Cognition is the intricate process involving the acquisition, encoding, manipulation, extraction, and utilization of sensory input information by individuals. It constitutes a mental process situated between input and output. Cognitive impairment arises when various factors lead to the impairment of memory, attention, language, and executive function, thereby affecting an individual’s capacity to engage in daily or social activities (Woodford and George, 2007). Cognitive impairment is particularly prevalent among older people and is closely associated with the aging process. Epidemiological studies have disclosed that the prevalence of mild cognitive impairment (MCI) is 15.4% in individuals aged 55 years and above in China (Deng et al., 2021), 27.3% in those aged 65 years and above in the United States (Rajan et al., 2021), and 15.56% in those aged 50 years and above globally. Notably, the incidence of MCI tends to rise with advancing age (Bai et al., 2022). Simultaneously, cognitive impairment is often concurrent with certain diseases. In Parkinson’s disease (PD) patients, cognitive impairment is a common cognitive state, with a prevalence of MCI at 40% (Baiano et al., 2020). Post-stroke cognitive impairment (PSCI) emerges as a prevalent functional impairment following a stroke, reaching an incidence rate of up to 80.97% (Qu et al., 2015). This not only impacts the functional recovery of patients and extends the disease course but also elevates the recurrence and mortality rates of stroke (Oksala et al., 2009; Kwon et al., 2020; Kwan et al., 2021). It is estimated that over the next 50 years, the number of older people in the world will increase by 21%, and the elderly population in developing and developed countries will increase by 140 and 51%, respectively (Eshkoor et al., 2015). As population aging intensifies, MCI will become a major threat to the health of the elderly. In addition, a meta-analysis of 41 cohort studies found that the cumulative proportion of MCI cases progressing to dementia was 39.2 percent (Mitchell and Shiri-Feshki, 2009), and treatment of MCI was seen as a potential intervention to slow the progression of dementia (Anderson, 2019). Consequently, the restoration of cognitive function has become a focal point for researchers worldwide. Neurologic music therapy (NMT) (Impellizzeri et al., 2020), exercise therapy (Swatridge et al., 2017), and virtual reality (Liao et al., 2020) have been implemented in clinical practice to train cognitive function, demonstrating promising efficacy.

NMT, a novel music therapy technique rooted in neurology (de L’Etoile Shannon, 2016), targets cognitive, sensory, and motor dysfunction resulting from neurological disorders in humans. It finds applications in neurological rehabilitation, neuropediatric therapy, neurogeriatric therapy, and neurodevelopmental therapy (Galińska, 2015). A specific therapeutic technique within NMT, rhythmic auditory stimulation (RAS), enhances cognitive function by engaging the basal ganglia-thalamic-cortical network (Kotz et al., 2009; Schwartze et al., 2011) and the cerebellar- thalamus- cortical circuit (Coull et al., 2011; Kotz and Schmidt-Kassow, 2015) through rhythmic and repetitive auditory stimulation. RASMT involves subjects following rhythmic auditory cues (such as music or a metronome) and executing rhythmic movements (e.g., playing percussion, piano, clapping, walking) involving the upper limbs, lower limbs, and trunk. This method concurrently conveys visual, auditory, and motoric information to a specialized brain network comprising fronto-temporo-parietal regions, components of the putative human mirror neuron system. This network, among its various functions, likely facilitates the coupling between perceptual events (visual or auditory) and motor actions (leg, arm/hand, or vocal/articulatory actions), integrating cognition and perception to enhance cognitive function (Schlaug et al., 2010). Research indicates that movement training with musical rhythm can stimulate the prefrontal cortex and enhance overall cognitive status in healthy older people with MCI compared to movement training without musical rhythm (Shimizu et al., 2018). This finding is further supported by Hars et al. (2014), who assessed Frontal Assessment Battery (FAB) and Mini-Mental State Examination (MMSE) scores before and after 6 months of walking to the rhythm of the piano in older people with MCI. Furthermore, RASMT exhibits positive effects on memory, attention, and executive function. Studies demonstrate that playing instrument training can improve memory and overall cognitive status in MCI patients (Doi et al., 2017). Drum playing intervention with rhythmic cueing (DPRC) has great potential to improve upper limb motor control and attention control (Park and Kim, 2021). Ronnie Gardner’s rhythm and music (RGRM) training have been shown to improve learning and episodic memory, speed, attention, visuospatial functions, language, and executive functions in Parkinson’s disease patients (Pohl et al., 2013, 2020). Auditory motor synchronization training (AMST) has been found to enhance attention, memory, and executive function in stroke patients (Park and Lee, 2018).

In conclusion, RASMT not only proves beneficial for addressing cognitive impairment in the normal aging process but also for the improvement of cognitive impairment in various diseases. However, it is noteworthy that as of now, in previous studies when discussing the effects of RASMT on cognitive impairment, there were differences in the subjects (including healthy people, mild to severe cognitive impairment, stroke, Parkinson’s disease, etc.), the intervention methods (specific exercise forms, exercise time, exercise frequency, duration) and the research objectives (the effects of RASMT on the general cognitive function, such as memory, attention, executive ability, speech fluency, etc.). To explore whether differences in subjects and intervention methods affect RAMST’s effects on cognitive function, and which aspects of RAMST’s improvement in cognitive function are more significant, we conducted a meta-analysis of randomized controlled trials. The selected studies for inclusion in this meta-analysis adhere to the criteria of being randomized controlled trials, ensuring a higher standard of research methodology. This rigorous selection aims to enhance the quality of the articles under examination, thereby furnishing more precise and evidence-based insights for the clinical treatment of cognitive impairment.

In this endeavor, a systematic review was meticulously planned and executed, adhering to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Additionally, this review was duly registered with PROSPERO under the registration number CRD42023483561.

Epidemiological studies show that the prevalence of MCI continues to increase, and with the worsening of population aging (Chen et al., 2022), MCI will become a major risk factor threatening the health of the elderly. Short-term conversion rate from MCI to dementia is between 20 and 40%, but long-term in 5–10 years ranges from 60 to 100% (Wang et al., 2022). In addition, MCI is also a common functional disorder in PD, stroke and other diseases, the main manifestations of patients with memory, attention, executive ability, speech and logical thinking (Tatemichi et al., 1994; Li et al., 2019), seriously affect the prognosis of patients. At present, neuromusic therapy (Galińska, 2015), motor therapy (Cassilhas et al., 2007), computer-assisted cognitive training (Maggio et al., 2023) and repetitive transcranial magnetic stimulation (Kaster et al., 2018) are widely used in the treatment of cognitive impairment, and have achieved good clinical results. RASMT, in which programs follow rhythmic auditory cues (music or metronom) based on rhythmic auditory stimulation, a training method for rhythmic movements (playing percussion, playing piano, clapping, walking, etc.) of the upper, lower, and trunk, through the activation of central, peripheral to improve cognition. Therefore, this article conducted a meta-analysis of the effects of rhythmic auditory stimulation-based movement training on cognitive impairment, which suggests that RASMT can enhance the overall cognitive status, attention, memory, executive abilities, depression and anxiety in individuals with cognitive dysfunction. In addition, from the included literature, it can be seen that the RAMST program (type of exercise: play percussion instruments; time of exercise:30–60 min; frequency of exercise:2–3 times/week; duration of exercise: more than 12 weeks) was proved to be more effective in improving cognitive function.

After conducting a comprehensive analysis of six studies, our meta-analysis reveals a significant enhancement in overall cognitive status with RASMT in older people with cognitive impairment (p < 0.05). The selected studies primarily focused on older people with MCI (Hars et al., 2014; Doi et al., 2017; Biasutti and Mangiacotti, 2018; Biasutti and Mangiacotti, 2021; Kim and Kang, 2021), and one study involved individuals with Alzheimer’s disease experiencing mild to moderate cognitive impairment (Satoh et al., 2017). Despite variations in intervention methods across studies, all incorporated rhythmic movement training accompanied by rhythmic music. In three of the studies (Hars et al., 2014; Satoh et al., 2017; Kim and Kang, 2021), participants engaged in rhythmic movements with their upper limbs, lower limbs, and trunk, following the musical rhythm. Activities included clapping, stretching, dancing, walking, and muscle training. The intensity of the exercises gradually progressed from simple, repetitive, and slow-paced music to more complex, varied, and fast-paced music. In the other three studies (Doi et al., 2017; Biasutti and Mangiacotti, 2018; Biasutti and Mangiacotti, 2021), a training program designed by professionals in music and neuropsychology was utilized. It involved participants following rhythmic music with body or instrument percussion. Participants in these studies stimulated various cognitive skills related to movement through the imitation, creation, and execution of rhythmic patterns, encompassing aspects such as persistence, differentiation, selective and alternating attention, short-term memory, long-term memory, as well as executive functions. The conscious motor sequence encoding and planned action exercises led to an improvement in cognitive function (Street et al., 2015).

RASMT has significantly improved attention, memory, and execution functions in cognitive functions, and can be widely used in clinical. In terms of attention, the results of this meta-analysis showed that there was no heterogeneity in the results (p = 0.8, I² = 0%) and p < 0.05, which was a significant difference. In the six included studies, attention was assessed in the same way, TMT-A, but in different forms of movement, including drum playing intervention with rhythmic cueing (Park and Kim, 2021), intensive cognitive music training (Biasutti and Mangiacotti, 2018), cognitive-motor dual-task training and auditory-motor synchronization training (Park and Lee, 2018), musical attention control training (Jones et al., 2021), physical exercise with music (Satoh et al., 2017), and playing percussion instruments (Doi et al., 2017). Although the forms of movement differed, they all required exact motor control and sustained attention, and subjects had to sustain their auditory attention to track the rhythmic cueing, this sustained attention caused entrainment between auditory functioning and upper extremity motor functioning, and the fast and slow music rhythms stimulated the subject’s sustained and selective attention and activated cognitive processing. For memory, the meta-analysis included five studies covering diverse populations, including older individuals with MCI (Doi et al., 2017), stroke patients with MCI (Park and Lee, 2018; Haire et al., 2021), Alzheimer’s disease patients with mild to moderate cognitive impairment (Satoh et al., 2017), and traumatic brain injury patients with cognitive impairment (Siponkoski et al., 2020). Despite variations in study populations, the meta-analysis results showed no heterogeneity (p = 0.63, I² = 0%) and a highly significant difference (p < 0.01), indicating the efficacy of RASMT in improving memory across various clinical populations. In terms of executive function, some studies utilized near-infrared brain functional imaging techniques to measure changes in cerebral blood flow (CBF) levels following RASMT. The findings revealed a significant increase in CBF, particularly within the medial prefrontal cortex (mPFC) regions associated with task performance and decision-making processes. Executive function, primarily governed by the prefrontal cortex (PFC), showed improved connectivity with other brain regions, including the dorsolateral PFC (DLPFC) and sensorimotor areas (Ries et al., 2012). In individuals with MCI, the connectivity between mPFC and other brain areas has been reported to decrease; hence, RASMT may increase CBF levels, activating frontal lobe regions involved in task performance and decision-making processes. This elevated blood flow may contribute to improved functional connectivity between prefrontal cortex regions and other relevant brain networks. Moreover, studies employing fMRI techniques found that RASMT enhances executive function performance by improving connectivity between prefrontal cortex regions and other relevant brain networks (Hars et al., 2014; Shimizu et al., 2018; Siponkoski et al., 2020).

Based on our team’s conducted meta-analysis, there is no significant heterogeneity observed in memory (I² = 0%), attention (I² = 0%), and executive function (I² = 0%) as cognitive indicators. However, overall cognitive status shows a highly significant heterogeneous effect (I² = 73%). Through subgroup analysis, it was identified that the variance in intervention duration might be the source of this heterogeneity. Acknowledging this as a potential limitation in our study, we suggest that future research concentrate on investigating the impact of intervention duration on research outcomes, aiming to attain more rigorous and precise results.

This study suggests that RASMT can enhance the overall cognitive status, attention, memory, and executive abilities in individuals with cognitive dysfunction. Given the relative limitation in the sample size included in this study, future research should focus on expanding the sample size and employing a more rigorous study design to attain robust evidence regarding the effectiveness of RASMT in improving cognitive function.

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