Musical engagement demonstrates a 64% reduction in dementia risk among adults over 65, with both active music-making and passive listening showing protective cognitive effects. The longitudinal analysis tracked over 10,000 participants for eight years, revealing that those who engaged with music daily maintained significantly better executive function and memory performance compared to non-musical peers. This finding adds compelling evidence to the emerging field of musical medicine, where rhythm and melody appear to stimulate neuroplasticity through multiple pathways. Music activates distributed brain networks simultaneously, potentially creating cognitive reserve that buffers against age-related neurodegeneration. The protective effect appears strongest for classical and jazz genres, though benefits extend across musical styles. While observational studies cannot establish definitive causation, the magnitude of this association rivals pharmaceutical interventions currently in development. The accessibility of music as an intervention is particularly striking—unlike complex lifestyle modifications or expensive treatments, musical engagement requires minimal resources and offers immediate enjoyment. However, the study's predominantly educated, health-conscious cohort may limit generalizability. Still, the convergence with previous research on musical training and brain structure suggests a genuine neuroprotective mechanism worthy of clinical investigation.