Aging, hearing acuity, and the attentional costs of effortful listening

Listening Effort in Younger and Older Adults: A Comparison of Auditory-Only and Auditory-Visual Presentations

One goal of the present study was to establish whether providing younger and older adults with visual speech information (both seeing and hearing a talker compared with listening alone) would reduce listening effort for understanding speech in noise. In addition, we used an individual differences approach to assess whether changes in listening effort were related to changes in visual enhancement-the improvement in speech understanding in going from an auditory-only (A-only) to an auditory-visual condition (AV) condition. To compare word recognition in A-only and AV modalities, younger and older adults identified words in both A-only and AV conditions in the presence of six-talker babble. Listening effort was assessed using a modified version of a serial recall task. Participants heard (A-only) or saw and heard (AV) a talker producing individual words without background noise. List presentation was stopped randomly and participants were then asked to repeat the last three words that were presented. Listening effort was assessed using recall performance in the two- and three-back positions. Younger, but not older, adults exhibited reduced listening effort as indexed by greater recall in the two- and three-back positions for the AV compared with the A-only presentations. For younger, but not older adults, changes in performance from the A-only to the AV condition were moderately correlated with visual enhancement. Results are discussed within a limited-resource model of both A-only and AV speech perception.

Brain changes associated with age-related hearing loss

PURPOSE OF REVIEW

To discuss brain changes associated with age-related hearing loss (ARHL), including cognitive abilities and neuroimaging findings. This information will be helpful to hypothesize and ultimately understand how ARHL may be mechanistically related to changes in brain structure and function. It will also be helpful to guide the strength of treatment recommendations.

RECENT FINDINGS

ARHL has recently been associated with cognitive impairment and dementia. This observation is present in both cross-sectional and longitudinal analyses, in diverse patient populations, and after controlling for a variety of potential confounders. Preliminary brain imaging studies show smaller brain volumes as well as white matter tract dysfunction in adults with hearing loss.

SUMMARY

ARHL is related to cognitive impairment and dementia. More study is needed to determine if the association is causal, and if treatment efforts could reduce the risk of cognitive impairment and dementia. Given the low risk of treating ARHL and the potential health benefit for the aging brain, it is recommended to proactively discuss ARHL and treatment with patients.

Impact of Age and Hearing Impairment on Work Performance during Long Working Hours

Based on demographic prognoses, it must be assumed that a greater number of older workers will be found in the future labor market. How to deal with their possible age-related impairments of sensory functions, like hearing impairment and work performance during extended working time, has not been addressed explicitly until now. The study addresses this interplay. The study was performed on two consecutive days after normal working hours. The 55 participants had to “work” in the study at least three additional hours to simulate a situation of long working hours. The tested measures for (job) performance were: general attention, long-term selective attention, concentration, and reaction time. All of the investigated variables were taken at both days of the study (2 × 2 × 2 repeated measurement design). The results show effects for age, the interaction of hearing impairment and time of measurement, and effects of the measurement time. Older participants reacted slower than younger participants did. Furthermore, younger participants reacted more frequently in a correct way. Hearing impairment seems to have a negative impact especially on measures of false reactions, and therefore especially on measurement time 1. The results can be interpreted in a way that hearing-impaired participants are able to compensate their deficits over time.

Hearing, Emotion, Amplification, Research, and Training Workshop: Current Understanding of Hearing Loss and Emotion Perception and Priorities for Future Research

The question of how hearing loss and hearing rehabilitation affect patients' momentary emotional experiences is one that has received little attention but has considerable potential to affect patients' psychosocial function. This article is a product from the Hearing, Emotion, Amplification, Research, and Training workshop, which was convened to develop a consensus document describing research on emotion perception relevant for hearing research. This article outlines conceptual frameworks for the investigation of emotion in hearing research; available subjective, objective, neurophysiologic, and peripheral physiologic data acquisition research methods; the effects of age and hearing loss on emotion perception; potential rehabilitation strategies; priorities for future research; and implications for clinical audiologic rehabilitation. More broadly, this article aims to increase awareness about emotion perception research in audiology and to stimulate additional research on the topic.

A Novel Communication Value Task Demonstrates Evidence of Response Bias in Cases with Presbyacusis

Decision-making about the expected value of an experience or behavior can explain hearing health behaviors in older adults with hearing loss. Forty-four middle-aged to older adults (68.45 ± 7.73 years) performed a task in which they were asked to decide whether information from a surgeon or an administrative assistant would be important to their health in hypothetical communication scenarios across visual signal-to-noise ratios (SNR). Participants also could choose to view the briefly presented sentences multiple times. The number of these effortful attempts to read the stimuli served as a measure of demand for information to make a health importance decision. Participants with poorer high frequency hearing more frequently decided that information was important to their health compared to participants with better high frequency hearing. This appeared to reflect a response bias because participants with high frequency hearing loss demonstrated shorter response latencies when they rated the sentences as important to their health. However, elevated high frequency hearing thresholds did not predict demand for information to make a health importance decision. The results highlight the utility of a performance-based measure to characterize effort and expected value from performing tasks in older adults with hearing loss.

A review of new insights on the association between hearing loss and cognitive decline in ageing

Age-related hearing loss (ARHL) has a multifactorial pathogenesis and it is an inevitable hearing impairment associated with reduction of communicative skills related to ageing. Increasing evidence has linked ARHL to more rapid progression of cognitive decline and incidental dementia. Many aspects of daily living of elderly people have been associated to hearing abilities, showing that hearing loss (HL) affects the quality of life, social relationships, motor skills, psychological aspects and function and morphology in specific brain areas. Epidemiological and clinical studies confirm the assumption of a relationship between these conditions. However, the mechanisms are still unclear and are reviewed herein. Long-term hearing deprivation of auditory inputs can impact cognitive performance by decreasing the quality of communication leading to social isolation and depression and facilitate dementia. On the contrary, the limited cognitive skills may reduce the cognitive resources available for auditory perception, increasing the effects of HL. In addition, hearing loss and cognitive decline may reflect a 'common cause' on the auditory pathway and brain. In fact, some pathogenetic factors are recongised in common microvascular disease factors such as diabetes, atherosclerosis and hypertension. Interdisciplinary efforts to investigate and address HL in the context of brain and cognitive ageing are needed. Surprisingly, few studies have been adressed on the effectiveness of hearing aids in changing the natural history of cognitive decline. Effective interventions with hearing aids or cochlear implant may improve social and emotional function, communication, cognitive function and positively impact quality of life. The aim of this review is to overview new insights on this challenging topic and provide new ideas for future research.

A novel study on association between untreated hearing loss and cognitive functions of older adults: Baseline non-verbal cognitive assessment results

BACKGROUND

Age-related hearing loss (ARHL) is highly prevalent in older adults, and more than two-thirds above age of 70 years suffer from ARHL. Recent studies have established a link between ARHL and cognitive impairment; however, most of the studies have used verbally loaded cognitive measures to investigate the association between ARHL and cognition. It is possible that due to hearing impairment, the elderly may experience difficulty in following verbal instructions or completing tasks that heavily rely on hearing during cognitive assessments. This may result in overestimation of cognitive impairment in such individuals. This baseline cross-sectional study investigated the associations between untreated hearing loss and a number of cognitive functions using a battery of non-verbal cognitive tests. Further, association between hearing loss and psychological status of older adults was examined.

STUDY DESIGN

Prospective case-controlled study.

METHODS

A total of 119 participants (54 males, M=66.33±10.50 years; 65 females M=61.51±11.46 years) were recruited. All participants completed a hearing assessment, a computerised test battery of non-verbal cognitive functions and the depression, anxiety and stress scale.

RESULTS

Hierarchical multiple regression analysis results revealed that hearing thresholds significantly associated with the working memory (P<0.05), paired associative learning scores (P<0.05), depression (P<0.001), and anxiety (P<0.001) and stress (P<0.001) scores. Analysis of covariance results revealed that participants with moderately-severe hearing loss performed significantly poorer in paired associative learning and working memory tasks and psychological function tests compared to those with normal hearing.

CONCLUSION

Results of the current study suggest a significant relationship between ARHL and both cognition and psychological status. Our results also have some implications for using non-verbal cognitive tests to evaluate cognitive functions in post-lingually hearing impaired ageing adults, at least for those with more than moderately-severe levels of hearing loss.

Toward a taxonomic model of attention in effortful listening

In recent years, there has been increasing interest in studying listening effort. Research on listening effort intersects with the development of active theories of speech perception and contributes to the broader endeavor of understanding speech perception within the context of neuroscientific theories of perception, attention, and effort. Due to the multidisciplinary nature of the problem, researchers vary widely in their precise conceptualization of the catch-all term listening effort. Very recent consensus work stresses the relationship between listening effort and the allocation of cognitive resources, providing a conceptual link to current cognitive neuropsychological theories associating effort with the allocation of selective attention. By linking listening effort to attentional effort, we enable the application of a taxonomy of external and internal attention to the characterization of effortful listening. More specifically, we use a vectorial model to decompose the demand causing listening effort into its mutually orthogonal external and internal components and map the relationship between demanded and exerted effort by means of a resource-limiting term that can represent the influence of motivation as well as vigilance and arousal. Due to its quantitative nature and easy graphical interpretation, this model can be applied to a broad range of problems dealing with listening effort. As such, we conclude that the model provides a good starting point for further research on effortful listening within a more differentiated neuropsychological framework.

Hearing Impairment and Incident Dementia: Findings from the English Longitudinal Study of Ageing

OBJECTIVES

To determine whether hearing loss is associated with incident physician-diagnosed dementia in a representative sample.

DESIGN

Retrospective cohort study.

SETTING

English Longitudinal Study of Ageing.

PARTICIPANTS

Adults aged 50 and older.

MEASUREMENTS

Cross-sectional associations between self-reported (n = 7,865) and objective hearing measures (n = 6,902) and dementia were examined using multinomial-logistic regression. The longitudinal association between self-reported hearing at Wave 2 (2004/05) and cumulative physician-diagnosed dementia up to Wave 7 (2014/15) was modelled using Cox proportional hazards regression.

RESULTS

After adjustment for potential confounders, in cross-sectional analysis, participants who had self-reported or objective moderate and poor hearing were more likely to have a dementia diagnosis than those with normal hearing (self-reported: odds ratio OR = 1.6, 95% CI = 1.1-2.4 moderate hearing; OR = 2.6, 95% CI = 1.7-3.9 poor hearing, objective: OR = 1.6, 95% CI = 1.0-2.8 moderate hearing; OR = 4.4, 95% CI = 1.9-9.9 poor hearing). Longitudinally, the hazard of developing dementia was 1.4 (95% CI = 1.0-1.9) times as high in individuals who reported moderate hearing and 1.6 (95% CI = 1.1-2.0) times as high in those who reported poor hearing.

CONCLUSION

Older adults with hearing loss are at greater risk of dementia than those with normal hearing. These findings are consistent with the rationale that correction of hearing loss could help delay the onset of dementia, or that hearing loss itself could serve as a risk indicator for cognitive decline.

Verbal working memory and inhibition-concentration in adults with cochlear implants

Objectives

Neurocognitive functions contribute to speech recognition in postlingual adults with cochlear implants (CIs). In particular, better verbal working memory (WM) on modality‐specific (auditory) WM tasks predicts better speech recognition. It remains unclear, however, whether this association can be attributed to basic underlying modality‐general neurocognitive functions, or whether it is solely a result of the degraded nature of auditory signals delivered by the CI. Three hypotheses were tested: 1) Both modality‐specific and modality‐general tasks of verbal WM would predict scores of sentence recognition in speech‐shaped noise; 2) Basic modality‐general neurocognitive functions of controlled fluency and inhibition‐concentration would predict both modality‐specific and modality‐general verbal WM; and 3) Scores on both tasks of verbal WM would mediate the effects of more basic neurocognitive functions on sentence recognition.

Study Design

Cross‐sectional study of 30 postlingual adults with CIs and thirty age‐matched normal‐hearing (NH) controls.

Materials and Methods

Participants were tested for sentence recognition in speech‐shaped noise, along with verbal WM using a modality‐general task (Reading Span) and an auditory modality‐specific task (Listening Span). Participants were also assessed for controlled fluency and inhibition‐concentration abilities.

Results

For CI users only, Listening Span scores predicted sentence recognition, and Listening Span scores mediated the effects of inhibition‐concentration on speech recognition. Scores on Reading Span were not related to sentence recognition for either group.

Conclusion

Inhibition‐concentration skills play an important role in CI users' sentence recognition skills, with effects mediated by modality‐specific verbal WM. Further studies will examine inhibition‐concentration and WM skills as novel targets for clinical intervention.

Level of Evidence

4.

Impairments of Speech Comprehension in Patients with Tinnitus-A Review

Tinnitus describes the subjective perception of a sound despite the absence of external stimulation. Being a sensory symptom the majority of studies focusses on the auditory pathway. In the recent years, a series of studies suggested a crucial involvement of the limbic system in the manifestation and development of chronic tinnitus. Regarding cognitive symptoms, several reviews addressed the presence of cognitive impairments in tinnitus as well and concluded that attention and memory processes are affected. Despite the importance for social communication and the reliance on a highly functional auditory system, speech comprehension remains a largely neglected field in tinnitus research. This is why we review here the existing literature on speech and language functions in tinnitus patients. Reviewed studies suggest that speech comprehension is impaired in patients with tinnitus, especially in the presence of competing noise. This is even the case in tinnitus patients with normal hearing thresholds. Additionally, speech comprehension measures seem independent of other measures such as tinnitus severity and perceived tinnitus loudness. According to the majority of authors, the speech comprehension difficulties arise as a result of central processes or dysfunctional neuroplasticity.

Cingulo-opercular activity affects incidental memory encoding for speech in noise

Correctly understood speech in difficult listening conditions is often difficult to remember. A long-standing hypothesis for this observation is that the engagement of cognitive resources to aid speech understanding can limit resources available for memory encoding. This hypothesis is consistent with evidence that speech presented in difficult conditions typically elicits greater activity throughout cingulo-opercular regions of frontal cortex that are proposed to optimize task performance through adaptive control of behavior and tonic attention. However, successful memory encoding of items for delayed recognition memory tasks is consistently associated with increased cingulo-opercular activity when perceptual difficulty is minimized. The current study used a delayed recognition memory task to test competing predictions that memory encoding for words is enhanced or limited by the engagement of cingulo-opercular activity during challenging listening conditions. An fMRI experiment was conducted with twenty healthy adult participants who performed a word identification in noise task that was immediately followed by a delayed recognition memory task. Consistent with previous findings, word identification trials in the poorer signal-to-noise ratio condition were associated with increased cingulo-opercular activity and poorer recognition memory scores on average. However, cingulo-opercular activity decreased for correctly identified words in noise that were not recognized in the delayed memory test. These results suggest that memory encoding in difficult listening conditions is poorer when elevated cingulo-opercular activity is not sustained. Although increased attention to speech when presented in difficult conditions may detract from more active forms of memory maintenance (e.g., sub-vocal rehearsal), we conclude that task performance monitoring and/or elevated tonic attention supports incidental memory encoding in challenging listening conditions.

Cognitive factors as predictors of accented speech perception for younger and older adults

Though some studies suggest that older adults are not differentially impacted by foreign-accented speech relative to younger adults, other studies indicate that older adults are poorer at perceiving foreign-accented speech than younger adults. The present study sought, first, to clarify the extent to which older and younger adults differed in their perception of foreign-accented speech. The secondary aim was to elucidate the extent to which the cognitive mechanisms supporting accented speech perception differ for older and younger adults. The data indicated that older adults were poorer at perceiving accented speech than younger adults. Older adults' speech perception accuracy was associated with a significant main effect of working memory as well as significant interactions between hearing acuity and cognitive flexibility and between hearing acuity and inhibitory control. Younger adults' speech perception accuracy, in contrast, was associated with a significant interaction between hearing acuity and processing speed. It therefore appears that the differences in performance between younger and older adults observed here may be attributable to differences in the cognitive mechanisms that support accented speech perception.

Auditory Verbal Working Memory as a Predictor of Speech Perception in Modulated Maskers in Listeners With Normal Hearing

PURPOSE

Background noise can interfere with our ability to understand speech. Working memory capacity (WMC) has been shown to contribute to the perception of speech in modulated noise maskers. WMC has been assessed with a variety of auditory and visual tests, often pertaining to different components of working memory. This study assessed the relationship between speech perception in modulated maskers and components of auditory verbal working memory (AVWM) over a range of signal-to-noise ratios.

METHOD

Speech perception in noise and AVWM were measured in 30 listeners (age range 31-67 years) with normal hearing. AVWM was estimated using forward digit recall, backward digit recall, and nonword repetition.

RESULTS

After controlling for the effects of age and average pure-tone hearing threshold, speech perception in modulated maskers was related to individual differences in the phonological component of working memory (as assessed by nonword repetition) but only in the least favorable signal-to-noise ratio. The executive component of working memory (as assessed by backward digit) was not predictive of speech perception in any conditions.

CONCLUSIONS

AVWM is predictive of the ability to benefit from temporal dips in modulated maskers: Listeners with greater phonological WMC are better able to correctly identify sentences in modulated noise backgrounds.

The effect of visual distraction on auditory-visual speech perception by younger and older listeners

Visual distractions are present in real-world listening environments, such as conversing in a crowded restaurant. This study examined the impact of visual distractors on younger and older adults' ability to understand auditory-visual (AV) speech in noise. AV speech stimuli were presented with one competing talker and with three different types of visual distractors. SNR₅₀ thresholds for both listener groups were affected by visual distraction; the poorest performance for both groups was the AV + Video condition, and differences across groups were noted for some conditions. These findings suggest that older adults may be more susceptible to irrelevant auditory and visual competition in a real-world environment.

Hearing Impairment and Incident Dementia and Cognitive Decline in Older Adults: The Health ABC Study

BACKGROUND

Age-related peripheral hearing impairment (HI) is prevalent, treatable, and may be a risk factor for dementia in older adults. In prospective analysis, we quantified the association of HI with incident dementia and with domain-specific cognitive decline in memory, perceptual speed, and processing speed.

METHODS

Data were from the Health, Aging and Body Composition (Health ABC) study, a biracial cohort of well-functioning adults aged 70-79 years. Dementia was defined using a prespecified algorithm incorporating medication use, hospital records, and neurocognitive test scores. A pure-tone average in decibels hearing level (dBHL) was calculated in the better hearing ear using thresholds from 0.5 to 4kHz, and HI was defined as normal hearing (≤25 dBHL), mild (26-40 dBHL), and moderate/severe (>40 dBHL). Associations between HI and incident dementia and between HI and cognitive change were modeled using Cox proportional hazards models and linear mixed models, respectively.

RESULTS

Three-hundred eighty seven (20%) participants had moderate/severe HI, and 716 (38%) had mild HI. After adjustment for demographic and cardiovascular factors, moderate/severe audiometric HI (vs. normal hearing) was associated with increased risk of incident dementia over 9 years (hazard ratio: 1.55, 95% confidence interval [CI]: 1.10, 2.19). Other than poorer baseline memory performance (difference of -0.24 SDs, 95% CI: -0.44, -0.04), no associations were observed between HI and rates of domain-specific cognitive change during 7 years of follow-up.

CONCLUSIONS

HI is associated with increased risk of developing dementia in older adults. Randomized trials are needed to determine whether treatment of hearing loss could postpone dementia onset in older adults.

Age-related deficits in auditory temporal processing: unique contributions of neural dyssynchrony and slowed neuronal processing

This study was guided by the hypothesis that the aging central nervous system progressively loses its ability to process rapid acoustic changes that are important for speech recognition. Specifically, we hypothesized that age-related deficits in neural synchrony and neuronal oscillatory activity occur independently in older adults and disrupt auditory temporal processing. Neural synchrony is largely dependent on phase locking within the central auditory pathway, beginning at the auditory nerve. In contrast, the resonance characteristics of oscillatory activity are dependent on the integrity and structure of long range cortical connections. We tested our hypotheses by assessing age-related differences in electrophysiologic correlates of neural synchrony and peak oscillatory frequency in younger and older adults with normal hearing and determining their associations with a behavioral measure of gap detection. Phase-locking values were smaller (poorer neural synchrony) and peak alpha frequency was lower for older than younger adults and decreased as gap detection thresholds increased; variations in phase-locking values and peak alpha frequency uniquely predicted gap detection thresholds. These effects were driven, in large part, by associations in older adults. These results reveal dissociable neural mechanisms associated with distinct underlying pathology that may differentially be present in older adults and contribute to auditory processing declines.

Adaptation to novel foreign-accented speech and retention of benefit following training: Influence of aging and hearing loss

Adaptation to speech with a foreign accent is possible through prior exposure to talkers with that same accent. For young listeners with normal hearing, short term, accent-independent adaptation to a novel foreign accent is also facilitated through exposure training with multiple foreign accents. In the present study, accent-independent adaptation is examined in younger and older listeners with normal hearing and older listeners with hearing loss. Retention of training benefit is additionally explored. Stimuli for testing and training were HINT sentences recorded by talkers with nine distinctly different accents. Following two training sessions, all listener groups showed a similar increase in speech perception for a novel foreign accent. While no group retained this benefit at one week post-training, results of a secondary reaction time task revealed a decrease in reaction time following training, suggesting reduced listening effort. Examination of listeners' cognitive skills reveals a positive relationship between working memory and speech recognition ability. The present findings indicate that, while this no-feedback training paradigm for foreign-accented English is successful in promoting short term adaptation for listeners, this paradigm is not sufficient in facilitation of perceptual learning with lasting benefits for younger or older listeners.

Impact of cognition and noise reduction on speech perception in adults with unilateral cochlear implants

OBJECTIVES

The purpose of this study was to investigate the impact of cognition and noise reduction (NR) technology in cochlear implants (CIs) on speech perception and listening effort.

METHODS

Thirteen adults fitted with unilateral CIs (Nucleus^® 6, CP900) participated in this study. Participants performed: (I) cognitive tests of working memory and processing speed, (II) speech perception in noise tests, and (III) an auditory-visual dual-task paradigm to quantify listening effort, as a part of the three-phase experimental study. Both the participant and the tester, performing the outcome measures, were blinded to the NR settings (ON/OFF) of the CI for phases II and III.

RESULTS

Speech intelligibility significantly improved with the NR activated, but was independent of individual differences in cognitive abilities. Listening effort did not significantly change with NR setting; however, there was a trend for participants with good working memory to have better speech perception scores with NR activated during the effortful listening task (dual-task paradigm).

CONCLUSION

Future studies are warranted to explore the interaction between cognition and CI NR algorithms during an effortful listening task.

Observed Hearing Loss and Incident Dementia in a Multiethnic Cohort

OBJECTIVES

To determine whether observed hearing loss (OHL) is associated with incident dementia in a multiethnic population.

DESIGN

Prospective epidemiological cohort study.

SETTING

Community in northern Manhattan.

PARTICIPANTS

Participants in the Washington Heights-Inwood Columbia Aging Project, a longitudinal study on aging and dementia in an ethnically diverse community (n = 1,881).

MEASUREMENTS

OHL was defined when the examiner observed it or according to self-reported hearing aid use. A consensus panel diagnosed dementia using standard research criteria. A Cox proportional hazards model was used to examine the relationship between OHL at baseline and risk of incident dementia (mean 7.3 ± 4.4 years of longitudinal followup, range 0.9-20 years).

RESULTS

OHL was associated with 1.69 (95% confidence interval (CI) = 1.3-2.3, P < .010) times the risk of incident dementia, adjusting for demographic characteristics, cardiovascular risk factors, apolipoprotein E4 genotype, and stroke. When stratified according to race, the association between OHL and incident dementia was high in all groups but was statistically significant only in blacks (hazard ratio = 2.62, 95% CI = 1.5-4.5, P < .010).

CONCLUSION

OHL was associated with greater risk of incident dementia in a multiethnic cohort. More study is needed to determine whether HL contributes to dementia and whether treating HL can reduce the risk of dementia.

A narrative review of obesity and hearing loss

The comorbidities related to obesity are already extensive, but as the prevalence of obesity increases globally, so do the number of its associated conditions. The relationship between hearing impairment and obesity is a relatively recent research interest, but is significant as both conditions have the ability to substantially reduce an individual's quality of life both physically and psychologically. Obesity has a significant effect on vascular function, and this may have an impact on highly vascular organs such as the auditory system. This review aims to provide an overview of the existing literature surrounding the association between hearing loss and obesity, in order to emphasise these two highly prevalent conditions, and to identify areas of further investigation. Our literature search identified a total of 298 articles with 11 articles of relevance to the review. The existing literature in this area is sparse, with interest ranging from obesity and its links to age-related hearing impairment (ARHI) and sudden sensorineural hearing loss (SSNHL), to animal models and genetic syndromes that incorporate both disorders. A key hypothesis for the underlying mechanism for the relationship between obesity and hearing loss is that of vasoconstriction in the inner ear, whereby strain on the capillary walls due to excess adipose tissue causes damage to the delicate inner ear system. The identified articles in this review have not established a causal relationship between obesity and hearing impairment. Further research is required to examine the emerging association between obesity and hearing impairment, and identify its potential underlying mechanisms.

Effort Not Speed Characterizes Comprehension of Spoken Sentences by Older Adults with Mild Hearing Impairment

In spite of the rapidity of everyday speech, older adults tend to keep up relatively well in day-to-day listening. In laboratory settings older adults do not respond as quickly as younger adults in off-line tests of sentence comprehension, but the question is whether comprehension itself is actually slower. Two unique features of the human eye were used to address this question. First, we tracked eye-movements as 20 young adults and 20 healthy older adults listened to sentences that referred to one of four objects pictured on a computer screen. Although the older adults took longer to indicate the referenced object with a cursor-pointing response, their gaze moved to the correct object as rapidly as that of the younger adults. Second, we concurrently measured dilation of the pupil of the eye as a physiological index of effort. This measure revealed that although poorer hearing acuity did not slow processing, success came at the cost of greater processing effort.

Hearing Care Intervention for Persons with Dementia: A Pilot Study

OBJECTIVE

Hearing loss is a commonly unmet need among adults with dementia that may exacerbate common dementia-related behavioral symptoms. Accessing traditional audiology services for hearing loss is a challenge because of high cost and time commitment. To improve accessibility and affordability of hearing treatment for persons with dementia, there is a need for unique service delivery models. The purpose of this study is to test a novel hearing intervention for persons with dementia and family caregivers delivered in outpatient settings.

METHODS

The Memory-HEARS pilot study delivered a 2-hour in-person intervention in an outpatient setting. A trained interventionist provided hearing screening, communication strategies, and provision of and instruction using a simple over-the-counter amplification device. Caregivers (N = 20) responded to questionnaires related to depression, neuropsychiatric symptoms, and caregiver burden at baseline and 1-month postintervention.

RESULTS

Overall, caregivers believed the intervention was beneficial, and most participants with dementia wore the amplification device daily. For the depression and neuropsychiatric outcome measures, participants with high symptom burden at baseline showed improvement at 1-month postintervention. The intervention had no effect on caregiver burden. Qualitative responses from caregivers described improved engagement for their loved ones, such as laughing more, telling more stories, asking more questions, and having more patience.

CONCLUSION

The Memory-HEARS intervention is a low-cost, low-risk, nonpharmacologic approach to addressing hearing loss and behavioral symptoms in patients with dementia. Improved communication has the potential to reduce symptom burden and improve quality of life.

The Effects of Directional Processing on Objective and Subjective Listening Effort

PURPOSE

The purposes of this investigation were (a) to evaluate the effects of hearing aid directional processing on subjective and objective listening effort and (b) to investigate the potential relationships between subjective and objective measures of effort.

METHOD

Sixteen adults with mild to severe hearing loss were tested with study hearing aids programmed with 3 settings: omnidirectional, fixed directional, and bilateral beamformer. A dual-task paradigm and subjective ratings were used to assess objective and subjective listening effort, respectively, in 2 signal-to-noise ratios. Testing occurred in rooms with either low or moderate reverberation.

RESULTS

Directional processing improved subjective and objective listening effort, although benefit for objective effort was found only in moderate reverberation. Subjective reports of work and tiredness were more highly correlated with word recognition performance than objective listening effort. However, subjective ratings about control were significantly correlated with objective listening effort.

CONCLUSIONS

Directional microphone technology in hearing aids has the potential to improve listening effort in moderately reverberant environments. In addition, subjective questions that probe a listener's desire to exercise control may be a viable method for eliciting ratings that are significantly related to objective listening effort.

Self-Assessed Hearing Handicap in Older Adults With Poorer-Than-Predicted Speech Recognition in Noise

PURPOSE

Even older adults with relatively mild hearing loss report hearing handicap, suggesting that hearing handicap is not completely explained by reduced speech audibility.

METHOD

We examined the extent to which self-assessed ratings of hearing handicap using the Hearing Handicap Inventory for the Elderly (HHIE; Ventry & Weinstein, 1982) were significantly associated with measures of speech recognition in noise that controlled for differences in speech audibility.

RESULTS

One hundred sixty-two middle-aged and older adults had HHIE total scores that were significantly associated with audibility-adjusted measures of speech recognition for low-context but not high-context sentences. These findings were driven by HHIE items involving negative feelings related to communication difficulties that also captured variance in subjective ratings of effort and frustration that predicted speech recognition. The average pure-tone threshold accounted for some of the variance in the association between the HHIE and audibility-adjusted speech recognition, suggesting an effect of central and peripheral auditory system decline related to elevated thresholds.

CONCLUSION

The accumulation of difficult listening experiences appears to produce a self-assessment of hearing handicap resulting from (a) reduced audibility of stimuli, (b) declines in the central and peripheral auditory system function, and (c) additional individual variation in central nervous system function.

Non-auditory neurocognitive skills contribute to speech recognition in adults with cochlear implants

OBJECTIVE

Unexplained variability in speech recognition outcomes among postlingually deafened adults with cochlear implants (CIs) is an enormous clinical and research barrier to progress. This variability is only partially explained by patient factors (e.g., duration of deafness) and auditory sensitivity (e.g., spectral and temporal resolution). This study sought to determine whether non-auditory neurocognitive skills could explain speech recognition variability exhibited by adult CI users.

STUDY DESIGN

Thirty postlingually deafened adults with CIs and thirty age-matched normal-hearing (NH) controls were enrolled.

METHODS

Participants were assessed for recognition of words in sentences in noise and several non-auditory measures of neurocognitive function. These non-auditory tasks assessed global intelligence (problem-solving), controlled fluency, working memory, and inhibition-concentration abilities.

RESULTS

For CI users, faster response times during a non-auditory task of inhibition-concentration predicted better recognition of sentences in noise; however, similar effects were not evident for NH listeners.

CONCLUSIONS

Findings from this study suggest that inhibition-concentration skills play a role in speech recognition for CI users, but less so for NH listeners. Further research will be required to elucidate this role and its potential as a novel target for intervention.

Linguistic Factors Influencing Speech Audiometric Assessment

In speech audiometric testing, hearing performance is typically measured by calculating the number of correct repetitions of a speech stimulus. We investigate to what extent the repetition accuracy of Dutch speech stimuli presented against a background noise is influenced by nonauditory processes. We show that variation in verbal repetition accuracy is partially explained by morpholexical and syntactic features of the target language. Verbs, prepositions, conjunctions, determiners, and pronouns yield significantly lower correct repetitions than nouns, adjectives, or adverbs. The reduced repetition performance for verbs and function words is probably best explained by the similarities in the perceptual nature of verbal morphology and function words in Dutch. For sentences, an overall negative effect of syntactic complexity on speech repetition accuracy was found. The lowest number of correct repetitions was obtained with passive sentences, reflecting the cognitive cost of processing a noncanonical sentence structure. Taken together, these findings may have important implications for the audiological practice. In combination with hearing loss, linguistic complexity may increase the cognitive demands to process sentences in noise, leading to suboptimal functional hearing in day-to-day listening situations. Using test sentences with varying degrees of syntactic complexity may therefore provide useful information to measure functional hearing benefits.

Age equivalence in the benefit of repetition for speech understanding

Although repetition is the most commonly used conversational repair strategy, little is known about its relative effectiveness among listeners spanning the adult age range. The purpose of this study was to identify differences in how younger, middle-aged, and older adults were able to use immediate repetition to improve speech recognition in the presence of different kinds of maskers. Results suggest that all groups received approximately the same amount of benefit from repetition. Repetition benefit was largest when the masker was fluctuating noise and smallest when it was competing speech.

Effect of informational content of noise on speech representation in the aging midbrain and cortex

The ability to understand speech is significantly degraded by aging, particularly in noisy environments. One way that older adults cope with this hearing difficulty is through the use of contextual cues. Several behavioral studies have shown that older adults are better at following a conversation when the target speech signal has high contextual content or when the background distractor is not meaningful. Specifically, older adults gain significant benefit in focusing on and understanding speech if the background is spoken by a talker in a language that is not comprehensible to them (i.e., a foreign language). To understand better the neural mechanisms underlying this benefit in older adults, we investigated aging effects on midbrain and cortical encoding of speech when in the presence of a single competing talker speaking in a language that is meaningful or meaningless to the listener (i.e., English vs. Dutch). Our results suggest that neural processing is strongly affected by the informational content of noise. Specifically, older listeners' cortical responses to the attended speech signal are less deteriorated when the competing speech signal is an incomprehensible language rather than when it is their native language. Conversely, temporal processing in the midbrain is affected by different backgrounds only during rapid changes in speech and only in younger listeners. Additionally, we found that cognitive decline is associated with an increase in cortical envelope tracking, suggesting an age-related over (or inefficient) use of cognitive resources that may explain their difficulty in processing speech targets while trying to ignore interfering noise.

Cognitive Compensation of Speech Perception With Hearing Impairment, Cochlear Implants, and Aging

External degradations in incoming speech reduce understanding, and hearing impairment further compounds the problem. While cognitive mechanisms alleviate some of the difficulties, their effectiveness may change with age. In our research, reviewed here, we investigated cognitive compensation with hearing impairment, cochlear implants, and aging, via (a) phonemic restoration as a measure of top-down filling of missing speech, (b) listening effort and response times as a measure of increased cognitive processing, and (c) visual world paradigm and eye gazing as a measure of the use of context and its time course. Our results indicate that between speech degradations and their cognitive compensation, there is a fine balance that seems to vary greatly across individuals. Hearing impairment or inadequate hearing device settings may limit compensation benefits. Cochlear implants seem to allow the effective use of sentential context, but likely at the cost of delayed processing. Linguistic and lexical knowledge, which play an important role in compensation, may be successfully employed in advanced age, as some compensatory mechanisms seem to be preserved. These findings indicate that cognitive compensation in hearing impairment can be highly complicated—not always absent, but also not easily predicted by speech intelligibility tests only.

Rapid Release From Listening Effort Resulting From Semantic Context, and Effects of Spectral Degradation and Cochlear Implants

People with hearing impairment are thought to rely heavily on context to compensate for reduced audibility. Here, we explore the resulting cost of this compensatory behavior, in terms of effort and the efficiency of ongoing predictive language processing. The listening task featured predictable or unpredictable sentences, and participants included people with cochlear implants as well as people with normal hearing who heard full-spectrum/unprocessed or vocoded speech. The crucial metric was the growth of the pupillary response and the reduction of this response for predictable versus unpredictable sentences, which would suggest reduced cognitive load resulting from predictive processing. Semantic context led to rapid reduction of listening effort for people with normal hearing; the reductions were observed well before the offset of the stimuli. Effort reduction was slightly delayed for people with cochlear implants and considerably more delayed for normal-hearing listeners exposed to spectrally degraded noise-vocoded signals; this pattern of results was maintained even when intelligibility was perfect. Results suggest that speed of sentence processing can still be disrupted, and exertion of effort can be elevated, even when intelligibility remains high. We discuss implications for experimental and clinical assessment of speech recognition, in which good performance can arise because of cognitive processes that occur after a stimulus, during a period of silence. Because silent gaps are not common in continuous flowing speech, the cognitive/linguistic restorative processes observed after sentences in such studies might not be available to listeners in everyday conversations, meaning that speech recognition in conventional tests might overestimate sentence-processing capability.

Effects of Age on Long Term Memory for Degraded Speech

Prior research suggests that acoustical degradation impacts encoding of items into memory, especially in elderly subjects. We here aimed to investigate whether acoustically degraded items that are initially encoded into memory are more prone to forgetting as a function of age. Young and old participants were tested with a vocoded and unvocoded serial list learning task involving immediate and delayed free recall. We found that degraded auditory input increased forgetting of previously encoded items, especially in older participants. We further found that working memory capacity predicted forgetting of degraded information in young participants. In old participants, verbal IQ was the most important predictor for forgetting acoustically degraded information. Our data provide evidence that acoustically degraded information, even if encoded, is especially vulnerable to forgetting in old age.

The Effects of Meaning-Based Auditory Training on Behavioral Measures of Perceptual Effort in Individuals with Impaired Hearing

There has been considerable interest in measuring the perceptual effort required to understand speech, as well as to identify factors that might reduce such effort. In the current study, we investigated whether, in addition to improving speech intelligibility, auditory training also could reduce perceptual or listening effort. Perceptual effort was assessed using a modified version of the n-back memory task in which participants heard lists of words presented without background noise and were asked to continually update their memory of the three most recently presented words. Perceptual effort was indexed by memory for items in the three-back position immediately before, immediately after, and 3 months after participants completed the Computerized Learning Exercises for Aural Rehabilitation (clEAR), a 12-session computerized auditory training program. Immediate posttraining measures of perceptual effort indicated that participants could remember approximately one additional word compared to pretraining. Moreover, some training gains were retained at the 3-month follow-up, as indicated by significantly greater recall for the three-back item at the 3-month measurement than at pretest. There was a small but significant correlation between gains in intelligibility and gains in perceptual effort. The findings are discussed within the framework of a limited-capacity speech perception system.

Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men

Background and objective: hearing impairment is common in older adults and has been implicated in the risk of disability and mortality. We examined the association between hearing impairment and risk of incident disability and all-cause mortality.

Design and setting: prospective cohort of community-dwelling older men aged 63–85 followed up for disability over 2 years and for all-cause mortality for 10 years in the British Regional Heart Study.

Methods: data were collected on self-reported hearing impairment including hearing aid use, and disability assessed as mobility limitations (problems walking/taking stairs), difficulties with activities of daily living (ADL) and instrumental ADL (IADL). Mortality data were obtained from the National Health Service register.

Results: among 3,981 men, 1,074 (27%) reported hearing impairment. Compared with men with no hearing impairment, men who could hear and used a hearing aid, and men who could not hear despite a hearing aid had increased risks of IADL difficulties (age-adjusted OR 1.86, 95% CI 1.29–2.70; OR 2.74, 95% CI 1.53–4.93, respectively). The associations remained after further adjustment for covariates including social class, lifestyle factors, co-morbidities and social engagement. Associations of hearing impairment with incident mobility limitations, incident ADL difficulties and all-cause mortality were attenuated on adjustment for covariates.

Conclusion: this study suggests that hearing problems in later life could increase the risk of having difficulties performing IADLs, which include more complex everyday tasks such as shopping and light housework. However, further studies are needed to determine the associations observed including the underlying pathways.

Hearing Aid Use is Associated with Better Mini-Mental State Exam Performance

OBJECTIVE

Hearing loss is associated with cognitive decline in the elderly. However, it is unknown if the use of hearing aids (HAs) is associated with enhanced cognitive function.

METHODS

In a cross-sectional study at an academic medical center, participants underwent audiometric evaluation, the Mini-Mental State Exam (MMSE), and the Trail Making Test, Part B (TMT-B). The impact of use versus disuse of HAs was assessed. Performance on cognitive tests was then compared with unaided hearing levels.

RESULTS

HA users performed better on the MMSE (1.9 points; rank-sum, p = 0.008) despite having worse hearing at both high frequencies (15.3-dB hearing level; t test, p < 0.001) and low frequencies (15.7-dB hearing level; t test p < 0.001). HA use had no effect TMT-B performance. Better performance on the MMSE was correlated with both low frequency (ρ = -0.28, p = 0.021) and high frequency (ρ = -0.21, p = 0.038) hearing level, but there was no correlation between performance on the TMT-B and hearing at any frequency.

CONCLUSION

Despite having poorer hearing, HA users performed better on the MMSE. Better performance on cognitive tests with auditory stimuli (MMSE) but not visual stimuli (TMT-B) suggests that hearing loss is associated with sensory-specific cognitive decline rather than global cognitive impairment. Because hearing loss is nearly universal in those older than 80 years, HAs should be strongly recommended to minimize cognitive impairment in the elderly.

Evidence of degraded representation of speech in noise, in the aging midbrain and cortex

Humans have a remarkable ability to track and understand speech in unfavorable conditions, such as in background noise, but speech understanding in noise does deteriorate with age. Results from several studies have shown that in younger adults, low-frequency auditory cortical activity reliably synchronizes to the speech envelope, even when the background noise is considerably louder than the speech signal. However, cortical speech processing may be limited by age-related decreases in the precision of neural synchronization in the midbrain. To understand better the neural mechanisms contributing to impaired speech perception in older adults, we investigated how aging affects midbrain and cortical encoding of speech when presented in quiet and in the presence of a single-competing talker. Our results suggest that central auditory temporal processing deficits in older adults manifest in both the midbrain and in the cortex. Specifically, midbrain frequency following responses to a speech syllable are more degraded in noise in older adults than in younger adults. This suggests a failure of the midbrain auditory mechanisms needed to compensate for the presence of a competing talker. Similarly, in cortical responses, older adults show larger reductions than younger adults in their ability to encode the speech envelope when a competing talker is added. Interestingly, older adults showed an exaggerated cortical representation of speech in both quiet and noise conditions, suggesting a possible imbalance between inhibitory and excitatory processes, or diminished network connectivity that may impair their ability to encode speech efficiently.

Mechanisms of the Hearing-Cognition Relationship

This review provides a description of age-related changes in hearing and cognition, the relationship between hearing and cognition, and several potential mechanisms that underlie the relationship. Several studies have shown a significant relationship between peripheral hearing loss and cognitive impairment/decline but other studies have not. Furthermore, poor performance on measures of central auditory processing has been significantly associated with cognitive impairment. Important to understanding these relationships are the nature of the underlying mechanisms. Possible mechanisms are overdiagnosis, widespread neural degeneration, sensory degradation/deprivation, cognitive resource allocation/depletion, and social isolation/depression. Overdiagnosis occurs when hearing loss impacts tests of cognitive function or vice versa. Widespread neural degeneration can impact hearing, cognition, or both. Sensory degradation/deprivation due to hearing loss can result in neural degradation and reduced cognitive function. Increased demands due to hearing loss can result in changes in neural resource allocation, reducing available resources for cognitive function. Finally, hearing difficulties can cause social isolation and even depression, increasing the risk for cognitive decline. Data from our laboratory provide support for cognitive resource allocation/depletion. Understanding all five of these mechanisms will advance the development of effective interventions and treatments, thereby enhancing the quality of life of older adults.

Visual word recognition across the adult lifespan

The current study examines visual word recognition in a large sample (N = 148) across the adult life span and across a large set of stimuli (N = 1,187) in three different lexical processing tasks (pronunciation, lexical decision, and animacy judgment). Although the focus of the present study is on the influence of word frequency, a diverse set of other variables are examined as the word recognition system ages and acquires more experience with language. Computational models and conceptual theories of visual word recognition and aging make differing predictions for age-related changes in the system. However, these have been difficult to assess because prior studies have produced inconsistent results, possibly because of sample differences, analytic procedures, and/or task-specific processes. The current study confronts these potential differences by using 3 different tasks, treating age and word variables as continuous, and exploring the influence of individual differences such as vocabulary, vision, and working memory. The primary finding is remarkable stability in the influence of a diverse set of variables on visual word recognition across the adult age spectrum. This pattern is discussed in reference to previous inconsistent findings in the literature and implications for current models of visual word recognition. (PsycINFO Database Record

Linking cognitive and visual perceptual decline in healthy aging: The information degradation hypothesis

Several hypotheses attempt to explain the relation between cognitive and perceptual decline in aging (e.g., common-cause, sensory deprivation, cognitive load on perception, information degradation). Unfortunately, the majority of past studies examining this association have used correlational analyses, not allowing for these hypotheses to be tested sufficiently. This correlational issue is especially relevant for the information degradation hypothesis, which states that degraded perceptual signal inputs, resulting from either age-related neurobiological processes (e.g., retinal degeneration) or experimental manipulations (e.g., reduced visual contrast), lead to errors in perceptual processing, which in turn may affect non-perceptual, higher-order cognitive processes. Even though the majority of studies examining the relation between age-related cognitive and perceptual decline have been correlational, we reviewed several studies demonstrating that visual manipulations affect both younger and older adults' cognitive performance, supporting the information degradation hypothesis and contradicting implications of other hypotheses (e.g., common-cause, sensory deprivation, cognitive load on perception). The reviewed evidence indicates the necessity to further examine the information degradation hypothesis in order to identify mechanisms underlying age-related cognitive decline.

Self-Reported Hearing in the Last 2 Years of Life in Older Adults

OBJECTIVES

To assess the prevalence and correlates of self-reported hearing loss during the last 2 years of life.

DESIGN

Observational cohort study.

SETTING

The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of adults aged 50 and older (2000-13).

PARTICIPANTS

Older adults (N = 5,895, mean age at death 78, 53% female, 20% nonwhite).

MEASUREMENTS

The HRS interview closest to death was used (mean 12.2 months before death). Participants rated their hearing (excellent, very good, good, fair, poor) and indicated whether they used hearing aids. The prevalence and correlates of fair and poor ratings are described, adjusted for age and sex.

RESULTS

Thirty-two percent (95% confidence interval (CI) = 31-34%) of all participants and 60% (95% CI = 57-64%) of the 7% of participants who used hearing aids rated their hearing as fair or poor. The prevalence of fair or poor hearing was highest in participants interviewed closest to death (29% 19-24 months before death, 36% 1-6 months before death, P for trend = .01). Correlates of fair or poor hearing during the last 2 years of life included age at death (50-59, 22%; 60-69, 21%; 70-79, 26%; 80-89, 38%; ≥90, 50%), sex (men 35%, women 30%), race and ethnicity (Hispanic 42%, white 33%), wealth (lowest quartile 38%, highest quartile 27%), history of heart disease (yes 38%, no 27%), activity of daily living dependence (yes 42%, no 26%), difficulty taking medications (yes 46%, no 29%), and probable dementia (yes 44%, no 24%).

CONCLUSION

Self-reported hearing loss increases during the last 2 years of life and is associated with physical and social vulnerability.

Neural Alterations in Acquired Age-Related Hearing Loss

Hearing loss is one of the most prevalent chronic health conditions in older adults. Growing evidence suggests that hearing loss is associated with reduced cognitive functioning and incident dementia. In this mini-review, we briefly examine literature on anatomical and functional alterations in the brains of adults with acquired age-associated hearing loss, which may underlie the cognitive consequences observed in this population, focusing on studies that have used structural and functional magnetic resonance imaging, diffusion tensor imaging, and event-related electroencephalography. We discuss structural and functional alterations observed in the temporal and frontal cortices and the limbic system. These neural alterations are discussed in the context of common cause, information-degradation, and sensory-deprivation hypotheses, and we suggest possible rehabilitation strategies. Although, we are beginning to learn more about changes in neural architecture and functionality related to age-associated hearing loss, much work remains to be done. Understanding the neural alterations will provide objective markers for early identification of neural consequences of age-associated hearing loss and for evaluating benefits of intervention approaches.

Multiple Solutions to the Same Problem: Utilization of Plausibility and Syntax in Sentence Comprehension by Older Adults with Impaired Hearing

A fundamental question in psycholinguistic theory is whether equivalent success in sentence comprehension may come about by different underlying operations. Of special interest is whether adult aging, especially when accompanied by reduced hearing acuity, may shift the balance of reliance on formal syntax vs. plausibility in determining sentence meaning. In two experiments participants were asked to identify the thematic roles in grammatical sentences that contained either plausible or implausible semantic relations. Comprehension of sentence meanings was indexed by the ability to correctly name the agent or the recipient of an action represented in the sentence. In Experiment 1 young and older adults’ comprehension was tested for plausible and implausible sentences with the meaning expressed with either an active-declarative or a passive syntactic form. In Experiment 2 comprehension performance was examined for young adults with age-normal hearing, older adults with good hearing acuity, and age-matched older adults with mild-to-moderate hearing loss for plausible or implausible sentences with meaning expressed with either a subject-relative (SR) or an object-relative (OR) syntactic structure. Experiment 1 showed that the likelihood of interpreting a sentence according to its literal meaning was reduced when that meaning expressed an implausible relationship. Experiment 2 showed that this likelihood was further decreased for OR as compared to SR sentences, and especially so for older adults whose hearing impairment added to the perceptual challenge. Experiment 2 also showed that working memory capacity as measured with a letter-number sequencing task contributed to the likelihood that listeners would base their comprehension responses on the literal syntax even when this processing scheme yielded an implausible meaning. Taken together, the results of both experiments support the postulate that listeners may use more than a single uniform processing strategy for successful sentence comprehension, with the existence of these alternative solutions only revealed when literal syntax and plausibility do not coincide.