DWI). Method: Thirty-three healthy music novices aged 51-80 years (M = 63.73, SD = 7.94) participated in a two-arm unblinded feasibility RCT. Participants were assigned by stratified allocation for age and sex to either (i) 8 weeks of PIANO-Cog, requiring 30 minutes of practice, 5 days per week, or (ii) a passive control group. Cognitive assessment and MRI scanning were conducted before and after the intervention using a strong-gradient (300mT/m) 3T Connectom scanner to acquire multi-shell DWI data with b-values ranging from 200 to 6,000 s/mm2. Grey and white matter microstructure were modelled with Soma And Neurite Density Imaging (SANDI) and Neurite Orientation Density and Dispersion Imaging (NODDI). Results: According to predefined criteria, feasibility was established for recruitment (91.6%), retention (75%) and adherence (>100%) rates. Preliminary observations suggest that piano training compared with control was associated with improvements in verbal fluency and multiple changes in brain microstructure including increases in apparent soma size and radius and reductions in extracellular signal in frontal and temporal cortical regions, larger apparent neurite density in right inferior frontal gyrus and changes in neurite dispersion in left middle temporal and right precentral gyri. Discussion: The results demonstrate that short-term remote piano training is a feasible cognitive intervention for healthy adults over 50. Preliminary evidence suggest that PIANO-Cog was associated cognitive improvements and changes in brain microstructure in executive, auditory and motor regions.
