Mild Cognitive Impairment Is Characterized by Deficient Brainstem and Cortical Representations of Speech

Correlation between cerebral neurotransmitters levels by proton magnetic resonance spectroscopy and HbA1c in patients with type 2 diabetes

BACKGROUND

Cognitive dysfunction is the main manifestation of central neuropathy. Although cognitive impairments tend to be overlooked in patients with diabetes mellitus (DM), there is a growing body of evidence linking DM to cognitive dysfunction. Hyperglycemia is closely related to neurological abnormalities, while often disregarded in clinical practice. Changes in cerebral neurotransmitter levels are associated with a variety of neurological abnormalities and may be closely related to blood glucose control in patients with type 2 DM (T2DM).

AIM

To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c (HbA1c) levels.

METHODS

A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital. The participants were divided into four groups according to their HbA1c levels using the interquartile method, namely Q1 (< 7.875%), Q2 (7.875%-9.050%), Q3 (9.050%-11.200%) and Q4 (≥ 11.200%). Clinical data were collected and measured, including age, height, weight, neck/waist/hip circumferences, blood pressure, comorbidities, duration of DM, and biochemical indicators. Meanwhile, neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.

RESULTS

The HbA1c level was significantly associated with urinary microalbumin (mALB), triglyceride, low-density lipoprotein cholesterol (LDL-C), homeostasis model assessment of insulin resistance (HOMA-IR), and beta cell function (HOMA-β), N-acetylaspartate/creatine (NAA/Cr), and NAA/choline (NAA/Cho). Spearman correlation analysis showed that mALB, LDL-C, HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c (P < 0.05), whereas HOMA-β was negatively correlated with the HbA1c level (P < 0.05). Ordered multiple logistic regression analysis showed that NAA/Cho [Odds ratio (OR): 1.608, 95% confidence interval (95%CI): 1.004-2.578, P < 0.05], LDL-C (OR: 1.627, 95%CI: 1.119-2.370, P < 0.05), and HOMA-IR (OR: 1.107, 95%CI: 1.031-1.188, P < 0.01) were independent predictors of poor glycemic control.

CONCLUSION

The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control, which may be the basis for the changes in cognitive function in diabetic patients.

Effect of dietary patterns on mild cognitive impairment and dementia: a machine learning bibliometric and visualization analysis

Objective

As a spectrum of neurodegenerative conditions, dementia presents a significant challenge to worldwide health. Mild cognitive impairment (MCI) is recognized as the intermediate stage between normal cognitive functioning and dementia. Studies highlight the significant impact of dietary patterns on the management of MCI and dementia. Currently, comprehensive research on dietary patterns specific to MCI and dementia is limited, but bibliometric analysis offers a method to pinpoint essential research directions.

Methods

On November 18, 2023, a search was conducted in the Web of Science Core Collection (WoSCC) for publications on diet and MCI/dementia. Tools such as Rstudio, CiteSpace, and VOSviewer were employed to create a knowledge atlas. This atlas analyzed collaborations, reference co-citations, keyword patterns, and emerging trends.

Results

The search yielded 1,493 publications on diet and MCI/dementia, indicating a growing interest despite fluctuations. Contributions came from 70 countries/regions and 410 organizations across 456 journals. The USA and China led in publication numbers, with significant contributions from Columbia University and Harvard Medical School. Top authors include Scarmeas Nikolaos, Morris Martha Clare, and Samieri Cecilia. The Ketogenic, Mediterranean, and MIND diets emerged as key dietary patterns for cognitive decline prevention, highlighting the role of genetic factors, especially ApoE polymorphisms, in cognitive deterioration.

Conclusion

This study provides core countries, institutions, and authors in the field, and points out the development directions in the field. Future research directions in dietary for MCI and dementia will focus on: (1) the potential effects of the KD in alleviating oxidative stress and modulating gut microbiota in neurodegenerative diseases; (2) how diet influences cognitive health through patterns of ApoE and protein expression; (3) investigating the interactions between gut microbiota and brain function, known as the "gut-brain axis."

Auditory Encoding of Natural Speech at Subcortical and Cortical Levels Is Not Indicative of Cognitive Decline

More and more patients worldwide are diagnosed with dementia, which emphasizes the urgent need for early detection markers. In this study, we built on the auditory hypersensitivity theory of a previous study-which postulated that responses to auditory input in the subcortex as well as cortex are enhanced in cognitive decline-and examined auditory encoding of natural continuous speech at both neural levels for its indicative potential for cognitive decline. We recruited study participants aged 60 years and older, who were divided into two groups based on the Montreal Cognitive Assessment, one group with low scores (n = 19, participants with signs of cognitive decline) and a control group (n = 25). Participants completed an audiometric assessment and then we recorded their electroencephalography while they listened to an audiobook and click sounds. We derived temporal response functions and evoked potentials from the data and examined response amplitudes for their potential to predict cognitive decline, controlling for hearing ability and age. Contrary to our expectations, no evidence of auditory hypersensitivity was observed in participants with signs of cognitive decline; response amplitudes were comparable in both cognitive groups. Moreover, the combination of response amplitudes showed no predictive value for cognitive decline. These results challenge the proposed hypothesis and emphasize the need for further research to identify reliable auditory markers for the early detection of cognitive decline.

Myogenic artifacts masquerade as neuroplasticity in the auditory frequency-following response (FFR)

The frequency-following response (FFR) is an evoked potential that provides a "neural fingerprint" of complex sound encoding in the brain. FFRs have been widely used to characterize speech and music processing, experience-dependent neuroplasticity (e.g., learning, musicianship), and biomarkers for hearing and language-based disorders that distort receptive communication abilities. It is widely assumed FFRs stem from a mixture of phase-locked neurogenic activity from brainstem and cortical structures along the hearing neuraxis. Here, we challenge this prevailing view by demonstrating upwards of ~50% of the FFR can originate from a non-neural source: contamination from the postauricular muscle (PAM) vestigial startle reflex. We first establish PAM artifact is present in all ears, varies with electrode proximity to the muscle, and can be experimentally manipulated by directing listeners' eye gaze toward the ear of sound stimulation. We then show this muscular noise easily confounds auditory FFRs, spuriously amplifying responses by 3-4x fold with tandem PAM contraction and even explaining putative FFR enhancements observed in highly skilled musicians. Our findings expose a new and unrecognized myogenic source to the FFR that drives its large inter-subject variability and cast doubt on whether changes in the response typically attributed to neuroplasticity/pathology are solely of brain origin.

rTMS of the auditory association cortex improves speech intelligibility in patients with sensorineural hearing loss

OBJECTIVE

Sensorineural hearing-loss (SHL) is accompanied by changes in the entire ear-brain pathway and its connected regions. While hearing-aid (HA) partially compensates for SHL, speech perception abilities often continue to remain poor, resulting in consequences in everyday activities. Repetitive transcranial magnetic stimulation (rTMS) promotes cortical network plasticity and may enhance language comprehension in SHL patients.

METHODS

27 patients using HA and with SHL were randomly assigned to a treatment protocol consisting of five consecutive days of either real (Active group: 13 patients) or placebo rTMS (Sham group: 14 patients). The stimulation parameters were as follows: 2-second trains at 10 Hz, 4-second inter-train-interval, and 1800 pulses. Neuronavigated rTMS was applied over the left superior temporal sulcus. Audiological tests were administered before (T0), immediately after (T1), and one week following treatment completion (T2) to evaluate the speech reception threshold (SRT) and the Pure Tone Average (PTA).

RESULTS

In the context of a general improvement likely due to learning, the treatment with real rTMS induced significant reduction of the SRT and PTA at T1 and T2 versus placebo.

CONCLUSIONS

The long-lasting effects on SRT and PTA observed in the Active group indicates that rTMS administered over the auditory cortex could promote sustained neuromodulatory-induced changes in the brain, improving the perception of complex sentences and pure tones reception skills.

SIGNIFICANCE

Five days of rTMS treatment enhances overall speech intelligibility and PTA in SHL patients.

Frequency-Following Responses in Sensorineural Hearing Loss: A Systematic Review

PURPOSE

This systematic review aims to assess the impact of sensorineural hearing loss (SNHL) on various frequency-following response (FFR) parameters.

METHODS

Following PRISMA guidelines, a systematic review was conducted using PubMed, Web of Science, and Scopus databases up to January 2023. Studies evaluating FFRs in patients with SNHL and normal hearing controls were included.

RESULTS

Sixteen case-control studies were included, revealing variability in acquisition parameters. In the time domain, patients with SNHL exhibited prolonged latencies. The specific waves that were prolonged differed across studies. There was no consensus regarding wave amplitude in the time domain. In the frequency domain, focusing on studies that elicited FFRs with stimuli of 170 ms or longer, participants with SNHL displayed a significantly smaller fundamental frequency (F0). Results regarding changes in the temporal fine structure (TFS) were inconsistent.

CONCLUSION

Patients with SNHL may require more time for processing (speech) stimuli, reflected in prolonged latencies. However, the exact timing of this delay remains unclear. Additionally, when presenting longer stimuli (≥ 170 ms), patients with SNHL show difficulties tracking the F0 of (speech) stimuli. No definite conclusions could be drawn on changes in wave amplitude in the time domain and the TFS in the frequency domain. Patient characteristics, acquisition parameters, and FFR outcome parameters differed greatly across studies. Future studies should be performed in larger and carefully matched subject groups, using longer stimuli presented at the same intensity in dB HL for both groups, or at a carefully determined maximum comfortable loudness level.

Proprioceptive and olfactory deficits in individuals with Parkinson disease and mild cognitive impairment

BACKGROUND

Individuals with neurodegenerative diseases such as Parkinson disease (PD) and Alzheimer's (AD) disease often present with perceptual impairments at an early clinical stage. Therefore, early identification and quantification of these impairments could facilitate diagnosis and early intervention.

OBJECTIVES

This study aimed to compare proprioceptive and olfactory sensitivities in individuals diagnosed with PD and mild cognitive impairment (MCI).

METHODS

Proprioception in the forearm and olfactory function were measured in neurotypical older adults, individuals with PD, and individuals with MCI. Position and passive motion senses were assessed using a passive motion apparatus. The traditional Chinese version of the University of Pennsylvania smell identification test (UPSIT-TC) and the smell threshold test (STT) were used to identify and discriminate smell, respectively.

RESULTS

Position sense threshold between the groups differed significantly (p < 0.001), with the PD (p < 0.001) and MCI (p = 0.004) groups showing significantly higher than the control group. The control group had significantly higher mean UPSIT-TC scores than the PD (p < 0.001) and MCI (p = 0.006) groups. The control group had a significantly lower mean STT threshold than the PD and MCI groups (p < 0.001 and p = 0.008, respectively). UPSIT-TC scores significantly correlated with disease progression in PD (r = - 0.50, p = 0.008) and MCI (r = 0.44, p = 0.04).

CONCLUSIONS

Proprioceptive and olfactory sensitivities were reduced in individuals with PD and MCI, and these deficits were related to disease severity. These findings support previous findings indicating that perceptual loss may be a potential biomarker for diagnosing and monitoring disease progression in individuals with neurodegenerative diseases.

Effects of Memantine on the Auditory Steady-State and Harmonic Responses to 40 Hz Stimulation Across Species

BACKGROUND

Click trains elicit an auditory steady-state response (ASSR) at the driving frequency (1F) and its integer multiple frequencies (2F, 3F, etc.) called harmonics; we call this harmonic response the steady-state harmonic response (SSHR). We describe the 40 Hz ASSR (1F) and 80 Hz SSHR (2F) in humans and rats and their sensitivity to the uncompetitive NMDA antagonist memantine.

METHODS

In humans (healthy control participants, n = 25; patients with schizophrenia, n = 28), electroencephalography was recorded after placebo or 20 mg memantine in a within-participant crossover design. ASSR used 1 ms, 85-dB clicks presented in 250 40/s 500-ms trains. In freely moving rats (n = 9), electroencephalography was acquired after memantine (0, 0.3, 1, 3 mg/kg) in a within-participant crossover design; 65-dB click trains used 5-mV monophasic, 1-ms square waves (40/s).

RESULTS

Across species, ASSR at 1F generated greater evoked power (EP) than the 2F SSHR. 1F > 2F intertrial coherence (ITC) was also detected in humans, but the opposite relationship (ITC: 2F > 1F) was seen in rats. EP and ITC at 1F were deficient in patients and were enhanced by memantine across species. EP and ITC at 2F were deficient in patients. Measures at 2F were generally insensitive to memantine across species, although in humans the ITC harmonic ratio (1F:2F) was modestly enhanced by memantine, and in rats, both the EP and ITC harmonic ratios were significantly enhanced by memantine.

CONCLUSIONS

ASSR and SSHR are robust, nonredundant electroencephalography signals that are suitable for cross-species analyses that reveal potentially meaningful differences across species, diagnoses, and drugs.

Monitoring Disease Severity of Mild Cognitive Impairment from Single-Channel EEG Data Using Regression Analysis

A deviation in the soundness of cognitive health is known as mild cognitive impairment (MCI), and it is important to monitor it early to prevent complicated diseases such as dementia, Alzheimer's disease (AD), and Parkinson's disease (PD). Traditionally, MCI severity is monitored with manual scoring using the Montreal Cognitive Assessment (MoCA). In this study, we propose a new MCI severity monitoring algorithm with regression analysis of extracted features of single-channel electro-encephalography (EEG) data by automatically generating severity scores equivalent to MoCA scores. We evaluated both multi-trial and single-trail analysis for the algorithm development. For multi-trial analysis, 590 features were extracted from the prominent event-related potential (ERP) points and corresponding time domain characteristics, and we utilized the lasso regression technique to select the best feature set. The 13 best features were used in the classical regression techniques: multivariate regression (MR), ensemble regression (ER), support vector regression (SVR), and ridge regression (RR). The best results were observed for ER with an RMSE of 1.6 and residual analysis. In single-trial analysis, we extracted a time-frequency plot image from each trial and fed it as an input to the constructed convolutional deep neural network (CNN). This deep CNN model resulted an RMSE of 2.76. To our knowledge, this is the first attempt to generate automated scores for MCI severity equivalent to MoCA from single-channel EEG data with multi-trial and single data.

Reduced tactile sensitivity is associated with mild cognitive impairment

BACKGROUND

Sensory impairment has been related to age-associated cognitive decline. While these associations were investigated primarily in the auditory and visual domain, other senses such as touch have rarely been studied. Thus, it remains open whether these results are specific for particular sensory domains, or rather point to a fundamental role of sensory deficits in cognitive decline.

METHODS

Data from 31 participants with mild cognitive impairment (MCI), 46 participants with frailty, and 23 non-clinical control participants (NCCs) were included. We assessed sensory function using visual acuity and contrast sensitivity, hearing threshold, and mechanical detection threshold. Cognitive function in participants with MCI was assessed using associative memory performance. Group differences on sensory thresholds were tested using analyses of covariance with age, sex, and years of education as covariates. Associations between measures within participants with MCI were evaluated using Spearman correlations.

FINDINGS

We found a significant difference in mechanical detection threshold between the groups (p < 0.001, η2 = 0.18). Participants with MCI showed significantly reduced tactile sensitivity compared to participants with frailty and NCCs. In participants with MCI, lower associative memory performance was significantly related to reduced tactile sensitivity (rs = 0.39, p = 0.031) and auditory acuity (rs = 0.41, p = 0.022).

INTERPRETATION

Our results indicate that reduced tactile sensitivity is related to cognitive decline. Prospective studies should investigate the age-related alterations of multimodal sensory processes and their contribution to dementia-related processes.

FUNDING

Deutsche Forschungsgemeinschaft (FL 156/41-1) and a grant of the Hector-Stiftung II, Weinheim, Germany.

Neuroinflammation in a Mouse Model of Alzheimer's Disease versus Auditory Dysfunction: Machine Learning Interpretation and Analysis

Background

Auditory dysfunction, including central auditory hyperactivity, hearing loss and hearing in noise deficits, has been reported in 5xFAD Alzheimer's disease (AD) mice, suggesting a causal relationship between amyloidosis and auditory dysfunction. Central auditory hyperactivity correlated in time with small amounts of plaque deposition in the inferior colliculus and medial geniculate body, which are the auditory midbrain and thalamus, respectively. Neuroinflammation has been associated with excitation to inhibition imbalance in the central nervous system, and therefore has been proposed as a link between central auditory hyperactivity and AD in our previous report. However, neuroinflammation in the auditory pathway has not been investigated in mouse amyloidosis models.

Methods

Machine learning was used to classify the previously obtained auditory brainstem responses (ABRs) from 5xFAD mice and their wild type (WT) littermates. Neuroinflammation was assessed in six auditory-related regions of the cortex, thalamus, and brainstem. Cochlear pathology was assessed in cryosection and whole mount. Behavioral changes were assessed with fear conditioning, open field testing and novel objection recognition.

Results

Reliable machine learning classification of 5xFAD and WT littermate ABRs were achieved for 6M and 12M, but not 3M. The top features for accurate classification at 6 months of age were characteristics of Waves IV and V. Microglial and astrocytic activation were pronounced in 5xFAD inferior colliculus and medial geniculate body at 6 months, two neural centers that are thought to contribute to these waves. Lower regions of the brainstem were unaffected, and cortical auditory centers also displayed inflammation beginning at 6 months. No losses were seen in numbers of spiral ganglion neurons (SGNs), auditory synapses, or efferent synapses in the cochlea. 5xFAD mice had reduced responses to tones in fear conditioning compared to WT littermates beginning at 6 months.

Conclusions

Serial use of ABR in early AD patients represents a promising approach for early and inexpensive detection of neuroinflammation in higher auditory brainstem processing centers. As changes in auditory processing are strongly linked to AD progression, central auditory hyperactivity may serve as a biomarker for AD progression and/or stratify AD patients into distinct populations.

Increased central auditory gain in 5xFAD Alzheimer's disease mice as an early biomarker candidate for Alzheimer's disease diagnosis

Alzheimer's Disease (AD) is a neurodegenerative illness without a cure. All current therapies require an accurate diagnosis and staging of AD to ensure appropriate care. Central auditory processing disorders (CAPDs) and hearing loss have been associated with AD, and may precede the onset of Alzheimer's dementia. Therefore, CAPD is a possible biomarker candidate for AD diagnosis. However, little is known about how CAPD and AD pathological changes are correlated. In the present study, we investigated auditory changes in AD using transgenic amyloidosis mouse models. AD mouse models were bred to a mouse strain commonly used for auditory experiments, to compensate for the recessive accelerated hearing loss on the parent background. Auditory brainstem response (ABR) recordings revealed significant hearing loss, a reduced ABR wave I amplitude, and increased central gain in 5xFAD mice. In comparison, these effects were milder or reversed in APP/PS1 mice. Longitudinal analyses revealed that in 5xFAD mice, central gain increase preceded ABR wave I amplitude reduction and hearing loss, suggesting that it may originate from lesions in the central nervous system rather than the peripheral loss. Pharmacologically facilitating cholinergic signaling with donepezil reversed the central gain in 5xFAD mice. After the central gain increased, aging 5xFAD mice developed deficits for hearing sound pips in the presence of noise, consistent with CAPD-like symptoms of AD patients. Histological analysis revealed that amyloid plaques were deposited in the auditory cortex of both mouse strains. However, in 5xFAD but not APP/PS1 mice, plaque was observed in the upper auditory brainstem, specifically the inferior colliculus (IC) and the medial geniculate body (MGB). This plaque distribution parallels histological findings from human subjects with AD and correlates in age with central gain increase. Overall, we conclude that auditory alterations in amyloidosis mouse models correlate with amyloid deposits in the auditory brainstem and may be reversed initially through enhanced cholinergic signaling. The alteration of ABR recording related to the increase in central gain prior to AD-related hearing disorders suggests that it could potentially be used as an early biomarker of AD diagnosis.

Age differences in central auditory system responses to naturalistic music

Aging influences the central auditory system leading to difficulties in the decoding and understanding of overlapping sound signals, such as speech in noise or polyphonic music. Studies on central auditory system evoked responses (ERs) have found in older compared to young listeners increased amplitudes (less inhibition) of the P1 and N1 and decreased amplitudes of the P2, mismatch negativity (MMN), and P3a responses. While preceding research has focused on simplified auditory stimuli, we here tested whether the previously observed age-related differences could be replicated with sounds embedded in medium and highly naturalistic musical contexts. Older (age 55-77 years) and younger adults (age 21-31 years) listened to medium naturalistic (synthesized melody) and highly naturalistic (studio recording of a music piece) stimuli. For the medium naturalistic music, the age group differences on the P1, N1, P2, MMN, and P3a amplitudes were all replicated. The age group differences, however, appeared reduced with the highly compared to the medium naturalistic music. The finding of lower P2 amplitude in older than young was replicated for slow event rates (0.3-2.9Hz) in the highly naturalistic music. Moreover, the ER latencies suggested a gradual slowing of the auditory processing time course for highly compared to medium naturalistic stimuli irrespective of age. These results support that age-related differences on ERs can partly be observed with naturalistic stimuli. This opens new avenues for including naturalistic stimuli in the investigation of age-related central auditory system disorders.

What do functional neuroimaging studies tell us about the association between falls and cognition in older adults? A systematic review

Impaired cognition is a known risk factor for falls in older adults. To enhance prevention strategies and treatment of falls among an aging global population, an understanding of the neural processes and networks involved is required. We present a systematic review investigating how functional neuroimaging techniques have been used to examine the association between falls and cognition in seniors. Peer-reviewed articles were identified through searching five electronic databases: 1) Medline, 2) PsycINFO, 3) CINAHL, 4) EMBASE, and 5) Pubmed. Key author, key paper, and reference searching was also conducted. Nine studies were included in this review. A questionnaire composed of seven questions was used to assess the quality of each study. EEG, fMRI, and PET were utilized across studies to examine brain function in older adults. Consistent evidence demonstrates that cognition is associated with measures of falls/falls risk, specifically visual attention and executive function. Our results show that falls/falls risk may be implicated with specific brain regions and networks. Future studies should be prospective and long-term in nature, with standardized outcome measures. Mobile neuroimaging techniques may also provide insight into brain activity as it pertains to cognition and falls in older adults in real-world settings.

The possible role of early-stage phase-locked neural activities in speech-in-noise perception in human adults across age and hearing loss

Ageing affects auditory neural phase-locked activities which could increase the challenges experienced during speech-in-noise (SiN) perception by older adults. However, evidence for how ageing affects SiN perception through these phase-locked activities is still lacking. It is also unclear whether influences of ageing on phase-locked activities in response to different acoustic properties have similar or different mechanisms to affect SiN perception. The present study addressed these issues by measuring early-stage phase-locked encoding of speech under quiet and noisy backgrounds (speech-shaped noise (SSN) and multi-talker babbles) in adults across a wide age range (19-75 years old). Participants passively listened to a repeated vowel whilst the frequency-following response (FFR) to fundamental frequency that has primary subcortical sources and cortical phase-locked response to slowly-fluctuating acoustic envelopes were recorded. We studied how these activities are affected by age and age-related hearing loss and how they are related to SiN performances (word recognition in sentences in noise). First, we found that the effects of age and hearing loss differ for the FFR and slow-envelope phase-locking. FFR was significantly decreased with age and high-frequency (≥ 2 kHz) hearing loss but increased with low-frequency (< 2 kHz) hearing loss, whilst the slow-envelope phase-locking was significantly increased with age and hearing loss across frequencies. Second, potential relationships between the types of phase-locked activities and SiN perception performances were also different. We found that the FFR and slow-envelope phase-locking positively corresponded to SiN performance under multi-talker babbles and SSN, respectively. Finally, we investigated how age and hearing loss affected SiN perception through phase-locked activities via mediation analyses. We showed that both types of activities significantly mediated the relation between age/hearing loss and SiN perception but in distinct manners. Specifically, FFR decreased with age and high-frequency hearing loss which in turn contributed to poorer SiN performance but increased with low-frequency hearing loss which in turn contributed to better SiN performance under multi-talker babbles. Slow-envelope phase-locking increased with age and hearing loss which in turn contributed to better SiN performance under both SSN and multi-talker babbles. Taken together, the present study provided evidence for distinct neural mechanisms of early-stage auditory phase-locked encoding of different acoustic properties through which ageing affects SiN perception.

Musical experience partially counteracts temporal speech processing deficits in putative mild cognitive impairment

Mild cognitive impairment (MCI) commonly results in more rapid cognitive and behavioral declines than typical aging. Individuals with MCI can exhibit impaired receptive speech abilities that may reflect neurophysiological changes in auditory-sensory processing prior to usual cognitive deficits. Benefits from current interventions targeting communication difficulties in MCI are limited. Yet, neuroplasticity associated with musical experience has been implicated in improving neural representations of speech and offsetting age-related declines in perception. Here, we asked whether these experience-dependent effects of musical experience might extend to aberrant aging and offer some degree of cognitive protection against MCI. During a vowel categorization task, we recorded single-channel electroencephalograms (EEGs) in older adults with putative MCI to evaluate speech encoding across subcortical and cortical levels of the auditory system. Critically, listeners varied in their duration of formal musical experience (0-21 years). Musical experience sharpened temporal precision in auditory cortical responses, suggesting that musical experience produces more efficient processing of acoustic features by counteracting age-related neural delays. Additionally, robustness of brainstem responses predicted the severity of cognitive decline, suggesting that early speech representations are sensitive to preclinical stages of cognitive impairment. Our results extend prior studies by demonstrating positive benefits of musical experience in older adults with emergent cognitive impairments.

Familiarity of Background Music Modulates the Cortical Tracking of Target Speech at the "Cocktail Party"

The "cocktail party" problem-how a listener perceives speech in noisy environments-is typically studied using speech (multi-talker babble) or noise maskers. However, realistic cocktail party scenarios often include background music (e.g., coffee shops, concerts). Studies investigating music's effects on concurrent speech perception have predominantly used highly controlled synthetic music or shaped noise, which do not reflect naturalistic listening environments. Behaviorally, familiar background music and songs with vocals/lyrics inhibit concurrent speech recognition. Here, we investigated the neural bases of these effects. While recording multichannel EEG, participants listened to an audiobook while popular songs (or silence) played in the background at a 0 dB signal-to-noise ratio. Songs were either familiar or unfamiliar to listeners and featured either vocals or isolated instrumentals from the original audio recordings. Comprehension questions probed task engagement. We used temporal response functions (TRFs) to isolate cortical tracking to the target speech envelope and analyzed neural responses around 100 ms (i.e., auditory N1 wave). We found that speech comprehension was, expectedly, impaired during background music compared to silence. Target speech tracking was further hindered by the presence of vocals. When masked by familiar music, response latencies to speech were less susceptible to informational masking, suggesting concurrent neural tracking of speech was easier during music known to the listener. These differential effects of music familiarity were further exacerbated in listeners with less musical ability. Our neuroimaging results and their dependence on listening skills are consistent with early attentional-gain mechanisms where familiar music is easier to tune out (listeners already know the song's expectancies) and thus can allocate fewer attentional resources to the background music to better monitor concurrent speech material.

Amyloid Pathology in the Central Auditory Pathway of 5XFAD Mice Appears First in Auditory Cortex

Background: Effective treatment of Alzheimer’s disease (AD) will hinge on early detection. This has led to the search for early biomarkers that use non-invasive testing. One possible early biomarker is auditory temporal processing deficits, which reflect central auditory pathway dysfunction and precede cognitive and memory declines in AD. Gap detection is a measure of auditory temporal processing, is impaired in human AD, and is also impaired in the 5XFAD mouse model of AD. Gap detection deficits appear as early as postnatal day 60 in 5XFAD mice, months before cognitive deficits or cell death, supporting gap detection as an early biomarker. However, it remains unclear how gap detection deficits relate to the progression of amyloid pathology in the auditory system. Objective: To determine the progression of amyloid pathology throughout the central auditory system and across age in 5XFAD mice. Methods: We quantified intracellular and extracellular antibody labelling of Aβ 42 in 6 regions of the central auditory system from p14 to p150. Results: Pathology appeared first in primary auditory cortex (A1) as intracellular accumulation of Aβ 42 in layer 5 pyramidal neurons by age p21. Extracellular plaques appeared later, by age p90, in A1, medial geniculate body, and inferior colliculus. Auditory brainstem structures showed minimal amyloid pathology. We also observed pathology in the caudal pontine reticular nucleus, a brainstem structure that is outside of the central auditory pathway but which is involved in the acoustic startle reflex. Conclusion: These results suggest that Aβ 42 accumulation, but not plaques, may impair gap detection.

Categorical Perception of Lexical Tones in Mandarin-Speaking Seniors

PURPOSE

This study aims to investigate the different degeneration processes of categorical perception (CP) of Mandarin lexical tones in the normal aging population and the pathological aging population with mild cognitive impairment (MCI).

METHOD

In Experiment I, we compared the identification and discrimination of Tone 1 and Tone 2 across young adults, seniors aged 60-65 years, and older seniors aged 75-80 years with normal cognitive abilities. In Experiment II, we compared lexical tone identification and discrimination across young adults, healthy seniors, and age-matched seniors with MCI.

RESULTS

In Experiment I, tone perception was intact in seniors aged below 65 years. Those aged above 75 years could also maintain normal tone identification, whereas they showed poorer tone discrimination correlated with age-related poorer hearing level. In Experiment II, healthy seniors showed normal CP of Mandarin tones. Tone identification was also normal in those with MCI, whereas their tone discrimination had significantly degenerated.

CONCLUSIONS

In the normal aging population, age-related hearing loss decreased signal audibility, accounting for poorer discrimination of Mandarin lexical tones in seniors above 75 years. In the pathological aging population with MCI, the poorer discrimination of lexical tones may be attributed to the additive effect of age, hearing loss, and cognitive impairment (e.g., impaired working memory and long-term phonological memory). This study uncovered the roles of low-level sensory processing and high-level cognitive processing in lexical tone perception in the Chinese aging population.

Cognitive screening in HTLV-1-infected people using a self-perceived memory score and auditory P300

The HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is the most common neurological manifestation associated with human T-cell lymphotropic virus type-1 (HTLV-1) infection. Although cognitive impairment has been highlighted in the spectrum of HTLV-1 neurological manifestations, it may go unnoticed in those who do not spontaneously report it. We aimed at evaluating the applicability of a self-perceived memory score (SMS) and the cognitive event-related potential (P300) for early detection of cognitive impairment in HTLV-1-infected people. The SMS was measured by a 0-10 point numeric scale combined with a sad-happy face rating scale. The higher the number, the better was the SMS. The P300 was obtained through an oddball paradigm with a mental counting task. The participants were 15 (21.4%) individuals with HAM/TSP, 20 (28.6%) HTLV-1 asymptomatic carriers, and 35 (50%) seronegative controls. We found that SMS (p < 0.001) and P300 latency (p < 0.001) got progressively worse from the seronegative controls to the asymptomatic carriers and then to the HAM/TSP. The results that indicated cognitive impairment were SMS < 7.2 points and P300 latency > 369.0 ms. The HAM/TSP group showed the highest prevalence of altered P300 (80%) and SMS (87%). Interestingly, the asymptomatic group also presented significantly higher prevalence of altered SMS (60%) and P300 (35%) when compared to controls (< 10%). The frequency of cognitive impairment was 16 times higher in the HTLV-1 asymptomatic group and 69 times higher in the HAM/TSP group when compared to controls. The use of SMS in the medical consultation was a useful and easy-to-apply method to screen HTLV-1-infected subjects for everyday memory complaints.

Objective Detection of the Speech Frequency Following Response (sFFR): A Comparison of Two Methods

Speech frequency following responses (sFFRs) are increasingly used in translational auditory research. Statistically-based automated sFFR detection could aid response identification and provide a basis for stopping rules when recording responses in clinical and/or research applications. In this brief report, sFFRs were measured from 18 normal hearing adult listeners in quiet and speech-shaped noise. Two statistically-based automated response detection methods, the F-test and Hotelling’s T² (HT²) test, were compared based on detection accuracy and test time. Similar detection accuracy across statistical tests and conditions was observed, although the HT² test time was less variable. These findings suggest that automated sFFR detection is robust for responses recorded in quiet and speech-shaped noise using either the F-test or HT² test. Future studies evaluating test performance with different stimuli and maskers are warranted to determine if the interchangeability of test performance extends to these conditions.

Pure Tone Audiometry and Hearing Loss in Alzheimer's Disease: A Meta-Analysis

An association between age-related hearing loss (ARHL) and Alzheimer's Disease (AD) has been widely reported. However, the nature of this relationship remains poorly understood. Quantification of hearing loss as it relates to AD is imperative for the creation of reliable, hearing-related biomarkers for earlier diagnosis and development of ARHL treatments that may slow the progression of AD. Previous studies that have measured the association between peripheral hearing function and AD have yielded mixed results. Most of these studies have been small and underpowered to reveal an association. Therefore, in the current report, we sought to estimate the degree to which AD patients have impaired hearing by performing a meta-analysis to increase statistical power. We reviewed 248 published studies that quantified peripheral hearing function using pure-tone audiometry for subjects with AD. Six studies, with a combined total of 171 subjects with AD compared to 222 age-matched controls, met inclusion criteria. We found a statistically significant increase in hearing threshold as measured by pure tone audiometry for subjects with AD compared to controls. For a three-frequency pure tone average calculated for air conduction thresholds at 500-1,000-2,000 Hz (0.5-2 kHz PTA), an increase of 2.3 decibel hearing level (dB HL) was found in subjects with AD compared to controls (p = 0.001). Likewise, for a four-frequency pure tone average calculated at 500-1,000-2,000-4,000 (0.5-4 kHz PTA), an increase of 4.5 dB HL was measured (p = 0.002), and this increase was significantly greater than that seen for 0.5-2 kHz PTA. There was no difference in the average age of the control and AD subjects. These data confirm the presence of poorer hearing ability in AD subjects, provided a quantitative estimate of the magnitude of hearing loss, and suggest that the magnitude of the effect is greater at higher sound frequencies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021288280.

Early auditory responses to speech sounds in Parkinson's disease: preliminary data

Parkinson’s disease (PD), as a manifestation of basal ganglia dysfunction, is associated with a number of speech deficits, including reduced voice modulation and vocal output. Interestingly, previous work has shown that participants with PD show an increased feedback-driven motor response to unexpected fundamental frequency perturbations during speech production, and a heightened ability to detect differences in vocal pitch relative to control participants. Here, we explored one possible contributor to these enhanced responses. We recorded the frequency-following auditory brainstem response (FFR) to repetitions of the speech syllable [da] in PD and control participants. Participants with PD displayed a larger amplitude FFR related to the fundamental frequency of speech stimuli relative to the control group. The current preliminary results suggest the dysfunction of the basal ganglia in PD contributes to the early stage of auditory processing and may reflect one component of a broader sensorimotor processing impairment associated with the disease.

Differences in Auditory Perception Between Young and Older Adults When Controlling for Differences in Hearing Loss and Cognition

This study was designed to examine age effects on various auditory perceptual skills using a large group of listeners (155 adults, 121 aged 60-88 years and 34 aged 18-30 years), while controlling for the factors of hearing loss and working memory (WM). All subjects completed 3 measures of WM, 7 psychoacoustic tasks (24 conditions) and a hearing assessment. Psychophysical measures were selected to tap phenomena thought to be mediated by higher-level auditory function and included modulation detection, modulation detection interference, informational masking (IM), masking level difference (MLD), anisochrony detection, harmonic mistuning, and stream segregation. Principal-components analysis (PCA) was applied to each psychoacoustic test. For 6 of the 7 tasks, a single component represented performance across the multiple stimulus conditions well, whereas the modulation-detection interference (MDI) task required two components to do so. The effect of age was analyzed using a general linear model applied to each psychoacoustic component. Once hearing loss and WM were accounted for as covariates in the analyses, estimated marginal mean thresholds were lower for older adults on tasks based on temporal processing. When evaluated separately, hearing loss led to poorer performance on roughly 1/2 the tasks and declines in WM accounted for poorer performance on 6 of the 8 psychoacoustic components. These results make clear the need to interpret age-group differences in performance on psychoacoustic tasks in light of cognitive declines commonly associated with aging, and point to hearing loss and cognitive declines as negatively influencing auditory perceptual skills.

Causal Relationship between the Right Auditory Cortex and Speech-Evoked Envelope-Following Response: Evidence from Combined Transcranial Stimulation and Electroencephalography

Speech-evoked envelope-following response (EFR) reflects brain encoding of speech periodicity that serves as a biomarker for pitch and speech perception and various auditory and language disorders. Although EFR is thought to originate from the subcortex, recent research illustrated a right-hemispheric cortical contribution to EFR. However, it is unclear whether this contribution is causal. This study aimed to establish this causality by combining transcranial direct current stimulation (tDCS) and measurement of EFR (pre- and post-tDCS) via scalp-recorded electroencephalography. We applied tDCS over the left and right auditory cortices in right-handed normal-hearing participants and examined whether altering cortical excitability via tDCS causes changes in EFR during monaural listening to speech syllables. We showed significant changes in EFR magnitude when tDCS was applied over the right auditory cortex compared with sham stimulation for the listening ear contralateral to the stimulation site. No such effect was found when tDCS was applied over the left auditory cortex. Crucially, we further observed a hemispheric laterality where aftereffect was significantly greater for tDCS applied over the right than the left auditory cortex in the contralateral ear condition. Our finding thus provides the first evidence that validates the causal relationship between the right auditory cortex and EFR.

Event-Related Potential Measures of the Passive Processing of Rapidly and Slowly Presented Auditory Stimuli in MCI

Much research effort is currently devoted to the development of a simple, low-cost method to determine early signs of Alzheimer’s disease (AD) pathology. The present study employs a simple paradigm in which event-related potentials (ERPs) were recorded to a single auditory stimulus that was presented rapidly or very slowly while the participant was engaged in a visual task. A multi-channel EEG was recorded in 20 healthy older adults and 20 people with mild cognitive impairment (MCI). In two different conditions, a single 80 dB sound pressure level (SPL) auditory stimulus was presented every 1.5 s (fast condition) or every 12.0 s (slow condition). Participants were instructed to watch a silent video and ignore the auditory stimuli. Auditory processing thus occurred passively. When the auditory stimuli were presented rapidly (every 1.5 s), N1 and P2 amplitudes did not differ between the two groups. When the stimuli were presented very slowly, the amplitude of N1 and P2 increased in both groups and their latencies were prolonged. The amplitude of N1 did not significantly differ between the two groups. However, the subsequent positivity was reduced in people with MCI compared to healthy older adults. This late positivity in the slow condition may reflect a delayed P2 or a summation of a composite P2 + P3a. In people with MCI, the priority of processing may not be switched from the visual task to the potentially much more relevant auditory input. ERPs offer promise as a means to identify the pathology underlying cognitive impairment associated with MCI.

Hearing and dementia: from ears to brain

The association between hearing impairment and dementia has emerged as a major public health challenge, with significant opportunities for earlier diagnosis, treatment and prevention. However, the nature of this association has not been defined. We hear with our brains, particularly within the complex soundscapes of everyday life: neurodegenerative pathologies target the auditory brain, and are therefore predicted to damage hearing function early and profoundly. Here we present evidence for this proposition, based on structural and functional features of auditory brain organization that confer vulnerability to neurodegeneration, the extensive, reciprocal interplay between 'peripheral' and 'central' hearing dysfunction, and recently characterized auditory signatures of canonical neurodegenerative dementias (Alzheimer's disease, Lewy body disease and frontotemporal dementia). Moving beyond any simple dichotomy of ear and brain, we argue for a reappraisal of the role of auditory cognitive dysfunction and the critical coupling of brain to peripheral organs of hearing in the dementias. We call for a clinical assessment of real-world hearing in these diseases that moves beyond pure tone perception to the development of novel auditory 'cognitive stress tests' and proximity markers for the early diagnosis of dementia and management strategies that harness retained auditory plasticity.

Cognitive performance and long-latency auditory evoked potentials: a study on aging

OBJECTIVE

To evaluate the relationship between cognitive performance and long-latency auditory evoked potentials in an elderly population.

METHODS

The sample consisted of adults between 20 and 58 years of age and elderly adults between 60 and 70 years of age. The screening procedures adopted were an inspection of the external auditory canal, tonal and vocal audiometry, tympanometry, brain stem auditory evoked potential, the Montreal Cognitive Assessment test, and long-latency auditory evoked potential.

RESULTS

The latency and amplitude values of cortical components by age group showed significant differences under the following conditions: (i) signals evoked by the speech stimulus /da/ and by the pure-tone stimulus at 2,000 Hz for the N2 amplitude (p=0.008 and p=0.001, respectively) , which were both higher for adults, and (ii) signals evoked by the speech stimulus /da/ for N1 latency (p=0.018) and by the pure-tone stimulus at 2,000 Hz for P2 latency (p=0.017), which were both higher in the elderly population. The cognitive component (P300) showed a significant difference when evoked by speech stimuli, with higher latency in the elderly population (p=0.013). When correlated with cognitive processes, the latency and amplitude of cortical potentials showed direct and medium-strength correlations between abnormal scores obtained on the Montreal Cognitive Assessment test and P2 amplitude (p<0.001 and r=0.452).

CONCLUSION

There is a relationship between long-latency potentials and cognitive performance in the elderly, which was observed by the increase in the P2 amplitude and the impairment of the process of sound decoding.

Cognitive Event-Related Potential Responses Differentiate Older Adults with and without Probable Mild Cognitive Impairment

Background: Older adults rarely seek cognitive assessment, but often visit other healthcare professionals (e.g., audiologists). Noninvasive clinical measures within the scopes of practice of those professions sensitive to cognitive impairment are needed. Purpose: This study examined the differences of probable mild cognitive impairment (MCI) on latency and mean amplitude of the P3b auditory event-related potential. Method: Fifty-four participants comprised two groups according to cognitive status (cognitively normal older adults [CNOA], n = 25; probable MCI, n = 29). P3b was recorded using an oddball paradigm for speech (/ba/, /da/) and non-speech (1000, 2000 Hz) stimuli. Amplitudes and latencies were compared from six electrodes (FPz, Fz, FCz, Cz, CPz, Pz) between groups across stimulus probability and type. Results: CNOA participants had larger P3b mean amplitudes for deviant stimuli than those with probable MCI. Group effects of latency were isolated to deviant stimuli at FCz only when those with unclear P3bs were included. Findings did not covary with age or education. Overall, CNOAs showed a large P3b oddball effect while those with probable MCI did not. Conclusions: P3b can be used to show electrophysiological differences between older adults with and without probable MCI. These results support the development of educational materials targeting professionals using auditory-evoked potentials.

Factors influencing classification of frequency following responses to speech and music stimuli

Successful mapping of meaningful labels to sound input requires accurate representation of that sound's acoustic variances in time and spectrum. For some individuals, such as children or those with hearing loss, having an objective measure of the integrity of this representation could be useful. Classification is a promising machine learning approach which can be used to objectively predict a stimulus label from the brain response. This approach has been previously used with auditory evoked potentials (AEP) such as the frequency following response (FFR), but a number of key issues remain unresolved before classification can be translated into clinical practice. Specifically, past efforts at FFR classification have used data from a given subject for both training and testing the classifier. It is also unclear which components of the FFR elicit optimal classification accuracy. To address these issues, we recorded FFRs from 13 adults with normal hearing in response to speech and music stimuli. We compared labeling accuracy of two cross-validation classification approaches using FFR data: (1) a more traditional method combining subject data in both the training and testing set, and (2) a "leave-one-out" approach, in which subject data is classified based on a model built exclusively from the data of other individuals. We also examined classification accuracy on decomposed and time-segmented FFRs. Our results indicate that the accuracy of leave-one-subject-out cross validation approaches that obtained in the more conventional cross-validation classifications while allowing a subject's results to be analysed with respect to normative data pooled from a separate population. In addition, we demonstrate that classification accuracy is highest when the entire FFR is used to train the classifier. Taken together, these efforts contribute key steps toward translation of classification-based machine learning approaches into clinical practice.

Eigenvector alignment: Assessing functional network changes in amnestic mild cognitive impairment and Alzheimer's disease

Eigenvector alignment, introduced herein to investigate human brain functional networks, is adapted from methods developed to detect influential nodes and communities in networked systems. It is used to identify differences in the brain networks of subjects with Alzheimer’s disease (AD), amnestic Mild Cognitive Impairment (aMCI) and healthy controls (HC). Well-established methods exist for analysing connectivity networks composed of brain regions, including the widespread use of centrality metrics such as eigenvector centrality. However, these metrics provide only limited information on the relationship between regions, with this understanding often sought by comparing the strength of pairwise functional connectivity. Our holistic approach, eigenvector alignment, considers the impact of all functional connectivity changes before assessing the strength of the functional relationship, i.e. alignment, between any two regions. This is achieved by comparing the placement of regions in a Euclidean space defined by the network’s dominant eigenvectors. Eigenvector alignment recognises the strength of bilateral connectivity in cortical areas of healthy control subjects, but also reveals degradation of this commissural system in those with AD. Surprisingly little structural change is detected for key regions in the Default Mode Network, despite significant declines in the functional connectivity of these regions. In contrast, regions in the auditory cortex display significant alignment changes that begin in aMCI and are the most prominent structural changes for those with AD. Alignment differences between aMCI and AD subjects are detected, including notable changes to the hippocampal regions. These findings suggest eigenvector alignment can play a complementary role, alongside established network analytic approaches, to capture how the brain’s functional networks develop and adapt when challenged by disease processes such as AD.

Decoding Hearing-Related Changes in Older Adults' Spatiotemporal Neural Processing of Speech Using Machine Learning

Speech perception in noisy environments depends on complex interactions between sensory and cognitive systems. In older adults, such interactions may be affected, especially in those individuals who have more severe age-related hearing loss. Using a data-driven approach, we assessed the temporal (when in time) and spatial (where in the brain) characteristics of cortical speech-evoked responses that distinguish older adults with or without mild hearing loss. We performed source analyses to estimate cortical surface signals from the EEG recordings during a phoneme discrimination task conducted under clear and noise-degraded conditions. We computed source-level ERPs (i.e., mean activation within each ROI) from each of the 68 ROIs of the Desikan-Killiany (DK) atlas, averaged over a randomly chosen 100 trials without replacement to form feature vectors. We adopted a multivariate feature selection method called stability selection and control to choose features that are consistent over a range of model parameters. We use parameter optimized support vector machine (SVM) as a classifiers to investigate the time course and brain regions that segregate groups and speech clarity. For clear speech perception, whole-brain data revealed a classification accuracy of 81.50% [area under the curve (AUC) 80.73%; F1-score 82.00%], distinguishing groups within ∼60 ms after speech onset (i.e., as early as the P1 wave). We observed lower accuracy of 78.12% [AUC 77.64%; F1-score 78.00%] and delayed classification performance when speech was embedded in noise, with group segregation at 80 ms. Separate analysis using left (LH) and right hemisphere (RH) regions showed that LH speech activity was better at distinguishing hearing groups than activity measured in the RH. Moreover, stability selection analysis identified 12 brain regions (among 1428 total spatiotemporal features from 68 regions) where source activity segregated groups with >80% accuracy (clear speech); whereas 16 regions were critical for noise-degraded speech to achieve a comparable level of group segregation (78.7% accuracy). Our results identify critical time-courses and brain regions that distinguish mild hearing loss from normal hearing in older adults and confirm a larger number of active areas, particularly in RH, when processing noise-degraded speech information.

Voice quality and speech fluency distinguish individuals with Mild Cognitive Impairment from Healthy Controls

Mild Cognitive Impairment (MCI) is a syndrome characterized by cognitive decline greater than expected for an individual's age and education level. This study aims to determine whether voice quality and speech fluency distinguish patients with MCI from healthy individuals to improve diagnosis of patients with MCI. We analyzed recordings of the Cookie Theft picture description task produced by 26 patients with MCI and 29 healthy controls from Sweden and calculated measures of voice quality and speech fluency. The results show that patients with MCI differ significantly from HC with respect to acoustic aspects of voice quality, namely H1-A3, cepstral peak prominence, center of gravity, and shimmer; and speech fluency, namely articulation rate and averaged speaking time. The method proposed along with the obtainability of connected speech productions can enable quick and easy analysis of speech fluency and voice quality, providing accessible and objective diagnostic markers of patients with MCI.

Effects of cTBS on the Frequency-Following Response and Other Auditory Evoked Potentials

The frequency-following response (FFR) is an auditory evoked potential (AEP) that follows the periodic characteristics of a sound. Despite being a widely studied biosignal in auditory neuroscience, the neural underpinnings of the FFR are still unclear. Traditionally, FFR was associated with subcortical activity, but recent evidence suggested cortical contributions which may be dependent on the stimulus frequency. We combined electroencephalography (EEG) with an inhibitory transcranial magnetic stimulation protocol, the continuous theta burst stimulation (cTBS), to disentangle the cortical contribution to the FFR elicited to stimuli of high and low frequency. We recorded FFR to the syllable /ba/ at two fundamental frequencies (Low: 113 Hz; High: 317 Hz) in healthy participants. FFR, cortical potentials, and auditory brainstem response (ABR) were recorded before and after real and sham cTBS in the right primary auditory cortex. Results showed that cTBS did not produce a significant change in the FFR recorded, in any of the frequencies. No effect was observed in the ABR and cortical potentials, despite the latter known contributions from the auditory cortex. Possible reasons behind the negative results include compensatory mechanisms from the non-targeted areas, intraindividual variability of the cTBS effectiveness, and the particular location of our target area, the primary auditory cortex.

5XFAD mice show early-onset gap encoding deficits in the auditory cortex

Early detection will be crucial for effective treatment or prevention of Alzheimer's disease. The identification and validation of early, noninvasive biomarkers is therefore key to avoiding the most devastating aspects of Alzheimer's disease. Measures of central auditory processing such as gap detection have recently emerged as potential biomarkers in both human patients and the 5XFAD mouse model of Alzheimer's disease. Full validation of gap detection deficits as a biomarker will require detailed understanding of the underlying neuropathology, including which brain structures are involved and how the operation of neural circuits is affected. Here we show that 5XFAD mice exhibit gap detection deficits as early as 2 months of age, well before development of Alzheimer's disease-associated pathology. We then examined responses of neurons in the auditory cortex to gaps in white noise. Both gap responses and baseline firing rates were robustly and progressively degraded in 5XFAD mice compared to littermate controls. These impairments were first evident at 2-4 months of age in males, and 4-6 months in females. This demonstrates early-onset impairments to the central auditory system, which could be due to damage in the auditory cortex, upstream subcortical structures, or both.

Hearing Aids Do Not Alter Cortical Entrainment to Speech at Audible Levels in Mild-to-Moderately Hearing-Impaired Subjects

BACKGROUND

Cortical entrainment to speech correlates with speech intelligibility and attention to a speech stream in noisy environments. However, there is a lack of data on whether cortical entrainment can help in evaluating hearing aid fittings for subjects with mild to moderate hearing loss. One particular problem that may arise is that hearing aids may alter the speech stimulus during (pre-)processing steps, which might alter cortical entrainment to the speech. Here, the effect of hearing aid processing on cortical entrainment to running speech in hearing impaired subjects was investigated.

METHODOLOGY

Seventeen native English-speaking subjects with mild-to-moderate hearing loss participated in the study. Hearing function and hearing aid fitting were evaluated using standard clinical procedures. Participants then listened to a 25-min audiobook under aided and unaided conditions at 70 dBA sound pressure level (SPL) in quiet conditions. EEG data were collected using a 32-channel system. Cortical entrainment to speech was evaluated using decoders reconstructing the speech envelope from the EEG data. Null decoders, obtained from EEG and the time-reversed speech envelope, were used to assess the chance level reconstructions. Entrainment in the delta- (1-4 Hz) and theta- (4-8 Hz) band, as well as wideband (1-20 Hz) EEG data was investigated.

RESULTS

Significant cortical responses could be detected for all but one subject in all three frequency bands under both aided and unaided conditions. However, no significant differences could be found between the two conditions in the number of responses detected, nor in the strength of cortical entrainment. The results show that the relatively small change in speech input provided by the hearing aid was not sufficient to elicit a detectable change in cortical entrainment.

CONCLUSION

For subjects with mild to moderate hearing loss, cortical entrainment to speech in quiet at an audible level is not affected by hearing aids. These results clear the pathway for exploring the potential to use cortical entrainment to running speech for evaluating hearing aid fitting at lower speech intensities (which could be inaudible when unaided), or using speech in noise conditions.

Sensor-based systems for early detection of dementia (SENDA): a study protocol for a prospective cohort sequential study

Background

Dementia and cognitive decline are serious social and economic burdens. An increase in the population of older people, as well as longer lifespans mean that numbers of dementia cases are exponentially rising. Neuropathological changes associated with dementia are thought to appear before the clinical manifestation of cognitive symptoms, i.e., memory impairments. Further, some older adults (OA) experience cognitive decline before it can be objectively diagnosed. For optimal care of these patients, it is necessary to detect cognitive decline and dementia at an early stage. In this vein, motor, sensory, and neurophysiological declines could be promising factors if found to be present before the onset of cognitive impairment. Hence, the objective of the SENDA study is to develop a multi-dimensional sensor-based instrument that allows early detection of cognitive decline or dementia in OA with the help of cognitive, sensory, motor, and neurophysiological parameters before its clinical manifestation.

Methods/design

In the cohort sequential study, participants are assigned to one of three study groups depending on their cognitive status: 1. cognitively healthy individuals (CHI), 2. subjectively cognitively impaired persons (SCI), or 3. (possible) mildly cognitively impaired persons (pMCI, MCI). All groups take part in the same cognitive (e.g., executive function tests), motor (e.g., gait analyses, balance tests), sensory (e.g., vibration perception threshold test, proprioception tests), and neurophysiological (e.g., electroencephalograms) measurements. Depending on the time at which participants are included into the study, all measurements are repeated up to four times in intervals of 8 months within 3 years to identify associations with cognitive changes over time.

Discussion

This study aims to detect possible motor, sensory, neurophysiological, and cognitive predictors to develop an early screening tool for dementia and its pre-stages in OA. Thus, affected persons could receive optimal health care at an earlier time point to maintain their health resources.

Trial status

The study is ongoing. The recruitment of participants will be continued until May 2020.

Decoding of single-trial EEG reveals unique states of functional brain connectivity that drive rapid speech categorization decisions

OBJECTIVE

Categorical perception (CP) is an inherent property of speech perception. The response time (RT) of listeners' perceptual speech identification is highly sensitive to individual differences. While the neural correlates of CP have been well studied in terms of the regional contributions of the brain to behavior, functional connectivity patterns that signify individual differences in listeners' speed (RT) for speech categorization is less clear. In this study, we introduce a novel approach to address these questions.

APPROACH

We applied several computational approaches to the EEG, including graph mining, machine learning (i.e., support vector machine), and stability selection to investigate the unique brain states (functional neural connectivity) that predict the speed of listeners' behavioral decisions.

MAIN RESULTS

We infer that (i) the listeners' perceptual speed is directly related to dynamic variations in their brain connectomics, (ii) global network assortativity and efficiency distinguished fast, medium, and slow RTs, (iii) the functional network underlying speeded decisions increases in negative assortativity (i.e., became disassortative) for slower RTs, (iv) slower categorical speech decisions cause excessive use of neural resources and more aberrant information flow within the CP circuitry, (v) slower responders tended to utilize functional brain networks excessively (or inappropriately) whereas fast responders (with lower global efficiency) utilized the same neural pathways but with more restricted organization.

SIGNIFICANCE

Findings show that neural classifiers (SVM) coupled with stability selection correctly classify behavioral RTs from functional connectivity alone with over 92% accuracy (AUC  =  0.9). Our results corroborate previous studies by supporting the engagement of similar temporal (STG), parietal, motor, and prefrontal regions in CP using an entirely data-driven approach.

Age-related hearing loss increases full-brain connectivity while reversing directed signaling within the dorsal-ventral pathway for speech

Speech comprehension difficulties are ubiquitous to aging and hearing loss, particularly in noisy environments. Older adults' poorer speech-in-noise (SIN) comprehension has been related to abnormal neural representations within various nodes (regions) of the speech network, but how senescent changes in hearing alter the transmission of brain signals remains unspecified. We measured electroencephalograms in older adults with and without mild hearing loss during a SIN identification task. Using functional connectivity and graph-theoretic analyses, we show that hearing-impaired (HI) listeners have more extended (less integrated) communication pathways and less efficient information exchange among widespread brain regions (larger network eccentricity) than their normal-hearing (NH) peers. Parameter optimized support vector machine classifiers applied to EEG connectivity data showed hearing status could be decoded (> 85% accuracy) solely using network-level descriptions of brain activity, but classification was particularly robust using left hemisphere connections. Notably, we found a reversal in directed neural signaling in left hemisphere dependent on hearing status among specific connections within the dorsal-ventral speech pathways. NH listeners showed an overall net "bottom-up" signaling directed from auditory cortex (A1) to inferior frontal gyrus (IFG; Broca's area), whereas the HI group showed the reverse signal (i.e., "top-down" Broca's → A1). A similar flow reversal was noted between left IFG and motor cortex. Our full-brain connectivity results demonstrate that even mild forms of hearing loss alter how the brain routes information within the auditory-linguistic-motor loop.

Afferent-efferent connectivity between auditory brainstem and cortex accounts for poorer speech-in-noise comprehension in older adults

Speech-in-noise (SIN) comprehension deficits in older adults have been linked to changes in both subcortical and cortical auditory evoked responses. However, older adults' difficulty understanding SIN may also be related to an imbalance in signal transmission (i.e., functional connectivity) between brainstem and auditory cortices. By modeling high-density scalp recordings of speech-evoked responses with sources in brainstem (BS) and bilateral primary auditory cortices (PAC), we show that beyond attenuating neural activity, hearing loss in older adults compromises the transmission of speech information between subcortical and early cortical hubs of the speech network. We found that the strength of afferent BS→PAC neural signaling (but not the reverse efferent flow; PAC→BS) varied with mild declines in hearing acuity and this "bottom-up" functional connectivity robustly predicted older adults' performance in a SIN identification task. Connectivity was also a better predictor of SIN processing than unitary subcortical or cortical responses alone. Our neuroimaging findings suggest that in older adults (i) mild hearing loss differentially reduces neural output at several stages of auditory processing (PAC > BS), (ii) subcortical-cortical connectivity is more sensitive to peripheral hearing loss than top-down (cortical-subcortical) control, and (iii) reduced functional connectivity in afferent auditory pathways plays a significant role in SIN comprehension problems.

Cortical auditory evoked potentials in mild cognitive impairment: Evidence from a temporal-spatial principal component analysis

Mild cognitive impairment (MCI) is considered an intermediate transitional stage for the development of dementia, especially Alzheimer's disease. The identification of neurophysiological biomarkers for MCI will allow improvement in detecting and tracking the progression of cognitive impairment. The primary objective of this study was to compare cortical auditory evoked potentials between older adults with and without probable MCI to identify potential neurophysiological indicators of cognitive impairment. We applied a temporal-spatial principal component analysis to the evoked potentials achieved during the processing of pure tones and speech sounds, to facilitate the separation of the components of the P1-N1-P2 complex. The probable MCI group showed a significant amplitude increase in a factor modeling N1b for speech sounds (Cohen's d = .84) and a decrease in a factor around the P2 time interval, especially for pure tones (Cohen's d = 1.17). Moreover, both factors showed a fair discrimination value between groups (area under the curve [AUC] = .698 for N1b in speech condition; AUC = .746 for P2 in tone condition), with high sensitivity to detect MCI cases (86% and 91%, respectively). The results for N1b suggest that MCI participants may suffer from a deficit to inhibit irrelevant speech information, and the decrease of P2 amplitude could be a signal of cholinergic hypoactivation. Therefore, both components could be proposed as early biomarkers of cognitive impairment.

Acoustic noise and vision differentially warp the auditory categorization of speech

Speech perception requires grouping acoustic information into meaningful linguistic-phonetic units via categorical perception (CP). Beyond shrinking observers' perceptual space, CP might aid degraded speech perception if categories are more resistant to noise than surface acoustic features. Combining audiovisual (AV) cues also enhances speech recognition, particularly in noisy environments. This study investigated the degree to which visual cues from a talker (i.e., mouth movements) aid speech categorization amidst noise interference by measuring participants' identification of clear and noisy speech (0 dB signal-to-noise ratio) presented in auditory-only or combined AV modalities (i.e., A, A+noise, AV, AV+noise conditions). Auditory noise expectedly weakened (i.e., shallower identification slopes) and slowed speech categorization. Interestingly, additional viseme cues largely counteracted noise-related decrements in performance and stabilized classification speeds in both clear and noise conditions suggesting more precise acoustic-phonetic representations with multisensory information. Results are parsimoniously described under a signal detection theory framework and by a reduction (visual cues) and increase (noise) in the precision of perceptual object representation, which were not due to lapses of attention or guessing. Collectively, findings show that (i) mapping sounds to categories aids speech perception in "cocktail party" environments; (ii) visual cues help lattice formation of auditory-phonetic categories to enhance and refine speech identification.

Predicting Speech Recognition Using the Speech Intelligibility Index and Other Variables for Cochlear Implant Users

Purpose Although the speech intelligibility index (SII) has been widely applied in the field of audiology and other related areas, application of this metric to cochlear implants (CIs) has yet to be investigated. In this study, SIIs for CI users were calculated to investigate whether the SII could be an effective tool for predicting speech perception performance in a population with CI. Method Fifteen pre- and postlingually deafened adults with CI participated. Speech recognition scores were measured using the AzBio sentence lists. CI users also completed questionnaires and performed psychoacoustic (spectral and temporal resolution) and cognitive function (digit span) tests. Obtained SIIs were compared with predicted SIIs using a transfer function curve. Correlation and regression analyses were conducted on perceptual and demographic predictor variables to investigate the association between these factors and speech perception performance. Result Because of the considerably poor hearing and large individual variability in performance, the SII did not predict speech performance for this CI group using the traditional calculation. However, new SII models were developed incorporating predictive factors, which improved the accuracy of SII predictions in listeners with CI. Conclusion Conventional SII models are not appropriate for predicting speech perception scores for CI users. Demographic variables (aided audibility and duration of deafness) and perceptual-cognitive skills (gap detection and auditory digit span outcomes) are needed to improve the use of the SII for listeners with CI. Future studies are needed to improve our CI-corrected SII model by considering additional predictive factors. Supplemental Material https://doi.org/10.23641/asha.8057003.

A Single-Channel EEG-Based Approach to Detect Mild Cognitive Impairment via Speech-Evoked Brain Responses

Mild cognitive impairment (MCI) is the preliminary stage of dementia, which may lead to Alzheimer's disease (AD) in the elderly people. Therefore, early detection of MCI has the potential to minimize the risk of AD by ensuring the proper mental health care before it is too late. In this paper, we demonstrate a single-channel EEG-based MCI detection method, which is cost-effective and portable, and thus suitable for regular home-based patient monitoring. We collected the scalp EEG data from 23 subjects, while they were stimulated with five auditory speech signals. The cognitive state of the subjects was evaluated by the Montreal cognitive assessment test (MoCA). We extracted 590 features from the event-related potential (ERP) of the collected EEG signals, which included time and spectral domain characteristics of the response. The top 25 features, ranked by the random forest method, were used for classification models to identify subjects with MCI. Robustness of our model was tested using leave-one-out cross-validation while training the classifiers. Best results (leave-one-out cross-validation accuracy 87.9%, sensitivity 84.8%, specificity 95%, and F score 85%) were obtained using support vector machine (SVM) method with radial basis kernel (RBF) (sigma = 10/cost = 10² ). Similar performances were also observed with logistic regression (LR), further validating the results. Our results suggest that single-channel EEG could provide a robust biomarker for early detection of MCI.

5XFAD Mice Show Early Onset Gap Detection Deficits

Alzheimer's patients show auditory temporal processing deficits very early in disease progression, before the onset of major cognitive impairments. In addition to potentially contributing to speech perception and communication deficits in patients, this also represents a potential early biomarker for Alzheimer's. For this reason, tests of temporal processing such as gap detection have been proposed as an early diagnosis tool. For a biomarker such as gap detection deficits to have maximum clinical value, it is important to understand what underlying neuropathology it reflects. For example, temporal processing deficits could arise from alterations at cortical, midbrain, or brainstem levels. Mouse models of Alzheimer's disease can provide the ability to reveal in detail the molecular and circuit pathology underlying disease symptoms. Here we tested whether 5XFAD mice, a leading Alzheimer's mouse model, exhibit impaired temporal processing. We found that 5XFAD mice showed robust gap detection deficits. Gap detection deficits were first detectable at about 2 months of age and became progressively worse, especially for males and for longer gap durations. We conclude that 5XFAD mice are well-suited to serve as a model for understanding the circuit mechanisms that contribute to Alzheimer's-related gap detection deficits.

Music and Visual Art Training Modulate Brain Activity in Older Adults

Cognitive decline is an unavoidable aspect of aging that impacts important behavioral and cognitive skills. Training programs can improve cognition, yet precise characterization of the psychological and neural underpinnings supporting different training programs is lacking. Here, we assessed the effect and maintenance (3-month follow-up) of 3-month music and visual art training programs on neuroelectric brain activity in older adults using a partially randomized intervention design. During the pre-, post-, and follow-up test sessions, participants completed a brief neuropsychological assessment. High-density EEG was measured while participants were presented with auditory oddball paradigms (piano tones, vowels) and during a visual GoNoGo task. Neither training program significantly impacted psychometric measures, compared to a non-active control group. However, participants enrolled in the music and visual art training programs showed enhancement of auditory evoked responses to piano tones that persisted for up to 3 months after training ended, suggesting robust and long-lasting neuroplastic effects. Both music and visual art training also modulated visual processing during the GoNoGo task, although these training effects were relatively short-lived and disappeared by the 3-month follow-up. Notably, participants enrolled in the visual art training showed greater changes in visual evoked response (i.e., N1 wave) amplitude distribution than those from the music or control group. Conversely, those enrolled in music showed greater response associated with inhibitory control over the right frontal scalp areas than those in the visual art group. Our findings reveal a causal relationship between art training (music and visual art) and neuroplastic changes in sensory systems, with some of the neuroplastic changes being specific to the training regimen.

Hearing impairment and the risk of neurodegenerative dementia: A longitudinal follow-up study using a national sample cohort

This study aimed to explore the risk of dementia in a middle- and older-aged population with severe or profound hearing impairments. Data were collected for the Korean National Health Insurance Service-National Sample Cohort from 2002 to 2013. Participants aged 40 or older were selected. The 4,432 severely hearing-impaired participants were matched 1:4 with 17,728 controls, and the 958 profoundly hearing-impaired participants were matched 1:4 with 3,832 controls who had not reported any hearing impairment. Age, sex, income, region of residence, hypertension, diabetes mellitus, and dyslipidemia histories were matched between hearing-impaired and control groups. The crude (simple) and adjusted (age, sex, income, region of residence, dementia, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, cerebrovascular disease, and depression) hazard ratios (HRs) of hearing impairment on dementia were analyzed using Cox-proportional hazard models. The severe hearing impairment group showed an increased risk of dementia (adjusted HR = 1.17, 95% confidence interval [CI] = 1.04–1.31, P = 0.010). The profound hearing impairment group also showed an increased risk of dementia (adjusted HR = 1.51, 95% CI = 1.14–2.00, P = 0.004). Both severe and profound hearing impairments were associated with elevated the risk of dementia in middle- and older-aged individuals.