Musical Instrument Practice as Sensorimotor and Motor–Cognitive Skill Training in Healthy Aging

Background/Objectives: Playing a musical instrument requires precisely timed movements, bimanual or interlimb coordination, visuomotor mapping, auditory and somatosensory feedback, sequence learning, prediction, and executive regulation. This narrative review synthesizes motor, cognitive, and neuroplastic adaptations associated with active instrumental practice in predominantly healthy adults aged 60 years or older, interpreting practice as a complex sensorimotor and motor–cognitive skill activity. Methods: English-language literature from January 2016 through August 2026 was searched in PubMed/MEDLINE, Scopus, and Web of Science Core Collection, supplemented by Google Scholar and citation chasing. Randomized and controlled interventions were prioritized, with longitudinal and observational evidence used contextually; earlier studies were included selectively for seminal or mechanistic context. Results: Direct motor evidence was less abundant than cognitive evidence. Both piano and mallet-percussion programs improved task-proximal bimanual synchronization, and one large active-control trial found greater improvement in untrained unimanual fine-motor control after one year of piano practice. Selective near transfer to continuation timing was also reported, whereas evidence for generalized dexterity, gait, balance, lower-limb coordination, and everyday motor function remained limited or mixed. Cognitive effects were selective, particularly for processing speed, verbal fluency or switching, and some working-memory measures. Neuroplastic findings included cortical-thickness increase, relative structural preservation, altered auditory–motor connectivity, reduced task activation, and oscillatory modulation. Conclusions: Instrumental practice may provide an engaging and adaptable form of sensorimotor and motor–cognitive skill practice in healthy aging, but broad transfer and neuroprotection are not established. Future trials should quantify skill acquisition, dose, retention, and transfer and compare instrument-specific demands.