Are age-related changes in cognitive function driven by age-related changes in sensory processing?

Atypical Integration of Sensory-to-Transmodal Functional Systems Mediates Symptom Severity in Autism

A notable characteristic of autism spectrum disorder (ASD) is co-occurring deficits in low-level sensory processing and high-order social interaction. While there is evidence indicating detrimental cascading effects of sensory anomalies on the high-order cognitive functions in ASD, the exact pathological mechanism underlying their atypical functional interaction across the cortical hierarchy has not been systematically investigated. To address this gap, here we assessed the functional organisation of sensory and motor areas in ASD, and their relationship with subcortical and high-order trandmodal systems. In a resting-state fMRI data of 107 ASD and 113 neurotypical individuals, we applied advanced connectopic mapping to probe functional organization of primary sensory/motor areas, together with targeted seed-based intrinsic functional connectivity (iFC) analyses. In ASD, the connectopic mapping revealed topological anomalies (i.e., excessively more segregated iFC) in the motor and visual areas, the former of which patterns showed association with the symptom severity of restricted and repetitive behaviors. Moreover, the seed-based analysis found diverging patterns of ASD-related connectopathies: decreased iFCs within the sensory/motor areas but increased iFCs between sensory and subcortical structures. While decreased iFCs were also found within the higher-order functional systems, the overall proportion of this anomaly tends to increase along the level of cortical hierarchy, suggesting more dysconnectivity in the higher-order functional networks. Finally, we demonstrated that the association between low-level sensory/motor iFCs and clinical symptoms in ASD was mediated by the high-order transmodal systems, suggesting pathogenic functional interactions along the cortical hierarchy. Findings were largely replicated in the independent dataset. These results highlight that atypical integration of sensory-to-high-order systems contributes to the complex ASD symptomatology.

Improvement of Working Memory and Processing Speed in Patients over 70 with Bilateral Hearing Impairment Following Unilateral Cochlear Implantation

Several studies demonstrated the association of hearing disorders with neurocognitive deficits and dementia disorders, but little is known about the effects of auditory rehabilitation on the cognitive performance of the elderly. Therefore, the research question of the present study was whether cochlear implantation, performed in 21 patients over 70 with bilateral severe hearing impairment, could influence their cognitive skills. The measuring points were before implantation and 12 months after the first cochlear implant (CI) fitting. Evaluation of the working memory (WMI) and processing speed (PSI) was performed using the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV). The audiological assessment included speech perception (SP) in quiet (Freiburg monosyllabic test; FMT), noise (Oldenburg sentence test; OLSA), and self-assessment inventory (Oldenburg Inventory; OI). Twelve months after the first CI fitting, not only the auditory parameters (SP and OI), but also the WMI and PSI, improved significantly (p < 0.05) in the cohort. The presented results imply that cochlear implantation of bilaterally hearing-impaired patients over 70 positively influences their cognitive skills.

Factors Underlying Individual Differences in Speech-Recognition Threshold (SRT) in Noise Among Older Adults

Many older adults have difficulty understanding speech in noisy backgrounds. In this study, we examined peripheral auditory, higher-level auditory, and cognitive factors that may contribute to such difficulties. A convenience sample of 137 volunteer older adults, 90 women, and 47 men, ranging in age from 47 to 94 years (M = 69.2 and SD = 10.1 years) completed a large battery of tests. Auditory tests included measures of pure-tone threshold, clinical and psychophysical, as well as two measures of gap-detection threshold and four measures of temporal-order identification. The latter included two monaural and two dichotic listening conditions. In addition, cognition was assessed using the complete Wechsler Adult Intelligence Scale-3rd Edition (WAIS-III). Two monaural measures of speech-recognition threshold (SRT) in noise, the QuickSIN, and the WIN, were obtained from each ear at relatively high presentation levels of 93 or 103 dB SPL to minimize audibility concerns. Group data, both aggregate and by age decade, were evaluated initially to allow comparison to data in the literature. Next, following the application of principal-components factor analysis for data reduction, individual differences in speech-recognition-in-noise performance were examined using multiple-linear-regression analyses. Excellent fits were obtained, accounting for 60-77% of the total variance, with most accounted for by the audibility of the speech and noise stimuli and the severity of hearing loss with the balance primarily associated with cognitive function.

Visual prediction cues can facilitate behavioural and neural speech processing in young and older adults

The ability to process speech evolves over the course of the lifespan. Understanding speech at low acoustic intensity and in the presence of background noise becomes harder, and the ability for older adults to benefit from audiovisual speech also appears to decline. These difficulties can have important consequences on quality of life. Yet, a consensus on the cause of these difficulties is still lacking. The objective of this study was to examine the processing of speech in young and older adults under different modalities (i.e. auditory [A], visual [V], audiovisual [AV]) and in the presence of different visual prediction cues (i.e., no predictive cue (control), temporal predictive cue, phonetic predictive cue, and combined temporal and phonetic predictive cues). We focused on recognition accuracy and four auditory evoked potential (AEP) components: P1-N1-P2 and N2. Thirty-four right-handed French-speaking adults were recruited, including 17 younger adults (28 ± 2 years; 20-42 years) and 17 older adults (67 ± 3.77 years; 60-73 years). Participants completed a forced-choice speech identification task. The main findings of the study are: (1) The faciliatory effect of visual information was reduced, but present, in older compared to younger adults, (2) visual predictive cues facilitated speech recognition in younger and older adults alike, (3) age differences in AEPs were localized to later components (P2 and N2), suggesting that aging predominantly affects higher-order cortical processes related to speech processing rather than lower-level auditory processes. (4) Specifically, AV facilitation on P2 amplitude was lower in older adults, there was a reduced effect of the temporal predictive cue on N2 amplitude for older compared to younger adults, and P2 and N2 latencies were longer for older adults. Finally (5) behavioural performance was associated with P2 amplitude in older adults. Our results indicate that aging affects speech processing at multiple levels, including audiovisual integration (P2) and auditory attentional processes (N2). These findings have important implications for understanding barriers to communication in older ages, as well as for the development of compensation strategies for those with speech processing difficulties.

Hearing Impairment and Cognition in an Aging World

With the increasing number of older adults around the world, the overall number of dementia cases is expected to rise dramatically in the next 40 years. In 2020, nearly 6 million individuals in the USA were living with Alzheimer's disease, the most common type of dementia, with anticipated growth to nearly 14 million by year 2050. This increasing prevalence, coupled with high societal burden, makes prevention and intervention of dementia a medical and public health priority. As clinicians and researchers, we will continue to see more individuals with hearing loss with other comorbidities including dementia. Epidemiologic evidence suggests an association between hearing loss and increased risk of dementia, presenting opportunity for targeted intervention for hearing loss to play a fundamental role in dementia prevention. In this discussion, we summarize current research on the association between hearing loss and dementia and review potential casual mechanisms behind the association (e.g., sensory-deprivation hypothesis, information-degradation hypothesis, common cause). We emphasize key areas of research which might best inform our investigation of this potential casual association. These selected research priorities include examination of the causal mechanism, measurement of co-existing hearing loss and cognitive impairment, and potential of aural rehabilitation. Addressing these research gaps and how results are then translated for clinical use is paramount for dementia prevention and overall health of older adults.

Effects of speech-rhythm disruption on selective listening with a single background talker

Recent work by McAuley et al. (Attention, Perception, & Psychophysics, 82, 3222-3233, 2020) using the Coordinate Response Measure (CRM) paradigm with a multitalker background revealed that altering the natural rhythm of target speech amidst background speech worsens target recognition (a target-rhythm effect), while altering background speech rhythm improves target recognition (a background-rhythm effect). Here, we used a single-talker background to examine the role of specific properties of target and background sound patterns on selective listening without the complexity of multiple background stimuli. Experiment 1 manipulated the sex of the background talker, presented with a male target talker, to assess target and background-rhythm effects with and without a strong pitch cue to aid perceptual segregation. Experiment 2 used a vocoded single-talker background to examine target and background-rhythm effects with envelope-based speech rhythms preserved, but without semantic content or temporal fine structure. While a target-rhythm effect was present with all backgrounds, the background-rhythm effect was only observed for the same-sex background condition. Results provide additional support for a selective entrainment hypothesis, while also showing that the background-rhythm effect is not driven by envelope-based speech rhythm alone, and may be reduced or eliminated when pitch or other acoustic differences provide a strong basis for selective listening.

Age-Related Changes in Audiovisual Simultaneity Perception and Their Relationship With Working Memory

OBJECTIVES

Perceiving simultaneity of a visual and an auditory signal is critical for humans to integrate these multisensory inputs effectively and respond properly. We examined age-related changes in audiovisual simultaneity perception, and the relationships between this perception and working memory performances with aging.

METHODS

Audiovisual simultaneity perception of young, middle-aged, and older adults was measured using a simultaneity judgment (SJ) task, in which a flash and a beep were presented at 1 of 11 stimulus-onset asynchronies (SOAs). Participants judged whether these two stimuli were perceived simultaneously. Precision of simultaneity perception, the SOA corresponding to the point of subjective simultaneity (PSS), and response errors at each SOA were estimated using model fitting. The precision and PSS are associated with multisensory perception per se, whereas the response error reflects executive ability when performing the SJ task. Visual working memory of the same middle-aged and older adults was measured using the Cambridge Neuropsychological Test Automated Battery (CANTAB) beforehand.

RESULTS

Compared to young adults' performances, middle-aged and older adults showed a decreased precision, a shift of PSS toward the visual-leading SOAs, and increased response errors at the visual-leading SOAs. Among these changes, only the increased response errors correlated with worse spatial recognition memory in middle-aged and older adults.

DISCUSSION

Age-related decrements in audiovisual simultaneity perception start from middle age and are manifested in both perceptual and executive parameters. Furthermore, higher-order executive ability is plausibly a common cause for age-related degenerations in the audiovisual simultaneity perception and visual working memory.

Age-related hearing loss and cognitive decline: MRI and cellular evidence

Extensive evidence supports the association between age-related hearing loss (ARHL) and cognitive decline. It is, however, unknown whether a causal relationship exists between these two, or whether they both result from shared mechanisms. This paper intends to study this relationship through a comprehensive review of MRI findings as well as evidence of cellular alterations. Our review of structural MRI studies demonstrates that ARHL is independently linked to accelerated atrophy of total and regional brain volumes and reduced white matter integrity. Resting-state and task-based fMRI studies on ARHL also show changes in spontaneous neural activity and brain functional connectivity; and alterations in brain areas supporting auditory, language, cognitive, and affective processing independent of age, respectively. Although MRI findings support a causal relationship between ARHL and cognitive decline, the contribution of potential shared mechanisms should also be considered. In this regard, the review of cellular evidence indicates their role as possible common mechanisms underlying both age-related changes in hearing and cognition. Considering existing evidence, no single hypothesis can explain the link between ARHL and cognitive decline, and the contribution of both causal (i.e., the sensory hypothesis) and shared (i.e., the common cause hypothesis) mechanisms is expected.

Listener characteristics differentially affect self-reported and physiological measures of effort associated with two challenging listening conditions

Listeners vary in their ability to understand speech in adverse conditions. Differences in both cognitive and linguistic capacities play a role, but increasing evidence suggests that such factors may contribute differentially depending on the listening challenge. Here, we used multilevel modeling to evaluate contributions of individual differences in age, hearing thresholds, vocabulary, selective attention, working memory capacity, personality traits, and noise sensitivity to variability in measures of comprehension and listening effort in two listening conditions. A total of 35 participants completed a battery of cognitive and linguistic tests as well as a spoken story comprehension task using (1) native-accented English speech masked by speech-shaped noise and (2) nonnative accented English speech without masking. Masker levels were adjusted individually to ensure each participant would show (close to) equivalent word recognition performance across the two conditions. Dependent measures included comprehension tests results, self-rated effort, and electrodermal, cardiovascular, and facial electromyographic measures associated with listening effort. Results showed varied patterns of responsivity across different dependent measures as well as across listening conditions. In particular, results suggested that working memory capacity may play a greater role in the comprehension of nonnative accented speech than noise-masked speech, while hearing acuity and personality may have a stronger influence on physiological responses affected by demands of understanding speech in noise. Furthermore, electrodermal measures may be more strongly affected by affective response to noise-related interference while cardiovascular responses may be more strongly affected by demands on working memory and lexical access.

Narrative review of the multisensory integration tasks used with older adults: inclusion of multisensory integration tasks into neuropsychological assessment

Introduction: Age-related changes in sensory functioning impact the activities of daily living and interact with cognitive decline. Given the interactions between sensory and cognitive functioning, combining multisensory integration (MI) assessment with the neuropsychological assessment of older adults seems promising. This review aims to examine the characteristics and utility of MI tasks in functional and cognitive assessment of older adults, with or without neurocognitive impairment.Areas covered: A literature search was conducted following the quality assessment of narrative review criteria. Results focused on tasks of detection, discrimination, sensory illusion, temporal judgment, and sensory conflict. Studies were not consensual regarding the enhancement of MI with age, but most studies showed that older adults had an expanded time window of integration. In older adults with mild cognitive impairment or major neurocognitive disorder it was a mediating role of the magnitude of visual-somatosensory integration between neurocognitive impairment and spatial aspects of gait.Expert opinion: Recently, some concerns have been raised about how to maximize the ecological validity of the neuropsychological assessment. Since most of our activities of daily living are multisensory and older adults benefit from multisensory information, MI assessment has the potential to improve the ecological validity of the neuropsychological assessment.

Age differences in the longitudinal associations of leisure-time physical activity and depressive symptoms with cognitive decline in older Taiwanese

Objectives: The associations of physical activity and depressive symptoms with cognitive decline are likely age dependent. The study was therefore aimed to investigate the age differences in the associations of leisure-time physical activity (LTPA) and depressive symptoms with cognitive decline in older Taiwanese.Method: A total of 3545 participants, age ≥50, from 2003 (baseline) and 2007 (end-point) survey datasets were analyzed. Cognitive decline was defined as a decrease of two or more points on the Short Portable Mental Status Questionnaire. The long-term LTPA and depressive symptoms were the change of status between the two time-points. Multivariable logistic regression was conducted to evaluate the longitudinal associations, stratified by age.Results: Significant associations between all levels of long-term LTPA status and cognitive decline were observed for the older group (age ≥70), but not any for the younger group (age 50-69). Significant associations between long-term depressive symptoms status and cognitive decline were also found in all levels for the older group, but only in one level for the younger group. The two odds ratios of cognitive decline between the age groups were further found to be significantly different for those with active LTPA in both time-points (p=.005) and for those with depressive symptoms decreased (p=.014).Conclusion: The findings suggest that there are age differences in the longitudinal associations of LTPA and depressive symptoms with cognitive decline in older Taiwanese. Understanding the pattern of age differences could be helpful in preventing cognitive decline of the elderly.

The Bidirectional Relationship between Vision and Cognition: A Systematic Review and Meta-analysis

TOPIC

Visual impairment (VI) and cognitive impairment (CIM) are prevalent age-related conditions that impose substantial burden on the society. Findings on the hypothesized bidirectional association of VI and CIM remains equivocal. Hence, we conducted a systematic review and meta-analysis to examine this bidirectional relationship.

CLINICAL RELEVANCE

Sixty percent risk of CIM has not been well elucidated in the literature. A bidirectional relationship between VI and CIM may support the development of strategies for early detection and management of risk factors for both conditions in older people.

METHODS

PubMed, Embase, and Cochrane Central registers were searched systematically for observational studies, published from inception until April 6, 2020, in adults 40 years of age or older reporting objectively measured VI and CIM assessment using clinically validated cognitive screening tests or diagnostic evaluation. Meta-analyses on cross-sectional and longitudinal associations between VI and CIM outcomes (any CIM assessed using screening tests and clinically diagnosed dementia) were examined. Random effect models were used to generate pooled odds ratios (ORs) and 95% confidence intervals (CIs). We also examined study quality, publication bias, and heterogeneity.

RESULTS

Forty studies were included (n = 47 913 570). Meta-analyses confirmed that persons with VI were more likely to have CIM, with significantly higher odds of: (1) any CIM (cross-sectional: OR, 2.38 [95% CI, 1.84-3.07]; longitudinal: OR, 1.66 [95% CI, 1.46-1.89]) and (2) clinically diagnosed dementia (cross-sectional: OR, 2.43 [95% CI, 1.48-4.01]; longitudinal: OR, 2.09 [95% CI, 1.37-3.21]) compared with persons without VI. Significant heterogeneity was explained partially by differences in age, sex, and follow-up duration. Also, some evidence suggested that individuals with CIM, relative to cognitively intact persons, were more likely to have VI, with most articles (8/9 [89%]) reporting significantly positive associations; however, meta-analyses on this association could not be conducted because of insufficient data.

DISCUSSION

Overall, our work suggests that VI is a risk factor of CIM, although further work is needed to confirm the association of CIM as a risk factor for VI. Strategies for early detection and management of both conditions in older people may minimize individual clinical and public health consequences.

Cognitive Hearing Science: Three Memory Systems, Two Approaches, and the Ease of Language Understanding Model

Purpose The purpose of this study was to conceptualize the subtle balancing act between language input and prediction (cognitive priming of future input) to achieve understanding of communicated content. When understanding fails, reconstructive postdiction is initiated. Three memory systems play important roles: working memory (WM), episodic long-term memory (ELTM), and semantic long-term memory (SLTM). The axiom of the Ease of Language Understanding (ELU) model is that explicit WM resources are invoked by a mismatch between language input-in the form of rapid automatic multimodal binding of phonology-and multimodal phonological and lexical representations in SLTM. However, if there is a match between rapid automatic multimodal binding of phonology output and SLTM/ELTM representations, language processing continues rapidly and implicitly. Method and Results In our first ELU approach, we focused on experimental manipulations of signal processing in hearing aids and background noise to cause a mismatch with LTM representations; both resulted in increased dependence on WM. Our second-and main approach relevant for this review article-focuses on the relative effects of age-related hearing loss on the three memory systems. According to the ELU, WM is predicted to be frequently occupied with reconstruction of what was actually heard, resulting in a relative disuse of phonological/lexical representations in the ELTM and SLTM systems. The prediction and results do not depend on test modality per se but rather on the particular memory system. This will be further discussed. Conclusions Related to the literature on ELTM decline as precursors of dementia and the fact that the risk for Alzheimer's disease increases substantially over time due to hearing loss, there is a possibility that lowered ELTM due to hearing loss and disuse may be part of the causal chain linking hearing loss and dementia. Future ELU research will focus on this possibility.

Longitudinal Changes in Auditory and Cognitive Function in Middle-Aged and Older Adults

Purpose This article aimed to document longitudinal changes in auditory function, including measures of temporal processing, and to examine the associations between observed changes in auditory and cognitive function in middle-aged and older adults. Method This was a prospective longitudinal study of 98 adults (66 women) with baseline ages ranging from 40 to 85 years. The mean interval between T1 baseline and T2 follow-up measurements was 8.8 years with a range of 7-11 years. Measures of hearing threshold, gap detection, and auditory temporal-order identification were completed at T1 and T2. Cognitive measures completed at T1 and T2 were the 13 scales of the Wechsler Adult Intelligence Scale-Third Edition. Three approaches were taken to analyze these data: (a) examination of changes over time in group performance, (b) correlations and slopes between auditory and cognitive measures to examine concomitant rates of decline over the 9-year T1-to-T2 period, and (c) regression analyses examining associations between auditory performance at T1 and cognitive performance 9 years later at T2. Results For the group data, there were significant declines in hearing loss, gap-detection thresholds at one frequency, and process-type measures of cognitive function from T1 to T2 matching the trends in the baseline cross-sectional data. Regression analyses of the longitudinal data revealed the strongest connection between auditory temporal-order processing and cognitive processing typically explaining 10%-15% of the variance. Conclusions A significant amount of variance in rates of cognitive decline, T1 to T2, and subsequent cognitive performance (T2) was explained by measures of auditory function. Although hearing loss occasionally emerged as a significant factor, auditory temporal-order identification emerged much more frequently as the auditory measure most strongly associated with cognitive function.

Interhemispheric differences in P1 and N1 amplitude in EEG and MEG differ across older individuals with a concussion compared with age-matched controls

We studied the effects of mild traumatic brain injury (mTBI) in an aging population. We examined visual search with event-related potentials (ERPs) and event-related fields (ERF) for a lateral color singleton focusing on the P1 and N1 in each hemisphere. Forty participants (19 mTBI and 21 controls) aged 50 to 72 performed a visual search task, while we recorded their magnetoencephalogram (MEG) with simultaneous electroencephalogram (EEG). We compared visual ERPs and ERFs and associated cortical activity estimated using MEG source localization. Relative to matched controls, participants with an mTBI had a smaller P1 in the left hemisphere and a smaller N1 in the right hemisphere. Also, mTBI participants showed inversed activation patterns across the hemispheres during the N1 in MEG compared with controls. This is the first study to investigate the impact of mTBI on neuronal source activations during early visual processing in an aging population. Results showed that when aging individuals suffer from an mTBI, there are perturbations in the amplitude and hemispheric dominance patterns in the visual P1 and N1 responses that are visible for months to years following the injury. Our findings indicate that mTBI can lead to modifications of sensory and/or perceptual responses, suggesting possible adaptive functional reorganization following mTBI.

Gray matter declines with age and hearing loss, but is partially maintained in tinnitus

The impact of age-related hearing loss extends beyond the auditory pathway and impacts brain areas related to cognitive impairment and even dementia. The presence of tinnitus, a sensation of sound that frequently co-occurs with hearing loss, is additionally linked to cognitive decline. Interestingly, structural neuroimaging studies have reported that hearing loss may precede or modulate the onset of cognitive impairment. In this study, we aimed to disentangle the effects of age, hearing loss, and tinnitus on gray matter structure. In total, 39 participants with hearing loss and tinnitus, 21 with hearing loss but without tinnitus, and 39 controls were included in this voxel- and surface-based morphometry MRI study. Whole brain volume and surface thickness measures were compared between the groups. Age-related gray matter volume decline was observed in all groups. Several brain areas showed smaller gray matter volume and cortical surface thickness in hearing loss without tinnitus, relative to controls. This reduction was observed both within and outside of the auditory pathway. Interestingly, these reductions were not observed in participants with tinnitus, who had similar hearing loss and were of similar age. Since we have tools to improve hearing loss, hearing screening may aid in the battle against cognitive decline.

Associations Between Measures of Auditory Function and Brief Assessments of Cognition

Purpose The two primary purposes of this report are (a) to compare the results of three brief cognitive screens in older adults and (b) to examine associations between performance on each of the screens and auditory function measured either concurrently or 9 years earlier. Method This was a prospective longitudinal study of 98 adults (66 women) with baseline ages ranging from 40 to 85 years. The mean interval between T1 baseline and T2 follow-up measurements was 8.8 years with a range from 7 to 11 years. Measures of hearing threshold, gap detection, and auditory temporal-order identification were completed at T1 and T2. The Mini-Mental State Examination was completed at T1 and T2, whereas the Montreal Cognitive Assessment (MoCA) and A Quick Test were completed at T2 only. Results Higher scores and pass rates were obtained for the Mini-Mental State Examination than for the MoCA or the A Quick Test. The measures were moderately correlated among themselves and with the Wechsler Adult Intelligence Scale-Third Edition. Significant associations emerged frequently between auditory and cognitive functions, most often for the auditory measure of temporal-order identification, including dichotic measures of this ability. Conclusions From this evaluation, the MoCA emerged as the preferred test for clinicians desiring a quick assessment of the cognitive function of their older patients. Auditory temporal-order identification is associated with cognitive function and explains about 10%-20% of the variation in cognitive function independent of age and hearing loss. Supplemental Material https://doi.org/10.23641/asha.12986021.

Associations of Hearing Sensitivity, Higher-Order Auditory Processing, and Cognition Over Time in Middle-Aged Adults

BACKGROUND

Age-related hearing loss (impairment in hearing sensitivity and/or higher-order auditory processing) and cognitive decline are common co-occurring impairments in elderly adults. Their relation in the process of aging remains insufficiently understood. We aim to assess the temporal relations of decline in hearing sensitivity, higher-order auditory processing, and cognition in middle-aged adults.

METHODS

This study included 1,274 Beaver Dam Offspring Study participants who participated in three examinations (baseline, 5-year, and 10-year follow-up). We assessed hearing sensitivity through pure-tone audiometry (PTA, averaged thresholds of 0.5, 1, 2, 4 kHz of the better ear), higher-order auditory processing as word recognition in competing message (WRCM) using the Northwestern University 6 word list in the better ear, and cognition through trail-making test performance (TMT). Linear mixed-effects models and linear regression models were used to determine associations over time and to what extent these measures influence each other over time.

RESULTS

The longitudinal decline between all functions was associated with the strongest relationships between PTA and WRCM. The effect of baseline PTA on WRCM 10 years later (standardized ß = -.30) was almost twice as big as the effect of baseline WRCM on PTA 10 years later (standardized ß = -.18). The effect of baseline WRCM on TMT 10 years later and vice versa were small (standardized ß = -.05). No directional relationship between PTA and TMT was identified (standardized ß ≤ .02).

CONCLUSIONS

While hearing sensitivity might affect higher-order auditory processing, associations between hearing and cognition appear bidirectional and weak in midlife. We need to be cautious before inferring causal effects of hearing on cognition.

Age- and movement-related modulation of cortical oscillations in a mouse model of presbycusis

Brain oscillations are associated with specific cognitive and sensory processes. How age-related hearing loss (presbycusis) alters cortical oscillations is unclear. Altered inhibitory neurotransmission and temporal processing deficits contribute to speech recognition impairments in presbycusis. Specifically, age-related reduction in parvalbumin positive interneurons and perineuronal nets in the auditory cortex predicts a reduction in gamma oscillations that may lead to a decline in temporal precision and attention. To test the hypothesis that resting and evoked gamma oscillations decline with presbycusis, EEGs were recorded from the auditory and frontal cortex of awake, freely moving C57BL/6 J mice at three ages (3, 14 and 24 months). Resting EEG data were analyzed according to movement state (move versus still). Evoked responses were recorded following presentation of noise bursts or amplitude modulated noise with time varying modulation frequencies. We report an age-related decrease in resting gamma power, a decline in gamma-range synchrony to time varying stimuli, and an increase in noise evoked and induced gamma power. A decline in temporal processing is seen in aged mice that exhibit robust auditory-evoked potentials, dissociating hearing loss from temporal processing deficits. We also report an increase in gamma power when mice moved compared to the still state. However, the movement-related modulation of gamma oscillations did not change with age. Together, these data identify a number of novel markers of presbycusis-related changes in auditory and frontal cortex. Because EEGs are commonly recorded in humans, the mouse data may serve as translation relevant preclinical biomarkers to facilitate the development of therapeutics to delay or reverse central auditory processing deficits in presbycusis.

Neuroanatomical changes associated with age-related hearing loss and listening effort

Age-related hearing loss is associated with a decrease in hearing abilities for high frequencies and therefore leads to impairments in understanding speech—in particular, under adverse listening conditions. Growing evidence suggests that age-related hearing loss is related to various neural changes, for instance, affecting auditory and frontal brain regions. How the decreased auditory input and the increased listening effort in daily life are associated with structural changes is less clear, since previous evidence is scarce and mostly involved low sample sizes. Hence, the aim of the current study was to investigate the impact of age-related untreated hearing loss and subjectively rated daily life listening effort on grey matter and white matter changes in a large sample of participants (n = 71). For that aim, we conducted anatomical MRI and diffusion tensor imaging (DTI) in elderly hard-of-hearing and age-matched normal-hearing participants. Our results showed significantly lower grey matter volume in the middle frontal cortex in hard-of-hearing compared to normal-hearing participants. Further, higher listening effort was associated with lower grey matter volume and cortical thickness in the orbitofrontal cortex and lower grey matter volume in the inferior frontal cortex. No significant relations between hearing abilities or listening effort were obtained for white matter integrity in tracts connecting auditory and prefrontal as well as visual areas. These findings provide evidence that hearing impairment as well as daily life listening effort seems to be associated with grey matter loss in prefrontal brain regions. We further conclude that alterations in cortical thickness seem to be linked to the increased listening effort rather than the hearing loss itself.

Screening for Vision Impairments in Individuals with Dementia Living in Long-Term Care: A Scoping Review

Vision impairments are prevalent, but underdiagnosed in individuals with dementia living in long-term care (LTC). Effective screening tools could identify remediable vision problems. This scoping review was conducted to identify vision screening tests used with individuals with dementia and assesses their suitability for administration by nurses in LTC. A literature search using the Arksey and O’Malley (2005) method included research articles, conference proceedings, and dissertations. Data were included from participants over 65 years of age with a diagnosis of probable dementia. A panel of vision experts evaluated the suitability of the candidate vision tests. The search yielded 179 publications that met the inclusion criteria. Of 134 vision tests that were identified, 19 were deemed suitable for screening by nurses in LTC. Tests screened for acuity (12), visual field (1), anatomy (2), color vision (2), and general visual abilities (2). Tests were excluded because of complexity of interpretation (90), need for specialized training (83), use in research only (57), need for specialized equipment (54), not assessing visual function (44), long test duration (21), uncommonness (13), and needing an act reserved for specialists (7). Psychometric properties were not often reported for tests. Few of the tests identified had been validated for use with individuals with dementia. Based on our review, few tests were deemed suitable for use by nurses to assess this population in LTC. Identifying appropriate tools to screen vision in individuals with dementia is a necessary first step to interventions that could potentially improve functioning and quality of life.

The Effects of Age-Related Hearing Loss on the Brain and Cognitive Function

Age-related hearing loss (ARHL) is a common problem for older adults, leading to communication difficulties, isolation, and cognitive decline. Recently, hearing loss has been identified as potentially the most modifiable risk factor for dementia. Listening in challenging situations, or when the auditory system is damaged, strains cortical resources, and this may change how the brain responds to cognitively demanding situations more generally. We review the effects of ARHL on brain areas involved in speech perception, from the auditory cortex, through attentional networks, to the motor system. We explore current perspectives on the possible causal relationship between hearing loss, neural reorganisation, and cognitive impairment. Through this synthesis we aim to inspire innovative research and novel interventions for alleviating hearing loss and cognitive decline.

Decoding Hearing-Related Changes in Older Adults' Spatiotemporal Neural Processing of Speech Using Machine Learning

Speech perception in noisy environments depends on complex interactions between sensory and cognitive systems. In older adults, such interactions may be affected, especially in those individuals who have more severe age-related hearing loss. Using a data-driven approach, we assessed the temporal (when in time) and spatial (where in the brain) characteristics of cortical speech-evoked responses that distinguish older adults with or without mild hearing loss. We performed source analyses to estimate cortical surface signals from the EEG recordings during a phoneme discrimination task conducted under clear and noise-degraded conditions. We computed source-level ERPs (i.e., mean activation within each ROI) from each of the 68 ROIs of the Desikan-Killiany (DK) atlas, averaged over a randomly chosen 100 trials without replacement to form feature vectors. We adopted a multivariate feature selection method called stability selection and control to choose features that are consistent over a range of model parameters. We use parameter optimized support vector machine (SVM) as a classifiers to investigate the time course and brain regions that segregate groups and speech clarity. For clear speech perception, whole-brain data revealed a classification accuracy of 81.50% [area under the curve (AUC) 80.73%; F1-score 82.00%], distinguishing groups within ∼60 ms after speech onset (i.e., as early as the P1 wave). We observed lower accuracy of 78.12% [AUC 77.64%; F1-score 78.00%] and delayed classification performance when speech was embedded in noise, with group segregation at 80 ms. Separate analysis using left (LH) and right hemisphere (RH) regions showed that LH speech activity was better at distinguishing hearing groups than activity measured in the RH. Moreover, stability selection analysis identified 12 brain regions (among 1428 total spatiotemporal features from 68 regions) where source activity segregated groups with >80% accuracy (clear speech); whereas 16 regions were critical for noise-degraded speech to achieve a comparable level of group segregation (78.7% accuracy). Our results identify critical time-courses and brain regions that distinguish mild hearing loss from normal hearing in older adults and confirm a larger number of active areas, particularly in RH, when processing noise-degraded speech information.

Development of a Combined Sensory-Cognitive Measure Based on the Common Cause Hypothesis: Heterogeneous Trajectories and Associated Risk Factors

BACKGROUND AND OBJECTIVES

There is a link between sensory and cognitive functioning across old age. However, there are no integrative measures for assessing common determinants of sensory-cognitive functioning. This study aims to develop a combined measure of sensory-cognitive functioning, and to identify heterogeneous trajectories and associated risk factors.

RESEARCH DESIGN AND METHODS

Two thousand two hundred and fifty-five individuals aged 60 years and over selected from the first six waves (2002-2012) of the English Longitudinal Study of Ageing completed a set of five self-reported visual and hearing functioning items and four cognitive items. Several health-related outcomes were also collected.

RESULTS

The common cause model presented longitudinal factorial invariance (Tucker-Lewis index [TLI] = 0.989; Comparative Fit Index [CFI] = 0.991; Root Mean Square Error of Approximation [RMSEA] = 0.026). A common factor explained 32%, 36%, and 26% of the visual, hearing, and cognitive difficulties, respectively. The developed sensory-cognitive measure predicted incident dementia over 10 years (area under the curve = .80; 95% confidence interval [CI] = .75, .86). A three-trajectory model was proved to fit better, according to growth mixture modeling. Low levels of education and household wealth, disability, diabetes, high blood pressure, depressive symptoms, and low levels of physical activity were risk factors associated with the classes showing trajectories with a steeper increase of sensory-cognitive difficulties.

DISCUSSION AND IMPLICATIONS

A time-invariant factor explains both sensory and cognitive functioning over 8 years. The sensory-cognitive measure derived from this factor showed a good performance for predicting dementia 10 years later. Several easily identifiable socioeconomic and health-related risk factors could be used as early markers of subsequent sensory-cognitive decline. Therefore, the proposed latent measure could be useful as a cost-effective indicator of sensory-cognitive functioning.

The Profiles and Correlates of Psychopathology in Adolescents and Adults with Williams, Fragile X and Prader-Willi Syndromes

Psychopathology is prevalent in Williams (WS), fragile X (FXS) and Prader–Willi (PWS) syndromes. However, little is known about the potential correlates of psychopathology in these groups. A questionnaire study was completed by 111 caregivers of individuals with WS (n = 35); FXS (n = 50) and PWS (n = 26). Mean age was 26 years (range 12–57 years); 74 (67%) were male. Multiple regression analyses indicated that higher rates of health problems and sensory impairments predicted higher psychopathology in WS (p < .0001). In PWS, poorer adaptive ability predicted higher overall psychiatric disturbance (p = .001), generalised anxiety (p = .006) and hyperactivity (p = .003). There were no significant predictors in FXS. This study highlights dissociations in the potential risk markers of psychopathology between genetic syndromes. Implications for intervention are discussed.

Reduced suprathreshold auditory nerve responses are associated with slower processing speed and thinner temporal and parietal cortex in presbycusis

Epidemiological evidence shows an association between hearing loss and dementia in elderly people. However, the mechanisms that connect hearing impairments and cognitive decline are still unknown. Here we propose that a suprathreshold auditory-nerve impairment is associated with cognitive decline and brain atrophy. Methods: audiological, neuropsychological, and brain structural 3-Tesla MRI data were obtained from elders with different levels of hearing loss recruited in the ANDES cohort. The amplitude of waves I (auditory nerve) and V (midbrain) from auditory brainstem responses were measured at 80 dB nHL. We also calculated the ratio between wave V and I as a proxy of suprathreshold brainstem function. Results: we included a total of 101 subjects (age: 73.5 ± 5.2 years (mean ± SD), mean education: 9.5 ± 4.2 years, and mean audiogram thresholds (0.5–4 kHz): 25.5 ± 12.0 dB HL). We obtained reliable suprathreshold waves V in all subjects (n = 101), while replicable waves I were obtained in 92 subjects (91.1%). Partial Spearman correlations (corrected by age, gender, education and hearing thresholds) showed that reduced suprathreshold wave I responses were associated with thinner temporal and parietal cortices, and with slower processing speed as evidenced by the Trail-Making Test-A and digit symbol performance. Non-significant correlations were obtained between wave I amplitudes and other cognitive domains. Conclusions: These results evidence that reduced suprathreshold auditory nerve responses in presbycusis are associated with slower processing speed and brain structural changes in temporal and parietal regions.

Evidence for independent peripheral and central age-related hearing impairment

Deleterious age-related changes in the central auditory nervous system have been referred to as central age-related hearing impairment (ARHI) or central presbycusis. Central ARHI is often assumed to be the consequence of peripheral ARHI. However, it is possible that certain aspects of central ARHI are independent from peripheral ARHI. A confirmation of this possibility could lead to significant improvements in current rehabilitation practices. The major difficulty in addressing this issue arises from confounding factors, such as other age-related changes in both the cochlea and central non-auditory brain structures. Because gap detection is a common measure of central auditory temporal processing, and gap detection thresholds are less influenced by changes in other brain functions such as learning and memory, we investigated the potential relationship between age-related peripheral hearing loss (i.e., audiograms) and age-related changes in gap detection. Consistent with previous studies, a significant difference was found for gap detection thresholds between young and older adults. However, among older adults, no significant associations were observed between gap detection ability and several other independent variables including the pure tone audiogram average, the Wechsler Adult Intelligence Scale-Vocabulary score, gender, and age. Statistical analyses showed little or no contributions from these independent variables to gap detection thresholds. Thus, our data indicate that age-related decline in central temporal processing is largely independent of peripheral ARHI.

Auditory Processing Deficits Are Selectively Associated with Medial Temporal Lobe Mnemonic Function and White Matter Integrity in Aging Macaques

Deficits in auditory function and cognition are hallmarks of normative aging. Recent evidence suggests that hearing-impaired individuals have greater risks of developing cognitive impairment and dementia compared to people with intact auditory function, although the neurobiological bases underlying these associations are poorly understood. Here, a colony of aging macaques completed a battery of behavioral tests designed to probe frontal and temporal lobe-dependent cognition. Auditory brainstem responses (ABRs) and visual evoked potentials were measured to assess auditory and visual system function. Structural and diffusion magnetic resonance imaging were then performed to evaluate the microstructural condition of multiple white matter tracts associated with cognition. Animals showing higher cognitive function had significantly better auditory processing capacities, and these associations were selectively observed with tasks that primarily depend on temporal lobe brain structures. Tractography analyses revealed that the fractional anisotropy (FA) of the fimbria-fornix and hippocampal commissure were associated with temporal lobe-dependent visual discrimination performance and auditory sensory function. Conversely, FA of frontal cortex-associated white matter was not associated with auditory processing. Visual sensory function was not associated with frontal or temporal lobe FA, nor with behavior. This study demonstrates significant and selective relationships between ABRs, white matter connectivity, and higher-order cognitive ability.

Time for a Systems Biological Approach to Cognitive Aging?-A Critical Review

The underlying premise of current theories of cognitive decline with age tend to be primarily cognitive or biological explanations, with relatively few theories adequately integrating both aspects. Though literature has also emphasized the importance of several factors that contribute to cognitive aging including: (a) decline in sensory abilities; (b) the effect of motor speed on paper-pencil measures of cognitive speed; (c) the impact of level of education and physical activity; and (d) molecular biological changes that occur with age, these factors have seldom been implicated into any single theoretical model of cognitive aging. Indeed, such an integrated bio-cognitive model of aging has the potential to provide a more comprehensive understanding of attention, perception, learning, and memory across the lifespan. Thus, the aim of this review was to critically evaluate common theories of age-related cognitive decline and highlight the need for a more comprehensive systems neuroscience approach to cognitive aging.

Auditory Training to Improve Speech Perception and Self-Efficacy in Aging Adults

Purpose Difficulty in understanding spoken speech is a common complaint among aging adults, even when hearing impairment is absent. Correlational studies point to a relationship between age, auditory temporal processing (ATP), and speech perception but cannot demonstrate causality unlike training studies. In the current study, we test (a) the causal relationship between a spatial-temporal ATP task (temporal order judgment [TOJ]) and speech perception among aging adults using a training design and (b) whether improvement in aging adult speech perception is accompanied by improved self-efficacy. Method Eighty-two participants aged 60-83 years were randomly assigned to a group receiving (a) ATP training (TOJ) over 14 days, (b) non-ATP training (intensity discrimination) over 14 days, or (c) no training. Results The data showed that TOJ training elicited improvement in all speech perception tests, which was accompanied by increased self-efficacy. Neither improvement in speech perception nor self-efficacy was evident following non-ATP training or no training. Conclusions There was no generalization of the improvement resulting from TOJ training to intensity discrimination or generalization of improvement resulting from intensity discrimination training to speech perception. These findings imply that the effect of TOJ training on speech perception is specific and such improvement is not simply the product of generally improved auditory perception. It provides support for the idea that temporal properties of speech are indeed crucial for speech perception. Clinically, the findings suggest that aging adults can be trained to improve their speech perception, specifically through computer-based auditory training, and this may improve perceived self-efficacy.

Temporal Sequence of Hearing Impairment and Cognition in the Baltimore Longitudinal Study of Aging

BACKGROUND

Hearing impairment (HI) could be a risk factor for cognitive decline, but cognition could plausibly also affect psychoacoustic assessment of hearing with audiometry. We examined the temporal sequence of hearing and cognitive function among nondemented, community-dwelling older adults.

METHODS

Hearing and cognition were assessed between 2012 and 2015 and 2 years thereafter in 313 nondemented participants aged ≥60 years in the Baltimore Longitudinal Study of Aging. Poorer hearing was defined by pure-tone average of 0.5-4 kHz tones in the better-hearing ear. Cognitive measures with either visual or auditory inputs were Trail-making Test Part B; Digit Symbol Substitution Test; California Verbal Learning Test immediate recall, short delay, and long delay; Digit Span Forward/Backward; Benton Visual Retention Test; and Mini-Mental State Examination. We used linear regression models for cross-sectional associations at each timepoint and autoregressive, cross-lagged models to evaluate whether baseline hearing impairment (Time 1) predicted cognitive performance 2 years after baseline (Time 2) and vice versa.

RESULTS

Cross-sectionally, there were no associations between poorer hearing and cognitive performance. Longitudinally, poorer hearing was associated with declines in California Verbal Learning Test immediate (β = -0.073, SE = 0.032, p = .024), short-delayed (β = -0.134, SE = 0.043, p = .002), long-delayed (β = -0.080, SE = 0.032, p = .012) recall, and Digit Span Forward (β = -0.074, SE = 0.029, p = .011).) from Time 1 to Time 2. Cognitive performance at Time 1 did not predict change in hearing status at Time 2.

CONCLUSIONS

Audiometric hearing impairment predicted short-term cognitive declines in both California Verbal Learning Test and auditory stimuli for attention.

Neural Signatures of Working Memory in Age-related Hearing Loss

Age-related hearing loss affects the ability to hear high frequencies and therefore leads to difficulties in understanding speech, particularly under adverse listening conditions. This decrease in hearing can be partly compensated by the recruitment of executive functions, such as working memory. The compensatory effort may, however, lead to a decrease in available neural resources compromising cognitive abilities. We here aim to investigate whether mild to moderate hearing loss impacts prefrontal functions and related executive processes and whether these are related to speech-in-noise perception abilities. Nineteen hard of hearing and nineteen age-matched normal-hearing participants performed a working memory task to drive prefrontal activity, which was gauged with functional magnetic resonance imaging. In addition, speech-in-noise understanding, cognitive flexibility and inhibition control were assessed. Our results showed no differences in frontoparietal activation patterns and working memory performance between normal-hearing and hard of hearing participants. The behavioral assessment of further executive functions, however, provided evidence of lower cognitive flexibility in hard of hearing participants. Cognitive flexibility and hearing abilities further predicted speech-in-noise perception. We conclude that neural and behavioral signatures of working memory are intact in mild to moderate hearing loss. Moreover, cognitive flexibility seems to be closely related to hearing impairment and speech-in-noise perception and should, therefore, be investigated in future studies assessing age-related hearing loss and its implications on prefrontal functions.

Effects of age, word frequency, and noise on the time course of spoken word recognition

This study assessed the effects of age, word frequency, and background noise on the time course of lexical activation during spoken word recognition. Participants (41 young adults and 39 older adults) performed a visual world word recognition task while we monitored their gaze position. On each trial, four phonologically unrelated pictures appeared on the screen. A target word was presented auditorily following a carrier phrase ("Click on the ________"), at which point participants were instructed to use the mouse to click on the picture that corresponded to the target word. High- and low-frequency words were presented in quiet to half of the participants. The other half heard the words in a low level of noise in which the words were still readily identifiable. Results showed that, even in the absence of phonological competitors in the visual array, high-frequency words were fixated more quickly than low-frequency words by both listener groups. Young adults were generally faster to fixate on targets compared to older adults, but the pattern of interactions among noise, word frequency, and listener age showed that older adults' lexical activation largely matches that of young adults in a modest amount of noise.

The impact of sensory processing on executive and cognitive functions in children with autism spectrum disorder in the school context

BACKGROUND

Theoretical approaches propose a hierarchical organization of sensory and higher-order cognitive processes, in which sensory processing influence some cognitive and executive functions.

AIMS

The main objective of this study was to analyze whether sensory processing dysfunctions can predict the cognitive and executive dysfunctions evaluated in a group of children with level 2 autism spectrum disorder (ASD) in the school context.

METHODS AND PROCEDURES

Two groups of children participated: an ASD group (n = 40) and a group of children with typical development (the comparison group, n = 40). The children's sensory processing was evaluated based on their teachers' perceptions, and the children's executive and cognitive functions were evaluated using direct performance measures.

RESULTS

In the ASD group, the sensory processing difficulties predicted executive and cognitive dysfunctions in the specific domains of inhibitory control, auditory sustained attention, and short-term verbal memory, after controlling the possible effect of ASD severity. Moreover, the ASD group showed higher levels of sensory, executive, and cognitive dysfunction than the comparison group.

CONCLUSIONS AND IMPLICATIONS

Future research should investigate whether adequate sensory interventions in children with ASD in the school context can improve these specific executive and cognitive functions.

Experiments in macaque monkeys provide critical insights into age-associated changes in cognitive and sensory function

The use of animal models in brain aging research has led to numerous fundamental insights into the neurobiological processes that underlie changes in brain function associated with normative aging. Macaque monkeys have become the predominant nonhuman primate model system in brain aging research due to their striking similarities to humans in their behavioral capacities, sensory processing abilities, and brain architecture. Recent public concern about nonhuman primate research has made it imperative to attempt to clearly articulate the potential benefits to human health that this model enables. The present review will highlight how nonhuman primates provide a critical bridge between experiments conducted in rodents and development of therapeutics for humans. Several studies discussed here exemplify how nonhuman primate research has enriched our understanding of cognitive and sensory decline in the aging brain, as well as how this work has been important for translating mechanistic implications derived from experiments conducted in rodents to human brain aging research.

Age-related hearing loss and tinnitus, dementia risk, and auditory amplification outcomes

Age-related hearing loss (ARHL) or presbycusis, as the third leading cause of chronic disability in older adults, has been shown to be associated with predisposing cognitive impairment and dementia. Tinnitus is also a chronic auditory disorder demonstrating a growth rate with increasing age. Recent evidence stands for the link between bothersome tinnitus and impairments in various aspects of cognitive function. Both ARHL and age-related tinnitus affect mental health and contribute to developing anxiety, stress, and depression. The present review is a comprehensive multidisciplinary study on diverse interactions among ARHL, tinnitus, and cognitive decline in older adults. This review incorporates the latest evidence in prevalence and risk factors of ARHL and tinnitus, the neural substrates of tinnitus-related cognitive impairments, hypothesized mechanisms concerning the association between ARHL and increased risk of dementia, hearing amplification outcomes in cases with ARHL and cognitive decline, and preliminary findings on the link between ARHL and cognitive impairment in animal studies. Given extensive evidence that demonstrates advantages of using auditory amplification in the alleviation of hearing handicap, depression, and tinnitus, and the improvement of cognition, social communication, and quality of life, regular hearing screening programs for identification and management of midlife hearing loss and tinnitus is strongly recommended.

Age-related hearing loss increases full-brain connectivity while reversing directed signaling within the dorsal-ventral pathway for speech

Speech comprehension difficulties are ubiquitous to aging and hearing loss, particularly in noisy environments. Older adults' poorer speech-in-noise (SIN) comprehension has been related to abnormal neural representations within various nodes (regions) of the speech network, but how senescent changes in hearing alter the transmission of brain signals remains unspecified. We measured electroencephalograms in older adults with and without mild hearing loss during a SIN identification task. Using functional connectivity and graph-theoretic analyses, we show that hearing-impaired (HI) listeners have more extended (less integrated) communication pathways and less efficient information exchange among widespread brain regions (larger network eccentricity) than their normal-hearing (NH) peers. Parameter optimized support vector machine classifiers applied to EEG connectivity data showed hearing status could be decoded (> 85% accuracy) solely using network-level descriptions of brain activity, but classification was particularly robust using left hemisphere connections. Notably, we found a reversal in directed neural signaling in left hemisphere dependent on hearing status among specific connections within the dorsal-ventral speech pathways. NH listeners showed an overall net "bottom-up" signaling directed from auditory cortex (A1) to inferior frontal gyrus (IFG; Broca's area), whereas the HI group showed the reverse signal (i.e., "top-down" Broca's → A1). A similar flow reversal was noted between left IFG and motor cortex. Our full-brain connectivity results demonstrate that even mild forms of hearing loss alter how the brain routes information within the auditory-linguistic-motor loop.

Keys to staying sharp: A randomized clinical trial of piano training among older adults with and without mild cognitive impairment

BACKGROUND

The prevalence of dementia, the most expensive medical condition (Kirschstein, 2000 and Hurd et al., 2013 [1,2]), and its precursor, mild cognitive impairment (MCI) are increasing [3]. Finding effective intervention strategies to prevent or delay dementia is imperative to public health. Prior research provides compelling evidence that central auditory processing (CAP) deficits are a risk factor for dementia [4-6]. Grounded in the information degradation theory [7, 8], we hypothesize that improving brain function at early perceptual levels (i.e., CAP) may be optimal to attenuate cognitive and functional decline and potentially curb dementia prevalence. Piano training is one avenue to enhance cognition [9-13] by facilitating CAP at initial perceptual stages [14-18].

OBJECTIVES

The Keys To Staying Sharp study is a two arm, randomized clinical trial examining the efficacy of piano training relative to music listening instruction to improve CAP, cognition, and everyday function among older adults. In addition, the moderating effects of MCI status on piano training efficacy will be examined and potential mediators of intervention effects will be explored.

HYPOTHESES

We hypothesize that piano training will improve CAP and cognitive performance, leading to functional improvements. We expect that enhanced CAP will mediate cognitive gains. We further hypothesize that cognitive gains will mediate functional improvements.

METHOD

We plan to enroll 360 adults aged 60 years and older who will be randomized to piano training or an active control condition of music listening instruction and complete pre- and immediate post- assessments of CAP, cognition, and everyday function.

Afferent-efferent connectivity between auditory brainstem and cortex accounts for poorer speech-in-noise comprehension in older adults

Speech-in-noise (SIN) comprehension deficits in older adults have been linked to changes in both subcortical and cortical auditory evoked responses. However, older adults' difficulty understanding SIN may also be related to an imbalance in signal transmission (i.e., functional connectivity) between brainstem and auditory cortices. By modeling high-density scalp recordings of speech-evoked responses with sources in brainstem (BS) and bilateral primary auditory cortices (PAC), we show that beyond attenuating neural activity, hearing loss in older adults compromises the transmission of speech information between subcortical and early cortical hubs of the speech network. We found that the strength of afferent BS→PAC neural signaling (but not the reverse efferent flow; PAC→BS) varied with mild declines in hearing acuity and this "bottom-up" functional connectivity robustly predicted older adults' performance in a SIN identification task. Connectivity was also a better predictor of SIN processing than unitary subcortical or cortical responses alone. Our neuroimaging findings suggest that in older adults (i) mild hearing loss differentially reduces neural output at several stages of auditory processing (PAC > BS), (ii) subcortical-cortical connectivity is more sensitive to peripheral hearing loss than top-down (cortical-subcortical) control, and (iii) reduced functional connectivity in afferent auditory pathways plays a significant role in SIN comprehension problems.

Does Asymmetric Hearing Loss Affect the Ability to Understand in Noisy Environments?

OBJECTIVES

This study aimed to determine whether, in asymmetric hearing loss, the presence of an ear with a better or worse hearing threshold is related to either better or worse speech-in-noise (SiN) intelligibility.

MATERIALS AND METHODS

A total of 618 subjects with different degrees of hearing loss were evaluated for their ability to understand SiN. A stepwise forward logistic regression analysis was performed to identify the factors that affect performance. The influencing factors of very high or very low performance were determined.

RESULTS

Age, especially after 70 years of age, and hearing loss, especially from moderate hearing loss, negatively influence SiN intelligibility. Remarkably high intelligibility was identified in subjects with a contralateral ear presenting a better auditory threshold.

CONCLUSION

Although age and hearing loss are known factors that affect SiN intelligibility, the presence of a healthy contralateral ear is presented as the first description of preservation of SiN hearing ability.

Visual and auditory temporal integration in healthy younger and older adults

As people age, they tend to integrate successive visual stimuli over longer intervals than younger adults. It may be expected that temporal integration is affected similarly in other modalities, possibly due to general, age-related cognitive slowing of the brain. However, the previous literature does not provide convincing evidence that this is the case in audition. One hypothesis is that the primacy of time in audition attenuates the degree to which temporal integration in that modality extends over time as a function of age. We sought to settle this issue by comparing visual and auditory temporal integration in younger and older adults directly, achieved by minimizing task differences between modalities. Participants were presented with a visual or an auditory rapid serial presentation task, at 40-100 ms/item. In both tasks, two subsequent targets were to be identified. Critically, these could be perceptually integrated and reported by the participants as such, providing a direct measure of temporal integration. In both tasks, older participants integrated more than younger adults, especially when stimuli were presented across longer time intervals. This difference was more pronounced in vision and only marginally significant in audition. We conclude that temporal integration increases with age in both modalities, but that this change might be slightly less pronounced in audition.

Longitudinal Relationships Between Decline in Speech-in-Noise Recognition Ability and Cognitive Functioning: The Longitudinal Aging Study Amsterdam

Purpose Various directional hypotheses for the observed links between aging, hearing, and cognition have been proposed: (a) cognitive load on perception hypothesis, (b) information degradation hypothesis, (c) sensory deprivation hypothesis, and (d) common cause hypothesis. Supporting evidence for all 4 hypotheses has been reported. No studies have modeled the corresponding 4 causal pathways into 1 single model, which would be required to evidence that multiple directional hypotheses apply. The aim of the current study was to tease out which pathways apply for 5 different cognitive measures. Method Data from 1,029 respondents of the Longitudinal Aging Study Amsterdam were used spanning a maximum follow-up of 7 years (3 measurements). Speech-in-noise recognition ability (digit triplet speech-in-noise test) was included as a measure of auditory function. Cognitive measures included global cognitive functioning, fluid intelligence, information processing speed, and verbal memory (immediate recall and retention). Bivariate dual change score modeling was used to model the causal pathways between hearing, cognition, and baseline age. Results For information processing speed, global cognitive functioning, fluid intelligence, and memory-immediate recall, all pathways except for the sensory deprivation pathway were supported. For memory-retention, only the common cause and the sensory deprivation pathways were supported. Conclusions Causal pathways corresponding to all 4 hypotheses were supported. Support for the common cause hypothesis, the information degradation hypothesis, and the cognitive load on perception hypotheses was found for 4 of 5 cognitive measures. This was unexpected in some cases (e.g., support for the information degradation pathway for cognitive measures that do not rely on auditory stimuli). The sensory deprivation pathway that emerged for memory-retention might point toward processes related to early stages of dementia. In summary, the results show that the links between decline in auditory function, cognition, and aging are complex and most likely are captured by pathways belonging to various directional hypotheses.

Aging and Orienting of Visual Attention: Emergence of a Rightward Attentional Bias with Aging?

Although some studies described the apparition of a rightward bias of attention with aging, no study has examined if this bias could be explained by modifications based on age in the mechanisms of attention orienting and, specially, in the cueing effects. 48 participants of different ages were tested with a spatial cueing paradigm to assess mechanisms of attention orienting. Our results suggest the appearance of specific difficulties to orient and reorient attention towards the left side of space with aging. These results identified a right attentional anchoring with aging.

Associations Between Self-Reported Sensory Impairment and Risk of Cognitive Decline and Impairment in the Health and Retirement Study Cohort

Objectives

We aimed to determine whether self-assessed single (hearing or visual) and dual sensory (hearing and visual) impairments are associated with cognitive decline and incident possible cognitive impairment, no dementia (CIND) and probable dementia.

Method

Data were drawn from the 1996–2014 surveys of the Health and Retirement Study (HRS), involving 19,618 respondents who had no probable dementia and who were aged 50 years or older at the baseline. We used linear mixed models to test the association between self-assessed sensory impairment and cognitive decline followed by a Cox proportional hazard model to estimate the relative risk of incident possible CIND and probable dementia associated with the presence of sensory impairment.

Results

Respondents with self-assessed single and dual sensory impairment performed worse in cognitive tests than those without sensory impairment. The fully adjusted incidence of developing possible CIND was 17% higher for respondents with hearing impairment than those without hearing impairment. Respondents with visual impairment had 35% and 25% higher risk for developing possible CIND and probable dementia, respectively, than those without visual impairment. Respondents with dual sensory impairment at baseline were 38% and 26% more likely to develop possible CIND and probable dementia, respectively, than those with no sensory impairment.

Discussion

Self-assessed sensory impairment is independently associated with cognitive decline and incident possible CIND and probable dementia. Further studies are needed to identify the mechanism underlying this association and to determine whether treatment of sensory impairment could ameliorate cognitive decline and delay the onset of dementia among older adults.

Listening Effort: How the Cognitive Consequences of Acoustic Challenge Are Reflected in Brain and Behavior

Everyday conversation frequently includes challenges to the clarity of the acoustic speech signal, including hearing impairment, background noise, and foreign accents. Although an obvious problem is the increased risk of making word identification errors, extracting meaning from a degraded acoustic signal is also cognitively demanding, which contributes to increased listening effort. The concepts of cognitive demand and listening effort are critical in understanding the challenges listeners face in comprehension, which are not fully predicted by audiometric measures. In this article, the authors review converging behavioral, pupillometric, and neuroimaging evidence that understanding acoustically degraded speech requires additional cognitive support and that this cognitive load can interfere with other operations such as language processing and memory for what has been heard. Behaviorally, acoustic challenge is associated with increased errors in speech understanding, poorer performance on concurrent secondary tasks, more difficulty processing linguistically complex sentences, and reduced memory for verbal material. Measures of pupil dilation support the challenge associated with processing a degraded acoustic signal, indirectly reflecting an increase in neural activity. Finally, functional brain imaging reveals that the neural resources required to understand degraded speech extend beyond traditional perisylvian language networks, most commonly including regions of prefrontal cortex, premotor cortex, and the cingulo-opercular network. Far from being exclusively an auditory problem, acoustic degradation presents listeners with a systems-level challenge that requires the allocation of executive cognitive resources. An important point is that a number of dissociable processes can be engaged to understand degraded speech, including verbal working memory and attention-based performance monitoring. The specific resources required likely differ as a function of the acoustic, linguistic, and cognitive demands of the task, as well as individual differences in listeners' abilities. A greater appreciation of cognitive contributions to processing degraded speech is critical in understanding individual differences in comprehension ability, variability in the efficacy of assistive devices, and guiding rehabilitation approaches to reducing listening effort and facilitating communication.

Influence of working memory and attention on sound-quality ratings

This study investigated the potential influence of cognitive factors on subjective sound-quality ratings. To this end, 34 older subjects (ages 61-79) with near-normal hearing thresholds rated the perceived sound quality of speech and music stimuli that had been distorted by linear filtering, non-linear processing, and multiband dynamic compression. In addition, all subjects performed the Reading Span Test (RST) to assess working memory capacity (WMC), and the test d2-R (a visual test of letter and symbol identification) was used to assess the subjects' selective and sustained attention. The quality-rating scores, which reflected the susceptibility to signal distortions, were characterized by large interindividual variances. Linear mixed modelling with age, high-frequency pure tone threshold, RST, and d2-R results as independent variables showed that individual speech-quality ratings were significantly related to age and attention. Music-quality ratings were significantly related to WMC. Taking these factors into account might lead to improved sound-quality prediction models. Future studies should, however, address the question of whether these effects are due to procedural mechanisms or actually do show that cognitive abilities mediate sensitivity to sound-quality modifications.