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Slugocki C, Kuk F, Korhonen P. Cortical sensory gating and reactions to dynamic speech-in-noise in older normal-hearing and hearing-impaired adults. Int J Audiol 2025; 64:70-79. [PMID: 38334072 DOI: 10.1080/14992027.2024.2311663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/07/2023] [Revised: 12/15/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To examine whether cortical sensory gating predicts how older adults with and without hearing loss perform the Tracking of Noise Tolerance (TNT) test. DESIGN Single-blind mixed design. TNT performance was defined by average tolerated noise relative to speech levels (TNTAve) and by an average range of noise levels over a two-minute trial (excursion). Sensory gating of P1-N1-P2 components was measured using pairs of 1 kHz tone pips. STUDY SAMPLE Twenty-three normal-hearing (NH) and 16 hearing-impaired (HI) older adults with a moderate-to-severe degree of sensorineural hearing loss. RESULTS NH listeners tolerated significantly more noise than HI listeners, but the two groups did not differ in their excursion. Both NH and HI listeners exhibited significant gating of P1 amplitudes and N1P2 peak-to-peak amplitudes with no difference in gating magnitudes between listener groups. Sensory gating magnitudes of P1 and N1P2 did not predict TNTAve scores, but N1P2 gating negatively predicted excursion after accounting for listener age and hearing thresholds. CONCLUSIONS Listeners' reactivity to a roving noise (excursion), but not their average noise tolerance (TNTAve), was predicted by sensory gating at N1P2 generators. These results suggest that temporal aspects of speech-in-noise processing may be affected by declines in the central inhibition of older adults.
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Affiliation(s)
- Christopher Slugocki
- Office of Research in Clinical Amplification (ORCA-USA), WS Audiology, Lisle, IL, USA
| | - Francis Kuk
- Office of Research in Clinical Amplification (ORCA-USA), WS Audiology, Lisle, IL, USA
| | - Petri Korhonen
- Office of Research in Clinical Amplification (ORCA-USA), WS Audiology, Lisle, IL, USA
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2
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Rahne T, Wagner TM, Kopsch AC, Plontke SK, Wagner L. Influence of Age on Speech Recognition in Noise and Hearing Effort in Listeners with Age-Related Hearing Loss. J Clin Med 2023; 12:6133. [PMID: 37834776 PMCID: PMC10573265 DOI: 10.3390/jcm12196133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/30/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
The aim of this study was to measure how age affects the speech recognition threshold (SRT50) of the Oldenburg Sentence Test (OLSA) and the listening effort at the corresponding signal-to-noise ratio (SNRcut). The study also investigated the effect of the spatial configuration of sound sources and noise signals on SRT50 and SNRcut. To achieve this goal, the study used olnoise and icra5 noise presented from one or more spatial locations from the front and back. Ninety-nine participants with age-related hearing loss in the 18-80 years age range, specifically in the 18-30, 31-40, 41-50, 51-60, 61-70, and 71-80 age groups, participated in this study. Speech recognition and listening effort in noise were measured and compared between the different age groups, different spatial sound configurations and noise signals. Speech recognition in noise decreased with age and became significant from the age group of 50-51. The decrease in SRT50 with age was greater for icra5 noise than for olnoise. For all age groups, SRT50 and SNRcut were better for icra5 noise than for olnoise. The measured age-related reference data for SRT50 and SNRcut can be used in further studies in listeners with age-related hearing loss and hearing aid or implant users.
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3
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Karunathilake IMD, Dunlap JL, Perera J, Presacco A, Decruy L, Anderson S, Kuchinsky SE, Simon JZ. Effects of aging on cortical representations of continuous speech. J Neurophysiol 2023; 129:1359-1377. [PMID: 37096924 PMCID: PMC10202479 DOI: 10.1152/jn.00356.2022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/24/2022] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 04/26/2023] Open
Abstract
Understanding speech in a noisy environment is crucial in day-to-day interactions and yet becomes more challenging with age, even for healthy aging. Age-related changes in the neural mechanisms that enable speech-in-noise listening have been investigated previously; however, the extent to which age affects the timing and fidelity of encoding of target and interfering speech streams is not well understood. Using magnetoencephalography (MEG), we investigated how continuous speech is represented in auditory cortex in the presence of interfering speech in younger and older adults. Cortical representations were obtained from neural responses that time-locked to the speech envelopes with speech envelope reconstruction and temporal response functions (TRFs). TRFs showed three prominent peaks corresponding to auditory cortical processing stages: early (∼50 ms), middle (∼100 ms), and late (∼200 ms). Older adults showed exaggerated speech envelope representations compared with younger adults. Temporal analysis revealed both that the age-related exaggeration starts as early as ∼50 ms and that older adults needed a substantially longer integration time window to achieve their better reconstruction of the speech envelope. As expected, with increased speech masking envelope reconstruction for the attended talker decreased and all three TRF peaks were delayed, with aging contributing additionally to the reduction. Interestingly, for older adults the late peak was delayed, suggesting that this late peak may receive contributions from multiple sources. Together these results suggest that there are several mechanisms at play compensating for age-related temporal processing deficits at several stages but which are not able to fully reestablish unimpaired speech perception.NEW & NOTEWORTHY We observed age-related changes in cortical temporal processing of continuous speech that may be related to older adults' difficulty in understanding speech in noise. These changes occur in both timing and strength of the speech representations at different cortical processing stages and depend on both noise condition and selective attention. Critically, their dependence on noise condition changes dramatically among the early, middle, and late cortical processing stages, underscoring how aging differentially affects these stages.
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Affiliation(s)
- I M Dushyanthi Karunathilake
- Department of Electrical and Computer Engineering, University of Maryland, College Park, Maryland, United States
| | - Jason L Dunlap
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, United States
| | - Janani Perera
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, United States
| | - Alessandro Presacco
- Institute for Systems Research, University of Maryland, College Park, Maryland, United States
| | - Lien Decruy
- Institute for Systems Research, University of Maryland, College Park, Maryland, United States
| | - Samira Anderson
- Department of Hearing and Speech Sciences, University of Maryland, College Park, Maryland, United States
| | - Stefanie E Kuchinsky
- Audiology and Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
| | - Jonathan Z Simon
- Department of Electrical and Computer Engineering, University of Maryland, College Park, Maryland, United States
- Institute for Systems Research, University of Maryland, College Park, Maryland, United States
- Department of Biology, University of Maryland, College Park, Maryland, United States
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4
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Binaural Background Noise Enhances Neuromagnetic Responses from Auditory Cortex. Symmetry (Basel) 2021. [DOI: 10.3390/sym13091748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/16/2022] Open
Abstract
The presence of binaural low-level background noise has been shown to enhance the transient evoked N1 response at about 100 ms after sound onset. This increase in N1 amplitude is thought to reflect noise-mediated efferent feedback facilitation from the auditory cortex to lower auditory centers. To test this hypothesis, we recorded auditory-evoked fields using magnetoencephalography while participants were presented with binaural harmonic complex tones embedded in binaural or monaural background noise at signal-to-noise ratios of 25 dB (low noise) or 5 dB (higher noise). Half of the stimuli contained a gap in the middle of the sound. The source activities were measured in bilateral auditory cortices. The onset and gap N1 response increased with low binaural noise, but high binaural and low monaural noise did not affect the N1 amplitudes. P1 and P2 onset and gap responses were consistently attenuated by background noise, and noise level and binaural/monaural presentation showed distinct effects. Moreover, the evoked gamma synchronization was also reduced by background noise, and it showed a lateralized reduction for monaural noise. The effects of noise on the N1 amplitude follow a bell-shaped characteristic that could reflect an optimal representation of acoustic information for transient events embedded in noise.
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Worschech F, Marie D, Jünemann K, Sinke C, Krüger THC, Großbach M, Scholz DS, Abdili L, Kliegel M, James CE, Altenmüller E. Improved Speech in Noise Perception in the Elderly After 6 Months of Musical Instruction. Front Neurosci 2021; 15:696240. [PMID: 34305522 PMCID: PMC8299120 DOI: 10.3389/fnins.2021.696240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/16/2021] [Accepted: 06/14/2021] [Indexed: 01/19/2023] Open
Abstract
Understanding speech in background noise poses a challenge in daily communication, which is a particular problem among the elderly. Although musical expertise has often been suggested to be a contributor to speech intelligibility, the associations are mostly correlative. In the present multisite study conducted in Germany and Switzerland, 156 healthy, normal-hearing elderly were randomly assigned to either piano playing or music listening/musical culture groups. The speech reception threshold was assessed using the International Matrix Test before and after a 6 month intervention. Bayesian multilevel modeling revealed an improvement of both groups over time under binaural conditions. Additionally, the speech reception threshold of the piano group decreased during stimuli presentation to the left ear. A right ear improvement only occurred in the German piano group. Furthermore, improvements were predominantly found in women. These findings are discussed in the light of current neuroscientific theories on hemispheric lateralization and biological sex differences. The study indicates a positive transfer from musical training to speech processing, probably supported by the enhancement of auditory processing and improvement of general cognitive functions.
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Affiliation(s)
- Florian Worschech
- Institute for Music Physiology and Musicians’ Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
- Center for Systems Neuroscience, Hanover, Germany
| | - Damien Marie
- Geneva Musical Minds Lab, Geneva School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Kristin Jünemann
- Center for Systems Neuroscience, Hanover, Germany
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Christopher Sinke
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Tillmann H. C. Krüger
- Center for Systems Neuroscience, Hanover, Germany
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hanover Medical School, Hanover, Germany
| | - Michael Großbach
- Institute for Music Physiology and Musicians’ Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
| | - Daniel S. Scholz
- Institute for Music Physiology and Musicians’ Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
- Center for Systems Neuroscience, Hanover, Germany
| | - Laura Abdili
- Geneva Musical Minds Lab, Geneva School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Matthias Kliegel
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | - Clara E. James
- Geneva Musical Minds Lab, Geneva School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), Geneva, Switzerland
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Eckart Altenmüller
- Institute for Music Physiology and Musicians’ Medicine, Hanover University of Music, Drama and Media, Hanover, Germany
- Center for Systems Neuroscience, Hanover, Germany
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Opoku-Baah C, Schoenhaut AM, Vassall SG, Tovar DA, Ramachandran R, Wallace MT. Visual Influences on Auditory Behavioral, Neural, and Perceptual Processes: A Review. J Assoc Res Otolaryngol 2021; 22:365-386. [PMID: 34014416 PMCID: PMC8329114 DOI: 10.1007/s10162-021-00789-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/13/2020] [Accepted: 02/07/2021] [Indexed: 01/03/2023] Open
Abstract
In a naturalistic environment, auditory cues are often accompanied by information from other senses, which can be redundant with or complementary to the auditory information. Although the multisensory interactions derived from this combination of information and that shape auditory function are seen across all sensory modalities, our greatest body of knowledge to date centers on how vision influences audition. In this review, we attempt to capture the state of our understanding at this point in time regarding this topic. Following a general introduction, the review is divided into 5 sections. In the first section, we review the psychophysical evidence in humans regarding vision's influence in audition, making the distinction between vision's ability to enhance versus alter auditory performance and perception. Three examples are then described that serve to highlight vision's ability to modulate auditory processes: spatial ventriloquism, cross-modal dynamic capture, and the McGurk effect. The final part of this section discusses models that have been built based on available psychophysical data and that seek to provide greater mechanistic insights into how vision can impact audition. The second section reviews the extant neuroimaging and far-field imaging work on this topic, with a strong emphasis on the roles of feedforward and feedback processes, on imaging insights into the causal nature of audiovisual interactions, and on the limitations of current imaging-based approaches. These limitations point to a greater need for machine-learning-based decoding approaches toward understanding how auditory representations are shaped by vision. The third section reviews the wealth of neuroanatomical and neurophysiological data from animal models that highlights audiovisual interactions at the neuronal and circuit level in both subcortical and cortical structures. It also speaks to the functional significance of audiovisual interactions for two critically important facets of auditory perception-scene analysis and communication. The fourth section presents current evidence for alterations in audiovisual processes in three clinical conditions: autism, schizophrenia, and sensorineural hearing loss. These changes in audiovisual interactions are postulated to have cascading effects on higher-order domains of dysfunction in these conditions. The final section highlights ongoing work seeking to leverage our knowledge of audiovisual interactions to develop better remediation approaches to these sensory-based disorders, founded in concepts of perceptual plasticity in which vision has been shown to have the capacity to facilitate auditory learning.
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Affiliation(s)
- Collins Opoku-Baah
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Adriana M Schoenhaut
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Sarah G Vassall
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - David A Tovar
- Neuroscience Graduate Program, Vanderbilt University, Nashville, TN, USA
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
| | - Ramnarayan Ramachandran
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
- Department of Hearing and Speech, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Vision Research Center, Nashville, TN, USA
| | - Mark T Wallace
- Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA.
- Department of Psychology, Vanderbilt University, Nashville, TN, USA.
- Department of Hearing and Speech, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Vision Research Center, Nashville, TN, USA.
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Pharmacology, Vanderbilt University, Nashville, TN, USA.
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7
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Mapping the human auditory cortex using spectrotemporal receptive fields generated with magnetoencephalography. Neuroimage 2021; 238:118222. [PMID: 34058330 DOI: 10.1016/j.neuroimage.2021.118222] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/12/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
We present a novel method to map the functional organization of the human auditory cortex noninvasively using magnetoencephalography (MEG). More specifically, this method estimates via reverse correlation the spectrotemporal receptive fields (STRF) in response to a temporally dense pure tone stimulus, from which important spectrotemporal characteristics of neuronal processing can be extracted and mapped back onto the cortex surface. We show that several neuronal populations can be found examining the spectrotemporal characteristics of their STRFs, and demonstrate how these can be used to generate tonotopic gradient maps. In doing so, we show that the spatial resolution of MEG is sufficient to reliably extract important information about the spatial organization of the auditory cortex, while enabling the analysis of complex temporal dynamics of auditory processing such as best temporal modulation rate and response latency given its excellent temporal resolution. Furthermore, because spectrotemporally dense auditory stimuli can be used with MEG, the time required to acquire the necessary data to generate tonotopic maps is significantly less for MEG than for other neuroimaging tools that acquire BOLD-like signals.
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Jiang J, Benhamou E, Waters S, Johnson JCS, Volkmer A, Weil RS, Marshall CR, Warren JD, Hardy CJD. Processing of Degraded Speech in Brain Disorders. Brain Sci 2021; 11:394. [PMID: 33804653 PMCID: PMC8003678 DOI: 10.3390/brainsci11030394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022] Open
Abstract
The speech we hear every day is typically "degraded" by competing sounds and the idiosyncratic vocal characteristics of individual speakers. While the comprehension of "degraded" speech is normally automatic, it depends on dynamic and adaptive processing across distributed neural networks. This presents the brain with an immense computational challenge, making degraded speech processing vulnerable to a range of brain disorders. Therefore, it is likely to be a sensitive marker of neural circuit dysfunction and an index of retained neural plasticity. Considering experimental methods for studying degraded speech and factors that affect its processing in healthy individuals, we review the evidence for altered degraded speech processing in major neurodegenerative diseases, traumatic brain injury and stroke. We develop a predictive coding framework for understanding deficits of degraded speech processing in these disorders, focussing on the "language-led dementias"-the primary progressive aphasias. We conclude by considering prospects for using degraded speech as a probe of language network pathophysiology, a diagnostic tool and a target for therapeutic intervention.
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Affiliation(s)
- Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Elia Benhamou
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Sheena Waters
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jeremy C. S. Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London WC1H 0AP, UK;
| | - Rimona S. Weil
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Charles R. Marshall
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK;
| | - Jason D. Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
| | - Chris J. D. Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK; (J.J.); (E.B.); (J.C.S.J.); (R.S.W.); (C.R.M.); (J.D.W.)
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9
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Dobri SGJ, Ross B. Total GABA level in human auditory cortex is associated with speech-in-noise understanding in older age. Neuroimage 2020; 225:117474. [PMID: 33099004 DOI: 10.1016/j.neuroimage.2020.117474] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/28/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022] Open
Abstract
Speech-in-noise (SIN) understanding often becomes difficult for older adults because of impaired hearing and aging-related changes in central auditory processing. Central auditory processing depends on a fine balance between excitatory and inhibitory neural mechanisms, which may be upset in older age by a change in the level of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). In this study, we used MEGA-PRESS magnetic resonance spectroscopy (MRS) to estimate GABA levels in both the left and right auditory cortices of young and older adults. We found that total auditory GABA levels were lower in older compared to young adults. To understand the relationship between GABA and hearing function, we correlated GABA levels with hearing loss and SIN performance. In older adults, the GABA level in the right auditory cortex was correlated with age and SIN performance. The relationship between chronological age and SIN loss was partially mediated by the GABA level in the right auditory cortex. These findings support the hypothesis that inhibitory mechanisms in the auditory system are reduced in aging, and this reduction relates to functional impairments.
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Affiliation(s)
- Simon G J Dobri
- Rotman Research Institute, Baycrest Centre, 3560 Bathurst Street, Toronto, ON M6A 2E1, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada.
| | - Bernhard Ross
- Rotman Research Institute, Baycrest Centre, 3560 Bathurst Street, Toronto, ON M6A 2E1, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
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