Aging is associated with cognitive decline, significantly impacting quality of life. Drumming-based cognitive and physical training, a novel intervention, engages motor and cognitive circuits simultaneously, potentially improving executive functions and emotional regulation in older adults. A randomized controlled trial (RCT) was conducted with 40 participants aged 55 years and older, assigned to either an experimental group receiving drumming-based training or a control group undergoing conventional memory exercises. The intervention lasted four weeks, consisting of 30-min training sessions three times per week. Functional near-infrared spectroscopy (fNIRS) was employed to measure brain activity, while cognitive and emotional outcomes were assessed through standardized tests, including the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS). Task performance metrics, such as accuracy and success rates, were also recorded. Experimental group exhibited significant improvements in cognitive performance, including a greater number of correct answers (p = 0.0004) and a higher task success rate (p = 0.0001) compared to the control group. fNIRS data revealed increased oxygenated hemoglobin levels in the left orbitofrontal cortex (OFC) (p = 0.028). This study provides compelling evidence that a drumming-based cognitive and physical training program can lead to significant cognitive and emotional benefits in older adults.