How older adults use cognition in sentence-final word recognition

Relationships Between Auditory Processing and Cognitive Abilities in Adults: A Systematic Review

PURPOSE

The contributions from the central auditory and cognitive systems play a major role in communication. Understanding the relationship between auditory and cognitive abilities has implications for auditory rehabilitation for clinical patients. The purpose of this systematic review is to address the question, "In adults, what is the relationship between central auditory processing abilities and cognitive abilities?"

METHOD

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to identify, screen, and determine eligibility for articles that addressed the research question of interest. Medical librarians and subject matter experts assisted in search strategy, keyword review, and structuring the systematic review process. To be included, articles needed to have an auditory measure (either behavioral or electrophysiologic), a cognitive measure that assessed individual ability, and the measures needed to be compared to one another.

RESULTS

Following two rounds of identification and screening, 126 articles were included for full analysis. Central auditory processing (CAP) measures were grouped into categories (behavioral: speech in noise, altered speech, temporal processing, binaural processing; electrophysiologic: mismatch negativity, P50, N200, P200, and P300). The most common CAP measures were sentence recognition in speech-shaped noise and the P300. Cognitive abilities were grouped into constructs, and the most common construct was working memory. The findings were mixed, encompassing both significant and nonsignificant relationships; therefore, the results do not conclusively establish a direct link between CAP and cognitive abilities. Nonetheless, several consistent relationships emerged across different domains. Distorted or noisy speech was related to working memory or processing speed. Auditory temporal order tasks showed significant relationships with working memory, fluid intelligence, or multidomain cognitive measures. For electrophysiology, relationships were observed between some cortical evoked potentials and working memory or executive/inhibitory processes. Significant results were consistent with the hypothesis that assessments of CAP and cognitive processing would be positively correlated.

CONCLUSIONS

Results from this systematic review summarize relationships between CAP and cognitive processing, but also underscore the complexity of these constructs, the importance of study design, and the need to select an appropriate measure. The relationship between auditory and cognitive abilities is complex but can provide informative context when creating clinical management plans. This review supports a need to develop guidelines and training for audiologists who wish to consider individual central auditory and cognitive abilities in patient care.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24855174.

Association Between Tinnitus Pitch and Consonant Recognition in Noise

Purpose Difficulties in speech-in-noise understanding are often reported in individuals with tinnitus. Building on our previous findings that speech-in-noise performance is correlated with subjective loudness of tinnitus, this study aimed to investigate the effect of tinnitus pitch on consonant recognition in noise. Method Pure-tone audiometry and the Quick Speech-in-Noise Test were conducted on 66 participants categorized into four groups by their hearing sensitivity and self-report of tinnitus. Consonant recognition scores at various frequency ranges were obtained at the 5 dB SNR condition of the Quick Speech-in-Noise Test. Participants with tinnitus also completed a tinnitus pitch-matching procedure. Correlation analyses were conducted between tinnitus pitch and the frequency of the worst consonant recognition, and the error rates based on word and sentence position were compared. Results Regardless of hearing sensitivity, tinnitus pitch did not correlate with the frequency of the worst consonant recognition. Sentence-initial word recognition was affected by hearing loss, whereas sentence-final word recognition was not affected by hearing loss or tinnitus. In contrast to individuals with normal hearing, participants with hearing loss varied in full-sentence recognition, with those reporting tinnitus exhibiting significantly higher error rates. Conclusions The findings suggest that the effect of tinnitus on consonant recognition in noise may involve higher level functions more than perceptual characteristics of tinnitus. Furthermore, for individuals with speech-in-noise concerns, clinical evaluation should address both hearing sensitivity and the presence of tinnitus. Future speech-in-noise studies should incorporate cognitive tests and, possibly, brain imaging to parse out the contribution of cognitive factors, such as cognitive control, in speech-in-noise in tinnitus.

Demographic Effects on Longitudinal Semantic Processing, Working Memory, and Cognitive Speed

OBJECTIVES

To better understand and compare effects of aging and education across domains of language and cognition, we investigated whether (a) these domains show different associations with age and education, (b) these domains show similar patterns of age-related change over time, and (c) education moderates the rate of decline in these domains.

METHOD

We analyzed data from 306 older adults aged 55-85 at baseline of whom 116 returned for follow-up 4-8 years later. An exploratory factor analysis identified domains of language and cognition across a range of tasks. A confirmatory factor analysis analyzed cross-sectional associations of age and education with these domains. Subsequently, mixed linear models analyzed longitudinal change as a function of age and moderation by education.

RESULTS

We identified 2 language domains, that is, semantic control and semantic memory efficiency, and 2 cognitive domains, that is, working memory and cognitive speed. Older age negatively affected all domains except semantic memory efficiency, and higher education positively affected all domains except cognitive speed at baseline. In language domains, a steeper age-related decline was observed after age 73-74 compared to younger ages, while cognition declined linearly with age. Greater educational attainment did not protect the rate of decline over time in any domain.

DISCUSSION

Separate domains show varying effects of age and education at baseline, language versus cognitive domains show dissimilar patterns of age-related change over time, and education does not moderate the rate of decline in these domains. These findings broaden our understanding of age effects on cognitive and language abilities by placing observed age differences in context.

Adaptation of the "active communication education" programme into Spanish for older adults with hearing loss

Objective: To adapt the Active Communication Education (ACE) programme into Spanish. In addition, this study aimed at determining the effects of the adapted ACE programme on the social/emotional impacts of hearing loss and hearing functioning in a group of older adults with hearing loss who do not wear hearing aids.Design: This was an exploratory cohort study. Study group participants received the newly adapted ACE programme and control group participants received a cognitive stimulation programme. The Shortened Hearing Handicap Inventory for the Elderly in Spanish (HHIE-S) and the Spanish version of the Amsterdam Inventory for Auditory Disability and Handicap (S-AIADH) were carried out before and after each programme.Study sample: Sixty-six older adults with hearing loss and who did not wear hearing aids were randomly assigned to either an ACE group (n = 30) or a cognitive stimulation group (n = 36).Results: Participants who received the ACE programme showed a significantly larger improvement for the S-AIADH than did the cognitive stimulation group participants.Conclusions: The ACE programme has been adapted into Spanish for use with Chilean older adults with hearing loss. The results show that older adults report better functioning in listening situations after attending the sessions of the adapted ACE programme.

The Role of Executive Functions in Object- and Action-Naming among Older Adults

Background/Study Context: Lexical retrieval abilities and executive function skills decline with age. The extent to which these processes might be interdependent remains unknown. The aim of the current study was to examine whether individual differences in three executive functions (shifting, fluency, and inhibition) predicted naming performance in older adults. Methods: The sample included 264 adults aged 55-84. Six measures of executive functions were combined to make three executive function composites scores. Lexical retrieval performance was measured by accuracy and response time on two tasks: object naming and action naming. We conducted a series of multiple regressions to test whether executive function performance predicts naming abilities in older adults. Results: We found that different executive functions predicted naming speed and accuracy. Shifting predicted naming accuracy for both object and action naming while fluency predicted response times on both tests as well as object naming accuracy, after controlling for education, gender, age, working memory span, and speed of processing in all regressions. Interestingly, inhibition did not contribute to naming accuracy or response times on either task. Conclusion: The findings support the notion that preservation of some executive functions contributes to successful naming in older adults and that different executive functions are associated with naming speed and accuracy.

Evidence for enhanced neural tracking of the speech envelope underlying age-related speech-in-noise difficulties

When we grow older, understanding speech in noise becomes more challenging. Research has demonstrated the role of auditory temporal and cognitive deficits in these age-related speech-in-noise difficulties. To better understand the underlying neural mechanisms, we recruited young, middle-aged, and older normal-hearing adults and investigated the interplay between speech understanding, cognition, and neural tracking of the speech envelope using electroencephalography. The stimuli consisted of natural speech masked by speech-weighted noise or a competing talker and were presented at several subject-specific speech understanding levels. In addition to running speech, we recorded auditory steady-state responses at low modulation frequencies to assess the effect of age on nonspeech sounds. The results show that healthy aging resulted in a supralinear increase in the speech reception threshold, i.e., worse speech understanding, most pronounced for the competing talker. Similarly, advancing age was associated with a supralinear increase in envelope tracking, with a pronounced enhancement for older adults. Additionally, envelope tracking was found to increase with speech understanding, most apparent for older adults. Because we found that worse cognitive scores were associated with enhanced envelope tracking, our results support the hypothesis that enhanced envelope tracking in older adults is the result of a higher activation of brain regions for processing speech, compared with younger adults. From a cognitive perspective, this could reflect the inefficient use of cognitive resources, often observed in behavioral studies. Interestingly, the opposite effect of age was found for auditory steady-state responses, suggesting a complex interplay of different neural mechanisms with advancing age.NEW & NOTEWORTHY We measured neural tracking of the speech envelope across the adult lifespan and found a supralinear increase in envelope tracking with age. Using a more ecologically valid approach than auditory steady-state responses, we found that young and older, as well as middle-aged, normal-hearing adults showed an increase in envelope tracking with increasing speech understanding and that this association is stronger for older adults.

Time-Compressed Speech Identification Is Predicted by Auditory Neural Processing, Perceptuomotor Speed, and Executive Functioning in Younger and Older Listeners

Older adults typically have difficulty identifying speech that is temporally distorted, such as reverberant, accented, time-compressed, or interrupted speech. These difficulties occur even when hearing thresholds fall within a normal range. Auditory neural processing speed, which we have previously found to predict auditory temporal processing (auditory gap detection), may interfere with the ability to recognize phonetic features as they rapidly unfold over time in spoken speech. Further, declines in perceptuomotor processing speed and executive functioning may interfere with the ability to track, access, and process information. The current investigation examined the extent to which age-related differences in time-compressed speech identification were predicted by auditory neural processing speed, perceptuomotor processing speed, and executive functioning. Groups of normal-hearing (up to 3000 Hz) younger and older adults identified 40, 50, and 60 % time-compressed sentences. Auditory neural processing speed was defined as the P1 and N1 latencies of click-induced auditory-evoked potentials. Perceptuomotor processing speed and executive functioning were measured behaviorally using the Connections Test. Compared to younger adults, older adults exhibited poorer time-compressed speech identification and slower perceptuomotor processing. Executive functioning, P1 latency, and N1 latency did not differ between age groups. Time-compressed speech identification was independently predicted by P1 latency, perceptuomotor processing speed, and executive functioning in younger and older listeners. Results of model testing suggested that declines in perceptuomotor processing speed mediated age-group differences in time-compressed speech identification. The current investigation joins a growing body of literature suggesting that the processing of temporally distorted speech is impacted by lower-level auditory neural processing and higher-level perceptuomotor and executive processes.

Predictors of Hearing-Aid Outcomes

Over 360 million people worldwide suffer from disabling hearing loss. Most of them can be treated with hearing aids. Unfortunately, performance with hearing aids and the benefit obtained from using them vary widely across users. Here, we investigate the reasons for such variability. Sixty-eight hearing-aid users or candidates were fitted bilaterally with nonlinear hearing aids using standard procedures. Treatment outcome was assessed by measuring aided speech intelligibility in a time-reversed two-talker background and self-reported improvement in hearing ability. Statistical predictive models of these outcomes were obtained using linear combinations of 19 predictors, including demographic and audiological data, indicators of cochlear mechanical dysfunction and auditory temporal processing skills, hearing-aid settings, working memory capacity, and pretreatment self-perceived hearing ability. Aided intelligibility tended to be better for younger hearing-aid users with good unaided intelligibility in quiet and with good temporal processing abilities. Intelligibility tended to improve by increasing amplification for low-intensity sounds and by using more linear amplification for high-intensity sounds. Self-reported improvement in hearing ability was hard to predict but tended to be smaller for users with better working memory capacity. Indicators of cochlear mechanical dysfunction, alone or in combination with hearing settings, did not affect outcome predictions. The results may be useful for improving hearing aids and setting patients’ expectations.

Exploring the Link Between Cognitive Abilities and Speech Recognition in the Elderly Under Different Listening Conditions

Elderly listeners are known to differ considerably in their ability to understand speech in noise. Several studies have addressed the underlying factors that contribute to these differences. These factors include audibility, and age-related changes in supra-threshold auditory processing abilities, and it has been suggested that differences in cognitive abilities may also be important. The objective of this study was to investigate associations between performance in cognitive tasks and speech recognition under different listening conditions in older adults with either age appropriate hearing or hearing-impairment. To that end, speech recognition threshold (SRT) measurements were performed under several masking conditions that varied along the perceptual dimensions of dip listening, spatial separation, and informational masking. In addition, a neuropsychological test battery was administered, which included measures of verbal working and short-term memory, executive functioning, selective and divided attention, and lexical and semantic abilities. Age-matched groups of older adults with either age-appropriate hearing (ENH, n = 20) or aided hearing impairment (EHI, n = 21) participated. In repeated linear regression analyses, composite scores of cognitive test outcomes (evaluated using PCA) were included to predict SRTs. These associations were different for the two groups. When hearing thresholds were controlled for, composed cognitive factors were significantly associated with the SRTs for the ENH listeners. Whereas better lexical and semantic abilities were associated with lower (better) SRTs in this group, there was a negative association between attentional abilities and speech recognition in the presence of spatially separated speech-like maskers. For the EHI group, the pure-tone thresholds (averaged across 0.5, 1, 2, and 4 kHz) were significantly associated with the SRTs, despite the fact that all signals were amplified and therefore in principle audible.

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

Objectives

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

Study Design

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

Materials and Methods

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

Results

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

Conclusion

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

Level of Evidence

4.

Application of Linear Mixed-Effects Models in Human Neuroscience Research: A Comparison with Pearson Correlation in Two Auditory Electrophysiology Studies

Neurophysiological studies are often designed to examine relationships between measures from different testing conditions, time points, or analysis techniques within the same group of participants. Appropriate statistical techniques that can take into account repeated measures and multivariate predictor variables are integral and essential to successful data analysis and interpretation. This work implements and compares conventional Pearson correlations and linear mixed-effects (LME) regression models using data from two recently published auditory electrophysiology studies. For the specific research questions in both studies, the Pearson correlation test is inappropriate for determining strengths between the behavioral responses for speech-in-noise recognition and the multiple neurophysiological measures as the neural responses across listening conditions were simply treated as independent measures. In contrast, the LME models allow a systematic approach to incorporate both fixed-effect and random-effect terms to deal with the categorical grouping factor of listening conditions, between-subject baseline differences in the multiple measures, and the correlational structure among the predictor variables. Together, the comparative data demonstrate the advantages as well as the necessity to apply mixed-effects models to properly account for the built-in relationships among the multiple predictor variables, which has important implications for proper statistical modeling and interpretation of human behavior in terms of neural correlates and biomarkers.

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

OBJECTIVE

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

STUDY DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Individual differences in selective attention predict speech identification at a cocktail party

Listeners with normal hearing show considerable individual differences in speech understanding when competing speakers are present, as in a crowded restaurant. Here, we show that one source of this variance are individual differences in the ability to focus selective attention on a target stimulus in the presence of distractors. In 50 young normal-hearing listeners, the performance in tasks measuring auditory and visual selective attention was associated with sentence identification in the presence of spatially separated competing speakers. Together, the measures of selective attention explained a similar proportion of variance as the binaural sensitivity for the acoustic temporal fine structure. Working memory span, age, and audiometric thresholds showed no significant association with speech understanding. These results suggest that a reduced ability to focus attention on a target is one reason why some listeners with normal hearing sensitivity have difficulty communicating in situations with background noise.