On the relationship between tinnitus distress, cognitive performance and aging

Isolated cognitive impairment in people with multiple sclerosis: frequency, MRI patterns and its development over time

OBJECTIVES

To study the frequency of isolated (i.e., single-domain) cognitive impairments, domain specific MRI correlates, and its longitudinal development in people with multiple sclerosis (PwMS).

METHODS

348 PwMS (mean age 48 ± 11 years, 67% female, 244RR/52SP/38PP) underwent neuropsychological testing (extended BRB-N) at baseline and at five-year follow-up. At baseline, structural MRI was acquired. Isolated cognitive impairment was defined as a Z-score of at least 1.5 SD below normative data in one domain only (processing speed, memory, executive functioning/working memory, and attention). Multi-domain cognitive impairment was defined as being affected in ≥ 2 domains, and cognitively preserved otherwise. For PwMS with isolated cognitive impairment, MRI correlates were explored using linear regression. Development of isolated cognitive impairment over time was evaluated based on reliable change index.

RESULTS

At baseline, 108 (31%) PwMS displayed isolated cognitive impairment, 148 (43%) PwMS displayed multi-domain cognitive impairment. Most PwMS with isolated cognitive impairment were impaired on executive functioning/working memory (EF/WM; N = 37), followed by processing speed (IPS; N = 25), memory (N = 23), and attention (N = 23). Isolated IPS impairment was explained by a model of cortical volume and fractional anisotropy (adj. R2 = 0.539, p < 0.001); memory by a model with cortical volume and hippocampal volume (adj. R2 = 0.493, p = 0.002); EF/WM and attention were not associated with any MRI measure. At follow-up, cognitive decline was present in 11/16 (69%) of PwMS with isolated IPS impairment at baseline. This percentage varied between 18 and 31% of PwMS with isolated cognitive impairment in domains other than IPS at baseline.

CONCLUSION

Isolated cognitive impairment is frequently present in PwMS and can serve as a proxy for further decline, particularly when it concerns processing speed. Cortical and deep grey matter atrophy seem to play a pivotal role in isolated cognitive impairment. Timely detection and patient-tailored intervention, predominantly for IPS, may help to postpone further cognitive decline.

Factors influencing the use of natural health products, in particular for concentration and cognition in Germany

BACKGROUND

Natural health products (NHP) are an important part of the healthcare system. They are mainly non-prescription and sold over the counter, which requires active decision making by the consumer. Within the framework of the Complementary and Alternative Healthcare Model, this study aims to identify factors that influence NHP usage, in particular related to concentration and cognition (CC), a topic that concerns all ages and social classes within the population.

METHODS

Data were collected by means of a representative online survey (n = 1,707) in Germany in April 2022. Three user groups were defined: NHPCC users, who used NHP for CC (12 month prevalence); nCC-NHP users, who used NHP but not for CC indications (12 month prevalence); and past NHP users, who have used NHP but not within the previous 12 months. Independent influencing variables were categorized into predisposing, enabling, need, and health service use factors. Data were analyzed with descriptive statistics, inferential statistics, and binary logistic regression models to compare NHPCC users to nCC-NHP users (model 1) and to past NHP users (model 2).

RESULTS

A higher share of NHPCC and nCC-NHP users compared to past NHP users were women, self-medicated with NHP, and used information about NHP provided by health professionals or on product. Their openness-to-change value orientation was more pronounced than of past users. Compared to nCC-NHP and past NHP users, the probability of being an NHPCC user increased if an individual had more difficulties in daily attention and memory performance, made use of health professionals and literature to seek information about NHP, and used NHP for health support and illness prevention. Additionally, a female gender, NHP self-medication, and having higher values of self-transcendence were significant indicators for NHPCC usage compared to past NHP usage.

CONCLUSION

NHP manufacturers, health professionals, and policymakers should be aware of the factors that lead to NHP consumption decisions and consider them in the development and optimization of healthcare strategies as well as in the marketing and communication strategies of companies producing NHP, in particular for CC. The current study can contribute to characterizing the target groups and to defining the aims and communication channels of such campaigns.

[Analysis of items on the short forms of the tinnitus questionnaire: Mini-TQ-12 and Mini-TQ-15]

BACKGROUND

A brief but reliable measurement of tinnitus-related distress is crucial for understanding and treatment options for this often very limiting symptom. Several self-report questionnaires are used in German-speaking countries and several short versions exist for the German translation of the Tinnitus Questionnaire (TQ).

OBJECTIVE

In the present work, the frequently used Mini-TQ-12 questionnaire and the newly developed Mini-TQ-15 questionnaire will be investigated with regard to reliability, item difficulty, sensitivity (discriminatory power), and predictive power of the items in order to facilitate a decision for one or the other questionnaire in different examination contexts.

METHODS

Data from 1409 patients with chronic tinnitus who completed the German 52-item version of the TQ and additional psychological tests (ADS‑L, BSF, PHQ, ACSA and SWOP) at the Tinnitus Centre of the Charité Universitaetsmedizin Berlin, Germany, were retrospectively analyzed. We performed external validation of items from different versions of the TQ (original version, Mini-TQ-12, and Mini-TQ-15).

RESULTS

The items of the Mini-TQ-12 and the Mini-TQ-15 predicted specifically the total score. Both short questionnaires are of comparable quality in terms of reliability and item construction (difficulty, discriminatory power).

CONCLUSION

Both questionnaires have a very good item quality and are clinically more efficient to use than the long-form TQ. If a similarity of the factor structure to the original questionnaire is required for research questions, the use of the Mini-TQ-15 is recommended.

Randomized controlled trial of a smartphone-based cognitive behavioral therapy for chronic tinnitus

Tinnitus, the phantom perception of sounds, generates distress and anxiety in those affected. Cognitive behavioral treatment approaches reproducibly help patients in managing chronic tinnitus. This study systematically evaluated the usefulness of a tinnitus app (with areas of attention and relaxation, mindfulness, acceptance, self-efficacy), which is prescribed for a total of nine months. One hundred eighty-seven participants with chronic tinnitus were equally randomized to an intervention arm that used a smartphone-based intervention -marketed as Kalmeda Tinnitus app-. and a control arm with delayed onset of treatment by 3 months. The first 3 months of a 9-months prescribed intervention have been analyzed as primary outcome. The Tinnitus Questionnaire (TQ) was used as primary endpoint to determine the reduction of tinnitus distress. Following intervention, there was a statistically significant and clinically relevant reduction of the TQ sum score in the intervention group compared to the control group (p<0.001, Cohen's d effect size = 1.1). The secondary parameters, Patient Health Questionnaire-9 (PHQ9) and Perceived-Stress-Questionnaire (PSQ20) scores improved significantly in the intervention group whereas the Self Efficacy-Optimism-Pessimism short form (SWOP-K9) scores remained unchanged in both groups. Patients reported no treatment-related side effects. Taken together, use of this Tinnitus app lead to a significant decrease in tinnitus distress and a clinically relevant effect in the patients´ self-reported everyday management.

Limited Link of Common Blood Parameters with Tinnitus

Background: Tinnitus severity is generally assessed by psychometric and audiological instruments. However, no objective measure exists to evaluate the subjective discomfort and suffering caused by this hearing phenomenon. The objective of this work was to determine the possible blood parameters for diagnostics and therapy. Methods: We measured tinnitus distress by using the Tinnitus Questionnaire (TQ) and collected tinnitus-related audiological measures, namely the hearing threshold (HT), tinnitus loudness (TL), and sensation level (SL, i.e., the tinnitus loudness/hearing threshold at a tinnitus frequency). Blood samples were taken from 200 outpatients of the Tinnitus Centre of the Charité, and 46 routine blood count parameters were examined. The possible interactions were determined by (robust) linear models. Results: Tinnitus distress and audiological measurements were largely uncorrelated but could partly be predicted by selected blood parameters. First, the erythrocyte counts predicted tinnitus distress to a small extent. Second, the levels of vitamin D3 explained about 6% of tinnitus loudness and, age-dependently, the hearing threshold variability. Last, the levels of uric acid explained about 5% of the sensation level variability. Conclusions: Tinnitus is a multidimensional phenomenon. The marginal influences of blood markers suggest the possible roles of inflammation and oxidative stress produced by psychological or somatic burdens. Clinically, a vitamin D substitution (in older patients) might have a hearing-protective effect.

What can we learn about selective attention processes in individuals with chronic pain using reaction time tasks? A systematic review and meta-analysis

ABSTRACT

Information-processing biases such as attentional, interpretation, and memory biases are believed to play a role in exacerbating and maintaining chronic pain (CP). Evidence suggests that individuals with CP show attentional bias toward pain-related information. However, the selective attentional processes that underpin this bias are not always well outlined in the literature. To improve current understanding, a systematic review was performed using a descriptive synthesis of reaction time-based studies. A random-effects meta-analysis was added to explore whether the results of previous meta-analyses would be confirmed using studies with a larger sample size. For this review, 2008 studies were screened from 4 databases, of which 34 (participant n = 3154) were included in the review and a subset of 15 (participant n = 1339) were included in the meta-analysis. Review results were summarised by producing a descriptive synthesis for all studies. Meta-analysis results indicated a mild significant attentional bias toward sensory pain-related information (k = 15, g = 0.28, 95% CI [0.16, 0.39], I2 = 43.2%, P = 0.038), and preliminary evidence of significant moderate bias towards affective pain-related information (k = 3, g = 0.48, 95% CI [0.23, 0.72], I2 = 7.1%, P = 0.341) for CP groups compared with control groups. We explored the main tasks, stimuli, and CP subtypes used to address attentional biases and related processes. However, variation across studies did not allow for a decisive conclusion about the role of stimulus, task type, or related attentional processes. In addition, a table of CP attention-related models was produced and tested for reliability. Finally, other results and recommendations are discussed.

Disruptions of default mode network and precuneus connectivity associated with cognitive dysfunctions in tinnitus

Tinnitus is the perception of a ringing, buzzing or hissing sound "in the ear" without external stimulation. Previous research has demonstrated changes in resting-state functional connectivity in tinnitus, but findings do not overlap and are even contradictory. Furthermore, how altered functional connectivity in tinnitus is related to cognitive abilities is currently unknown. Here we investigated resting-state functional connectivity differences between 20 patients with chronic tinnitus and 20 control participants matched in age, sex and hearing loss. All participants underwent functional magnetic resonance imaging, audiometric and cognitive assessments, and filled in questionnaires targeting anxiety and depression. Significant differences in functional connectivity between tinnitus patients and control participants were not obtained. However, we did find significant associations between cognitive scores and functional coupling of the default mode network and the precuneus with the superior parietal lobule, supramarginal gyrus, and orbitofrontal cortex. Further, tinnitus distress correlated with connectivity between the precuneus and the lateral occipital complex. This is the first study providing evidence for disruptions of default mode network and precuneus coupling that are related to cognitive dysfunctions in tinnitus. The constant attempt to decrease the tinnitus sensation might occupy certain brain resources otherwise available for concurrent cognitive operations.

Considering hearing loss as a modifiable risk factor for dementia

INTRODUCTION

Accumulating evidence links hearing loss to impaired cognitive performance and increased risk for dementia. Hearing loss can lead to deafferentation-induced atrophy of frontotemporal brain regions and dysregulation of cognitive control networks from increased listening effort. Hearing loss is also associated with reduced social engagement, loneliness, and depression, which are independently associated with poor cognitive function.

AREAS COVERED

We summarize the evidence and postulated mechanisms linking hearing loss to dementia in older adults and synthesize the available literature demonstrating beneficial effects of hearing remediation on brain structure and function.

EXPERT OPINION

: Further research is needed to evaluate whether treatment of hearing loss may reduce risk of cognitive decline and improve neural consequences of hearing loss. Studies may investigate the pathologic mechanisms linking these late-life disorders and identify individuals vulnerable to dementia, and future clinical trials may evaluate whether hearing treatment may reduce the risk for dementia.

Dimensions of Tinnitus-Related Distress

Objectives: (1) To determine which psychosocial aspects predict tinnitus-related distress in a large self-reported dataset of patients with chronic tinnitus, and (2) to identify underlying constructs by means of factor analysis. Methods: A cohort of 1958 patients of the Charité Tinnitus Center, Berlin completed a large questionnaire battery that comprised sociodemographic data, tinnitus-related distress, general psychological stress experience, emotional symptoms, and somatic complaints. To identify a construct of “tinnitus-related distress”, significant predictive items were grouped using factor analysis. Results: For the prediction of tinnitus-related distress (linear regression model with R² = 0.7), depressive fatigue symptoms (concentration, sleep, rumination, joy decreased), the experience of emotional strain, somatization tendencies (pain experience, doctor contacts), and age appeared to play a role. The factor analysis revealed five factors: “stress”, “pain experience”, “fatigue”, “autonomy”, and low “educational level”. Conclusions: Tinnitus-related distress is predicted by psychological and sociodemographic indices. Relevant factors seem to be depressive exhaustion with somatic expressions such as sleep and concentration problems, somatization, general psychological stress, and reduced activity, in addition to higher age.

The Influence of Depression, Anxiety and Cognition on the Treatment Effects of Ginkgo biloba Extract EGb 761® in Patients with Tinnitus and Dementia: A Mediation Analysis

Background: Comorbid occurrence of tinnitus and emotional symptoms of anxiety and depression is highly prevalent. The Ginkgo biloba extract EGb 761^® has been shown to be effective in reducing neuropsychiatric symptoms in patients with dementia and tinnitus. Methods: We performed a mediation analysis to evaluate direct effects of EGb 761^® on tinnitus severity, as well as indirect effects mediated by symptoms of depression and anxiety and by changed cognition. We pooled data from subsets of patients suffering from tinnitus that were enrolled in three double-blind, randomized, placebo-controlled clinical trials, which investigated the efficacy of EGb 761^® (240 mg/day for 22–24 weeks) in dementia with concomitant neuropsychiatric symptoms. Results: In total, 594 patients suffered from tinnitus (EGb 761^®, 289; placebo, 305). Direct effects of EGb 761^® on tinnitus severity (p < 0.001) in patients with mild to moderate dementia were found to represent about 60% of the total effect, whereas the indirect effects (p < 0.001) mediated by improvement of anxiety, depression and cognition represented about 40% of the total effect. Conclusions: EGb 761^® could be considered as a supporting treatment for tinnitus in elderly patients suffering from dementia, with added benefit in those with symptoms of depression or anxiety.