Hearing Loss and Cognition Among Older Adults in a Han Chinese Cohort

Analysis of the Spanish Auditory Test of Speech in Noise (PAHRE) in a Population with Hearing Loss

BACKGROUND

Speech recognition in noise is one of the difficulties faced by people with hearing loss that increases with age. The recently developed Spanish Auditory Test of Speech in Noise (Prueba Auditiva de Habla en Ruido en Español, PAHRE) allows for the identification of these intelligibility difficulties in noise. The aim of this study was to assess speech recognition in noise in people with hearing loss and to test the benefits of the Lombard effect.

METHODS

The participants were 104 people with hearing difficulties, ranging in age from 37 to 98 years. The variables age, degree of hearing loss, presence of high-frequency dropout, and years of formal education were assessed.

RESULTS

Psychometric curves were obtained as a function of signal-to-noise ratio as well as threshold values of speech reception as a function of age group for mild and moderate hearing loss. The results indicated that the speech reception threshold increased with both age and the degree of hearing loss, becoming particularly significant after the age of 70. Furthermore, it was found that the combined factors of age, degree of hearing loss, and educational level predicted a high percentage of the variability in the speech reception threshold.

CONCLUSIONS

Therefore, the Spanish Auditory Test of Speech in Noise could be a useful clinical tool for diagnosis, monitoring, auditory rehabilitation planning, and hearing aid fitting.

Alpha and theta oscillations on a visual strategic processing task in age-related hearing loss

Introduction

Emerging evidence suggests changes in several cognitive control processes in individuals with age-related hearing loss (ARHL). However, value-directed strategic processing, which involves selectively processing salient information based on high value, has been relatively unexplored in ARHL. Our previous work has shown behavioral changes in strategic processing in individuals with ARHL. The current study examined event-related alpha and theta oscillations linked to a visual, value-directed strategic processing task in 19 individuals with mild untreated ARHL and 17 normal hearing controls of comparable age and education.

Methods

Five unique word lists were presented where words were assigned high- or low-value based on the letter case, and electroencephalography (EEG) data was recorded during task performance.

Results

The main effect of the group was observed in early time periods. Specifically, greater theta synchronization was seen in the ARHL group relative to the control group. Interaction between group and value was observed at later time points, with greater theta synchronization for high- versus low-value information in those with ARHL.

Discussion

Our findings provide evidence for oscillatory changes tied to a visual task of value-directed strategic processing in individuals with mild untreated ARHL. This points towards modality-independent neurophysiological changes in cognitive control in individuals with mild degrees of ARHL and adds to the rapidly growing literature on the cognitive consequences of ARHL.

The Self-Stigma of Hearing Loss in Adults and Older Adults: A Systematic Review

OBJECTIVES

Previous studies have demonstrated that individuals with hearing loss can internalize social stigmas, resulting in several self-perceived negative connotations, such as incompetence, cognitive impairment, and social disability. This systematic review aimed to investigate the impact of the social stigma associated with hearing loss on the self-stigma experienced by adults and older adults.

DESIGN

Combinations of words and appropriate truncations were selected and adjusted specifically for each electronic database. The Population, Exposure, Comparator, Outcomes, and Study Characteristics strategy was used to delimit the scope of the review, bearing in mind the importance of a well-formulated research question.

RESULTS

A total of 953 articles were retrieved from the final search of each database. Thirty-four studies were selected for full-text reading. Thirteen were excluded, and 21 studies were ultimately included in this review. The results of this review were divided into three themes: (1) impact of social stigmas on self-stigma, (2) effect of emotions on self-stigma, and (3) other factors that impact self-stigma. The themes were related to the relationship between the individual and social perceptions reported by the participants with respect to their hearing experiences.

CONCLUSIONS

Our results suggest that the impact of social stigma associated with hearing loss on the self-stigma of adults and older adults is strongly associated with the effects of aging and hearing loss, which may lead to withdrawal, social segregation, and negative self-perception.

Hearing loss, depression, and cognition in younger and older adult CI candidates

Background and Aim

Hearing loss in old age is associated with cognitive decline and with depression. Our study aimed to investigate the relationship between hearing loss, cognitive decline, and secondary depressive symptoms in a sample of younger and older cochlear implant candidates with profound to severe hearing loss.

Methods

This study is part of a larger cohort study designated to provide information on baseline data before CI. Sixty-one cochlear implant candidates with hearing loss from adulthood onwards (>18 years) were enrolled in this study. All had symmetrical sensorineural hearing loss in both ears (four-frequency hearing threshold difference of no more than 20 dB, PTA). Individuals with primary affective disorders, psychosis, below-average intelligence, poor German language skills, visual impairment, and a medical diagnosis with potential impact on cognition (e.g., neurodegenerative diseases,) were excluded. Four-frequency hearing thresholds (dB, PTA, better ear) were collected. Using the Abbreviated Profile of Hearing Aid Benefit, we assessed subjective hearing in noise. Clinical and subclinical depressive symptoms were assessed with the Beck Depression Inventory (BDI II). Cognitive status was assessed with a neurocognitive test battery.

Results

Our findings revealed a significant negative association between subjective hearing in noise (APHAB subscale "Background Noise") and BDII. However, we did not observe any link between hearing thresholds, depression, and cognition. Additionally, no differences emerged between younger (25-54 years) and older subjects (55-75 years). Unexpectedly, further unplanned analyses unveiled correlations between subjective hearing in quiet environments (APHAB) and cognitive performance [phonemic fluency (Regensburg Word Fluency), cognitive flexibility (TMTB), and nonverbal episodic memory (Nonverbal Learning Test), as well as subjective hearing of aversive/loud sounds (APHAB)], cognitive performance [semantic word fluency (RWT), and inhibition (Go/Nogo) and depression]. Duration of hearing loss and speech recognition at quiet (Freiburg Monosyllables) were not related to depression and cognitive performance.

Conclusion

Impact of hearing loss on mood and cognition appears to be independent, suggesting a relationship with distinct aspects of hearing loss. These results underscore the importance of considering not only conventional audiometric measures like hearing thresholds but also variables related to hearing abilities during verbal communication in everyday life, both in quiet and noisy settings.

A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults

Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as "standard" despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services.

The longitudinal relationship between hearing loss and cognitive decline in tonal language-speaking older adults in China

Introduction

Previous longitudinal studies indicate that hearing loss and cognitive impairment are associated in non-tonal language-speaking older adults. This study aimed to investigate whether there is a longitudinal association between hearing loss and cognitive decline in older adults who speak a tonal language.

Methods

Chinese-speaking older adults aged 60 years and above were recruited for baseline and 12 month follow-up measurements. All participants completed a pure tone audiometric hearing test, Hearing Impaired-Montreal Cognitive Assessment Test (HI-MoCA), and a Computerized Neuropsychological Test Battery (CANTAB). The De Jong Gierveld Loneliness Scale was used to measure loneliness, and the 21-item Depression Anxiety Stress Scale (DASS-21) was used to measure aspects of mental health. Associations between baseline hearing loss and various cognitive, mental and psychosocial measures were evaluated using logistic regression.

Results

A total of 71 (29.6%) of the participants had normal hearing, 70 (29.2%) had mild hearing loss, and 99 (41.2%) had moderate or severe hearing loss at baseline, based on mean hearing thresholds in the better ear. After adjusting for demographic and other factors, baseline moderate/severe audiometric hearing loss was associated with an increased risk of cognitive impairment at follow-up (OR: 2.20, 95% CI: 1.06, 4.50). When pure-tone average (PTA) was modeled continuously, an average difference of 0.24 in HI-MoCA scores for every 10 dB increase in BE4FA existed, and an average difference of 0.07 in the change of HI-MoCA scores in a 12 month period.

Discussion

The results revealed a significant longitudinal relationship between age-related hearing loss and cognitive decline in this cohort of tonal language-speaking older adults. Steps should also be taken to incorporate hearing assessment and cognitive screening in clinical protocols for older adults 60 years and above in both hearing and memory clinics.

The Relationship of Age-Related Hearing Loss with Cognitive Decline and Dementia in a Sinitic Language-Speaking Adult Population: A Systematic Review and Meta-Analysis

Background and Objectives

Substantial evidence supports the association between untreated hearing loss, cognitive decline, and dementia in the non-tonal language-speaking population. Whether a similar association between hearing loss and cognitive decline and dementia exists in Sinitic tonal language-speaking people is yet to be elucidated. We aimed to systematically review the current evidence on the association between hearing loss and cognitive impairment/decline, and dementia in older adults who speak a Sinitic tonal language.

Research Design and Methods

This systematic review considered peer-reviewed articles that employed objective or subjective hearing measurement and cognitive function, cognitive impairment, or diagnosis of dementia. All articles written in English and Chinese and published before March 2022 were included. Databases including Embase, MEDLINE, Web of Science, PsycINFO and Google Scholar, SinoMed, and CBM were utilized using MeSH terms and keywords.

Results

Thirty-five articles met our inclusion criteria. Of these, 29 unique studies with an estimated 372,154 participants were included in the meta-analyses. Among all included studies, the effect size of cognitive function with hearing loss, the regression coefficient was -0.26 (95% confidence interval [CI], -0.45 to -0.07). Among cross-sectional and cohort studies, a significant association was found between hearing loss and cognitive impairment and dementia, with odds ratios of 1.85 (95% CI, 1.59-2.17) and 1.89 (95% CI, 1.50-2.38), respectively.

Discussion and Implications

Most of the studies included in this systematic review observed a significant association between hearing loss and cognitive impairment and dementia. There was no significant difference to the findings in non-tonal language populations.

Genome-wide DNA methylation analysis of middle-aged and elderly monozygotic twins with age-related hearing loss in Qingdao, China

OBJECTIVE

To explore the differences in DNA methylation associated with age-related hearing loss in a study of 57 twin pairs from China.

DESIGN

Monozygotic twins were identified through the Qingdao Twin Registration system. The median age of participants was >50 years. Their hearing thresholds were measured using a multilevel pure-tone audiometry assessment. The pure-tone audiometry was calculated at low frequencies (0.5, 1.0, and 2.0 kHz), speech frequencies (0.5, 1.0, 2.0, and 4.0kHz), and high frequencies (4.0 and 8 kHz). The CpG sites were tested using a linear mixed-effects model, and the function of the cis-regulatory regions and ontological enrichments were predicted using the online Genomic Regions Enrichment of Annotations Tool. The differentially methylated regions were identified using a comb-p python library approach.

RESULTS

In each of the PTA categories (low-, speech-, high-frequency), age-related hearing loss was detected in 25.9%, 19.3%, and 52.8% of participants. In the low-, speech- and high-frequency categories we identified 18, 42, and 12 individual CpG sites and 6, 11, and 6 differentially methylated regions. The CpG site located near DUSP4 had the strongest association with low- and speech-frequency, while the strongest association with high-frequency was near C21orf58. We identified associations of ALG10 with high-frequency hearing, C3 and LCK with low- and speech-frequency hearing, and GBX2 with low-frequency hearing. Top pathways that may be related to hearing, such as the Notch signaling pathway, were also identified.

CONCLUSION

Our study is the first of its kind to identify these genes and their associated with DNA methylation may play essential roles in the hearing process. The results of our epigenome-wide association study on twins clarify the complex mechanisms underlying age-related hearing loss.

Relationship of age-related hearing loss with cognitive decline and dementia in Sinitic tonal language-speaking populations: protocol for a systematic review and meta-analysis

INTRODUCTION

Existing research on the potential association between age-related hearing loss (ARHL) and cognitive decline and dementia in tonal language-speaking populations is limited and inconsistent. There is psychophysiological evidence suggesting a tonal language background may be linked to enhanced general cognitive functions. We aim to systematically review the current evidence on the association between hearing loss and cognitive impairment/decline and dementia in older adults who speak a Sinitic tonal language, the most commonly spoken tonal language.

METHODS AND ANALYSIS

This systematic review will consider peer-reviewed articles that employ objective or subjective hearing measurement and cognitive impairment or diagnosis of dementia. All relevant research publications in English or Chinese and published up to March 2022 will be considered for inclusion. Embase, MEDLINE, Web of Science, PsycINFO Google Scholar, SinoMed and Chinese Biomedical Database will be used, using both medical subject heading terms and keywords. The quality of evidence of an association between ARHL and cognitive impairment and/or dementia will be evaluated by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. A random-effects meta-analysis will be carried out with the Comprehensive Meta-Analysis software.

ETHICS AND DISSEMINATION

Ethical approval will not be required for this systematic review. The results will be disseminated through peer-reviewed publications and conferences.

PROSPERO REGISTRATION NUMBER

CRD42021235310.

High-Frequency Cochlear Amplifier Dysfunction: A Dominating Contribution to the Cognitive-Ear Link

Objective: The objective of this study was to investigate the role of the high-frequency cochlear dysfunction in the cognitive-ear link.

Methods: Seventy-four presbycusis patients (PC group) and seventy-one age-, sex-, and education-level matched normal hearing controls (NH group) were recruited in this study. Participants underwent a battery of cognitive tests estimated by Montreal Cognitive Assessment (MoCA), Stroop Color-Word Interference Test (Stroop), Symbol Digit Modalities Test (SDMT), Auditory Verbal Learning Test (AVLT), and Trail-Making Test (TMT-A and B), as well as auditory tests including distortion product otoacoustic emission (DPOAE), pure tone (PT) thresholds, and speech reception thresholds (SRT). Data were analyzed using the factor analysis, partial correlation analysis, multiple linear regression models, and mediation models.

Results: Distortion product otoacoustic emission detection amplitudes and PT thresholds performed worse gradually from low to high frequencies in both the NH and PC groups. High-frequency DPOAE (H-DPOAE) was significantly correlated with cognitive domains in the PC group (AVLT: r = 0.30, p = 0.04; SDMT: r = 0.36, p = 0.01; Stroop: r = –0.32, p = 0.03; TMT-A: r = –0.40, p = 0.005; TMT-B: r = –0.34, p = 0.02). Multiple linear regression models showed that H-DPOAE predicted cognitive impairment effectively for aspects of memory (R2 = 0.27, 95% CI, 0.03 to 1.55), attention (R2 = 0.32, 95% CI, –6.18 to –0.40), processing speed (R2 = 0.37, 95% CI, 0.20 to 1.64), and executive function (TMT-A: R2 = 0.34, 95% CI, –5.52 to 1.03; TMT-B: R2 = 0.29, 95% CI, –11.30 to –1.12). H-DPOAE directly affected cognition and fully mediated the relationship between pure tone average (PTA)/SRT and cognitive test scores, excluding MoCA.

Conclusion: This study has demonstrated that the high-frequency cochlear amplifier dysfunction has a direct predictive effect on the cognitive decline and makes a large contribution to the cognitive-ear link.

Peripheral Hearing Loss and Its Association with Cognition among Ethnic Chinese Older Adults

INTRODUCTION

Many studies on hearing loss (HL) and cognition are limited by subjective hearing assessments and verbally administered cognition tests, the majority of the document findings in Western populations. This study aimed to assess the association of HL with cognitive impairment among ethnic Chinese Singaporean older adults using visually presented cognitive tests.

METHODS

The hearing of community-dwelling older adults was assessed using pure tone audiometry. Cognitive function was assessed using the Computerized Cambridge Cognitive Test Battery (CANTAB). Multiple regression analyses examined the association between hearing and cognitive function, adjusted for age, education, and gender.

RESULTS

HL (pure-tone average [PTA] of thresholds at 0.5, 1, 2, and 4 kHz in the better ear, BE4PTA) was associated with reduced performance in delayed matching and multitasking tasks (β = -0.25, p = 0.019, and β = 0.02, p = 0.023, respectively). Moderate to severe HL was associated with reduced performance in delayed matching and verbal recall memory tasks (β = -10.6, p = 0.019, and β = -0.28, p = 0.042). High-frequency HL was associated with reduced performance in the spatial working memory task (β = 0.004, p = 0.022). All-frequency HL was associated with reduced performance in spatial working memory and multitasking (β = 0.01, p = 0.040, and β = 0.02, p = 0.048).

CONCLUSION

Similar to Western populations, HL among tonal language-speaking ethnic Chinese was associated with worse performance in tasks requiring working memory and executive function.

The Relationship Between Hearing Loss and Cognitive Impairment in a Chinese Elderly Population: The Baseline Analysis

Objectives: The objective of the study was to investigate the association between untreated age-related hearing loss and cognitive impairment in Mandarin-speaking older adults living in China. Methods: Older adults (293; 111 males, M = 70.33 ± 4.90 years; 182 females, M = 69.02 ± 4.08 years) were recruited. All participants completed a pure tone audiometric hearing assessment, Hearing Impairment-Montreal Cognitive Assessment Test (HI-MoCA), and a computerized neuropsychology test battery (CANTAB). The Mandarin version of the De Jong Gierveld Loneliness Scale was used to measure the loneliness, and the Mandarin version of the 21-item Depression Anxiety Stress Scale (DASS-21) was used to measure the current severity of a range of symptoms common to depression, stress, and anxiety of the participants. Results: A multiple stepwise regression analysis showed that the average of four mid-frequency thresholds in the better ear was related to CANTAB Paired Associates Learning (β = 0.20, p = 0.002), and the global cognitive function score (HI-MoCA) (β = -0.25, p < 0.001). The average of three high frequencies in the better ear was significantly associated with CANTAB Delayed Matching to Sample (β = -0.16, p = 0.008), and Spatial Working Memory (β = 0.17, p = 0.003). Conclusion: The results revealed a significant relationship between age-related hearing loss and cognitive impairment in Mandarin-speaking older adults. These research outcomes have clinical implications specifically for hearing health care professionals in China and other populations that speak a tonal language, especially when providing hearing rehabilitation.

Hearing function, perception of disability (handicap) and cognition in the elderly: a relation to be elucidated

PURPOSE

To analyze auditory perception, hearing and cognition in the elderly referred for audiological evaluation and search for correlations between hearing and cognitive abilities.

METHOD

An observational and descriptive study, carried out with 135 elderly people. The participants did the auditory (tonal audiometry, speech audiometry, immittance measures, HHIE Questionnaire - Hearing Handicap Inventory for the Elderly) and the cognitive (MMSE - Mini Mental State Examination) assessments.

RESULTS

There is a high prevalence of hearing complaints (91.85%) and hearing loss (91.85%) in the elderly referred for audiological assessment, but there was no relation between the degree of hearing loss (p = 0.537) and the auditory perception (p = 0.930) in relation to cognitive performance.

CONCLUSION

In this study, the degree of hearing loss did not influence the cognitive performance of the elderly, and the auditory handicap perception did not differ between individuals with normal or altered cognition.

Brain Frequency-Specific Changes in the Spontaneous Neural Activity Are Associated With Cognitive Impairment in Patients With Presbycusis

Presbycusis (PC) is characterized by preferential hearing loss at high frequencies and difficulty in speech recognition in noisy environments. Previous studies have linked PC to cognitive impairment, accelerated cognitive decline and incident Alzheimer’s disease. However, the neural mechanisms of cognitive impairment in patients with PC remain unclear. Although resting-state functional magnetic resonance imaging (rs-fMRI) studies have explored low-frequency oscillation (LFO) connectivity or amplitude of PC-related neural activity, it remains unclear whether the abnormalities occur within all frequency bands or within specific frequency bands. Fifty-one PC patients and fifty-one well-matched normal hearing controls participated in this study. The LFO amplitudes were investigated using the amplitude of low-frequency fluctuation (ALFF) at different frequency bands (slow-4 and slow-5). PC patients showed abnormal LFO amplitudes in the Heschl’s gyrus, dorsolateral prefrontal cortex (dlPFC), frontal eye field and key nodes of the speech network exclusively in slow-4, which suggested that abnormal spontaneous neural activity in PC was frequency dependent. Our findings also revealed that stronger functional connectivity between the dlPFC and the posterodorsal stream of auditory processing, as well as lower functional coupling between the PCC and key nodes of the DMN, which were associated with cognitive impairments in PC patients. Our study might underlie the cross-modal plasticity and higher-order cognitive participation of the auditory cortex after partial hearing deprivation. Our findings indicate that frequency-specific analysis of ALFF could provide valuable insights into functional alterations in the auditory cortex and non-auditory regions involved in cognitive impairment associated with PC.

Cognitive Flexibility and Inhibition in Individuals with Age-Related Hearing Loss

Growing evidence suggests alterations in cognitive control processes in individuals with varying degrees of age-related hearing loss (ARHL); however, alterations in those with unaided mild ARHL are understudied. The current study examined two cognitive control processes, cognitive flexibility, and inhibition, in 21 older adults with unaided mild ARHL and 18 age- and education-matched normal hearing (NH) controls. All participants underwent comprehensive audiological and cognitive evaluations including Trail Making Test-B, Verbal Fluency, Stroop, and two Go/NoGo tasks. Group differences in cognitive flexibility and inhibition as well as associations between peripheral and central hearing ability and measures of cognitive flexibility and inhibition were investigated. Findings revealed that the ARHL group took significantly longer to complete the Stroop task and had higher error rates on NoGo trials on both Go/NoGo tasks relative to the NH controls. Additionally, poorer peripheral and central hearing were associated with poorer cognitive flexibility and inhibitory control. Our findings suggest slower and more inefficient inhibitory control in the mild ARHL group relative to the NH group and add to decades of research on the association between hearing and cognition.