Music and the Human Brain: A Critical Narrative Review of Neural Mechanisms, Training-Induced Plasticity, and Clinical Applications

Abstract

Music engages an unusually distributed set of cortical and subcortical systems, spanning auditory, motor, limbic and prefrontal territories, and has therefore become a widely used model for studying perception, prediction, reward and experience-dependent plasticity in the human brain. Over the past two decades, neuroimaging, electrophysiological and genetic methods have converged to describe how the brain encodes melody, harmony and rhythm, how listening to preferred music engages corticostriatal reward circuitry, and how sustained musical training reshapes auditory, motor and interoceptive networks. This critical narrative review synthesises evidence from cognitive, developmental, clinical and cross-cultural neuroscience to evaluate the strength, consistency and limitations of current knowledge on the effects of music on brain activity. The review examines four broad areas: the neural architecture of music perception and its formulation within predictive-coding accounts; the reward and emotional response to music and its individual variability; structural and functional plasticity associated with musical training, including the persistently contested question of transfer to non-musical cognition; and the translation of auditory-motor and reward mechanisms into neurorehabilitation for Parkinson's disease, post-stroke aphasia and motor impairment, and dementia-related agitation. Genetic, developmental and cross-cultural findings are integrated to indicate that musicality reflects a highly polygenic and only partially culture-general trait. Across these domains, the literature shows areas of convergent, replicated evidence, particularly for auditory-motor coupling and mesolimbic reward engagement, alongside areas of unresolved disagreement, most notably the magnitude and generalisability of cognitive transfer from musical training and the mechanistic basis of neurorehabilitative benefit. Methodological constraints common to the field, including modest sample sizes, heterogeneous outcome measures and inconsistent control conditions, are shown to limit the strength of causal inference that can currently be drawn. The review concludes that music exerts measurable and mechanistically plausible effects on brain structure, function and behaviour, but that confidence in specific causal claims varies substantially across sub-domains and warrants more cautious interpretation than is often conveyed in secondary literature.