A Comparison of Montreal Cognitive Assessment Scores among Individuals with Normal Hearing and Cochlear Implants

OBJECTIVES

The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool that has 4 of 10 test items heavily dependent on auditory input, potentially leaving hearing-impaired (HI) individuals at a disadvantage. Previous work found that HI individuals scored lower than normal-hearing (NH) individuals on the MoCA, potentially attributed to the degraded auditory signals negatively impacting the ability to commit auditory information to memory. However, there is no research comparing how cochlear implant (CI) recipients perform on the MoCA relative to NH and HI individuals. This study aimed to (1) examine the effect of implementing three different hearing-adjusted scoring methods for a group of age-matched CI recipients and NH individuals, (2) determine if there is a difference between the two groups in overall scores and hearing-adjusted scores, and (3) compare scores across our CI and NH data to the published HI data for all scoring methods. We hypothesized that (1) scores for CI recipients would improve with implementation of the hearing-adjusted scoring methods over the original method, (2) CI recipients would score lower than NH participants for both original and adjusted scoring methods, and (3) the difference in scores between NH and CI listeners for both adjusted and unadjusted scores would be greater than that reported in the literature between NH and HI individuals due to the greater severity of hearing loss and relatively poor spectral resolution of CIs.

DESIGN

A total of 94 adults with CIs and 105 adults with NH were initially enrolled. After age-matching the two groups and excluding those who self-identified as NH but failed a hearing screening, a total of 75 CI participants (mean age 61.2 y) and 74 NH participants (mean age 58.8 y) were administered the MoCA. Scores were compared between the NH and CI groups, as well as to published HI data, using the original MoCA scoring method and three alternative scoring methods that excluded various auditory-dependent test items.

RESULTS

MoCA scores improved for all groups when two of the three alternative scoring methods were used, with no significant interaction between scoring method and group. Scores for CI recipients were significantly poorer than those for age-matched NH participants for all scoring methods. CI recipients scored better than the published data for HI individuals; however, the HI group was not age matched to the CI and NH groups.

CONCLUSIONS

MoCA scores are only partly affected by the potentially greater cognitive processing required to interpret degraded auditory signals. Even with the removal of the auditory-dependent items, CI recipients still did not perform as well as the age-matched NH group. Importantly, removing auditory-dependent items significantly and fundamentally alters the test, thereby reducing its sensitivity. This has important limitations for administration and interpretation of the MoCA for people with hearing loss.

The effects of various auditory takeover requests: A simulated driving study considering the modality of non-driving-related tasks

With the era of automated driving approaching, designing an effective auditory takeover request (TOR) is critical to ensure automated driving safety. The present study investigated the effects of speech-based (speech and spearcon) and non-speech-based (earcon and auditory icon) TORs on takeover performance and subjective preferences. The potential impact of the non-driving-related task (NDRT) modality on auditory TORs was considered. Thirty-two participants were recruited in the present study and assigned to two groups, with one group performing the visual N-back task and another performing the auditory N-back task during automated driving. They were required to complete four simulated driving blocks corresponding to four auditory TOR types. The earcon TOR was found to be the most suitable for alerting drivers to return to the control loop because of its advantageous takeover time, lane change time, and minimum time to collision. Although participants preferred the speech TOR, it led to relatively poor takeover performance. In addition, the auditory NDRT was found to have a detrimental impact on auditory TORs. When drivers were engaged in the auditory NDRT, the takeover time and lane change time advantages of earcon TORs no longer existed. These findings highlight the importance of considering the influence of auditory NDRTs when designing an auditory takeover interface. The present study also has some practical implications for researchers and designers when designing an auditory takeover system in automated vehicles.

The effect of age on the hearing-related quality of life in normal-hearing adults

INTRODUCTION

Recently, a new holistic Patient Reported Outcome Measure (PROM) to assess hearing-related quality of life was developed, named the hearing-related quality of life questionnaire for Auditory-VIsual, COgnitive and Psychosocial functioning (hAVICOP). The purpose of the current study was to evaluate if the hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life.

METHODS

One-hundred thirteen normal-hearing participants (mean age: 42.13; range: 19 to 69 years) filled in the entire hAVICOP questionnaire online through the Research Electronic Data Capture surface. The hAVICOP consists of 27 statements, across three major subdomains (auditory-visual, cognitive, and psychosocial functioning), which have to be rated on a visual analogue scale ranging from 0 (rarely to never) to 100 (almost always). Mean scores were calculated for each subdomain separately as well as combined within a total score; the worse one's hearing-related quality of life, the lower the score. Linear regression models were run to predict the hAVICOP total as well as the three subdomain scores from age and sex.

RESULTS

A significant main effect of age was observed for the total hAVICOP and all three subdomain scores, indicating a decrease in hearing-related quality of life with increasing age. For none of the analyses, a significant sex effect was found.

CONCLUSION

The hAVICOP is sufficiently sensitive to detect an age effect in the hearing-related quality of life within a large group of normal-hearing adults, emphasizing its clinical utility. This age effect on the hearing-related quality of life might be related to the interplay of age-related changes in the bottom-up and top-down processes involved during speech processing.

Effects of Auditory Training in Older Adults

PURPOSE

This study examines the effects of an auditory training program on the auditory and cognitive abilities of older adults. Auditory rehabilitation programs are generally designed for hearing aid users, and studies have demonstrated benefits for them. In this study, we seek to understand whether such a training program can also benefit older adults who do not wear hearing aids. We also examined if cognitive benefits can indeed be observed as a result of the training.

METHOD

Sixty-four older adults were recruited and assigned into three groups: the experimental group (n = 20), the active control group (n = 21), and the no-training control group (n = 23). The experimental group underwent an auditory training program (Listening and Communication Enhancement [LACE]) during the training phase. Meanwhile, the active control group listened to short audio clips and the no-training control group did not participate in any program. An auditory test (Quick Speech-in-Noise [QuickSIN]) and a battery of cognitive tests were conducted before and after the training to examine the participants' performance on auditory ability, short-term memory, and attention.

RESULTS

The results showed improvements in auditory and cognitive abilities during the training period. When assessing the training effects by comparing the pre- and the posttraining performances, a significant improvement on the QuickSIN task was found in the training group but not in the other two groups. However, other cognitive tests did not show any significant improvement. That is, the LACE training did not benefit short-term memory and attention. The improved performance on short-term memory during the training was not maintained in the posttraining session.

CONCLUSION

Overall, the study has extended the auditory benefit from the LACE training to the typical aging population in terms of improved communication ability, but the effect of training on auditory abilities did not transfer to gains in cognitive abilities.

Age-related asymmetry in left-right ears of sound lateralization with respect to four different rise times

An experimental investigation was conducted to elucidate the auditory characteristics of the older adult population. The study involved 24 older adult and 24 young participants, with the aim of exploring their horizontal lateralization ability. This was achieved by presenting 1-kHz pure tones to the participants' right and left ears while introducing interaural time differences (ITDs). We examined the impact of four rise times (2, 5, 20, and 50 ms) on the onset of the test sound. The findings revealed that older adult participants exhibited lower levels of lateralization than young participants. Moreover, both older adult and young participants demonstrated diminished recognition of the onset portion as the rise time increased. Of particular significance was the conspicuous presence of a right ear advantage (REA) among young participants as the rise time was extended (statistically significant between the left and right ears at the 1% level, considering an ITD of 0.8 ms and a rise time of 50 ms). In contrast, older adult participants did not exhibit REA, even with a prolonged rise time (not significant at the 5% level at the same condition). These results indicate that the REA is not only present in language, as previously observed, but also extends to a pure tone in young participants. The older adult participants exhibited reduced performance in both left-and right-ear sound recognition. The influence of hearing threshold and preferred ear on sound lateralization performance was minimal. Therefore, it can be inferred that factors other than hearing threshold or preferred ear contribute to the presence of REA in young participants or its decline with age. The central and/or corpus callosum functions may also contribute to this phenomenon.

Cochlear implants: the effects of age on outcomes

INTRODUCTION

Cochlear implants (CIs) provide access to sound for children and adults who do not receive adequate benefit from hearing aids. Age at implantation is known to affect outcomes across the lifespan.

AREAS COVERED

The effects of age on CI outcomes are examined for infants, children, adolescents, and older adults. A variety of outcome measures are considered, including speech perception, language, cognition, and quality of life measures.

EXPERT OPINION/COMMENTARY

For those meeting candidacy criteria, CIs are beneficial at any age. In general, younger age is related to greater benefit when considering pre-lingual deafness. Other factors such as additional disabilities, may mitigate this effect. Post-lingually deafened adults demonstrate similar benefit regardless of age, though the oldest individuals (80+) may see smaller degrees of improvement from preoperative scores. Benefit can be measured in many ways, and the areas of greatest benefit may vary based on age: young children appear to see the greatest effects of age at implantation on language measures, whereas scores on cognitive measures appear to be most impacted for the oldest population. Future research should consider implantation at extreme ages (5-9 months or > 90 years), unconventional measures of CI benefit including qualitative assessments, and longitudinal designs.

Noise-Vocoded Sentence Recognition and the Use of Context in Older and Younger Adult Listeners

PURPOSE

When listening to speech under adverse conditions, older adults, even with "age-normal" hearing, face challenges that may lead to poorer speech recognition than their younger peers. Older listeners generally demonstrate poorer suprathreshold auditory processing along with aging-related declines in neurocognitive functioning that may impair their ability to compensate using "top-down" cognitive-linguistic functions. This study explored top-down processing in older and younger adult listeners, specifically the use of semantic context during noise-vocoded sentence recognition.

METHOD

Eighty-four adults with age-normal hearing (45 young normal-hearing [YNH] and 39 older normal-hearing [ONH] adults) participated. Participants were tested for recognition accuracy for two sets of noise-vocoded sentence materials: one that was semantically meaningful and the other that was syntactically appropriate but semantically anomalous. Participants were also tested for hearing ability and for neurocognitive functioning to assess working memory capacity, speed of lexical access, inhibitory control, and nonverbal fluid reasoning, as well as vocabulary knowledge.

RESULTS

The ONH and YNH listeners made use of semantic context to a similar extent. Nonverbal reasoning predicted recognition of both meaningful and anomalous sentences, whereas pure-tone average contributed additionally to anomalous sentence recognition. None of the hearing, neurocognitive, or language measures significantly predicted the amount of context gain, computed as the difference score between meaningful and anomalous sentence recognition. However, exploratory cluster analyses demonstrated four listener profiles and suggested that individuals may vary in the strategies used to recognize speech under adverse listening conditions.

CONCLUSIONS

Older and younger listeners made use of sentence context to similar degrees. Nonverbal reasoning was found to be a contributor to noise-vocoded sentence recognition. However, different listeners may approach the problem of recognizing meaningful speech under adverse conditions using different strategies based on their hearing, neurocognitive, and language profiles. These findings provide support for the complexity of bottom-up and top-down interactions during speech recognition under adverse listening conditions.

The Overview of Cognitive Aging Models

To understand the cause of the age-related decline in cognitive function and its underlying mechanism, the cognitive aging model can provide us with important insights. In this section, we will introduce behavioral and neural models about age-related cognitive changes. Among behavioral models, several aging theories were discussed from the perspectives of educational, biological, and sociological factors, which could explain parts of the aging process. With the development of imaging technology, many studies have discussed the neural mechanism of aging and successively proposed neural models to explain the aging phenomenon. Behavioral models and neural mechanism models supplement each other, gradually unveiling the mystery of cognitive aging.

Hearing aid use and gender differences in the auditory-cognitive cascade in the oldest old

OBJECTIVES

This study analyzed cognitive differences between hearing-aid (HA) and non-HA users. We hypothesized that HA-use attenuates the auditory-cognitive cascade, thereby, the latter is more conspicuous in non-HA users. Since hearing impairment (HI) shows male predominance, we hypothesized gender differences within the auditory-cognitive relationship.

METHODS

Non-frail community-dwellers ≥ 80 years were assessed for HI (pure tone audiogram-PTA; speech reception threshold-SRT) and global and domain-specific cognitive impairments (Mini-Mental State Examination-MMSE; Montreal Cognitive Assessment-MOCA; Reaction Time Test-RT1-4). Pearson and partial correlations (correcting for age and PTA) assessed auditory-cognitive associations within gender and HA subgroups. Fisher's z test compared correlations between HA and non-HA users.

RESULTS

126 participants (age range 80-91 years) were included. HA-use prevalence was 21%. HA-users were older with worse HI (mean PTA 49.5dBHL). HA-users exhibited no significant auditory (PTA, SRT) and cognitive (MMSE, MOCA, RT1- RT4) correlations. Male non-HA users, displayed a significant association between HI and global cognition, processing speed, selective and alternating attention. Significant differences were noted between MMSE and PTA and SRT (z-score 2.28, 3.33, p = 0.02, <0.01, respectively) between HA and non-HA users.

CONCLUSION

Male non-HA users displayed an association between HI and global and domain-specific (processing speed; selective and alternating attention) cognitive decline. Associations between global cognition and HI were significantly different between HA and non-HA users. This may be partially attributable to underlying subgroups sample sizes and statistical power disparity. If larger scale longitudinal or interventional studies confirm these findings, timely HI assessment and management may be the cornerstone for delaying cognitive decline.

Identifying Listeners Whose Speech Intelligibility Depends on a Quiet Extra Moment After a Sentence

PURPOSE

An extra moment after a sentence is spoken may be important for listeners with hearing loss to mentally repair misperceptions during listening. The current audiologic test battery cannot distinguish between a listener who repaired a misperception versus a listener who heard the speech accurately with no need for repair. This study aims to develop a behavioral method to identify individuals who are at risk for relying on a quiet moment after a sentence.

METHOD

Forty-three individuals with hearing loss (32 cochlear implant users, 11 hearing aid users) heard sentences that were followed by either 2 s of silence or 2 s of babble noise. Both high- and low-context sentences were used in the task.

RESULTS

Some individuals showed notable benefit in accuracy scores (particularly for high-context sentences) when given an extra moment of silent time following the sentence. This benefit was highly variable across individuals and sometimes absent altogether. However, the group-level patterns of results were mainly explained by the use of context and successful perception of the words preceding sentence-final words.

CONCLUSIONS

These results suggest that some but not all individuals improve their speech recognition score by relying on a quiet moment after a sentence, and that this fragility of speech recognition cannot be assessed using one isolated utterance at a time. Reliance on a quiet moment to repair perceptions would potentially impede the perception of an upcoming utterance, making continuous communication in real-world scenarios difficult especially for individuals with hearing loss. The methods used in this study-along with some simple modifications if necessary-could potentially identify patients with hearing loss who retroactively repair mistakes by using clinically feasible methods that can ultimately lead to better patient-centered hearing health care.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21644801.

Understanding the Relationship Between Age-Related Hearing Loss and Alzheimer’s Disease: A Narrative Review

Evidence suggests that hearing loss (HL), even at mild levels, increases the long-term risk of cognitive decline and incident dementia. Hearing loss is one of the modifiable risk factors for dementia, with approximately 4 million of the 50 million cases of dementia worldwide possibly attributed to untreated HL. This paper describes four possible mechanisms that have been suggested for the relationship between age-related hearing loss (ARHL) and Alzheimer’s disease (AD), which is the most common form of dementia. The first mechanism suggests mitochondrial dysfunction and altered signal pathways due to aging as a possible link between ARHL and AD. The second mechanism proposes that sensory degradation in hearing impaired people could explain the relationship between ARHL and AD. The occupation of cognitive resource (third) mechanism indicates that the association between ARHL and AD is a result of increased cognitive processing that is required to compensate for the degraded sensory input. The fourth mechanism is an expansion of the third mechanism, i.e., the function and structure interaction involves both cognitive resource occupation (neural activity) and AD pathology as the link between ARHL and AD. Exploring the specific mechanisms that provide the link between ARHL and AD has the potential to lead to innovative ideas for the diagnosis, prevention, and/or treatment of AD. This paper also provides insight into the current evidence for the use of hearing treatments as a possible treatment/prevention for AD, and if auditory assessments could provide an avenue for early detection of cognitive impairment associated with AD.

Adult Normative Data for the Adaptation of the Hearing in Noise Test in European French (HINT-5 Min)

Decreased speech-in-noise (SpIN) understanding is an early marker not only of presbycusis but also of auditory processing disorder. Previous research has shown a strong relationship between hearing disorders and cognitive limitations. It is therefore crucial to allow SpIN testing in subjects who cannot sustain prolonged diagnostic procedures. The objectives of this study were to develop a rapid and reproducible version of the Hearing in Noise Test (HINT-5 min), and to determine its adult normative values in free-field and monaural or binaural headphone conditions. Following an adaptive signal-to-noise ratio (SNR) protocol, the test used a fixed noise level, while the signal level varied to reach the 50% speech reception threshold (SRT50). The speech material consisted of five lists of 20 sentences each, all recorded in European French. The whole semi-automated procedure lasted 5 min and was administered to 83 subjects aged 19 to 49 years with no reported listening difficulties. Fifty-two subjects were retested between 7 and 8 days later. For the binaural free-field condition, the mean SRT50 was −1.0 dB SNR with a standard deviation of 1.3 dB SNR. There was no significant difference between the results obtained at test and retest, nor was there any effect of listening condition, sex, or age on SRT50. The results indicate that the procedure is robust and not affected by any learning phenomenon. The HINT-5 min was found to be both a fast and reliable marker of the ability to understand speech in background noise.

Rapid Effects of Vagus Nerve Stimulation on Sensory Processing Through Activation of Neuromodulatory Systems

After sensory information is encoded into neural signals at the periphery, it is processed through multiple brain regions before perception occurs (i.e., sensory processing). Recent work has begun to tease apart how neuromodulatory systems influence sensory processing. Vagus nerve stimulation (VNS) is well-known as an effective and safe method of activating neuromodulatory systems. There is a growing body of studies confirming VNS has immediate effects on sensory processing across multiple sensory modalities. These immediate effects of VNS on sensory processing are distinct from the more well-documented method of inducing lasting neuroplastic changes to the sensory pathways through repeatedly delivering a brief VNS burst paired with a sensory stimulus. Immediate effects occur upon VNS onset, often disappear upon VNS offset, and the modulation is present for all sensory stimuli. Conversely, the neuroplastic effect of pairing sub-second bursts of VNS with a sensory stimulus alters sensory processing only after multiple pairing sessions, this alteration remains after cessation of pairing sessions, and the alteration selectively affects the response properties of neurons encoding the specific paired sensory stimulus. Here, we call attention to the immediate effects VNS has on sensory processing. This review discusses existing studies on this topic, provides an overview of the underlying neuromodulatory systems that likely play a role, and briefly explores the potential translational applications of using VNS to rapidly regulate sensory processing.

The Views and Experience of Audiologists Working in Flemish Hearing Aid Centers Concerning Cognition Within Audiological Practice

PURPOSE

This study aimed to get insight into the views and experience of audiologists, employed in Flemish hearing aid centers, concerning cognition within audiological practice.

METHOD

An online 49-item questionnaire was developed and subdivided into five categories: (a) work setting, (b) practical experience regarding hearing aid fitting linked to cognition, (c) knowledge regarding the auditory-cognitive perspective of speech understanding, (d) willingness and guidelines to implement cognitive measures within audiological practice, and (e) demographics. Respondents were surveyed during January and February 2021.

RESULTS

One hundred twenty-nine audiologists working in Flemish hearing aid centers responded to the entire questionnaire and showed a mean work experience of 8.0 years. Results revealed that cognition was taken into account, especially within the anamnesis interview and general communication strategy, whereas only a minority took cognition into account when actually fitting hearing aids. Knowledge and experience did not determine whether or not respondents took cognition into account. A willingness to implement cognitive measures in a time-efficient manner in audiological practice was observed among respondents.

CONCLUSION

Evidence-based guidelines regarding hearing aid fitting based on an individual's auditory-cognitive profile are needed to improve the quality of hearing rehabilitation.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19593388.

Lexical Effects on the Perceived Clarity of Noise-Vocoded Speech in Younger and Older Listeners

When listening to degraded speech, such as speech delivered by a cochlear implant (CI), listeners make use of top-down linguistic knowledge to facilitate speech recognition. Lexical knowledge supports speech recognition and enhances the perceived clarity of speech. Yet, the extent to which lexical knowledge can be used to effectively compensate for degraded input may depend on the degree of degradation and the listener's age. The current study investigated lexical effects in the compensation for speech that was degraded via noise-vocoding in younger and older listeners. In an online experiment, younger and older normal-hearing (NH) listeners rated the clarity of noise-vocoded sentences on a scale from 1 ("very unclear") to 7 ("completely clear"). Lexical information was provided by matching text primes and the lexical content of the target utterance. Half of the sentences were preceded by a matching text prime, while half were preceded by a non-matching prime. Each sentence also consisted of three key words of high or low lexical frequency and neighborhood density. Sentences were processed to simulate CI hearing, using an eight-channel noise vocoder with varying filter slopes. Results showed that lexical information impacted the perceived clarity of noise-vocoded speech. Noise-vocoded speech was perceived as clearer when preceded by a matching prime, and when sentences included key words with high lexical frequency and low neighborhood density. However, the strength of the lexical effects depended on the level of degradation. Matching text primes had a greater impact for speech with poorer spectral resolution, but lexical content had a smaller impact for speech with poorer spectral resolution. Finally, lexical information appeared to benefit both younger and older listeners. Findings demonstrate that lexical knowledge can be employed by younger and older listeners in cognitive compensation during the processing of noise-vocoded speech. However, lexical content may not be as reliable when the signal is highly degraded. Clinical implications are that for adult CI users, lexical knowledge might be used to compensate for the degraded speech signal, regardless of age, but some CI users may be hindered by a relatively poor signal.

Gender-specific associations of speech-frequency hearing loss, high-frequency hearing loss, and cognitive impairment among older community dwellers in China

Background and Aims

This study aimed atinvestigating the relationship between speech-frequency hearing loss (SFHL), high-frequency hearing loss (HFHL), and cognitive impairment (CI) and then to determine whether there are any differences in gender among older community dwellers in China.

Methods

1012 adults aged ≥ 60 years (428 males; average age, 72.61 ± 5.51 years) and living in Chongming District, Shanghai were enrolled in the study. We used the audiometric definition of hearing loss (HL) adopted by the World Health Organization (WHO). Speech-frequencies were measured at 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz; high-frequencies were measured at 4 kHz and 8 kHz. Pure tone average (PTA) was measured as hearing sensitivity. Cognitive performance was measured using the mini mental state examination (MMSE).

Results

Our studies demonstrated a 37.6% prevalence of HL in males and a 36.0% prevalence of HL in females. Adjusted for confounding variables, the results from a multivariate analysis showed that SFHL was associated with CI in females (OR = 2.922, 95% Confidence Interval = 1.666–5.124) and males (OR = 2.559, 95% Confidence Interval = 1.252–5.232). However, HFHL was associated with CI only in females (OR = 3.490, 95% Confidence Interval = 1.834–6.643). HL was associated with poorer cognitive scores (P < 0.05). “Registration” (P < 0.05) in MMSE was associated with speech- and high-frequency hearing sensitivity.

Conclusions

The associations between HL and CI varied according to gender in older community-dwellers, suggesting that different mechanisms are involved in the etiology of HL. Moreover, hearing sensitivity was negatively associated with cognition scores; therefore, early screening for HL and CI among older community-dwelling adults is advised.

Difficulties Experienced by Older Listeners in Utilizing Voice Cues for Speaker Discrimination

Human listeners are assumed to apply different strategies to improve speech recognition in background noise. Young listeners with normal hearing (NH), e.g., have been shown to follow the voice of a particular speaker based on the fundamental (F0) and formant frequencies, which are both influenced by the gender, age, and size of the speaker. However, the auditory and cognitive processes that underlie the extraction and discrimination of these voice cues across speakers may be subject to age-related decline. The present study aimed to examine the utilization of F0 and formant cues for voice discrimination (VD) in older adults with hearing expected for their age. Difference limens (DLs) for VD were estimated in 15 healthy older adults (65–78 years old) and 35 young adults (18–35 years old) using only F0 cues, only formant frequency cues, and a combination of F0 + formant frequencies. A three-alternative forced-choice paradigm with an adaptive-tracking threshold-seeking procedure was used. Wechsler backward digit span test was used as a measure of auditory working memory. Trail Making Test (TMT) was used to provide cognitive information reflecting a combined effect of processing speed, mental flexibility, and executive control abilities. The results showed that (a) the mean VD thresholds of the older adults were poorer than those of the young adults for all voice cues, although larger variability was observed among the older listeners; (b) both age groups found the formant cues more beneficial for VD, compared to the F0 cues, and the combined (F0 + formant) cues resulted in better thresholds, compared to each cue separately; (c) significant associations were found for the older adults in the combined F0 + formant condition between VD and TMT scores, and between VD and hearing sensitivity, supporting the notion that a decline with age in both top-down and bottom-up mechanisms may hamper the ability of older adults to discriminate between voices. The present findings suggest that older listeners may have difficulty following the voice of a specific speaker and thus implementing doing so as a strategy for listening amid noise. This may contribute to understanding their reported difficulty listening in adverse conditions.

Hearing Loss and Cognition: What We Know and Where We Need to Go

Although a causal association remains to be determined, epidemiologic evidence suggests an association between hearing loss and increased risk of dementia. If we determine the association is causal, opportunity for targeted intervention for hearing loss may 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 determination of any bias in testing, potential for managing hearing loss for prevention of dementia and cognitive decline, or the potential to reduce dementia-related symptoms through the management of hearing loss. Addressing these research gaps and how results are then translated for clinical use may prove paramount for dementia prevention, management, and overall health of older adults.

Speech Perception in Noise Is Associated With Different Cognitive Abilities in Chinese-Speaking Older Adults With and Without Hearing Aids

Chinese-speaking older adults usually do not perceive a hearing problem until audiometric thresholds exceed 45 dB HL, and the audiometric thresholds of the average hearing-aid (HA) user often exceed 60 dB HL. The purpose of this study was to examine the relationships between cognitive and hearing functions (measured as audiometric or speech reception thresholds) in older Chinese adults with HAs and with untreated hearing loss (HL). Participants were 49 Chinese older adults who used HAs and had moderate to severe HL (HA group), and 46 older Chinese who had mild to moderately severe HL but did not use HAs (untreated; or UT group). Multiple linear regression analysis was employed to evaluate how well age, education level, audiometric thresholds, and speech perception in noise were related to performance on general cognitive function, working memory, executive function, attention, and verbal learning tests. Results showed that speech perception in noise alone accounted for 13–25% of the variance in general cognitive function, working memory, and executive function in the UT group, and 9–21% of the variance in general cognitive function and verbal learning in the HA group (i.e., medium effect sizes). Audiometric thresholds did not explain any proportion of the variance in cognitive functioning in the HA or UT group. Thus, speech perception in noise accounts for more variance in cognitive performance than audiometric thresholds, and is significantly associated with different cognitive functions in older Chinese adults with HAs and with untreated HL.

Spoken Word Recognition in Listeners with Mild Dementia Symptoms

BACKGROUND

Difficulty understanding speech is a common complaint of older adults. In quiet, speech perception is often assumed to be relatively automatic. However, higher-level cognitive processes play a key role in successful communication in noise. Limited cognitive resources in adults with dementia may therefore hamper word recognition.

OBJECTIVE

The goal of this study was to determine the impact of mild dementia on spoken word recognition in quiet and noise.

METHODS

Participants were 53-86 years with (n = 16) or without (n = 32) dementia symptoms as classified by the Clinical Dementia Rating scale. Participants performed a word identification task with two levels of word difficulty (few and many similar sounding words) in quiet and in noise at two signal-to-noise ratios, +6 and +3 dB. Our hypothesis was that listeners with mild dementia symptoms would have more difficulty with speech perception in noise under conditions that tax cognitive resources.

RESULTS

Listeners with mild dementia symptoms had poorer task accuracy in both quiet and noise, which held after accounting for differences in age and hearing level. Notably, even in quiet, adults with dementia symptoms correctly identified words only about 80% of the time. However, word difficulty was not a factor in task performance for either group.

CONCLUSION

These results affirm the difficulty that listeners with mild dementia may have with spoken word recognition, both in quiet and in background noise, consistent with a role of cognitive resources in spoken word identification.

Effects of Age and Uncertainty on the Visual Speech Benefit in Noise

PURPOSE

Listeners understand significantly more speech in noise when the talker's face can be seen (visual speech) in comparison to an auditory-only baseline (a visual speech benefit). This study investigated whether the visual speech benefit is reduced when the correspondence between auditory and visual speech is uncertain and whether any reduction is affected by listener age (older vs. younger) and how severe the auditory signal is masked.

METHOD

Older and younger adults completed a speech recognition in noise task that included an auditory-only condition and four auditory-visual (AV) conditions in which one, two, four, or six silent talking face videos were presented. One face always matched the auditory signal; the other face(s) did not. Auditory speech was presented in noise at -6 and -1 dB signal-to-noise ratio (SNR).

RESULTS

When the SNR was -6 dB, for both age groups, the standard-sized visual speech benefit reduced as more talking faces were presented. When the SNR was -1 dB, younger adults received the standard-sized visual speech benefit even when two talking faces were presented, whereas older adults did not.

CONCLUSIONS

The size of the visual speech benefit obtained by older adults was always smaller when AV correspondence was uncertain; this was not the case for younger adults. Difficulty establishing AV correspondence may be a factor that limits older adults' speech recognition in noisy AV environments. Supplemental Material https://doi.org/10.23641/asha.16879549.

Association of hearing loss with land transport accidents: a nationwide population-based study

OBJECTIVE

This study aimed to investigate the association of prior hearing loss with land transport accidents using a nationwide population-based dataset.

DESIGN

A case-control study.

STUDY SAMPLE

Data for this study were obtained from Taiwan's National Health Insurance Dataset. We retrieved data on 2066 patients who had received a diagnosis of a land transport accident as cases. We used a propensity score-matched method to select 6198 controls.

RESULTS

A Chi-squared test revealed that there was a significant difference in the prevalence of prior hearing loss between cases and controls (6.8% vs. 5.6%, p = 0.046). The odds ratio (OR) of prior hearing loss for cases was 1.128 (95% confidence interval [CI]: 1.003 ∼ 1.503) compared to controls. After adjusting for demographic variables and comorbidities, the OR of hearing loss for cases was 1.238 (95% CI: 1.008 ∼ 1.522) that of controls.

CONCLUSIONS

Our finding suggests that pre-existing hearing loss may be associated with land transport accidents among adults aged 50 years and older. Further study is needed to elucidate the mechanism(s) through which hearing loss may contribute to land transport accidents and examine how the use of hearing rehabilitation devices, for example, hearing aids impacts the observed associations.

Binaural processing deficit and cognitive impairment in Alzheimer's disease

Speech comprehension in noisy environments depends on central auditory functions, which are vulnerable in Alzheimer's disease (AD). Binaural processing exploits two ear sounds to optimally process degraded sound information; its characteristics are poorly understood in AD. We studied behavioral and electrophysiological alterations in binaural processing among 121 participants (AD = 27; amnestic mild cognitive impairment [aMCI] = 33; subjective cognitive decline [SCD] = 30; cognitively normal [CN] = 31). We observed impairment of binaural processing in AD and aMCI, and detected a U-shaped curve change in phase synchrony (declining from CN to SCD and to aMCI, but increasing from aMCI to AD). This improvement in phase synchrony accompanying more severe cognitive stages could reflect neural adaptation for binaural processing. Moreover, increased phase synchrony is associated with worse memory during the stages when neural adaptation apparently occurs. These findings support a hypothesis that neural adaptation for binaural processing deficit may exacerbate cognitive impairment, which could help identify biomarkers and therapeutic targets in AD.

Mishearing as a Side Effect of Rational Language Comprehension in Noise

Language comprehension in noise can sometimes lead to mishearing, due to the noise disrupting the speech signal. Some of the difficulties in dealing with the noisy signal can be alleviated by drawing on the context – indeed, top-down predictability has shown to facilitate speech comprehension in noise. Previous studies have furthermore shown that strong reliance on the top-down predictions can lead to increased rates of mishearing, especially in older adults, which are attributed to general deficits in cognitive control in older adults. We here propose that the observed mishearing may be a simple consequence of rational language processing in noise. It should not be related to failure on the side of the older comprehenders, but instead would be predicted by rational processing accounts. To test this hypothesis, we extend earlier studies by running an online listening experiment with younger and older adults, carefully controlling the target and direct competitor in our stimuli. We show that mishearing is directly related to the perceptibility of the signal. We furthermore add an analysis of wrong responses, which shows that results are at odds with the idea that participants overly strongly rely on context in this task, as most false answers are indeed close to the speech signal, and not to the semantics of the context.

Factors related to the performance of elderly people in temporal ordering tests

PURPOSE

To describe the performance of elderly individuals in Pitch Pattern Sequence (PPS) and Duration Pattern Sequence (DPS) tests and research related factors.

METHODS

An observational, cross-sectional study conducted with elderly people aged 60 to 79 years. The participants underwent cognitive screening tests, interviews containing socio-demographic data and general health, as well as audiologic evaluation and temporal auditory processing (PPS and DPS) evaluation tests. A descriptive analysis of the association between the performance in temporal processing and the variables gender, age, level of education and audiometric alterations was conducted through multiple linear regression.

RESULTS

86 elderly people participated in the study, most of them female, with ages between 60 and 69. Male participants performed better in both tests as well as the participants with higher education, whereas no difference in performance was observed across the different age ranges. In the DPS, the participants with auditory alteration performed worse in relation to the ones with average frequencies of 0.5 to 4 kHz.

CONCLUSION

The male gender and higher level of education were associated with better results in the temporal ordering tests, whereas auditory alteration was associated with worse performance only in the pitch pattern sequence test.

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.

Impact of Cochlear Implant Array Placement on Speech Perception

PURPOSE

To assess the role of flat panel computed tomography (FPCT) in the evaluation of cochlear implant (CI) electrode position and its relation to speech perception.

METHODS

From March 2015 to March 2019, we retrospectively enrolled deaf subjects ≥ 18 years who underwent unilateral CI by one surgeon, imaged with FPCT and assessed with disyllabic words score before CI and at 6 months of follow-up. We calculated the disyllabic score difference before CI and after CI (ΔSDS) and divided the subjects in favorable and unfavorable outcome groups using the median ΔSDS as a cutoff. We compared the demographic, clinical, electrode characteristics, and the CI positioning variables scalar position, surgical insertion depth (SID), linear insertion depth (LID), angular insertion depth (AID) and wrapping factor (WF).

RESULTS

We studied 50 subjects (F/M = 27/23; median age = 60.5 years, IQR: 50-70 years). The median ΔSDS was 80% (interquartile range [IQR]: 60-100%) in quiet and 80% (IQR: 47.5-100%) in noise. Of the subjects 23 demonstrated a favorable outcome and had earlier age at CI (median 52 years; IQR 45-67 years versus median 62 years; IQR: 56-71 years p = 0.032) and a significantly higher SID (median: 4.02 mm IQR: 3.00-5.35 mm versus median: 2.94 mm IQR: 2.06-3.90 mm; p = 0.029). No difference was found for LID (p = 0.977), AID (p = 0.302), and WF (p = 0.224). A logistic regression model built with the age at CI, number of CI electrodes, and the SID was significant χ2 ((df = 3, N = 50) = 14.517, p = 0.002). The model explained 33.7% (Nagelkerke R2) of ΔSDS variance and correctly classified 76% of the cases.

CONCLUSION

The SID measured by FPCT predicts the ΔSDS at 6 months follow-up, alongside with age at implantation and number of CI electrodes.

Differences in auditory associative memory between younger adults and older adults

Aging impairs visual associative memories. Up to date, little is known about whether aging impairs auditory associative memories. Using the head-related-transfer function to induce perceived spatial locations of auditory phonemes, this study used an audiospatial paired-associates-learning (PAL) paradigm to assess the auditory associative memory for phoneme-location pairs in both younger and older adults. Both aging groups completed the PAL task with various levels of difficulty, which were defined by the number of items to be remembered. The results showed that compared with younger participants' performance, older participants passed fewer stages and had lower capacity of auditory associative memory. For maintaining a single audiospatial pair, no significant behavioral differences between the two aging grous werefound. However, when multiple sound-location pairs were required to be remembered, older adults made more errors and demonstrated a lower working memory capacity than younger adults. Our study indicates aging impairs audiospatial associative learning and memory.

The effect of monetary reward on listening effort and sentence recognition

Recently we showed that higher reward results in increased pupil dilation during listening (listening effort). Remarkably, this effect was not accompanied with improved speech reception. Still, increased listening effort may reflect more in-depth processing, potentially resulting in a better memory representation of speech. Here, we investigated this hypothesis by also testing the effect of monetary reward on recognition memory performance. Twenty-four young adults performed speech reception threshold (SRT) tests, either hard or easy, in which they repeated sentences uttered by a female talker masked by a male talker. We recorded the pupil dilation response during listening. Participants could earn a high or low reward and the four conditions were presented in a blocked fashion. After each SRT block, participants performed a visual sentence recognition task. In this task, the sentences that were presented in the preceding SRT task were visually presented in random order and intermixed with unfamiliar sentences. Participants had to indicate whether they had previously heard the sentence or not. The SRT and sentence recognition were affected by task difficulty but not by reward. Contrary to our previous results, peak pupil dilation did not reflect effects of reward. However, post-hoc time course analysis (GAMMs) revealed that in the hard SRT task, the pupil response was larger for high than low reward. We did not observe an effect of reward on visual sentence recognition. Hence, the current results provide no conclusive evidence that the effect of monetary reward on the pupil response relates to the memory encoding of speech.

Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study

Background

The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction.

Objective

The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV.

Methods

Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect.

Results

The group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group).

Conclusions

The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem.

Impact of Hearing Loss on Geriatric Assessment

Background

Due to the aging society, the incidence of age-related hearing loss (ARHL) is strongly increasing. Hearing loss has a high impact on various aspects of life and may lead to social isolation, depression, loss of gain control, frailty and even mental decline. Comorbidity of cognitive and sensory impairment is not rare. This might have an impact on diagnostics and treatment in the geriatric setting.

Objective

The aim of the study was to evaluate the impact of hearing impairment on geriatric assessment and cognitive testing routinely done in geriatrics.

Material and Methods

This review is based on publications retrieved by a selective search in Medline, including individual studies, meta-analyses, guidelines, Cochrane reviews, and other reviews from 1960 until August 2020.

Results

Awareness of sensory impairment is low among patients and health professionals working with elderly people. The evaluation of the hearing status is not always part of the geriatric assessment and not yet routinely done in psychiatric settings. However, neurocognitive testing as an important part can be strongly influenced by auditory deprivation. Misunderstanding of verbal instructions, cognitive changes, and delayed central processes may lead to a false diagnosis in up to 16% of subjects with hearing loss. To minimize this bias, several neurocognitive assessments were transformed into non-auditory versions recently, eg the most commonly used Hearing-Impaired Montreal Cognitive Assessment (HI-MoCA). However, most of them still lack normative data for elderly people with hearing loss.

Conclusion

Hearing loss should be taken into consideration when performing geriatric assessment and cognitive testing in elderly subjects. Test batteries suitable for ARLH should be applied.

Age-related altering temporal processing and binaural interaction functions in normal hearing individuals: Observational and cross-sectional study

OBJECTIVE

This study aimed to investigate the temporal processing and binaural interaction functions of central auditory processing tests according to the anatomical localizations of young and elderly individuals. It also sought to evaluate the relationships between the same individuals' central auditory processing tests.

METHODS

This observational and cross-sectional study included individuals with normal hearing between 18 and 30 and 60-75 years of age, who were referred to as the young group and the elderly group, respectively. The evaluation of the central auditory processing tests was completed using the frequency pattern test, duration pattern test, masking level difference test, and random gap detection test. Furthermore, speech discrimination and speech in noise scores were analyzed for both groups.

RESULTS

Statistically significant differences were identified between the groups' scores for the speech in noise test, masking level difference test, random gap detection test, frequency pattern test, and duration pattern test (p < 0.05). A statistically significant relationship was observed between the age and the results of the central auditory processing tests (p < 0.05).

CONCLUSION

When compared to younger individuals, elderly individuals presented with declined temporal sequences, temporal resolutions, and binaural interaction skills.

Effect of age on the gap-prepulse inhibition of the cortical N1-P2 complex in humans as a step towards an objective measure of tinnitus

The gap-prepulse inhibition of the acoustic startle reflex has been widely used as a behavioral method for tinnitus screening in animal studies. The cortical-evoked potential gap-induced inhibition has also been investigated in animals as well as in human subjects. The present study aimed to investigate the effect of age on the cortical N1-P2 complex in the gap-prepulse inhibition paradigm. Fifty-seven subjects, aged 20 to 68 years, without continuous tinnitus, were tested with two effective gap conditions (embedded gap of 50- or 20-ms duration). Retest sessions were performed within one month. A significant gap-induced inhibition of the N1-P2 complex was found in both gap durations. Age differently affected the inhibition, depending on gap duration. With a 50-ms gap, the inhibition decreased significantly with the increase in age. This age-inhibition relationship was not found when using a 20-ms gap. The results were reproducible in the retest session. Our findings suggest that the interaction between age and gap duration should be considered when applying the gap-induced inhibition of the cortical-evoked potential as an objective measure of tinnitus in human subjects. Further studies with tinnitus patients are warranted to identify gap duration that would minimize the effects of age and maximize the difference in the inhibition between those with and without tinnitus.

Psychoacoustic and Demographic Factors for Speech Recognition of Older Adult Cochlear Implant Users

Purpose This study aimed to evaluate the effects of aging and cochlear implant (CI) on psychoacoustic and speech recognition abilities and to assess the relative contributions of psychoacoustic and demographic factors to speech recognition of older CI (OCI) users. Method Twelve OCI users, 12 older acoustic-hearing (OAH) listeners age-matched to OCI users, and 12 younger normal-hearing (YNH) listeners underwent tests of temporal amplitude modulation detection, temporal gap detection in noise, and spectral-temporal modulated ripple discrimination. Speech reception thresholds were measured for sentence recognition in multitalker, speech-babble noise. Results Statistical analyses showed that, for the small sample of OAH listeners, the degree of hearing loss did not significantly affect any outcome measure. Temporal resolution, spectral resolution, and speech recognition all significantly degraded with both age and the use of a CI (i.e., YNH better than OAH and OAH better than OCI performance). Although both were significantly correlated with OCI users' speech recognition, the duration of CI use no longer had a significant effect on speech recognition once the effect of spectral-temporal ripple discrimination performance was taken into account. For OAH listeners, the only significant predictor of speech recognition was temporal gap detection performance. Conclusion The preliminary results suggest that speech recognition of OCI users may improve with longer duration of CI use, mainly due to higher perceptual acuity to spectral-temporal modulated ripples in acoustic stimuli.

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.

An exploration of higher-level language comprehension deficits and factors influencing them following blast TBI in US veterans

PRIMARY OBJECTIVE

The objective of this study was to investigate the factors that might have a negative influence on auditory processing and higher-level language processing in the US veterans of the recent foreign wars (Iraq and Afghanistan).

RESEARCH DESIGN

Exploratory, cross-sectional, correlational, prospective, cohort-design.

METHODS AND PROCEDURES

The experimental group consisted of 12 US veterans of war (10 males and 2 females) with blast exposure. The control group consisted of six US veterans (5 males and 1 female) without the history of blast exposure. Both groups were matched in mean age. Both groups were tested on Boston Assessment of Traumatic Brain Injury, Consonant Trigrams Test, Symbol Digit Modality Test, Trail Making Test, SCAN-3, CELF-5-Metalinguistics, CASL, and an unpublished test on the processing of sentence prosody.

MAIN OUTCOMES AND RESULTS

Significant group differences in attention, and time-compressed sentence processing were found. For those veterans (in the experimental group) who were not wearing their helmets at the time of blast, additional significant differences were noted with inferencing and auditory figure-ground tasks.

CONCLUSIONS

Findings support the importance of including speech/language pathologists in all stages of recovery for veterans post-blast exposure.

Cortical Neuroplasticity and Cognitive Function in Early-Stage, Mild-Moderate Hearing Loss: Evidence of Neurocognitive Benefit From Hearing Aid Use

Age-related hearing loss (ARHL) is associated with cognitive decline as well as structural and functional brain changes. However, the mechanisms underlying neurocognitive deficits in ARHL are poorly understood and it is unclear whether clinical treatment with hearing aids may modify neurocognitive outcomes. To address these topics, cortical visual evoked potentials (CVEPs), cognitive function, and speech perception abilities were measured in 28 adults with untreated, mild-moderate ARHL and 13 age-matched normal hearing (NH) controls. The group of adults with ARHL were then fit with bilateral hearing aids and re-evaluated after 6 months of amplification use. At baseline, the ARHL group exhibited more extensive recruitment of auditory, frontal, and pre-frontal cortices during a visual motion processing task, providing evidence of cross-modal re-organization and compensatory cortical neuroplasticity. Further, more extensive cross-modal recruitment of the right auditory cortex was associated with greater degree of hearing loss, poorer speech perception in noise, and worse cognitive function. Following clinical treatment with hearing aids, a reversal in cross-modal re-organization of auditory cortex by vision was observed in the ARHL group, coinciding with gains in speech perception and cognitive performance. Thus, beyond the known benefits of hearing aid use on communication, outcomes from this study provide evidence that clinical intervention with well-fit amplification may promote more typical cortical organization and functioning and provide cognitive benefit.

Behavioral tests in adults: reference values and comparison between groups presenting or not central auditory processing disorder

ABSTRACT Purpose: to generate reference values for different behavioral central auditory processing (CAP) tests in normally hearing adults, with age stratification, as well as to compare the results, according to the presence or absence of CAP disorder (CAPD). Methods: the study sample consisted of 94 adults with normal auditory thresholds, with at least 11 years of schooling, who were divided into two groups, according to the performance in the Dichotic Sentences Identification Test (DSI), Masking Level Difference (MLD), Random Gap Detection Test (RGDT), Adapted Time-Compressed Speech (ATCS) and Duration and Frequency Pattern Tests (DPT/FPT).The 64 subjects who presented normality in all the tests formed the G1 group and the 30 subjects who presented alteration in at least one of them, originated the G2 group. To accomplish the analysis it was used the Mann-Whitney U Test. In all analyzes, the significance level was 5% (p≤0.05). Results: the sum of the two standard deviations for the mean performance of G1 yielded reference values for the different tests addressed. When G1 and G2 groups were compared, G1 presented better results, this being significant in the DSI (left ear), MLD, RGDT, DPT and FPT tests, for the group aged between 18 and 29 years and, DSI (right ear), RGDT and ATCS (right ear), for the group from 30 to 58 years. Conclusion: it was possible to generate reference values for different behavioral tests of CAP in normally hearing adults, as well as to verify a better performance for the group with no CAPD.

Assessment of Temporal Fine Structure Processing Among Older Adults With Cochlear Implants

OBJECTIVES

The purpose of this study was to determine if older adults with cochlear implants are able to take advantage of coding schemes that preserve temporal fine structure (TFS) cues.

DESIGN

A total of 19 older adults with cochlear implants participated in a prospective, repeated measures, A to B design. Participants entered the study using TFS. The participants used strategy A (high definition continuous interleaved sampling [HDCIS]) for 3 months and strategy B (TFS) for 3 months. Endpoint testing was administered at the end of each 3-month period. Testing included consonant recognition, speech understanding in noise, temporal modulation thresholds, and self-perceived benefit.

RESULTS

Older adults were able to use TFS successfully. Speech perception performance was improved using TFS compared with HDCIS for voicing, but not manner or place of articulation. There were no differences between the two strategies for speech understanding in noise, temporal modulation detection, or self-perceived benefit. At the end of the study, 13 out of 19 (68%) of participants chose to continue using TFS processing.

CONCLUSIONS

Advanced age does not prevent adults with cochlear implants from using TFS coding strategies. Performance outcomes using TFS and HDCIS were similar, with the exception of voicing which was improved when using TFS. The data support the idea of using various sound processing strategies with older adults.

[Hearing and cognition: neurocognitive test batteries in otorhinolaryngology]

BACKGROUND

Hearing and cognition are closely related to each other. Particularly in suboptimal listening situations, cognitive abilities become important to enable speech comprehension. Besides, studies have indicated that hearing impairment is associated with a more rapid mental decline compared to persons with normal hearing. However, hearing loss also has an impact on neurocognitive testing, which is generally based on auditive stimuli. With increasing age, the risk of sensory but also of cognitive impairments increases. So far this comorbidity receives little consideration in otorhinolaryngology.

MATERIALS AND METHODS

The paper presents an overview and evaluation of widely used German neurocognitive test batteries for older patients, with regard to the different test modalities and their focus.

RESULTS

A multitude of different neurocognitive screening tests and detailed test batteries are available, particularly in the field of dementia. So far, sensory deficits have not been considered in neurocognitive testing, neither concerning application nor interpretation. Normative data adapted to the hearing impaired are still missing.

CONCLUSION

With regard to demographic changes and the well-known bias between hearing and cognition, screening of neurocognitive functions should be implemented in basic otorhinolaryngologic diagnostics. More comprehensive test batteries might be useful for research purposes or speech therapy.

Modality Effects on Lexical Encoding and Memory Representations of Spoken Words

OBJECTIVES

The present study investigated presentation modality differences in lexical encoding and working memory representations of spoken words of older, hearing-impaired adults. Two experiments were undertaken: a memory-scanning experiment and a stimulus gating experiment. The primary objective of experiment 1 was to determine whether memory encoding and retrieval and scanning speeds are different for easily identifiable words presented in auditory-visual (AV), auditory-only (AO), and visual-only (VO) modalities. The primary objective of experiment 2 was to determine if memory encoding and retrieval speed differences observed in experiment 1 could be attributed to the early availability of AV speech information compared with AO or VO conditions.

DESIGN

Twenty-six adults over age 60 years with bilateral mild to moderate sensorineural hearing loss participated in experiment 1, and 24 adults who took part in experiment 1 participated in experiment 2. An item recognition reaction-time paradigm (memory-scanning) was used in experiment 1 to measure (1) lexical encoding speed, that is, the speed at which an easily identifiable word was recognized and placed into working memory, and (2) retrieval speed, that is, the speed at which words were retrieved from memory and compared with similarly encoded words (memory scanning) presented in AV, AO, and VO modalities. Experiment 2 used a time-gated word identification task to test whether the time course of stimulus information available to participants predicted the modality-related memory encoding and retrieval speed results from experiment 1.

RESULTS

The results of experiment 1 revealed significant differences among the modalities with respect to both memory encoding and retrieval speed, with AV fastest and VO slowest. These differences motivated an examination of the time course of stimulus information available as a function of modality. Results from experiment 2 indicated the encoding and retrieval speed advantages for AV and AO words compared with VO words were mostly driven by the time course of stimulus information. The AV advantage seen in encoding and retrieval speeds is likely due to a combination of robust stimulus information available to the listener earlier in time and lower attentional demands compared with AO or VO encoding and retrieval.

CONCLUSIONS

Significant modality differences in lexical encoding and memory retrieval speeds were observed across modalities. The memory scanning speed advantage observed for AV compared with AO or VO modalities was strongly related to the time course of stimulus information. In contrast, lexical encoding and retrieval speeds for VO words could not be explained by the time-course of stimulus information alone. Working memory processes for the VO modality may be impacted by greater attentional demands and less information availability compared with the AV and AO modalities. Overall, these results support the hypothesis that the presentation modality for speech inputs (AV, AO, or VO) affects how older adult listeners with hearing loss encode, remember, and retrieve what they hear.

The Musical Emotion Discrimination Task: A New Measure for Assessing the Ability to Discriminate Emotions in Music

Previous research has shown that levels of musical training and emotional engagement with music are associated with an individual's ability to decode the intended emotional expression from a music performance. The present study aimed to assess traits and abilities that might influence emotion recognition, and to create a new test of emotion discrimination ability. The first experiment investigated musical features that influenced the difficulty of the stimulus items (length, type of melody, instrument, target-/comparison emotion) to inform the creation of a short test of emotion discrimination. The second experiment assessed the contribution of individual differences measures of emotional and musical abilities as well as psychoacoustic abilities. Finally, the third experiment established the validity of the new test against other measures currently used to assess similar abilities. Performance on the Musical Emotion Discrimination Task (MEDT) was significantly associated with high levels of self-reported emotional engagement with music as well as with performance on a facial emotion recognition task. Results are discussed in the context of a process model for emotion discrimination in music and psychometric properties of the MEDT are provided. The MEDT is freely available for research use.

Auditory psychomotor vigilance testing in older and young adults: a revised threshold setting procedure

BACKGROUND

One of the most common ways to examine the daytime impact of sleep loss is the use of the psychomotor vigilance test (PVT). PVT metrics, including median reaction time (RT) and number of lapses, have been examined in a variety of studies in which both acute and chronic sleep times are manipulated. Most of these studies involve young, healthy individuals and use a visual stimulus. As light is a possible countermeasure to sleep loss, and sometimes incompatible with the use of visual PVT, PVT with auditory cues (aPVT) has been used. A threshold of 400 ms is commonly used to delineate lapses from normal RT in the aPVT. As aging can influence a variety of brain functions, we wanted to examine whether this lapse threshold was accurate for use in older adults.

METHODS

Twenty-eight young and 19 healthy older participants performed a 10-min auditory PVT approximately 90 min before habitual bedtime. The occurrence of lapses was determined by five objective RT thresholds: (1) 400 ms, (2) 500 ms, (3) 2 × median, (4) mean + 2 × SD, and (5) method 4 without outliers. Results of these methods were compared with a triplicate visual inspection of RT histograms to determine RT outside of the expected log normal distribution.

RESULTS

In both groups, methods 1, 4, and 5 performed poorly, while methods 2 and 3 were adequate, though method 3 was statistically superior.

CONCLUSION

In both age groups, the use of twice the median as an objective threshold had the best concurrence with visual scoring.

Establishing the Feasibility of a Tablet-Based Consent Process with Older Adults: A Mixed-Methods Study

Purpose of the Study

This mixed-methods study explored the feasibility and acceptability of using a tablet-based research consent process with adults aged ≥65 years.

Design and Methods

In the first phase, focus group participants reported on their perceptions of a tablet-based consent process. In the second phase, older adults were randomized to view either a tablet-based or paper-based consent for a mock clinical trial. Measurements included: time to complete, adverse/unexpected events, user-friendliness, immediate comprehension, and retention at a 1-week delay.

Results

Focus group participants (N = 15) expressed interest in the novel format, cautioning that peers would need comprehensive orientation to use the technology. In the randomized pilot (N = 20), retention was 100% and all participants completed the protocol without the occurrence of adverse/unexpected events. Although the participants took longer to complete the tablet-based consent than the paper-based version, user-friendliness, immediate comprehension, and retention of the tablet-based consent were similar to the paper-based consent.

Discussion and Implications

The findings suggest that a tablet-based consent process is feasible to implement with older adults and acceptable to this population, but we would underscore that efforts to optimize design of tablet-based consent forms for older adults are warranted.

Effects of Aging and Dual-Task Demands on the Comprehension of Less Expected Sentence Continuations: Evidence From Pupillometry

Prior studies on language processing in aging have shown that older adults experience integration difficulties for contextually unpredictable target words (as indicated by low cloze probabilities in prior ratings), and that such comprehension difficulties are more likely to occur under more demanding processing conditions (e.g., dual-task situations). However, these effects have primarily been demonstrated for conditions when cloze probability of the linguistic stimuli was very low. The question we asked here was do dual-task demands also impair comprehension when target words provide a good, but not perfect, match with prior context? We used a dual-task design, consisting of a sentence comprehension and secondary motor tracking task. Critical target words were those which were not perfectly predictable based on context (words with a cloze probability of 0.7), as opposed to words that were near perfectly predictable based on context (cloze probabilities of 0.99). As a measure to index online processing difficulty for less expected target words, we took into account participants' pupil size. Separate mixed effects models were fit for language comprehension, motor tracking, and pupil size, showing the following: (1) dual-task demands led to age-related comprehension difficulties when target words were less expected (as opposed to very highly expected), (2) integration difficulty in older adults was related to cognitive overload as less expected sentence continuations progressed over time, resulting in behavioral trade-offs between language comprehension and motor tracking, and (3) lower levels of working memory were predictive of whether or not older adults experienced cognitive overload when processing less expected words. In sum, more demanding processing conditions lead to comprehension impairments when words are highly unpredictable based on context, as many prior studies showed. Comprehension impairments among older individuals also occur for conditions when words provide a good, but not perfect, match with prior context. Higher working memory capacity can alleviate such impairments in older adults, thereby suggesting that only high-WM older adults have sufficient cognitive resources to pre-activate words that complete a sentence context plausibly, but not perfectly.

Older Adults With Hearing Loss Have Reductions in Visual, Motor and Attentional Functioning

Evidence from epidemiological, laboratory and clinical research suggests a link between age-related auditory declines and domain-general cognitive declines. Nevertheless, few studies have experimentally compared measures of non-auditory cognitive functions in younger normal hearing adults (YN), older adults with typical hearing thresholds for their age (ONHA) and older adults with clinically significant threshold hearing loss (OHL). The current study investigated the differences between these groups on measures of attentional response selection and execution to visual stimuli. A visual reaction time (RT) paradigm involving four tasks with differing and hierarchical attentional demands was administered. RTs on trials with differing foreperiods (FPs; pre-stimulus waiting times) were analyzed to assess context-related slowing, error commission and related cognitive control and strategic and automatic neural preparatory processes. The OHL group demonstrated a general slowing that was most apparent on the simplest tasks. Although the number of errors was similar when comparing all three groups, the OHL group exhibited less control over recovery from an error compared to the younger and ONHA groups. Unlike the YN and ONHA groups, the OHL group also showed difficulties with both strategic and automatic response preparation, although automatic preparation was more affected across all tasks. This pattern of results suggests that in older adults with hearing loss there is an underlying difficulty in automatic temporal processing that can affect higher order cognitive functions, although there may not be a completely generalized decline in cognitive functioning that is associated with hearing loss.

How does aging affect recognition of spectrally degraded speech?

OBJECTIVES/HYPOTHESIS

Cochlear implants (CIs) restore auditory sensation to patients with moderate-to-profound sensorineural hearing loss. However, the benefits to speech recognition vary considerably among patients. Advancing age contributes to this variability in postlingual adult CI users. Similarly, older individuals with normal hearing (NH) perform more poorly on tasks of recognition of spectrally degraded speech. The overarching hypothesis of this study was that the detrimental effects of advancing age on speech recognition can be attributed both to declines in auditory spectral resolution as well as declines in cognitive functions.

STUDY DESIGN

Case-control study.

METHODS

Speech recognition was assessed in CI users (in the clear) and NH controls (spectrally degraded using noise-vocoding), along with auditory spectral resolution using the Spectral-Temporally Modulated Ripple Test. Cognitive skills were assessed using nonauditory visual measures of working memory, inhibitory control, speed of lexical/phonological access, nonverbal reasoning, and perceptual closure. Linear regression models were tested for mediation to explain aging effects on speech recognition performance.

RESULTS

For both groups, older age predicted poorer sentence and word recognition. The detrimental effects of advancing age on speech recognition were partially mediated by declines in spectral resolution and in some measures of cognitive function.

CONCLUSIONS

Advancing age contributes to poorer recognition of degraded speech for CI users and NH controls through declines in both auditory spectral resolution and cognitive functions. Findings suggest that improvements in spectral resolution as well as cognitive improvements may serve as therapeutic targets to optimize CI speech recognition outcomes.

LEVEL OF EVIDENCE

3b Laryngoscope, 2018.

Speech understanding in noise in elderly adults: the effect of inhibitory control and syntactic complexity

BACKGROUND

Previous research has suggested that speech perception in elderly adults is influenced not only by age-related hearing loss or presbycusis but also by declines in cognitive abilities, by background noise and by the syntactic complexity of the message.

AIMS

To gain further insight into the influence of these cognitive as well as acoustic and linguistic factors on speech perception in elderly adults by investigating inhibitory control as a listener characteristic and background noise type and syntactic complexity as input characteristics.

METHODS & PROCEDURES

Phoneme identification was measured in different noise conditions and in different linguistic contexts (single words, sentences with varying syntactic complexity). Additionally, inhibitory control was measured using a visual stimulus-response matching task. Fifty-one adults participated in this study, including elderly adults with age-related hearing loss (n = 9) and with normal hearing (n = 17), and a control group of normal hearing younger adults (n = 25).

OUTCOMES & RESULTS

The analysis revealed that elderly adults with normal hearing and with hearing loss were less likely to identify successfully phonemes in single words than younger normal hearing controls. In the context of sentences, only elderly adults with hearing loss had a lower odds of correct phoneme perception than the control group. Additionally, in elderly adults with hearing loss, phoneme-in-sentence perception was linked to age-related declines in inhibitory control. In all participants, phoneme identification in sentences was influenced by both noise type and syntactic complexity.

CONCLUSIONS & IMPLICATIONS

Inhibitory control and syntactic complexity might play a significant role in speech perception, especially in elderly listeners. These factors might also influence the results of clinical assessments of speech perception. Testing procedures thus need to be selected and their results interpreted carefully with these influences in mind.

Validation of a Computer-Administered Version of the Digits-in-Noise Test for Hearing Screening in the United States

BACKGROUND

The sooner people receive treatment for hearing loss (HL), the quicker they are able to recognize speech and to master hearing aid technology. Unfortunately, a majority of people with HL wait until their impairments have progressed from moderate to severe levels before seeking auditory rehabilitation. To increase the number of individuals with HL who pursue and receive auditory rehabilitation, it is necessary to improve methods for identifying and informing these people via widely accessible hearing screening procedures. Screening for HL is the first in a chain of events that must take place to increase the number of patients who enter the hearing health-care system. New methods for hearing screening should be readily accessible through a common medium (e.g., telephone or computer) and should be relatively easy and quick for people to self-administer.

PURPOSE

The purpose of this study was to assess a digits-in-noise (DIN) hearing screening test that was delivered via personal computer.

RESEARCH DESIGN

Participants completed the Hearing Handicap Inventory for Adults (HHIA) questionnaire, audiometric testing in a sound booth, and computerized DIN testing. During the DIN test, sequences of three spoken digits were presented in noise via headphones at varying signal-to-noise ratios (SNRs). Participants entered each three-digit sequence they heard using an on-screen keypad.

STUDY SAMPLE

Forty adults (16 females, 24 males) participated in the study, of whom 20 had normal hearing and 20 had HL (pure-tone average [PTA] thresholds for 0.5, 1, 2, and 4 kHz >25 dB HL).

DATA COLLECTION AND ANALYSIS

DIN SNR and PTA data were analyzed and compared for each ear tested. Receiver operating characteristic curves based on these data were plotted. A measure of overall accuracy of a screening test is the area under the receiver operating characteristic curve (AUC). This measures the average true positive rate across false positives at varying DIN SNR cutoffs. Larger values of the AUC indicate, on average, more accurate screening tests. HHIA responses were analyzed and compared to PTA and DIN SNR results using Pearson correlation statistics.

RESULTS

HHIA scores were positively correlated with audiometric PTA and DIN SNR results (p < 0.001 for all correlations). For an HL criterion of one or more frequencies from 0.25 to 8 kHz >25 dB HL, the AUC for the DIN test was 0.95. When a criterion of hearling level was set at one or more frequencies from 0.25 to 8 kHz >20 dB HL, the AUC for the DIN test was 0.96.

CONCLUSIONS

The computer version of the DIN test demonstrated excellent sensitivity and specificity for our sample of 40 participants. AUC results (≥0.95) suggest that this DIN test administered via computer should be very useful for adult hearing screening.