690020

research-article2017
MSX0010.1177/1029864917690020Musicae ScientiaeBugos and Kochar

Article

Musicae Scientiae

Efficacy of a short-term intense

2017, Vol. 21(2) 137­–150
© The Author(s) 2017
Reprints and permissions:
piano training program for sagepub.co.uk/journalsPermissions.nav
DOI: 10.1177/1029864917690020
https://doi.org/10.1177/1029864917690020
cognitive aging: A pilot study journals.sagepub.com/home/msx

Jennifer Bugos
University of South Florida, USA

Simran Kochar
University of South Florida, USA

Abstract
The purpose of this research was to evaluate the efficacy of a short-term intense piano training program
on executive functions in healthy older adults. Thirty-four adult participants with little to no formal
music training were recruited and completed a battery of standardized cognitive measures at three time
points: pre-training, pre-training two (upon completion of a control time period), and post-training. The
piano training program included 30 hours of focused music theory, finger dexterity exercises, bimanual
coordination exercises, technical exercises, performance duets, and standard piano repertoire. Results of
a Repeated Measures MANOVA show significantly enhanced verbal fluency and processing speed, post-
training; however, no difference was found in verbal memory performance. Data suggest that a short-
term intense piano training program may benefit cognitive performance in areas of verbal fluency and
processing speed. Short-term intense music programs may be an appropriate structure for a cognitive
training program with the added benefit of increased interest in continued music participation.

Keywords
executive functions, music training, piano training, processing speed, verbal fluency

Music training programs have been associated with many cognitive benefits related to verbal
performance. Long-term musical training is associated with enhanced verbal memory perfor-
mance and processing speed in young children and young adults (Bugos & Mazuc, 2013; Bugos
& Mostafa, 2011; Chan, Ho, & Cheung, 1998; Ho, Cheung, & Chan, 2003; Hogan & Huesman,
2008; Moreno et al., 2011). For example, young children with violin or flute training demon-
strated enhanced verbal memory compared to child non-musicians (Ho et al., 2003). In another
study, children with violin training scored higher on measures of verbal memory performance
by employing semantic categorization strategies more frequently than those with no previous
musical training (Bugos & Mazuc, 2013). Findings from studies of young adult musicians

Corresponding author:
Jennifer A. Bugos, University of South Florida, 4202 E. Fowler Ave, MUS 101, Tampa, FL 33620, USA.
Email: bugosj@usf.edu
138 Musicae Scientiae 21(2)

compared to non-musicians echo these results in increased memory for spoken and sung lyrics
(Kilgour, Jakobson, & Cuddy, 2000) and superior recall of immediate and delayed word lists
(Jakobson, Lewycky, Kilgour, & Stoesz, 2008).
These associations between music training and enhanced areas of verbal performance were
found predominantly within focused long-term training studies in younger adult- or child-
based populations with one specific musical instrument. Further experimental research is nec-
essary to examine causal effects of long-term music training. One limitation of long-term
training studies, especially in older adults, is the potential for high levels of attrition due to ill-
ness of participants or family members, a need to return to the workforce, unforeseen travel, or
loss of a family/social networks. Consistent repetition of progressively difficult exercises in a
short-term intense intervention, such as intense piano training, may assist with retention
while reducing the likelihood of attrition. For the purpose of this research, intense music train-
ing refers to long sessions conducted over a short-term time period accompanied by the com-
plexities of learning a new instrument. The purpose of this research is to examine the efficacy
of a short-term intense piano training program on executive functions in verbal fluency, verbal
memory, and processing speed in healthy older adults.
Short-term intense piano training could potentially serve as a progressively difficult multi-
modal cognitive intervention. It promotes active engagement in motor activity with short-term
planning and long-term cognitive strategies that may contribute to maintaining executive
functions. Intense short-term music training requires sustained attention which engages an
executive network that supports generalized cognition and emotional control (Posner & Patoine,
2009). We hypothesize that a short-term intense piano training program will result in transfer
to verbal fluency, verbal memory, and processing speed, as measured by standardized cognitive
measures.

Verbal fluency and cognitive deficits

Deficits in verbal fluency impair life functioning, and may serve as indicators of greater health
issues. Reduced performance in verbal fluency, the ability to produce words under specific time
constraints, is among one of the first symptoms of cognitive decline and may serve as an indica-
tor of neurological disorders such as Mild Cognitive Impairment (MCI) and Alzheimer’s disease
(AD) (Nutter-Upham et al., 2008). Deficits in verbal fluency among the older adult population
are associated with cognitive impairment, communication issues, and lower self-efficacy
(Herbert, Brookes, Markus, & Morris, 2014). Reduced performance on verbal fluency tasks may
be perceptible up to five years prior to a clinical diagnosis of AD (Artero, Tierney, Touchon, &
Ritchie, 2003; Bäckman, Jones, Berger, Laukka, & Small, 2005). It is relevant to note that an
association of verbal fluency with serious general cognitive impairment suggests that there may
be a tight integration between verbal fluency and critically important general cognitive mecha-
nisms. It is a reasonable hypothesis that behaviors which support, maintain, and enhance verbal
fluency will also support, maintain and enhance cognition more generally, and vice-versa.
Verbal fluency tasks measure two dimensions of semantic fluency, the generation of words
with categorical associations, and phonemic fluency, generation of words based upon lexical
processing. Most tasks require measurements taken at various time increments throughout a
trial; thus, there is a reliance on processing speed in most verbal fluency tasks. Verbal fluency
tasks are commonly used to diagnose mild cognitive impairment and Alzheimer’s disease.
While the diagnostic utility of verbal fluency tasks is still debatable, it has been shown that both
types of fluency decline with age though not to the same degree. Unlike semantic fluency, an
Bugos and Kochar 139

association between phonemic fluency and neurological impairment has not been found
(Brickman et  al., 2005). Additional neurological differences between semantic fluency and
phonemic fluency show that inferior and mid-frontal brain regions mediate letter fluency tasks,
whereas category fluency tasks recruit frontal and temporal structures often affected by demen-
tia. Specifically, semantic fluency deficits may predict mild dementia of the Alzheimer’s type
(Murphy, Rich, & Troyer, 2006).
Individuals with AD generate fewer words during semantic fluency tasks compared to pho-
nemic tasks when compared to healthy individuals and those with MCI. The total number of
words generated and the total number of switches on semantic fluency trials may differentiate
those with AD from healthy aging (Haugrud, Crossley, & Vrbancic, 2011). Thus, verbal fluency
performance on many standardized measures may depend upon the ability to switch between
tasks, adding a degree of complexity and reliance upon processing speed. Therefore, interven-
tions that train a broad array of executive functions may produce the most benefits based upon
current standardized measures.
Interventions that target task switching and dual-task performance, common in multimodal
training programs, may provide the most benefit to verbal performance. When behavioral pro-
grams that do not directly train on verbal tasks lead to improved verbal fluency, this is referred
to as far cognitive transfer (Lustig, Shah, Seidler, & Reuter-Lorenz, 2009). Far cognitive transfer
suggests that core cognitive systems have been exercised and enhanced. Sustained participa-
tion in interventions which support core cognitive functions may prevent, or slow the progres-
sion, of cognitive decline.

Multimodal interventions
Multimodal tasks with high levels of task novelty and progressive difficulty demonstrate greater
likelihood of cognitive transfer to untrained tasks (i.e., far transfer) (Lustig et  al., 2009). In
addition to multimodal tasks, recent evidence in the aging literature associates motor-based
tasks with increased cognitive performance (Bernard & Seidler, 2014). One reason for these
associations may be that aging results in decreased grey matter and degradation of white mat-
ter tracts, such as the pontocerebellar tract, potentially reducing connectivity between the cer-
ebellum, an area responsible for fine motor skills, and the frontal cortex. Biological changes
such as these can result in reduced cognition and motor control.
Piano training is one such multimodal task that relies heavily upon auditory processing and
fine motor control. Individual and group piano training programs are associated with enhanced
executive functions including working memory, processing speed, and verbal fluency in older
adults with little to no previous musical training (Bugos, 2010; Bugos, Perlstein, Brophy,
McCrae, & Bedenbaugh, 2007; Seinfeld, Figueroa, Ortiz-Gil, & Sanchez-Vives, 2013). Previous
research shows that long-term group piano training yields an increase in verbal fluency in
adults who receive 16 weeks of training (Bugos, 2010). When training is provided for six
months in an individualized piano training paradigm, enhancements to working memory were
sustained up to three months post-training (Bugos et al., 2007). Since novel music listening
interventions demonstrated increases in verbal fluency, specifically category fluency in healthy
older adults and patients with AD (Thompson, Moulin, Hayre, & Jones, 2005), we predict that
an active short-term music education program such as piano training may enhance verbal flu-
ency, verbal memory, and processing speed performance in healthy aging and may serve as a
model for future arts-based interventions.
140 Musicae Scientiae 21(2)

Table 1.  Mean (± SD) demographic data.

Participants (n = 34)
No. of males/no. of females 6/28
Age (years) 70.79 (6.20)
Education (years) 16.63 (2.36)
FSIQ 113.59 (13.16)
AMMA Tonal 26.88 (3.80)
AMMA Rhythm 24.21 (4.33)

Note. AMMA = Advanced Measures of Music Audiation; FSIQ = Full Scale Intelligence.

Method
This research focused upon programmatic assessment with a within-subjects design in which
participants served as their own controls. We chose this design as it is relatively powerful when
examining differences between time intervals in a group of older adults of differing ages (i.e.,
less threat to internal validity compared to random assignment) (Charness, Gneezy, & Kuhn,
2012). We used different forms of all measures at each assessment time point: pre-training,
upon completion of a two-week control time period, and post-training. While causality was not
the underlying question of this research study, it should be noted that within-subjects designs
do not allow for the assessment of causality.

Participants
Forty-two participants from a large metropolitan city were recruited through community adver-
tisements, social media, and large churches with extensive community outreach. Thirty-four
participants (6 male, 28 female; Mage = 70.79; SD = 6.20) completed the study (see Table 1).
Mean education level was 16.63; SD = 2.36 years with a mean age-adjusted intelligence score of
113.59; SD = 13.16 based upon WASI scores. Criteria for enrollment included participants aged
60–85 years; fluent English speakers; less than three years of formal music training; not cur-
rently reading music or engaging in musical activities; having no history of manual motor dif-
ficulties or neurological deficits; no learning, speech, or language disabilities; and typical hearing
as scaled by age. Screening for research participation included a short telephone interview to
ensure normal cognitive function using the Telephone Interview for Cognitive Status (TICS) (Brandt,
Spencer, & Folstein, 1988). A minimum score of 30 on the TICS was required for research par-
ticipation. Two participants failed screening and were ineligible to enroll in the study with TICS
scores <30. A short questionnaire excluded individuals who reported taking psycho-reactive
medications or a history of neurological conditions such as strokes or seizures. Informed written
consent was obtained from all participants in accordance with the policies and procedures of the
University Institutional Review Board.

Measures
Evaluation of music aptitude included baseline administration of the Advanced Measures of
Music Audiation (AMMA; Gordon, 1989). AMMA was chosen for its reliability and its usage
in adults with no previous musical training. The measure consists of 30 paired piano melodies
in which listeners distinguished via written response whether the two melodic phrases are
Bugos and Kochar 141

precisely the same, tonally altered, or rhythmically altered. Research suggests that music
aptitude stabilizes at age 10 and could affect music learning outcomes, thus we administered
this measure at baseline to evaluate potential relationships between music aptitude and scores
on dependent measures (Gordon, 1989).
Participants completed a brief measure of estimated full-scale intelligence, the two-subtest
form of the Wechsler Abbreviated Scale of Intelligence (WASI; Wechsler, 1999), which includes
the Vocabulary and Matrix Reasoning subtests. WASI scores correspond to longer standardized
intelligence measures such as the Wechsler Adult Intelligence Scale III (WAIS-III; Wechsler, 1997)
and provide norms for a broad age range (6–89 years). The 42-item Vocabulary subtest meas-
ures expressive verbal knowledge with aurally and visually presented words. Oral responses
were recorded and scored based upon content. The Matrix Reasoning subtest is a measure of
non-verbal reasoning with 35 gridded incomplete patterned items. Participants responded to
each pattern by selecting the appropriate missing grid shape to complete the pattern.

Primary outcomes
Processing speed was measured with the Coding and Symbol Search subtests, part of the Wechsler
Adult Intelligence Scale-Fourth edition (WAIS-IV; Wechsler, 2008). The WAIS-IV, chosen for its
brevity and strong psychometric properties, is a highly reliable instrument for usage in adults
(55–90 years). Reliability coefficient ranges for adults include: Coding (r = .86–.89) and Symbol
Search (r = .81–.86). These subtests allow for the computation of Processing Speed Index scores.
The Coding subtest, a visual-scan paper/pencil timed measure, consists of a key of nine symbols
each corresponding to one of nine independent digits. Participants utilized the key to sequen-
tially complete a series of digits with appropriate corresponding symbols within 120 seconds.
The Symbol Search subtest measures processing speed and cognitive flexibility by requiring par-
ticipants to scan and compare two target symbols on the left side of the page with five symbols
on the right. Participants checked a box marked “yes” if either of two symbols on the left
matched any of the symbols on the right. If neither of the two target symbols on the left
matched any symbols on the right, participants checked the box marked “no”. Participants had
60 possible items to complete within 120 seconds.
The Delis-Kaplan Executive Function System Verbal Fluency subtest (D-KEFS; Delis, Kaplan, &
Kramer, 2001) assesses word generation with a series of 60-second trials in letter fluency, cat-
egory fluency, and category switching. The D-KEFS Verbal Fluency subtest was chosen for its
scaled-scores utility in individuals across a broad age range and inclusion of scaled-scores.
Reliability coefficients calculated for the D-KEFS Verbal Fluency subtest are letter fluency (.88),
category fluency (.82), and category switching (.51) (Delis et al., 2001). In the letter fluency
trials, words could not consist of names of people, places, or numbers. In the category trials,
generated words belonged to a specific category (i.e., girl’s names). In the category switching
trials, generated words must alternate between two pre-established categories (i.e., fruit and
furniture) and overall switching scores were obtained. Research suggests that switching scores
are a measure of executive function and may be implicated with music training (Moradzadeh,
Blumenthal, & Wiseheart, 2015).
The Rey Auditory Verbal Learning Test (RAVLT; Rey, 1941) was used to evaluate verbal memory
through the auditory presentation and verbal recall of 15 words over five learning trials (List A),
distraction list (List B), immediate short-delay free recall, long-delay free recall, and recognition
trials. RAVLT is one of the most commonly used measures of verbal memory performance given
its utility in healthy and clinical populations. The range of reliability coefficients in a healthy
142 Musicae Scientiae 21(2)

Figure 1.  Overall study design with three testing time points.

adult population is (r = .61–.86) for Trials 1–5 and (r = .51–.72) for delayed recall and recogni-
tion trials (Delaney, Prevey, Cramer, & Mattson, 1992).

Procedure
The study used a within-subjects design to evaluate the effects of a short-term intense piano
training program. Baseline assessments included measures of music aptitude and intelligence.
Potential differences in baseline measures were used as co-variates. Participants completed
dependent measures of verbal memory, verbal fluency, and processing speed at three time
points: an initial pre-training session (T1), a second pre-training session (T2, subsequent to a
two-week control time period), and a post-training session (T3) (see Figure 1). A two-week time
interval was maintained between testing visits. When possible, alternative forms of the meas-
ures administered were used on each of the dependent measures to control for potential prac-
tice effects.

Short-term intense group piano training

The short-term intense piano training program included three hours of concentrated group
practice and learning in a university Yamaha Clavinova piano lab. The program comprised of
music theory, finger dexterity exercises, bimanual coordination exercises, technical exercises,
performance duets, and standard piano repertoire, taught by an accomplished pianist with a
Ph.D. in Music Education. Each session included an initial 15–minute review of the previous
lesson followed by the introduction of new music theory concepts, technical exercises, and
accompanying piano repertoire. While participation did not require outside music practice,
daily written music theory assignments reinforced knowledge acquisition outside of each class
session.
Bimanual performance of standard piano repertoire was required; however, isolating parts
for independent hands assisted with manageability for beginning level pianists. When requested
to perform isolated parts, participants were encouraged to partner and perform standard pieces
in a duet fashion (i.e., hands separate for two players taking turns) prior to the required solo
performance that included performing hands together. Performing pieces with partners assisted
with increasing musical learning by isolating learning challenges, enhancing rhythmic accu-
racy, and establishing social cohesion. Additionally, participants were independently required
to demonstrate a piano performance with less than three errors for each piece of the Alfred
Adult All-in-One Course (Palmer, Manus, & Lethco, 1995). Each session concluded with oppor-
tunities to demonstrate musical achievement in individual performances. Participants were
instructed not to practice outside of the intervention. As part of this accelerated program, most
participants completed level one in two weeks, which normally requires most beginning pia-
nists up to six months. Previous research employing this paradigm suggests that an accelerated
Bugos and Kochar 143

learning environment can expedite learning without increasing stress levels (Bugos, Maxfield,
& Kochar, 2015).

Statistical analysis
Scores from each of three cognitive domain indices: verbal fluency, verbal memory, and pro-
cessing speed, were included in a Repeated Measures MANOVA with time at three levels (Pre-
Testing 1, Pre-Testing 2, and Post-Testing) as a within-subjects variable. Original F-values are
reported along with Greenhouse-Geisser corrected p-values when the sphericity assumption
was violated. The alpha level was set at .05 for all statistical measures. Statistically significant
ANOVAs were followed-up with Bonferroni-corrected pairwise comparisons. Cohen’s d effect
sizes were calculated based upon pre-training data and post-training data (Cohen, 1988).

Results
Thirty-four participants completed the study. Attrition was due to death in the family, family
commitments, sudden illness, and a need to return to the workforce. A correlation was con-
ducted to evaluate the potential influence of music aptitude (AMMA scores) and education
levels on cognitive variables, revealing no significant influence of either variable on verbal flu-
ency, verbal memory, or processing speed.

Verbal fluency
Analysis of the D-KEFS Verbal Fluency subtest data with age-adjusted scaled scores for total
words generated on each of the three types of tasks: letter fluency, category fluency, and cate-
gory switching, indicate enhanced performance post-training. Results of a Repeated Measures
ANOVA Time (all three time points: Pre-testing 1; Pre-testing 2, Post-testing) × Measures
(Verbal Fluency (D-KEFS) × Verbal Memory (RAVLT) × Processing Speed Indices) with
Bonferroni post-hoc analysis show significantly (p > .05) enhanced verbal fluency scores in let-
ter fluency, F(2, 66) = 22.88, p = .001, d = .52; category fluency, F(2, 66) = 10.24, p = .001,
d = .49; and category switching, F(2, 66) = 10.78, p = .001, d = .70 (Figure 2). Pairwise com-
parisons reveal significant increases between pre-testing 1 and post-testing time points (letter
fluency, p = .01; category fluency, p = .001) as well as between pre-testing 2 and post-testing
(letter fluency, p = .01; category fluency, p = .02, category switching, p = .001). No significant
difference (p > .05) was found between pre-testing 1 and pre-testing 2 for all verbal fluency
conditions.
Since we found significant differences in the total number of words generated between pre-
testing 2 and post-testing time points, we were interested in evaluating specifically when these
differences occurred during each 60-second trial for each fluency type: letter, category, and cat-
egory switching. The D-KEFS Verbal Fluency subtest measures the number of words generated
during each of four 15-second intervals. We conducted a Repeated Measures ANOVA on letter
fluency pre-testing 1, pre-testing 2, and post-testing scores during the first interval (1–15 sec-
onds), second interval (16–30 seconds), third-interval (31–45 seconds), and fourth interval
(46–60 seconds) with Bonferroni post-hoc analysis. Results show significantly (p > .05)
increased word generation for letter fluency during the first interval (1–15 seconds), F(2, 66) =
29.18, p = .001, d = .70; second 15-second interval (16–30 seconds), F(2, 66) = 6.59, p = .002,
d = .33; and third interval (31–45 seconds), F(2, 66) = 5.60, p = .007, d = .49 (see Table 2).
These differences were significantly different between pre-testing 2 and post-testing time points
144 Musicae Scientiae 21(2)

Figure 2.  Results of D-KEFS by Trial Type.

for the first and third 15-second intervals of the task. During the second interval, differences
were only found between pre-testing 1 and post-testing time points. No significant difference was
found between pre-testing and post-testing time points for word generation during the fourth
interval (46–60 seconds) of letter fluency trials, F(2, 66) = 1.38, p = .26.
Bugos and Kochar 145

Table 2.  Mean and standard deviations by intervals for verbal fluency trials.

Fluency type and interval Pre-testing 1 Pre-testing 2 Post-testing 3

Letter: 1st interval (1–15 s)* 14.67 (3.80) 15.97 (3.34) 19.03 (5.20)
Letter: 2nd interval (16–30 s)* 9.44 (3.61) 10.32 (3.44) 11.44 (3.30)
Letter: 3rd interval (31–45 s)* 8.53 (2.93) 7.56 (2.89) 9.27 (3.99)
Letter: 4th interval (46–60 s) 7.29 (2.95) 6.88 (3.41) 7.85 (4.27)
Category: 1st interval (1–15 s)* 14.27 (2.14) 14.24 (3.02) 16.74 (3.05)
Category: 2nd interval (16–30 s) 9.71 (3.31) 10.18 (2.77) 10.82 (3.20)
Category: 3rd interval (31–45 s) 7.15 (2.89) 7.71 (2.41) 8.21 (3.14)
Category: 4th interval (46–60 s) 6.21 (3.19) 6.82 (2.75) 7.71 (3.87)
Category Switching: 1st interval (1–15 s)* 6.09 (1.44) 5.12 (1.45) 6.68 (1.19)
Category Switching: 2nd interval (16–30 s) 3.21 (1.15) 3.12 (1.29) 3.29 (1.24)
Category Switching: 3rd interval (31–45 s) 2.47 (1.19) 2.79 (1.01) 2.68 (1.47)
Category Switching: 4th interval (46–60 s)* 2.18 (1.11) 1.91 (1.22) 2.77 (1.58)

Note. *Denotes significant time interaction.

Results of a Repeated Measures ANOVA with Bonferroni post-hoc analysis on category flu-
ency intervals shows significant enhancement in word generation during the first interval (1–
15 seconds) only, F(2, 66) = 15.04, p = .001, d = .82. Pairwise comparisons reveal differences
between pre-testing 1 and post-testing, and pre-testing 2 and post-testing. No difference was
found between pre-testing 1 and pre-testing 2 time points for category fluency suggesting that
this difference may be due to training. No differences were found in category fluency on the
second interval (16–30 seconds), F(2, 66) = 2.67, p = .08; third interval (31–45 seconds), F(2,
66) = 1.96, p =.15, or fourth interval (46–60 seconds), F(2, 66) = 2.78, p = .08.
The last portion of the D-KEFS Verbal Fluency subtest contains the category switching flu-
ency trials. The same analysis was conducted on these trials. Significant time interactions were
found on the first interval (15–30 seconds), F(2, 66) = 19.53, p = .001, d = 1.18, and the
fourth interval (46–60 seconds), F(2, 66) = 3.88, p = .027, d = .61. Pairwise comparisons
revealed that these differences only occur between pre-testing and post-testing time points. No
interactions were found between pre-testing 1 and pre-testing 2 time points suggesting the
influence of training. In addition, we found no differences in category switching across time for
the second interval (16–30 seconds), F(2, 66) = .27, p = .76, and third interval (31–45 sec-
onds), F(2, 66) = .72, p = .49.

Verbal memory
Verbal memory was measured in performance on the RAVLT Trials 1–5 (learning trials), Trial
B (distraction list), short-delay free recall, and long-delay free recall (Table 3). Results of the
Repeated Measures ANOVA with Bonferroni post-hoc analysis on Trials 1–5 indicate no signifi-
cant difference across time points, F(2, 66) = 5.01, p = .01. No differences were found in perfor-
mance on short- and long-delay free recall trials or Trial B indicating a lack of transfer to verbal
memory performance.

Processing speed
Over each time point, processing speed increased. A Repeated Measures ANOVA with Bonferroni
post-hoc analysis on processing speed scores showed significant (p > .05) enhancements
146 Musicae Scientiae 21(2)

Table 3.  Mean (±) SD cognitive assessment.

Measures T1 T2 T3
D-KEFS letter fluency 11.49 (3.14) 11.79 (3.12) 13.58 (3.79)
D-KEFS category fluency 11.52 (3.41) 12.36 (2.69) 13.94 (3.70)
D-KEFS category switching 12.33 (3.21) 11.21 (3.86) 13. 79 (3.51)
D-KEFS switching scores 12.79 (2.47) 12.09 (2.68) 13.62 (3.10)
RAVLT Trials 1–5 43.09 (7.99) 45. 85 (6.99) 46.85 (8.83)
RAVLT Trial B 5.21 (1.36) 4.76 (1.60) 5.70 (1.45)
RAVLT short-delay free recall 8.94 (2.51) 9.21 (2.51) 9.61 (3.42)
RAVLT long-delay free recall 8.36 (2.75) 8.46 (2.96) 8.79 (3.43)
WAIS-IV coding 63.41 (14.11) 65.79 (12.08) 71.65 (14.13)
WAIS-IV symbol search 28.65 (5.35) 28.91 (6.80) 31.32 (6.40)
Processing speed index scores 92.61 (18.12) 96.06 (17.59) 103.00 (19.24)

Note. D-KEFS: Delis-Kaplan Executive Function Measure Verbal Fluency Scaled Scores; RAVLT: Rey Auditory Verbal
Learning Test; WAIS-IV: Wechsler Adult Intelligence Scale-IV.

post-training, F(2, 66) = 24.70, p = .001, d = .45 (see Table 3). Pairwise comparisons reveal
significant increases between pre-testing 1 and post-testing time points (p = .01) as well as
between pre-testing 2 and post-testing time points (p = .04). No significant differences were
found between pre-testing 1 and pre-testing 2 (p > .05) time points. Since Coding and Symbol
Search subtests were the only measures that did not contain alternate forms, we examined data
for potential practice effects. Literature suggests that practice effects on the WAIS can range
from 3.2–5.6 points (Estevis, Basso, & Combs, 2012). Data from this study show increases post-
training beyond those of a practice effect.

Discussion
The primary aim of this study was to investigate the efficacy of an intense piano training pro-
gram on verbal fluency, verbal memory, and processing speed in a diverse group of older adult
novice musicians. As hypothesized, our results indicate enhanced verbal fluency and process-
ing speed post-training. Intense short-term piano training represents a novel intervention that
may contribute to improvements in verbal fluency and processing speed in only 30 hours of
contact time, with no outside practice. Future research is necessary to examine causality with
a true experimental design. This study served as the first step in determining the efficacy of the
program. These results were similar to our previous work in individualized piano training
which resulted in increases in processing speed and working memory. In the individualized
piano training program, participants had a similar number of instructional hours provided as
individual lessons, along with extensive required practice over a longer intervention duration
of six months. Intense short-term piano training represents a more efficient training program
in the facilitation of a group-based intervention with an added social component.
Although no recital requirement was included as part of this research, participants per-
formed daily for other program participants allowing for positive feedback opportunities from
colleagues in addition to instructor feedback. Social components such as this contribute to the
facilitation of self-efficacy and contribute to cognitive performance in aging adults. It is possible
that the social components contributed to the overall increases in cognitive performance found
in this research.
Bugos and Kochar 147

Despite connections between music and language, verbal fluency, an area of executive func-
tions, is rarely a construct examined in the context of music training studies. Only two previous
studies, both long-term piano training studies, show effects of training on verbal fluency in
older adults (Bugos, 2010; Seinfeld et al., 2013). While verbal fluency and processing speed
were measured independently, previous literature shows that processing speed strongly con-
tributes to performance on letter and category fluency (Stolwyk, Bannirchelvam, Kraan, &
Simpson, 2015). Stolwyk et al. (2015) indicate that adults over age 60 recruit additional cogni-
tive resources such as inhibition to complete fluency tasks. Therefore, it is unclear if piano
training contributed to increases in verbal fluency and processing speed alone or if additional
areas of executive functions were recruited to maintain task performance on the D-KEFS Verbal
Fluency subtest. Further research is necessary to isolate the constructs that support verbal
fluency in aging and the extent to which short-term multimodal cognitive interventions, such
as piano training, can influence independent areas of executive functioning.
Age-related decreases in verbal memory performance are mediated by working memory and
indirectly associated with processing speed and inhibition (Van der Linden et al., 1999). While
we initially hypothesized enhanced verbal memory performance resulting from intense short-
term piano training, we did not observe any change in verbal memory post-training. Long-term
training may be necessary to demonstrate such enhancements on verbal memory tasks due to
consolidation requirements. Previous studies that demonstrate associations between verbal
memory performance and musical training include participants with four or more years of
training (Bugos & Mazuc, 2013: Hogan & Huesman, 2008). Further research is necessary to
evaluate the extent of training necessary to foster increases in verbal memory in novice
musicians.

Limitations and potential explanations

To our knowledge this research is the first to examine the capacity for enhanced cognitive per-
formance following a short-term intense piano intervention in novice older adults. While this
study contained a relatively small size within-subjects design, a randomized trial is needed to
demonstrate generalizable statistical results. Participants included fairly intelligent individuals,
predominately women. Although a larger sample of women is more common in aging research
due to gender differences in life expectancies (West, Cole, Goodkind, & He, 2010), additional
research is necessary to evaluate the efficacy of an intense music program in males. Future
research with a larger, more diverse pool is necessary to evaluate the impact of a short-term
intense intervention on cognitive outcomes sustainability related to such an intervention.
Cognitive interventions that include high degrees of novelty with progressive difficulty
require that participants develop domain-specific self-efficacy. Development of self-efficacy in an
intervention contributes to continued task engagement. Learning a complex skill, such as play-
ing a musical instrument, in a short intense fashion is similar to a military boot camp. Once the
boot camp is complete, military personnel come back for booster training. The intense boot camp
prepares individuals in a particular domain and provides self-efficacy to transfer to similar tasks.
Intense piano training offered a paradigm that inspired many participants to continue music
training upon study completion, providing an ecologically valid task-continued enrichment.
While a four-month intervention can increase verbal fluency, the intense short-term pro-
gram shows a larger magnitude of an effect on cognitive performance (Bugos, 2010). We
attribute the benefits in this present study to sustained intensity. Intensity is utilized in other
cognitive interventions (i.e., sports and fitness intervallic training); however, intervallic train-
ing refers to intervals of intense physical exertion followed by less strenuous periods. In this
148 Musicae Scientiae 21(2)

training study, intensity was maintained for a short time period lasting 10 days. Nevertheless,
cognitive training intensity is a common element associated positively with gains in perfor-
mance. For instance, moderate to high levels of aerobic physical activity are associated with
reductions in functional impairment and disability in aging (see Lautenschlager, Cox, & Cyarto,
2012). Applications of intense training paradigms may prove useful in the development of
effective cognitive interventions.
While this study did not employ a randomly assigned control group, the study design was
respectful of older adult research participants by allowing all participants to enroll in a desired
training program. By testing participants twice before training began, we demonstrated the sta-
bility of the measures over time, and controlled for the effects of practice on the measures. By
comparing the scores of the same individuals before and after training, and using their own
scores in two pre-training test sessions as a control, participants served as their own control
subjects, perfectly matched for age, sex, education, IQ, socioeconomic status, and all other medi-
cal, cognitive, and lifestyle variables not related to our central research question. This design
reduces the spurious variability intrinsic to studies with large numbers of people who have expe-
rienced the accumulated effects of many life choices, and addresses the research question.
Individuals who participated in the piano program experienced a positive change compared
to when the same individuals did not participate in the program. The within-subjects design
respects the wishes of participants to use their remaining time in life in a way that furthers their
own interests, rather than being assigned to participate in a program which they do not enjoy,
and would not be willing to complete. By respecting the independence of our participants up
front, we avoided the biases intrinsic to attrition in randomly assigned controlled trials which
often contribute to limited external validity

Implications
An intense music training program for individuals with mild cognitive impairment may have
the potential to assist verbal fluency particularly in category fluency and switching tasks.
The focused attention and shifting between coordinated motor tasks in music training may
contribute to executive functions responsible for instrumental activities of daily living (IADLs)
(i.e., housework, meal planning, and adherence to medications as prescribed). While future
experimental research is necessary to determine if an intense music training program can
mitigate deficits in verbal fluency or enhance verbal fluency in those with MCI, there is some
evidence to suggest that intense music programs can foster musical self-efficacy leading to
continued participation and/or an interest enrollment in additional music programs (Bugos
et al., 2015).
There are many additional benefits associated with an intense music training program.
Novel short-term intense music programs encourage the development of new social networks.
Individuals in an intense music program share common learning challenges (i.e., bimanual
coordination) and strategies to overcome such challenges. Many older adults with no previous
music training do not realize the challenges encountered in learning an instrument, nor strate-
gies to practice effectively.
Additional logistical benefits include flexible scheduling for older adults with extensive plans
for retirement (e.g., travel, caregiving, or volunteering). Programming short-term intense
music training programs may be more feasible than long-term training for assisted living cent-
ers and senior residence facilities. Opportunities for the inclusion of short-term intense music
programs could positively impact arts-based interventions for aging adults.
Bugos and Kochar 149

Acknowledgements
We would like to thank the University of South Florida College of The Arts (CoTA) Summer Research
Grant for their support. We would also like to thank Nathan Maxfield for his advice and suggestions, and
Shannon Casey, Vandana Persad, and Erik Teal for testing assistance.

Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-
profit sectors.

References
Artero, S., Tierney, M.C., Touchon, J., & Ritchie, K. (2003). Prediction of transition from cognitive impair-
ment to senile dementia: A prospective, longitudinal study. Acta Psychiatrica Scandinavica, 107(5),
390–393.
Bäckman, L., Jones, S., Berger, A. K., Laukka, E. J., & Small, B. J. (2005). Cognitive impairment in preclini-
cal Alzheimer’s disease: A meta-analysis. Neuropsychology, 19(4), 520–531.
Bernard, J. A., & Seidler, R. D. (2014). Moving forward: Age effects on the cerebellum underlie cognitive
and motor declines. Neuroscience and Biobehavioral Reviews, 42, 193–207.
Brandt, J., Spencer, M., & Folstein, M. (1988). The Telephone Interview for Cognitive Status (TICS).
Neuropsychiatry, Neuropsychology, & Behavioral Neurology, 1, 111–117.
Brickman, A. M., Paul, R. H., Cohen, R. A., Williams, L. M., MacGregor, K. L., Jefferson, A. L., … Gordon,
E. (2005). Category and letter fluency across the adult lifespan: Relationship to EEG theta power.
Archives of Clinical Neuropsychology, 20, 561–573.
Bugos, J. A. (2010). The benefits of music instruction on processing speed, verbal fluency, and cognitive
control in aging. Music Education Research International, 4, 1–9.
Bugos, J. A., Maxfield, N., & Kochar, S. (2015). Intense piano training on self-efficacy and physiological
stress in aging, Psychology of Music, 44(4), 611–624.
Bugos, J. A., & Mazuc, J. (2013). Semantic clustering and processing speed in Suzuki violinists. Bulletin of
the Council for Research in Music Education, 198, 7–21.
Bugos, J. A., & Mostafa, W. (2011). Musical training enhances information processing speed. Bulletin of
the Council for Research in Music Education, 187, 7–18.
Bugos, J. A., Perlstein, W. M., Brophy, T. S., McCrae, C. S., & Bedenbaugh, P. H. (2007). Individualized
piano instruction enhances executive functions and working memory in older adults. Aging and
Mental Health, 11(4), 464–471.
Chan, A. S., Ho, Y. C., & Cheung, M. C. (1998). Music training improves verbal memory. Nature, 396, 128.
Charness, G., Gneezy, U., & Kuhn, M. A. (2012). Experimental methods: Between-subject and within-
subject design. Journal of Economic Behavior and Organization, 81(1), 1–8.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
Delaney, R. C., Prevey, M. L., Cramer, J., & Mattson, R. H. (1992). Test-retest comparability and control
subject data for the Rey-Auditory Verbal Learning Test and Rey-Osterrieth/Taylor Complex Figures.
Archives of Clincal Neuropsychology, 7(6), 523–528.
Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis Kaplan Executive Function System. San Antonio: TX:
The Psychological Corporation.
Estevis, E., Basso, M. R., & Combs, D. (2012) Effects of practice on the Wechsler Adult Intelligence Scale-IV
across 3- and 6-month intervals. The Clinical Neuropsychologist, 26(2), 239–254.
Gordon, E. E. (1989). Manual for the Advanced Measures of Music Audiation. Chicago: GIA.
Haugrud, N., Crossley, M., & Vrbancic, M. (2011). Clustering and switching strategies during verbal flu-
ency performance differentiate Alzheimer’s disease and healthy aging. Journal of the International
Neuropsychological Society, 17, 11153–1175.
Herbert, V., Brookes, R. L., Markus, H. S., & Morris, R. G. (2014). Verbal fluency in cerebral small vessel
disease and Alzheimer’s disease. Journal of the International Neuropsychological Society, 20, 413–420.
150 Musicae Scientiae 21(2)

Ho, Y. C., Cheung, M. C., & Chan, A. S. (2003). Music training improves verbal but not visual memory:
Cross-sectional and longitudinal explorations in children. Neuropsychology, 17, 439–450.
Hogan, D. E., & Huesman, T. (2008). Music training and semantic clustering in college students. The
Journal of Genetic Psychology, 169(4), 322–331.
Jakobson, L., Lewycky, S. T., Kilgour, A. R., & Stoesz, B. (2008). Memory for verbal and visual material in
highly trained musicians. Music Perception, 26(1), 41–55.
Kilgour, A. R., Jakobson, L., & Cuddy, L. (2000). Music training and rate of presentation as mediators of
text and song recall. Memory & Cognition, 28(5), 700–710.
Lautenschlager, N., Cox, K., & Cyarto, E. V. (2012). The influence of exercise on brain aging and demen-
tia. Biochimica et Biophysica Acta, 1822, 474–481.
Lustig, C., Shah, P., Seidler, R., & Reuter-Lorenz, P.A. (2009). Aging, training, and the brain: A review
and future directions. Neuropsychology Review, 19(4), 504–522.
Moradzadeh, L., Blumenthal, G., & Wiseheart, M. (2015). Musical training, bilingualism, and executive
function: A closer look at task switching and dual-task performance. Cognitive Science, 39(5), 992–
1020.
Moreno, S., Bialystok, E., Barac, R., Schellenberg, E. G., Cepeda, N. J., & Chau, T. (2011). Short-term
music training enhances verbal intelligence and executive function. Psychological Science, 22(11),
1425–1433.
Murphy, K., Rich, J. B., & Troyer, A. K. (2006). Verbal fluency patterns in amnestic mild cognitive impair-
ment are characteristic of Alzheimer’s type dementia. Journal of International Neuropsychological
Society, 12(4), 570–574.
Nutter-Upham, K. E., Saykin, A. J., Rabin, L. A., Roth, R. M., Wishart, H. A., Pare, N., & Flashman, L. A.
(2008). Verbal fluency performance in amnestic MCI and older adults with cognitive complaints.
Archives of Clinical Neurology, 23(3), 229–241.
Palmer, W. A., Manus, M., & Lethco, A. V. (1995). Adult all-in-one course: Alfred’s basic adult piano course
level 1. Van Nuys, CA: Alfred.
Posner, M. I., & Patoine, B. (2009). How arts training improves attention and cognition. Dana Foundation
Cerebrum. Retrieved from http://www.dana.org/Cerebrum/2009/How_Arts_Training_Improves_
Attention_and_Cognition/
Rey, A. (1941). L’examen psychologique dans les cas d’encéphalopathie traumatique [The psychological
examination in cases of traumatic encephalopathy]. Archives de Psychologie, 28, 215–285.
Seinfeld, S., Figueroa, H., Ortiz-Gil, J., & Sanchez-Vives, M. V. (2013). Effects of music learning and piano
practice on cognitive function, mood, and quality of life in older adults. Frontiers in Psychology,
4(810).
Stolwyk, R., Bannirchelvam, B., Kraan, C., & Simpson, K. (2015). The cognitive abilities associated with
verbal fluency task performance differ across fluency variants and age groups in healthy young and
old adults. Journal of Clinical and Experimental Neuropsychology, 37(1), 70–83.
Thompson, R. G., Moulin, C. J. A., Hayre, S., & Jones, R. W. (2005). Music enhances category fluency in
healthy older adults and Alzheimer’s disease patients. Experimental Aging Research, 31(1), 91–99.
Van der Linden, M., Hupet, M., Feyereisen, P., Schelstraete, M., Bestgen, Y., & Bruyer, R., … Seron, X.
(1999). Cognitive mediators of age-related differences in language comprehensivion and verbal
memory performance. Aging, Neuropsychology, and Cognition, 6(1), 32–55.
Wechsler, D. (1997). Wechsler Adult Intelligence Scale III. San Antonio, TX: The Psychological Corporation.
Wechsler, D. (1999). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: The Psychological
Corporation.
Wechsler, D. (2008). Wechsler Adult Intelligence Scale IV. San Antonio, TX: The Psychological Corporation.
West, L. A., Cole, S., Goodkind, D., & He, W. (2010). 65+ in the United States: 2010. Retrieved from https://
www.census.gov/content/dam/Census/library/publications/2014/demo/p23-212.pdf