Volume 56, March–April 2024, Pages 259-269Author links open overlay panel, , , , , , , Highlights•

Targeted interventions in people with mild cognitive impairment are crucial to preventing progression towards dementia or Alzheimer's disease.

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40 Hz auditory stimulation may be a promising treatment modality cognition in people with early stage of Alzheimer's disease.

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Merging 40 Hz sound with self-selected music may improve usability and practical enjoyment among older adults with mild cognitive impairment.

Abstract

Emerging evidence suggests that 40 Hz auditory stimulation may benefit cognition. Nested within a randomized crossover trial, this qualitative study evaluates the acceptability and experience of three auditory interventions—self-selected music, 40 Hz sound, and a novel combination, termed 40 Hz music—in individuals with Mild Cognitive Impairment (MCI). Semi-structured interviews were conducted with individuals with MCI post-intervention exposure. Findings indicated a preference for self-selected music due to its memory-boosting and emotional benefits, while responses to 40 Hz sound were mixed, with several participants reporting discomfort. The composite 40 Hz music intervention showed promise, striking a balance by enhancing user experience and mitigating the 40 Hz sound's negative aspects. Engagement was influenced by personal music interests, listening routines, and support networks. This study highlights the potential of integrating 40 Hz sound with personalized music to offer a more acceptable 40 Hz auditory intervention for cognition in older adults with MCI.

Section snippetsBackground

With the growing population of older adults, cognitive impairment and dementia have become prominent public health concerns worldwide1,2. Mild cognitive impairment (MCI) affects around 20 % of individuals aged 65 years or older3,4 and represents a level of cognitive decline that exceeds generally expected age-related changes. It is often considered a transitional or prodromal phase between normal cognitive aging and dementia. Approximately 18.4 % of those older adults with MCI develop dementia

Study design overview

This qualitative study is nested in an ongoing prospective randomized controlled crossover trial that aims to evaluate the feasibility and preliminary acceptability of three distinct auditory interventions: (Condition A) Self-selected music alone; (Condition B) 40 Hz sound alone; and (Condition C) 40 Hz music, which combines 40 Hz sound with self-selected music. In the parent study, participants underwent all available conditions sequentially, with 2-week washout periods interposed between

Results

We interviewed 25 participants in total, with an average age of 68 years. The majority of participants were women (68 %), identified as Black/African American (68 %), and nearly half reported some college education (refer to Fig. 5). Additionally, 50 % (n = 9) of the 18 participants who reported participant incomes were below the Maryland extreme poverty threshold. Data on intervention adherence were not yet available at the time of writing.

Our analysis highlighted varying levels of

Discussion

We studied the acceptance and listening experience of three auditory interventions in individuals with MCI, including self-selected music, 40 Hz sound, and a combination of the two—40 Hz music. The findings revealed varied experience and acceptance, with self-selected music acting as a memory preserver and emotional support, 40 Hz sound producing more adverse reactions, and 40 Hz music offering a more harmonized and bridged experience between the two modalities. The findings suggest that

Conclusion

Given the diverse reactions to the three auditory interventions, factors such as a strong emotional connection to music, the personalization of the experience, and established listening habits significantly influenced the acceptability and engagement with the 40 Hz music intervention. These elements of acceptability and listening enjoyment are crucial considerations that have been absent in prior 40 Hz interventions. Although both transgenic mouse models and initial short-term human trials have

Funding

This work was supported by the National Institute on Aging (Grant R21 AG078917), the Johns Hopkins Center for Equity in Aging Pilot Fund, and the Johns Hopkins School of Nursing Discovery and Innovation Award.

CRediT authorship contribution statement

Claire Wang: . Mengchi Li: Conceptualization, Formal analysis, Project administration, Writing – original draft, Writing – review & editing. Sarah Szanton: Conceptualization, Funding acquisition, Writing – review & editing. Susan Courtney: Funding acquisition, Writing – review & editing. Alex Pantelyat: Conceptualization, Writing – review & editing. Qiwei Li: Software, Writing – review & editing. Jing Huang: Project administration, Writing – review & editing. Junxin Li: Conceptualization, Data

Declaration of competing interest

None

Acknowledgements

As the team leading this study, we recognize the importance of reflexivity and positionality in our research process. Our primary coders, CW and ML, as early-career researchers, bring a unique and evolving perspective to this work. Their youth and position at the onset of their research careers provide fresh insights. Nonetheless, we acknowledge the generational divide between ourselves and our older adult subjects. Through ongoing self-reflection, learning, and consultation with study

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