https://orcid.org/0000-0003-4501-8602
Figures
Abstract
Music engages sensory, motor, cognitive, and emotional systems, making it a powerful model for studying experience-dependent neuroplasticity. Although research on music-related brain changes is expanding, integration of structural, functional, and cerebrovascular findings remains limited, and effects on higher-order cognitive processes remain unclear. This systematic review will primarily synthesize evidence on music-induced cortical adaptations, including structural changes (e.g., gray and white matter alterations), functional modifications in neural networks, and cerebrovascular dynamics. Further, associations with behavioral measures such as attentional control, executive functioning, and language processing will also be examined when these outcomes are directly linked to the neural adaptations across the adult lifespan (≥ 50 years). The protocol was prepared in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines and has been indexed in International Prospective Register of Systematic Reviews (PROSPERO ID: CRD420251159362). The systematic review will be conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Using controlled vocabularies and medical subject headings (MeSH), a systematic search will be conducted across PubMed, Scopus, Web of Science, PsycINFO, EMBASE, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases, and supplemented by citation tracking from relevant review articles. Eligible studies will include randomized controlled trials (RCTs), non-randomized controlled trials, quasi-experimental, and observational designs (longitudinal, case-control, cross-sectional studies). The primary outcome will be changes in brain structure, function, and cerebrovascular hemodynamic activity following music intervention. Cognitive measures will be reviewed and consolidated as secondary endpoints. Data extraction, risk of bias and quality assessment will be performed independently by two reviewers using validated instruments, including Cochrane Risk of Bias 2 (RoB 2.0), Risk Of Bias In Non-randomized Studies – of Interventions (ROBINS-I), Risk Of Bias In Non-randomized Studies of Exposures (ROBINS-E), Strengthening the Reporting of Observational Studies in Epidemiology (STROBE), and National Heart, Lung, and Blood Institute (NHLBI) tools. A narrative synthesis will be conducted in accordance with Synthesis Without Meta-analysis (SWiM) guidelines, with meta-analyses undertaken where appropriate. Certainty of evidence will be assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) scale. Collectively, this protocol establishes a rigorous framework to systematically evaluate how music shapes the brain’s structure, function, and vascular systems, and how these changes translate into cognitive and behavioral outcomes.
Citation: Osei Duah Junior I, Rodriguez DS, Germain CM (2026) Music-induced cortical plasticity: Protocol for a systematic review. PLoS One 21(7): e0336011. https://doi.org/10.1371/journal.pone.0336011
Editor: Carlos Tomaz, Ceuma University: Universidade Ceuma, BRAZIL
Received: October 19, 2025; Accepted: June 5, 2026; Published: July 2, 2026
Copyright: © 2026 Osei Duah Junior et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: No datasets were generated or analysed during the current study. All relevant data from this study will be made available upon study completion.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors declare that they have no competing interests.
Abbreviation:: CBF, Cerebral Blood Flow; CENTRAL, Cochrane Central Register of Controlled Trials; DTI, Diffusion Tensor Imaging; EEG, Electroencephalography; EMBASE, Excerpta Medica Database; ERP, Event-Related Potential; GM, Gray Matter; MEG, Magnetoencephalography; MRI, Magnetic Resonance Imaging; NHLBI, National Heart, Lung, and Blood Institute; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PRISMA-P, Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols; PROSPERO, International Prospective Register of Systematic Reviews; ROBINS-E, Risk of Bias in Non-randomized Studies – of Exposures; ROBINS-I, Risk of Bias in Non-randomized Studies – of Interventions; RoB 2.0, Risk of Bias 2.0; STROBE, Strengthening the Reporting of Observational Studies in Epidemiology; SWiM, Synthesis Without Meta-analysis; WM, White Matter
Introduction
Music is a unique human activity that engages the brain in a uniquely multimodal manner, simultaneously recruiting sensory, motor, cognitive, and affective systems [1–5]. Beyond its cultural and aesthetic significance, music has emerged as a powerful model for studying neuroplasticity, the brain’s capacity to reorganize its structure, connectivity, and function in response to experience [6–9]. By activating auditory, visual, motor, cognitive, and emotional networks in parallel [1–4,10–13], music provides a rich, multisensory stimulus for probing experience-dependent neural plasticity across the lifespan [14–18].
Although evidence for the cognitive benefits of music exposure (e.g., intervention, therapy, training) remains mixed [19–21], converging neurobiology data consistently demonstrate structural and functional cortical adaptations associated with musical training and engagement [22–29]. Structurally, music exposure has been linked to increased gray matter volume and cortical thickness in sensory and motor cortices, enhanced white matter integrity in fiber tracts such as the corpus callosum and arcuate fasciculus, and region-specific cortical map reorganization [22–27]. Functionally, music engagement supports enhanced auditory discrimination [28–32], improved sensorimotor integration [33–35], refined executive function [36], and strengthened intra- and inter-network connectivity [37–39]. These functional improvements, together with anatomical adaptations, have been observed across the lifespan, suggesting music may promote cognitive resilience [22–28,31,36,40,41,42]. Conversely, a large-scale multi-site study have reported no association between musical training and early auditory neural responses, such as brainstem-level frequency-following response measures, suggesting that music-related plasticity may preferentially manifest at higher-order, context-dependent stages of auditory and cognitive processing rather than at subcortical encoding levels [43].
In addition to structural and functional adaptations, emerging evidence suggests that music engagement may influence cerebral blood flow (CBF), a critical physiological marker of cortical activity and plasticity [44–46]. The CBF reflects the brain’s metabolic demands and vascular responsiveness [47], providing a dynamic index of localized neural activity that supports synaptic remodeling [48]. Despite its importance, the relationship between music-induced plasticity and CBF remains poorly understood, leaving the vascular and hemodynamic dimensions understudied. Systematic reviews that integrate CBF metrics with measures of cortical plasticity are particularly promising, as they can consolidate fragmented findings, reveal consistent patterns across diverse study designs, and provide mechanistic insights linking neural remodeling to functional and metabolic dynamics. By simultaneously engaging sensorimotor networks, music has the potential to modulate regional cortical perfusion, enhance neurovascular coupling, and facilitate experience-dependent cortical reorganization [41,49,50].
Of note, cognitive and behavioral findings also complement these neural evidence, with music training linked to improved performance in language acquisition [31,41,42], verbal memory [51–53], attentional control [54,55], short term memory [56], emotional regulation [57,58], social communication [59,60], and motor coordination [61]. Additionally, music exposure has been associated with improved academic performance [62], enhance cognitive function and reduce cognitive decline [63,64]. Collectively, these findings illustrate how music-induced cortical plasticity translate into behavioral outcomes, yielding meaningful practical benefits (see Fig 1).
The figure illustrates how music exposure influences the brain across multiple domains: in the top left, music drives focal cortical remapping, alters grey matter volume, and enhances white matter integrity, reflecting its capacity to reshape neural architecture; in the bottom left, functional indices are depicted, including changes in cortical activation, neural network connectivity, and sensorimotor processing; in the top right, the diagram highlights cerebrovascular measures, emphasizing music’s effects on cerebral blood flow, perfusion, and hemodynamics, which together support healthier vascular function and metabolic activity in the brain; and in the bottom right, shifts in behavioral and cognitive domains are shown, encompassing learning, language, attention control, and motor coordination. Created in BioRender. Osei Duah, I. (2025) https://BioRender.com/w0phamk.
Despite notable scientific advances in this field, the evidence base remains highly fragmented, primarily due to marked heterogeneity in study populations, intervention protocols, and assessment methodologies. For example, some studies focus exclusively on adults or children [22,25,29,65,66], others include both musicians and non-musicians [66–71], and still others examine the short- and long-term effects of music-based interventions [29,66,72,73]. The modalities of music exposure and engagement under study are diverse, ranging from actively playing instruments and singing to passive listening, and structured music therapies [74–76]. In addition, neural outcomes have been characterized using a broad spectrum of techniques, including diffusion tensor imaging (DTI) [77,78], electroencephalography (EEG) [79–81], magnetoencephalography (MEG) [82–84], and structural and/or functional magnetic resonance imaging (MRI) [25,74,85–88]. This methodological and conceptual heterogeneity complicates interpretation and constrains cross-study comparability. Taken together this impedes the formulation of generalizable conclusions about the nature, extent, and persistence of music-induced cortical plasticity, as well as its translational potential for therapeutic innovation.
Existing reviews and meta-analyses on neuromusicology have provided valuable insights but remain limited in scope. Most have focused primarily on music’s effects within auditory and motor cortices, regions central to perception and production [1,89]. Yet emerging evidence indicates that music also induces plasticity in occipital [90], prefrontal [91], parietotemporal [92,93], and limbic cortices [94]. These higher-order regions support multisensory integration, executive function, attention, and emotional regulation [95,96]. Collectively, these findings provide convergent evidence that musical training is associated with structural remodeling, functional network refinement and efficiency, and cerebrovascular adaptations. However, no systematic review has yet comprehensively synthesized music’s influence across these cortical domains. Prior reviews disproportionate emphasize behavioral and cognitive outcomes, such as memory [97,98], attention [99,100], language [101,102], and emotional regulation [57,103]. Although informative, these behavioral outcomes offer only indirect insight into the neural mechanisms through which music exerts its effects. In the absence of systematic integration across structural, functional, and cerebrovascular findings, the neurobiological underpinnings of music-induced behavioral changes will remain poorly understood. Addressing this evidence gap is critical, as delineating cortical adaptations offers direct mechanistic insight and advances the field beyond purely descriptive accounts of music influence on behavior.
Clarifying the neurobiological underpinning of music carries both theoretical and practical significance. Systematic mapping of how music reshapes cortical architecture, connectivity, and cerebrovascular remodeling advances fundamental principles of neuroplasticity while informing translational innovation. If music reliably induces plasticity in neural circuits supporting sensory integration, executive function, attention, or emotion regulation, it can be leveraged to develop novel, neuroscience-based interventions. Its cultural ubiquity, appeal, and reach render music uniquely suited as a potential treatment strategy for neurological and psychiatric conditions, including stroke, dementia, depression, neurodevelopmental, and neurodivergent disorders.
Collectively, these considerations underscore the need for a systematic review that critically consolidates evidence on music-related cortical plasticity. By applying transparent, rigorous, and reproducible methods, the present review will synthesize findings across structural and functional domains, examines effects spanning auditory, motor, visual, and higher-order associative cortices, and situates these outcomes within emerging mechanistic frameworks. This integrative approach aims to clarify inconsistencies in the literature, identify methodological strengths and limitations, and highlight critical gaps for future investigation. The primary objective of this systematic review is to comprehensively synthesize evidence on music-related neuroplasticity. Specifically, the review will focus on three domains of neural adaptation: (i) structural brain measures, including cortical thickness and gray and white matter integrity; (ii) functional brain organization and neural activity, such as task-based and resting-state functional connectivity; and (iii) cerebrovascular adaptations, including regional cerebral blood flow and neurovascular coupling. Further, the secondary aim is to synthesize evidence linking these neural measures to behavioral outcomes associated with music engagement or musical training, thereby elucidating the functional relevance of observed neuroplastic changes. Interpretation of the findings is guided by an explicit theoretical framework in which musical training is conceptualized as a multimodal, enriched experience that repeatedly co-engages auditory, motor, cognitive, emotional, and reward networks. Altogether, such sustained co-activation is hypothesized to promote experience-dependent plasticity through established processes, including synaptic strengthening, large-scale network reorganization, and neurovascular adaptation (see Fig 1).
Materials and methods
This systematic review protocol was prepared following the PRISMA-P checklist (S1 File) to provide a structured framework for the design, planning, and prospective reporting of methods [104,105]. The protocol is prospectively indexed in PROSPERO (Protocol registration ID: CRD420251159362) to ensure methodological rigor, prevent unnecessary duplication, and promote accountability and transparency in the review process. The systematic review will be conducted in accordance with the PRISMA guidelines to ensure comprehensive, transparent, and standardized reporting [106]. In instances where quantitative synthesis or meta-analysis is not feasible due to heterogeneity in study designs, populations, interventions, or outcomes, the SWiM reporting framework will be applied to guide the narrative synthesis and enhance the clarity, transparency, and reproducibility of the evidence synthesis process [107].
Eligibility criteria
Inclusion criteria.
The eligibility criteria for this systematic review will be defined according to the PICOS framework, encompassing the population, intervention, comparators, outcomes, and study design.
Population (P): This review will include studies enrolling participants aged ≥ 50 years without formal musical training. Studies enrolling infants, children, and adolescents will be excluded due to potential brain maturation influences that may confound interpretation of music-induced adaptations. Both healthy and clinical populations (e.g., individuals with neurodevelopmental or neurodegenerative conditions) will be eligible, provided structured music exposure (e.g., intervention, therapy or training) is part of the intervention. Studies with formal musicians will also be excluded due to potential confounding effects.
Intervention/Exposure (I): The review will include studies that evaluate different forms of music exposure (see Table 1 for a comprehensive list), including but not limited to active music making (instrumental practice, vocal training, structured lessons, ensemble participation etc.), and passive music listening, such as background and attentive listening. Both short-term and long-term music exposures will be considered, as well as observational studies examining the extent and type of musical experience.
Comparison (C): Studies will be eligible if they employ cross-sectional, longitudinal, randomized, or quasi-experimental designs in which there is a control arm consisting of participants receiving no music exposure.
Outcomes (O): The primary outcome of interest will encompass structural brain adaptations, functional and neurovascular changes. Structural outcomes include morphological brain alterations, neuroanatomical changes, brain morphology indices, gray matter density, gray matter volume, white matter organization and integrity, cortical thickness and architecture, neurostructural markers, brain connectivity patterns, and neural circuitry reorganization. Functional outcomes include neural processing improvements, cognitive function enhancements, perceptual gains, information-processing efficiency, and sensorimotor integration. Neurovascular outcomes will comprise measures of cerebral blood flow, oxygenation, and autoregulatory function. The secondary outcomes of this study will include cognitive domains such as working memory, language, attention control, and executive functions, as well as broader behavioral and cognitive performance measures, including learning efficiency, skill acquisition, academic achievement, social competence, cognitive-behavioral outcomes, and adaptive functioning. Of note, the latter will be extracted and consolidated only when the study has reported one of the primary measures.
Study design (S): The review will include a broad range of study designs to capture the diverse evidence on music-related plasticity and brain outcomes. These will include cross-sectional studies, case-control studies, quasi-experimental, and non-randomized controlled trials comparing individuals with and without music exposure or intervention, to examine group differences in neural plasticity as well as cognitive and behavioral outcomes to explore associations between musical experience and markers of brain structure, brain function, and cerebrovascular hemodynamic activity. The review will also include longitudinal intervention studies, where participants undergo structured music training or music-based activities over a defined period with both pre- and post-intervention assessments, providing insights into causal effects of music engagement on neural plasticity and cognitive or behavioral change. In addition, RCTs which is regarded as the gold standard for causal inference, will be incorporated where music-based interventions such as instrumental training, singing, ensemble participation, or music interventions are compared to active or passive control groups such as non-musical enrichment, leisure activities, or no intervention, thereby helping to determine the specificity and robustness of music-related effects. The review will further include neuroimaging studies employing modalities such as functional magnetic resonance imaging (fMRI), electroencephalography (EEG), electroretinography (ERG), Event-Related Potentials (ERP), magnetoencephalography (MEG), diffusion tensor imaging (DTI), or structural MRI when they examine the structural and functional correlates of music engagement. These studies may adopt either cross-sectional or longitudinal designs but must explicitly assess neural outcomes linked to music training or experience. By including this variety of designs, the review will capture both correlational and causal evidence, spanning behavioral and neurobiological levels of analysis.
Exclusion criteria.
The review will exclude studies if they involve human participants under eighteen years (given the temporal changes in brain development), non-human primates, as this review focuses exclusively on human participants from young adulthood to older adults. Research that does not include music engagement or where the effects of music cannot be independently assessed, such as interventions combined with other modalities without isolating music-specific contributions, will also be excluded. Additionally, studies lacking a comparison group or appropriate control conditions will not be considered, as these designs do not allow for the evaluation of causal or relative effects of music engagement. Studies will be excluded if they do not report measurable outcomes related to structural or functional neuroplasticity, cognitive functions, or behavioral and psychosocial domains associated with music engagement; those reporting only subjective experiences or anecdotal observations will similarly be excluded. Finally, publication types such as reviews, commentaries, editorials, conference abstracts without full datasets, methodological or theoretical papers without original empirical findings, and non-peer-reviewed or unpublished studies without sufficient data will be excluded. These criteria ensure that only high-quality, empirically rigorous studies providing meaningful evidence on the effects of music engagement are included.
Database sources and search strategy
A comprehensive search will be conducted in electronic databases including PubMed, Scopus, Web of Science, PsycINFO, EMBASE, Google Scholar, and the CENTRAL from inception to the present, with no restrictions on language or publication year. Additional sources will include reference lists of eligible studies and pertinent reviews. Search terms will be derived from the PICOS framework and will consist of combinations of keywords and controlled vocabulary (e.g., MeSH terms) related to music exposure, training, or engagement; neuroplasticity, brain structure, brain function, or cognitive outcomes; and human participants. Boolean operators (“AND,” “OR”) will be used to combine terms (see Table 1).
Study selection
The studies that will be retrieved from the databases will be organized by database using the “My Groups” feature in EndNote Reference Manager Version 20 and subsequently exported to Covidence for comprehensive screening based on a priori eligibility criteria. Specifically, two reviewers (I.O.D.J. and D.S.R.) will independently screen all titles and abstracts to determine their relevance to the research question. Studies that appear to meet the inclusion criteria, or those for which the abstract provides insufficient information to decide, will be retrieved in full text for further evaluation. Each full-text article will then be assessed independently by the two reviewers against the pre-specified inclusion and exclusion criteria. Any discrepancies or disagreements between the reviewers at either the screening or full-text review stage will be resolved through discussion and consensus. If consensus cannot be reached, a third reviewer (C.M.G.) will be consulted to make a final decision. The entire study selection process, including the number of records identified, screened, excluded, and included, will be systematically documented using a PRISMA flow diagram to ensure transparency and reproducibility (see Fig 2).
The PRISMA flow diagram outlines the study-selection protocol for a systematic review, documenting each step from identification of records across major databases through screening and eligibility assessment to final study inclusion.
Data extraction
Data will be independently extracted by two reviewers (I.O.D.J. and C.M.G.) using a standardized extraction form. The extracted information will include study characteristics such as author, year, country, study design, sample size, age range, and population. Details of the intervention or exposure will be collected, including the type, duration, frequency, and intensity of music engagement or training. Comparison conditions will be recorded, including the type of control group or alternative activity. Outcome measures will encompass neuroplasticity indicators (structural, functional, and cerebrovascular) together with cognitive and behavioral performance metrics, and assessment methods. The key findings and statistical results will be extracted and synthesized. Any discrepancies in data extraction will be resolved through consensus or, if necessary, with input from a third reviewer.
Risk of bias
The risk of bias of included studies will be assessed independently by two reviewers (I.O.D.J. and D.S.R.), with any disagreements resolved through discussion or consultation with a third reviewer (C.M.G.). The assessment tools will be selected according to study design to ensure a rigorous evaluation. For RCTs, the RoB 2.0 will be used to evaluate potential biases across key domains, including the randomization process, deviations from intended interventions, missing outcome data, outcome measurement, and selection of reported results, with each domain rated as “low risk,” “some concerns,” or “high risk,” and an overall risk-of-bias judgment assigned for each study [108]. For non-randomized interventional studies, the ROBINS-I tool will be used to assess bias across domains such as confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, outcome measurement, and selection of reported results [109]. Similarly, the ROBINS-E will be used to assess bias in observational studies by examining exposure effects across multiple domains, including confounding, participant selection, exposure classification, deviations from intended exposures, missing data, outcome measurement, and selective reporting, rating each as “low” “some concerns,” or “high” risk, with an overall judgment provided for the study [110]. For observational studies, adherence to the STROBE checklist will be adopted to guide the evaluation of study quality and reporting transparency [111].
Quality assessment
The methodological quality of the studies included in the review will be assessed using the NHLBI quality assessment tools to evaluate overall study rigor (See link: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools). These assessments will consider the clarity of research questions, definition and selection of study populations, sample size justification, validity and reliability of exposure and outcome measurements, appropriateness of statistical analyses, adjustment for confounding variables, and transparency in reporting, with studies classified as “good”, “fair”, or “poor” based on the overall evaluation. For neuroimaging studies, an adapted set of quality assessment criteria will be applied to account for the unique methodological considerations of this research. These criteria will focus on sample size adequacy, participant selection and description, imaging modality and acquisition parameters, preprocessing and analysis pipelines, statistical rigor, correction for multiple comparisons, and clarity of reporting, with studies rated according to methodological rigor and susceptibility to bias. Taken together, this structured, design-specific approach will ensure a comprehensive evaluation of study quality, enhance the reliability of the evidence synthesis and support a robust interpretation of findings.
Data synthesis
A narrative synthesis will be conducted in accordance with the SWiM guidelines due to the anticipated heterogeneity across included studies in terms of study design, intervention characteristics, and outcome measures [107]. The narrative synthesis will involve a structured and systematic approach to summarizing findings across studies, highlighting patterns, consistencies, and discrepancies in results. Where appropriate, results will be presented in tables, with separate consideration given to the type of study design, as well as to those employing active or passive music exposure. Further, where feasible, effect sizes, such as Cohen’s d or Hedges’ g, will be extracted from primary studies or calculated from reported statistics including means, standard deviations, t-values, or F-values to allow for quantitative comparison across studies. Structural and functional neuroplasticity outcomes will be summarized according to brain region (e.g., prefrontal cortex, motor cortex, auditory regions, hippocampus), modality (e.g., structural MRI, DTI, fMRI, EEG, ERG, ERP, Eye tracking e.t.c), and measurement method (e.g., voxel-based morphometry, cortical thickness analysis, connectivity metrics, hemodynamic or electrophysiological indices). Behavioral and cognitive outcomes will be categorized by domain to facilitate interpretation, including memory (working memory, episodic memory), executive function (inhibitory control, cognitive flexibility, planning), attention and processing speed, social and emotional skills (emotional regulation, empathy, interpersonal functioning), and learning and academic performance. Where subsets of studies demonstrate sufficient homogeneity in intervention type, outcome measures, and study design, meta-analyses will be conducted to quantitatively synthesize results [112]. Heterogeneity among studies will be assessed using the I² statistic, with thresholds interpreted as low (25%), moderate (50%), and high (75%) heterogeneity, and random-effects models will be applied to account for expected between-study variability. Sensitivity analyses may be performed to explore the influence of study quality, sample characteristics, or intervention parameters on pooled effect sizes. The publication bias will be assessed using funnel plot visualization and statistically tested using Egger’s regression test, with adjustments considered, such as the trim-and-fill method, if asymmetry is detected. All meta- analysis will be performed in R-studio using metaprop function from the R-meta-package.
Confidence in cumulative evidence
The certainty of evidence for each outcome will be evaluated using the GRADE framework [113]. This approach assesses the overall body of evidence across five key domains: risk of bias, inconsistency of results, indirectness of evidence, imprecision, and publication bias. Based on these criteria, evidence will be classified as high, moderate, low, or very low, reflecting the confidence in the results [113]. Employing the GRADE approach will ensure that the review not only synthesizes findings but also communicates the reliability of the evidence, which is essential for guiding culturally relevant interventions.
Handling of missing data
For studies with missing, incomplete, or unclear information, attempts will be made to contact corresponding authors to obtain additional data or clarifications. When such data cannot be retrieved, the nature and extent of the missing information will be clearly documented. For quantitative outcomes, the potential impact of missing data on the results will be assessed, and sensitivity analyses will be performed where possible to evaluate how assumptions regarding missing data influence the findings. Studies with substantial or critical missing data that could undermine the validity of outcomes may be rated lower in quality or excluded from meta-analysis, though their results will still contribute to the narrative synthesis. The presence of missing data will also inform the risk of bias and quality assessments using the ROB2.0, ROBINS-I, and the STROBE checklist. By systematically addressing missing data, the review aims to reduce potential bias and ensure conclusions are based on the most complete and reliable evidence available.
Patient and public involvement
Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of our research.
Ethical consideration
This study is a systematic review protocol that relies exclusively on previously published studies and secondary data sources. No new data will be collected from human participants or animals, and no interventions or experimental procedures will be conducted. As such, the review does not involve direct interaction with participants, nor does it include the collection of identifiable personal information. Consequently, ethical approval from an institutional review board or ethics committee was not required. The study will, however, adhere to established ethical standards for research conduct, including transparent reporting, accurate citation of original sources, and responsible synthesis of evidence. All included studies will be appropriately referenced to respect intellectual property and the integrity of the original research.
Discussion
This review will synthesize current evidence on music-related cortical plasticity in adults. Music is a uniquely powerful stimulus, engaging auditory, visual, motor, cognitive, and emotional systems simultaneously. Converging research demonstrates that music can induce structural and functional brain changes [38,114], yet findings remain fragmented, with many studies addressing isolated outcomes such as neural activity [115,116], cerebral blood flow [44–46], or behavior [117,118]. What remains unclear is whether musical engagement induces coordinated structural, functional, and neurovascular brain plasticity in older adults, and whether these neural changes are associated with measurable improvements in cognitive and behavioral outcomes, including language, learning, and social functioning.
The primary aim of this review is to evaluate the evidence for music-induced neuroplasticity, encompassing structural adaptations (e.g., gray and white matter changes), functional dynamics (e.g., inter-regional connectivity and activity), and neurovascular responses (e.g., cerebral blood flow). A secondary aim is to link these neural changes to behavioral outcomes, including cognition, learning, and social functioning across adult populations (see Fig 1). This synthesis is clinically and socially relevant, as it may clarify whether and how music can serve as a tool to support brain health and well-being. Specifically, it may inform mental health interventions, optimize learning, and guide therapeutic approaches for aging populations at risk of cognitive decline.
Of note, the study has some strengths worth mentioning. The review will follow standard systematic review guidelines to ensure rigor and transparency. Multiple major scientific databases will be searched, supplemented by reference screening of prior reviews to enhance breath and coverage. Eligible studies will include randomized and non-randomized trials as well as observational designs. Study quality will be appraised using established tools. Anticipated challenges will include methodological heterogeneity, variable research quality, and the complexity of cultural, developmental, and music-type influences, which may constrain the ability to generalize findings or conduct meta-analysis.
In conclusion, upon successful completion, this review will advance understanding of how music influences neural and behavioral processes in adults by integrating evidence on its effects on brain structure, function, and cerebral hemodynamics. It will identify critical knowledge gaps and inform future research directions. The findings may support the development of evidence-based interventions to enhance cognition, strengthen emotional resilience, and mitigate age-related cognitive decline, thereby advancing the application of music as a therapeutic and preventive strategy for brain health.
Supporting information
S1 File. PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 checklist: Recommended items to address in a systematic review protocol.
https://doi.org/10.1371/journal.pone.0336011.s001
(DOCX)
Acknowledgments
The author would like to thank Ms. Mary White of the F.D. Bluford Library, North Carolina Agricultural and Technical State University, Greensboro, NC, United States, for her assistance with developing the search terms and strategies.
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