Upregulation of cognitive control networks in older adults' speech comprehension

The effect of hearing loss on age-related differences in neural distinctiveness

Age differences in cognitive performance have been shown to be overestimated if age-related hearing loss is not taken into account. Here, we investigated the role of age-related hearing loss on age differences in functional brain organization by assessing its impact on previously reported age differences in neural differentiation. To this end, we analyzed the data of 36 younger adults, 21 older adults with clinically normal hearing, and 21 older adults with mild-to-moderate hearing loss who had taken part in a functional localizer task comprising visual (i.e., faces, scenes) and auditory stimuli (i.e., voices, music) while undergoing functional magnetic resonance imaging. Evidence for reduced neural distinctiveness in the auditory cortex was observed only in older adults with hearing loss relative to younger adults, whereas evidence for reduced neural distinctiveness in the visual cortex was observed both in older adults with normal hearing and in older adults with hearing loss relative to younger adults. These results indicate that age-related dedifferentiation in the auditory cortex is exacerbated by age-related hearing loss.

Compensation or Preservation? Different Roles of Functional Lateralization in Speech Perception of Older Non-musicians and Musicians

Musical training can counteract age-related decline in speech perception in noisy environments. However, it remains unclear whether older non-musicians and musicians rely on functional compensation or functional preservation to counteract the adverse effects of aging. This study utilized resting-state functional connectivity (FC) to investigate functional lateralization, a fundamental organization feature, in older musicians (OM), older non-musicians (ONM), and young non-musicians (YNM). Results showed that OM outperformed ONM and achieved comparable performance to YNM in speech-in-noise and speech-in-speech tasks. ONM exhibited reduced lateralization than YNM in lateralization index (LI) of intrahemispheric FC (LI_intra) in the cingulo-opercular network (CON) and LI of interhemispheric heterotopic FC (LI_he) in the language network (LAN). Conversely, OM showed higher neural alignment to YNM (i.e., a more similar lateralization pattern) compared to ONM in CON, LAN, frontoparietal network (FPN), dorsal attention network (DAN), and default mode network (DMN), indicating preservation of youth-like lateralization patterns due to musical experience. Furthermore, in ONM, stronger left-lateralized and lower alignment-to-young of LI_intra in the somatomotor network (SMN) and DAN and LI_he in DMN correlated with better speech performance, indicating a functional compensation mechanism. In contrast, stronger right-lateralized LI_intra in FPN and DAN and higher alignment-to-young of LI_he in LAN correlated with better performance in OM, suggesting a functional preservation mechanism. These findings highlight the differential roles of functional preservation and compensation of lateralization in speech perception in noise among elderly individuals with and without musical expertise, offering insights into successful aging theories from the lens of functional lateralization and speech perception.

Effects of absolute pitch on brain activation and functional connectivity during hearing-in-noise perception

Hearing-in-noise (HIN) ability is crucial in speech and music communication. Recent evidence suggests that absolute pitch (AP), the ability to identify isolated musical notes, is associated with HIN benefits. A theoretical account postulates a link between AP ability and neural network indices of segregation. However, how AP ability modulates the brain activation and functional connectivity underlying HIN perception remains unclear. Here we used functional magnetic resonance imaging to contrast brain responses among a sample (n = 45) comprising 15 AP musicians, 15 non-AP musicians, and 15 non-musicians in perceiving Mandarin speech and melody targets under varying signal-to-noise ratios (SNRs: No-Noise, 0, -9 dB). Results reveal that AP musicians exhibited increased activation in auditory and superior frontal regions across both HIN domains (music and speech), irrespective of noise levels. Notably, substantially higher sensorimotor activation was found in AP musicians when the target was music compared to speech. Furthermore, we examined AP effects on neural connectivity using psychophysiological interaction analysis with the auditory cortex as the seed region. AP musicians showed decreased functional connectivity with the sensorimotor and middle frontal gyrus compared to non-AP musicians. Crucially, AP differentially affected connectivity with parietal and frontal brain regions depending on the HIN domain being music or speech. These findings suggest that AP plays a critical role in HIN perception, manifested by increased activation and functional independence between auditory and sensorimotor regions for perceiving music and speech streams.

Processing reduced speech in the L1 and L2: a combined eye-tracking and ERP study

We examined the cognitive processes underlying the comprehension of reduced word pronunciation variants in natives and advanced learners of French. In a passive listening visual world task, participants heard sentences containing either a reduced or a full form and saw pictures representing the target word, a phonological competitor and two neutral distractors. After each sentence they saw a picture and had to decide whether it matched the content of that sentence. Eye movements and EEG were recorded simultaneously. Because the two recordings offer complementary information about cognitive processes, we developed methods for analysing the signals in combination. We found a stronger effect of reduction on phonetic processing and semantic integration in learners than in natives, but the effects are different from the N100/N400 and P600 effects found in previous research. Time-locking EEG signals on fixation moments in the eye movements offers a window onto the time course of semantic integration.

Contributions of listening effort and intelligibility to cortical tracking of speech in adverse listening conditions

Cortical tracking of speech is vital for speech segmentation and is linked to speech intelligibility. However, there is no clear consensus as to whether reduced intelligibility leads to a decrease or an increase in cortical speech tracking, warranting further investigation of the factors influencing this relationship. One such factor is listening effort, defined as the cognitive resources necessary for speech comprehension, and reported to have a strong negative correlation with speech intelligibility. Yet, no studies have examined the relationship between speech intelligibility, listening effort, and cortical tracking of speech. The aim of the present study was thus to examine these factors in quiet and distinct adverse listening conditions. Forty-nine normal hearing adults listened to sentences produced casually, presented in quiet and two adverse listening conditions: cafeteria noise and reverberant speech. Electrophysiological responses were registered with electroencephalogram, and listening effort was estimated subjectively using self-reported scores and objectively using pupillometry. Results indicated varying impacts of adverse conditions on intelligibility, listening effort, and cortical tracking of speech, depending on the preservation of the speech temporal envelope. The more distorted envelope in the reverberant condition led to higher listening effort, as reflected in higher subjective scores, increased pupil diameter, and stronger cortical tracking of speech in the delta band. These findings suggest that using measures of listening effort in addition to those of intelligibility is useful for interpreting cortical tracking of speech results. Moreover, reading and phonological skills of participants were positively correlated with listening effort in the cafeteria condition, suggesting a special role of expert language skills in processing speech in this noisy condition. Implications for future research and theories linking atypical cortical tracking of speech and reading disorders are further discussed.

Lexical tone perception and learning in older adults: A review and future directions

While the literature is well represented in accounting for how aging influences segmental properties of speech, less is known about its influences on suprasegmental properties such as lexical tones. In addition, foreign language learning is increasingly endorsed as being a potential intervention to boost cognitive reserve and overall well-being in older adults. Empirical studies on young learners learning lexical tones are aplenty in comparison with older learners. Challenges in this domain for older learners might be different due to aging and other learner-internal factors. This review consolidates behavioural and neuroscientific research related to lexical tone, speech perception, factors characterising learner groups, and other variables that would influence lexical tone perception and learning in older adults. Factors commonly identified to influence tone learning in younger adult populations, such as musical experience, language background, and motivation in learning a new language, are discussed in relation to older learner groups and recommendations to boost lexical tone learning in older age are provided based on existing studies.

At-home computerized executive-function training to improve cognition and mobility in normal-hearing adults and older hearing aid users: a multi-centre, single-blinded randomized controlled trial

BACKGROUND

Hearing loss predicts cognitive decline and falls risk. It has been argued that degraded hearing makes listening effortful, causing competition for higher-level cognitive resources needed for secondary cognitive or motor tasks. Therefore, executive function training has the potential to improve cognitive performance, in turn improving mobility, especially when older adults with hearing loss are engaged in effortful listening. Moreover, research using mobile neuroimaging and ecologically valid measures of cognition and mobility in this population is limited. The objective of this research is to examine the effect of at-home cognitive training on dual-task performance using laboratory and simulated real-world conditions in normal-hearing adults and older hearing aid users. We hypothesize that executive function training will lead to greater improvements in cognitive-motor dual-task performance compared to a wait-list control group. We also hypothesize that executive function training will lead to the largest dual-task improvements in older hearing aid users, followed by normal-hearing older adults, and then middle-aged adults.

METHODS

A multi-site (Concordia University and KITE-Toronto Rehabilitation Institute, University Health Network) single-blinded randomized controlled trial will be conducted whereby participants are randomized to either 12 weeks of at-home computerized executive function training or a wait-list control. Participants will consist of normal-hearing middle-aged adults (45-60 years old) and older adults (65-80 years old), as well as older hearing aid users (65-80 years old, ≥ 6 months hearing aid experience). Separate samples will undergo the same training protocol and the same pre- and post-evaluations of cognition, hearing, and mobility across sites. The primary dual-task outcome measures will involve either static balance (KITE site) or treadmill walking (Concordia site) with a secondary auditory-cognitive task. Dual-task performance will be assessed in an immersive virtual reality environment in KITE's StreetLab and brain activity will be measured using functional near infrared spectroscopy at Concordia's PERFORM Centre.

DISCUSSION

This research will establish the efficacy of an at-home cognitive training program on complex auditory and motor functioning under laboratory and simulated real-world conditions. This will contribute to rehabilitation strategies in order to mitigate or prevent physical and cognitive decline in older adults with hearing loss.

TRIAL REGISTRATION

Identifier: NCT05418998. https://clinicaltrials.gov/ct2/show/NCT05418998.

Cortical networks for recognition of speech with simultaneous talkers

The relative contributions of superior temporal vs. inferior frontal and parietal networks to recognition of speech in a background of competing speech remain unclear, although the contributions themselves are well established. Here, we use fMRI with spectrotemporal modulation transfer function (ST-MTF) modeling to examine the speech information represented in temporal vs. frontoparietal networks for two speech recognition tasks with and without a competing talker. Specifically, 31 listeners completed two versions of a three-alternative forced choice competing speech task: "Unison" and "Competing", in which a female (target) and a male (competing) talker uttered identical or different phrases, respectively. Spectrotemporal modulation filtering (i.e., acoustic distortion) was applied to the two-talker mixtures and ST-MTF models were generated to predict brain activation from differences in spectrotemporal-modulation distortion on each trial. Three cortical networks were identified based on differential patterns of ST-MTF predictions and the resultant ST-MTF weights across conditions (Unison, Competing): a bilateral superior temporal (S-T) network, a frontoparietal (F-P) network, and a network distributed across cortical midline regions and the angular gyrus (M-AG). The S-T network and the M-AG network responded primarily to spectrotemporal cues associated with speech intelligibility, regardless of condition, but the S-T network responded to a greater range of temporal modulations suggesting a more acoustically driven response. The F-P network responded to the absence of intelligibility-related cues in both conditions, but also to the absence (presence) of target-talker (competing-talker) vocal pitch in the Competing condition, suggesting a generalized response to signal degradation. Task performance was best predicted by activation in the S-T and F-P networks, but in opposite directions (S-T: more activation = better performance; F-P: vice versa). Moreover, S-T network predictions were entirely ST-MTF mediated while F-P network predictions were ST-MTF mediated only in the Unison condition, suggesting an influence from non-acoustic sources (e.g., informational masking) in the Competing condition. Activation in the M-AG network was weakly positively correlated with performance and this relation was entirely superseded by those in the S-T and F-P networks. Regarding contributions to speech recognition, we conclude: (a) superior temporal regions play a bottom-up, perceptual role that is not qualitatively dependent on the presence of competing speech; (b) frontoparietal regions play a top-down role that is modulated by competing speech and scales with listening effort; and (c) performance ultimately relies on dynamic interactions between these networks, with ancillary contributions from networks not involved in speech processing per se (e.g., the M-AG network).

Successful aging of musicians: Preservation of sensorimotor regions aids audiovisual speech-in-noise perception

Musicianship can mitigate age-related declines in audiovisual speech-in-noise perception. We tested whether this benefit originates from functional preservation or functional compensation by comparing fMRI responses of older musicians, older nonmusicians, and young nonmusicians identifying noise-masked audiovisual syllables. Older musicians outperformed older nonmusicians and showed comparable performance to young nonmusicians. Notably, older musicians retained similar neural specificity of speech representations in sensorimotor areas to young nonmusicians, while older nonmusicians showed degraded neural representations. In the same region, older musicians showed higher neural alignment to young nonmusicians than older nonmusicians, which was associated with their training intensity. In older nonmusicians, the degree of neural alignment predicted better performance. In addition, older musicians showed greater activation in frontal-parietal, speech motor, and visual motion regions and greater deactivation in the angular gyrus than older nonmusicians, which predicted higher neural alignment in sensorimotor areas. Together, these findings suggest that musicianship-related benefit in audiovisual speech-in-noise processing is rooted in preserving youth-like representations in sensorimotor regions.

Cortical tracking of formant modulations derived from silently presented lip movements and its decline with age

The integration of visual and auditory cues is crucial for successful processing of speech, especially under adverse conditions. Recent reports have shown that when participants watch muted videos of speakers, the phonological information about the acoustic speech envelope, which is associated with but independent from the speakers' lip movements, is tracked by the visual cortex. However, the speech signal also carries richer acoustic details, for example, about the fundamental frequency and the resonant frequencies, whose visuophonological transformation could aid speech processing. Here, we investigated the neural basis of the visuo-phonological transformation processes of these more fine-grained acoustic details and assessed how they change as a function of age. We recorded whole-head magnetoencephalographic (MEG) data while the participants watched silent normal (i.e., natural) and reversed videos of a speaker and paid attention to their lip movements. We found that the visual cortex is able to track the unheard natural modulations of resonant frequencies (or formants) and the pitch (or fundamental frequency) linked to lip movements. Importantly, only the processing of natural unheard formants decreases significantly with age in the visual and also in the cingulate cortex. This is not the case for the processing of the unheard speech envelope, the fundamental frequency, or the purely visual information carried by lip movements. These results show that unheard spectral fine details (along with the unheard acoustic envelope) are transformed from a mere visual to a phonological representation. Aging affects especially the ability to derive spectral dynamics at formant frequencies. As listening in noisy environments should capitalize on the ability to track spectral fine details, our results provide a novel focus on compensatory processes in such challenging situations.

Considering hearing loss as a modifiable risk factor for dementia

INTRODUCTION

Accumulating evidence links hearing loss to impaired cognitive performance and increased risk for dementia. Hearing loss can lead to deafferentation-induced atrophy of frontotemporal brain regions and dysregulation of cognitive control networks from increased listening effort. Hearing loss is also associated with reduced social engagement, loneliness, and depression, which are independently associated with poor cognitive function.

AREAS COVERED

We summarize the evidence and postulated mechanisms linking hearing loss to dementia in older adults and synthesize the available literature demonstrating beneficial effects of hearing remediation on brain structure and function.

EXPERT OPINION

: Further research is needed to evaluate whether treatment of hearing loss may reduce risk of cognitive decline and improve neural consequences of hearing loss. Studies may investigate the pathologic mechanisms linking these late-life disorders and identify individuals vulnerable to dementia, and future clinical trials may evaluate whether hearing treatment may reduce the risk for dementia.

Evidence for cortical adjustments to perceptual decision criteria during word recognition in noise

Extensive increases in cingulo-opercular frontal activity are typically observed during speech recognition in noise tasks. This elevated activity has been linked to a word recognition benefit on the next trial, termed "adaptive control," but how this effect might be implemented has been unclear. The established link between perceptual decision making and cingulo-opercular function may provide an explanation for how those regions benefit subsequent word recognition. In this case, processes that support recognition such as raising or lowering the decision criteria for more accurate or faster recognition may be adjusted to optimize performance on the next trial. The current neuroimaging study tested the hypothesis that pre-stimulus cingulo-opercular activity reflects criterion adjustments that determine how much information to collect for word recognition on subsequent trials. Participants included middle-age and older adults (N = 30; age = 58.3 ± 8.8 years; m ± sd) with normal hearing or mild sensorineural hearing loss. During a sparse fMRI experiment, words were presented in multitalker babble at +3 dB or +10 dB signal-to-noise ratio (SNR), which participants were instructed to repeat aloud. Word recognition was significantly poorer with increasing participant age and lower SNR compared to higher SNR conditions. A perceptual decision-making model was used to characterize processing differences based on task response latency distributions. The model showed that significantly less sensory evidence was collected (i.e., lower criteria) for lower compared to higher SNR trials. Replicating earlier observations, pre-stimulus cingulo-opercular activity was significantly predictive of correct recognition on a subsequent trial. Individual differences showed that participants with higher criteria also benefitted the most from pre-stimulus activity. Moreover, trial-level criteria changes were significantly linked to higher versus lower pre-stimulus activity. These results suggest cingulo-opercular cortex contributes to criteria adjustments to optimize speech recognition task performance.

Amateur singing benefits speech perception in aging under certain conditions of practice: behavioural and neurobiological mechanisms

Limited evidence has shown that practising musical activities in aging, such as choral singing, could lessen age-related speech perception in noise (SPiN) difficulties. However, the robustness and underlying mechanism of action of this phenomenon remain unclear. In this study, we used surface-based morphometry combined with a moderated mediation analytic approach to examine whether singing-related plasticity in auditory and dorsal speech stream regions is associated with better SPiN capabilities. 36 choral singers and 36 non-singers aged 20-87 years underwent cognitive, auditory, and SPiN assessments. Our results provide important new insights into experience-dependent plasticity by revealing that, under certain conditions of practice, amateur choral singing is associated with age-dependent structural plasticity within auditory and dorsal speech regions, which is associated with better SPiN performance in aging. Specifically, the conditions of practice that were associated with benefits on SPiN included frequent weekly practice at home, several hours of weekly group singing practice, singing in multiple languages, and having received formal singing training. These results suggest that amateur choral singing is associated with improved SPiN through a dual mechanism involving auditory processing and auditory-motor integration and may be dose dependent, with more intense singing associated with greater benefit. Our results, thus, reveal that the relationship between singing practice and SPiN is complex, and underscore the importance of considering singing practice behaviours in understanding the effects of musical activities on the brain-behaviour relationship.

Longitudinal Changes in Resting-State Functional Connectivity and Gray Matter Volume Are Associated with Conversion to Hearing Impairment in Older Adults

BACKGROUND

Hearing loss was recently identified as a modifiable risk factor for dementia although the potential mechanisms explaining this relationship are unknown.

OBJECTIVE

The current study examined longitudinal change in resting-state fMRI functional connectivity and gray matter volume in individuals who developed a hearing impairment compared to those whose hearing remained normal.

METHODS

This study included 440 participants from the UK Biobank: 163 who had normal hearing at baseline and impaired hearing at follow-up (i.e., converters, mean age = 63.11±6.33, 53% female) and 277 who had normal hearing at baseline and maintained normal hearing at follow-up (i.e., non-converters, age = 63.31±5.50, 50% female). Functional connectivity was computed between a priori selected auditory seed regions (left and right Heschl's gyrus and cytoarchitectonic subregions Te1.0, Te1.1, and Te1.2) and select higher-order cognitive brain networks. Gray matter volume within these same regions was also obtained.

RESULTS

Converters had increased connectivity from left Heschl's gyrus to left anterior insula and from right Heschl's gyrus to right anterior insula, and decreased connectivity between right Heschl's gyrus and right hippocampus, compared to non-converters. Converters also had reduced gray matter volume in left hippocampus and left lateral visual cortex compared to non-converters.

CONCLUSION

These findings suggest that conversion to a hearing impairment is associated with altered brain functional connectivity and gray matter volume in the attention, memory, and visual processing regions that were examined in this study.

Unique patterns of hearing loss and cognition in older adults' neural responses to cues for speech recognition difficulty

Older adults with hearing loss experience significant difficulties understanding speech in noise, perhaps due in part to limited benefit from supporting executive functions that enable the use of environmental cues signaling changes in listening conditions. Here we examined the degree to which 41 older adults (60.56-86.25 years) exhibited cortical responses to informative listening difficulty cues that communicated the listening difficulty for each trial compared to neutral cues that were uninformative of listening difficulty. Word recognition was significantly higher for informative compared to uninformative cues in a + 10 dB signal-to-noise ratio (SNR) condition, and response latencies were significantly shorter for informative cues in the + 10 dB SNR and the more-challenging + 2 dB SNR conditions. Informative cues were associated with elevated blood oxygenation level-dependent contrast in visual and parietal cortex. A cue-SNR interaction effect was observed in the cingulo-opercular (CO) network, such that activity only differed between SNR conditions when an informative cue was presented. That is, participants used the informative cues to prepare for changes in listening difficulty from one trial to the next. This cue-SNR interaction effect was driven by older adults with more low-frequency hearing loss and was not observed for those with more high-frequency hearing loss, poorer set-shifting task performance, and lower frontal operculum gray matter volume. These results suggest that proactive strategies for engaging CO adaptive control may be important for older adults with high-frequency hearing loss to optimize speech recognition in changing and challenging listening conditions.

Speech motor facilitation is not affected by ageing but is modulated by task demands during speech perception

Motor areas for speech production activate during speech perception. Such activation may assist speech perception in challenging listening conditions. It is not known how ageing affects the recruitment of articulatory motor cortex during active speech perception. This study aimed to determine the effect of ageing on recruitment of speech motor cortex during speech perception. Single-pulse Transcranial Magnetic Stimulation (TMS) was applied to the lip area of left primary motor cortex (M1) to elicit lip Motor Evoked Potentials (MEPs). The M1 hand area was tested as a control site. TMS was applied whilst participants perceived syllables presented with noise (-10, 0, +10 dB SNRs) and without noise (clear). Participants detected and counted syllables throughout MEP recording. Twenty younger adult subjects (aged 18-25) and twenty older adult subjects (aged 65-80) participated in this study. Results indicated a significant interaction between age and noise condition in the syllable task. Specifically, older adults significantly misidentified syllables in the 0 dB SNR condition, and missed the syllables in the -10 dB SNR condition, relative to the clear condition. There were no differences between conditions for younger adults. There was a significant main effect of noise level on lip MEPs. Lip MEPs were unexpectedly inhibited in the 0 dB SNR condition relative to clear condition. There was no interaction between age group and noise condition. There was no main effect of noise or age group on control hand MEPs. These data suggest that speech-induced facilitation in articulatory motor cortex is abolished when performing a challenging secondary task, irrespective of age.

Speech-Driven Spectrotemporal Receptive Fields Beyond the Auditory Cortex

We recently developed a method to estimate speech-driven spectrotemporal receptive fields (STRFs) using fMRI. The method uses spectrotemporal modulation filtering, a form of acoustic distortion that renders speech sometimes intelligible and sometimes unintelligible. Using this method, we found significant STRF responses only in classic auditory regions throughout the superior temporal lobes. However, our analysis was not optimized to detect small clusters of STRFs as might be expected in non-auditory regions. Here, we re-analyze our data using a more sensitive multivariate statistical test for cross-subject alignment of STRFs, and we identify STRF responses in non-auditory regions including the left dorsal premotor cortex (dPM), left inferior frontal gyrus (IFG), and bilateral calcarine sulcus (calcS). All three regions responded more to intelligible than unintelligible speech, but left dPM and calcS responded significantly to vocal pitch and demonstrated strong functional connectivity with early auditory regions. Left dPM's STRF generated the best predictions of activation on trials rated as unintelligible by listeners, a hallmark auditory profile. IFG, on the other hand, responded almost exclusively to intelligible speech and was functionally connected with classic speech-language regions in the superior temporal sulcus and middle temporal gyrus. IFG's STRF was also (weakly) able to predict activation on unintelligible trials, suggesting the presence of a partial 'acoustic trace' in the region. We conclude that left dPM is part of the human dorsal laryngeal motor cortex, a region previously shown to be capable of operating in an 'auditory mode' to encode vocal pitch. Further, given previous observations that IFG is involved in syntactic working memory and/or processing of linear order, we conclude that IFG is part of a higher-order speech circuit that exerts a top-down influence on processing of speech acoustics. Finally, because calcS is modulated by emotion, we speculate that changes in the quality of vocal pitch may have contributed to its response.

Global and local brain connectivity changes associated with sudden unilateral sensorineural hearing loss

Recent studies suggest that even moderate sudden sensorineural hearing loss (SSNHL) causes reduction of gray matter volume in the primary auditory cortex, diminishing its ability to react to sound stimulation, as well as reorganization of functional brain networks. We employed resting-state functional MRI (rs-fMRI), in conjunction with graph-theoretical analysis and a newly developed functional "disruption index," to study whole-brain as well as local functional changes in patients with unilateral SSNHL. We also assessed the potential of graph-theoretical measures as biomarkers of disease, in terms of their relationship to clinically relevant audiological parameters. Eight patients with moderate or severe unilateral SSNHL and 15 healthy controls were included in this prospective pilot study. All patients underwent rs-fMRI to study potential changes in brain connectivity. From rs-fMRI data, global and local graph-theoretical measures, disruption index, and audiological examinations were estimated. Mann-Whitney U tests were used to study the differences between SSNHL patients and healthy controls. Associations between brain metrics and clinical variables were studied using multiple linear regressions, and the presence or absence of brain network hubs was assessed using Fisher's exact test. No statistically significant differences between SSNHL patients and healthy controls were found in global or local network measures. However, when analyzing brain networks through the disruption index, we found a brain-wide functional network reorganization (p < 0.001 as compared with controls), whose extent was associated with clinical impairment (p < 0.05). We also observed several functional hubs in SSNHL patients that were not present in healthy controls and vice versa. Our results demonstrate a brain involvement in SSNHL patients, not detectable using conventional graph-theoretical analysis, which may yield subtle disease clues and possibly aid in monitoring disease progression in clinical trials.

The cortical organization of listening effort: New insight from functional near-infrared spectroscopy

Everyday challenges impact our ability to hear and comprehend spoken language with ease, such as accented speech (source factors), spectral degradation (transmission factors), complex or unfamiliar language use (message factors), and predictability (context factors). Auditory degradation and linguistic complexity in the brain and behavior have been well investigated, and several computational models have emerged. The work here provides a novel test of the hypotheses that listening effort is partially reliant on higher cognitive auditory attention and working memory mechanisms in the frontal lobe, and partially reliant on hierarchical linguistic computation in the brain's left hemisphere. We specifically hypothesize that these models are robust and can be applied in ecologically relevant and coarse-grain contexts that rigorously control for acoustic and linguistic listening challenges. Using functional near-infrared spectroscopy during an auditory plausibility judgment task, we show the hierarchical cortical organization for listening effort in the frontal and left temporal-parietal brain regions. In response to increasing levels of cognitive demand, we found (i) poorer comprehension, (ii) slower reaction times, (iii) increasing levels of perceived mental effort, (iv) increasing levels of brain activity in the prefrontal cortex, (v) hierarchical modulation of core language processing regions that reflect increasingly higher-order auditory-linguistic processing, and (vi) a correlation between participants' mental effort ratings and their performance on the task. Our results demonstrate that listening effort is partly reliant on higher cognitive auditory attention and working memory mechanisms in the frontal lobe and partly reliant on hierarchical linguistic computation in the brain's left hemisphere. Further, listening effort is driven by a voluntary, motivation-based attention system for which our results validate the use of a single-item post-task questionnaire for measuring perceived levels of mental effort and predicting listening performance. We anticipate our study to be a starting point for more sophisticated models of listening effort and even cognitive neuroplasticity in hearing aid and cochlear implant users.

Relationship between Memory Load and Listening Demands in Age-Related Hearing Impairment

Age-related hearing loss has been associated with increased recruitment of frontal brain areas during speech perception to compensate for the decline in auditory input. This additional recruitment may bind resources otherwise needed for understanding speech. However, it is unknown how increased demands on listening interact with increasing cognitive demands when processing speech in age-related hearing loss. The current study used a full-sentence working memory task manipulating demands on working memory and listening and studied untreated mild to moderate hard of hearing (n = 20) and normal-hearing age-matched participants (n = 19) with functional MRI. On the behavioral level, we found a significant interaction of memory load and listening condition; this was, however, similar for both groups. Under low, but not high memory load, listening condition significantly influenced task performance. Similarly, under easy but not difficult listening conditions, memory load had a significant effect on task performance. On the neural level, as measured by the BOLD response, we found increased responses under high compared to low memory load conditions in the left supramarginal gyrus, left middle frontal gyrus, and left supplementary motor cortex regardless of hearing ability. Furthermore, we found increased responses in the bilateral superior temporal gyri under easy compared to difficult listening conditions. We found no group differences nor interactions of group with memory load or listening condition. This suggests that memory load and listening condition interacted on a behavioral level, however, only the increased memory load was reflected in increased BOLD responses in frontal and parietal brain regions. Hence, when evaluating listening abilities in elderly participants, memory load should be considered as it might interfere with the assessed performance. We could not find any further evidence that BOLD responses for the different memory and listening conditions are affected by mild to moderate age-related hearing loss.

Visual impairment increases the risk of dementia, especially in young males in a 12-year longitudinal follow-up study of a national cohort

We investigated the effect of visual impairment (VI) on dementia development in a national cohort. In this 12-year nationwide population-based retrospective cohort study, national data were collected from National Health Insurance Cooperation of South Korea from 2002 to 2017, comprising 799,074 subjects selected from the dementia-free cohort representative of the Korean population. Crude hazard ratios (HRs) as well as age- and sex-adjusted HRs and confidence intervals (CIs) for the development of dementia were estimated using multivariable Cox regression models. VI significantly increased the risk of dementia with a HR of 2.726 (95% CI 2.251–3.300, p < 0.0001) after adjusting for age, sex, and interaction between age, sex, and VI. HR of interaction between VI and age for dementia was 0.539 (95% CI 0.436–0.667, p < 0.0001). In the sensitivity analysis after adjustment for age, sex, household income level, BMI and other comorbidities, VI showed higher risk for all the type of dementia (p < 0.0001). In subgroup analysis of VI, young males showed the highest risk for development of dementia with a HR of 2.687 (95% CI 2.219–3.254, p < 0.0001). VI significantly increased the risk of dementia in the study cohort, and young males with VI appeared to be the most susceptible to the development of dementia.

Development of the Reading Cognitive Test Kyoto (ReaCT Kyoto) for Early Detection of Cognitive Decline in Patients with Hearing Loss

Background:

Early detection of cognitive decline allows timely intervention to delay progression of dementia. However, current cognitive evaluation tools often include items delivered via verbal forms of instruction, which can cause poor performance in patients with hearing loss.

Objective:

To develop and validate a cognitive screening battery, the Reading Cognitive Test Kyoto (ReaCT Kyoto), comprising test items given through non-verbal instruction.

Methods:

A cross-sectional and multi-center study was conducted in the three medical institutes. ReaCT Kyoto was designed to evaluate domains of “registration,” “repetition,” “delayed recall,” “visuospatial recognition,” “orientation in time and place,” and “executive function.” The Japanese version of the Mini-Mental State Examination Test (MMSE-J) and ReaCT Kyoto were applied by experienced psychotherapists. Concurrent validity was evaluated between the ReaCT Kyoto Test and MMSE-J and between the ReaCT Kyoto Test and physician-diagnosed dementia.

Results:

ReaCT Kyoto was validated in a sample of 115 participants. The mean age of subjects was 81.0±6.4 years, and the sample comprised 53.0% females. The area under the receiver operating curves was 0.95 for detecting physician-diagnosed dementia. When classifying patients in accordance with presence or absence of hearing loss, the AUCs were 0.93 and 0.97 for those with and without hearing loss, respectively. With a cut-off score of < 29 points for suspected dementia, ReaCT Kyoto correctly classified 90.4% of the subjects as belonging to the group with or without physician-diagnosed dementia.

Conclusion:

ReaCT Kyoto provides an appropriate solution for detection of cognitive impairment in persons with or without hearing loss.

Neural circuits and behavioral pathways linking hearing loss to affective dysregulation in older adults

Substantial evidence now links age-related hearing loss to incident major depressive disorder in older adults. However, research examining the neural circuits and behavioral mechanisms by which age-related hearing loss leads to depression is at an early phase. It is known that hearing loss has adverse structural and functional brain consequences, is associated with reduced social engagement and loneliness, and often results in tinnitus, which can independently affect cognitive control and emotion processing circuits. While pathways leading from these sequelae of hearing loss to affective dysregulation and depression are intuitive to hypothesize, few studies have yet been designed to provide conclusive evidence for specific pathophysiological mechanisms. Here we review the neurobiological and behavioral consequences of age-related hearing loss, present a model linking them to increased risk for major depressive disorder and suggest how future studies may facilitate the development of rationally designed therapeutic interventions for older adults with impaired hearing to reduce risk for depression and/or ameliorate depressive symptoms.

Neural correlates of subjective comprehension of noise-vocoded speech

Under an acoustically degraded condition, the degree of speech comprehension fluctuates within individuals. Understanding the relationship between such fluctuations in comprehension and neural responses might reveal perceptual processing for distorted speech. In this study we investigated the cerebral activity associated with the degree of subjective comprehension of noise-vocoded speech sounds (NVSS) using functional magnetic resonance imaging. Our results indicate that higher comprehension of NVSS sentences was associated with greater activation in the right superior temporal cortex, and that activity in the left inferior frontal gyrus (Broca's area) was increased when a listener recognized words in a sentence they did not fully comprehend. In addition, results of laterality analysis demonstrated that recognition of words in an NVSS sentence led to less lateralized responses in the temporal cortex, though a left-lateralization was observed when no words were recognized. The data suggest that variation in comprehension within individuals can be associated with changes in lateralization in the temporal auditory cortex.

Effects of age-related hearing loss and hearing aid experience on sentence processing

Age-related hearing loss typically affects the hearing of high frequencies in older adults. Such hearing loss influences the processing of spoken language, including higher-level processing such as that of complex sentences. Hearing aids may alleviate some of the speech processing disadvantages associated with hearing loss. However, little is known about the relation between hearing loss, hearing aid use, and their effects on higher-level language processes. This neuroimaging (fMRI) study examined these factors by measuring the comprehension and neural processing of simple and complex spoken sentences in hard-of-hearing older adults (n = 39). Neither hearing loss severity nor hearing aid experience influenced sentence comprehension at the behavioral level. In contrast, hearing loss severity was associated with increased activity in left superior frontal areas and the left anterior insula, but only when processing specific complex sentences (i.e. object-before-subject) compared to simple sentences. Longer hearing aid experience in a sub-set of participants (n = 19) was associated with recruitment of several areas outside of the core speech processing network in the right hemisphere, including the cerebellum, the precentral gyrus, and the cingulate cortex, but only when processing complex sentences. Overall, these results indicate that brain activation for language processing is affected by hearing loss as well as subsequent hearing aid use. Crucially, they show that these effects become apparent through investigation of complex but not simple sentences.

Improving older adults' understanding of challenging speech: Auditory training, rapid adaptation and perceptual learning

The literature surrounding auditory perceptual learning and auditory training for challenging speech signals in older adult listeners is highly varied, in terms of both study methodology and reported outcomes. In this review, we discuss some of the pertinent features of listener, stimulus, and training protocol. Literature regarding the elicitation of auditory perceptual learning for time-compressed speech, non-native speech, and noise-vocoded speech is reviewed, as are auditory training protocols designed to improve speech-in-noise recognition. The literature is synthesized to establish some over-arching findings for the aging population, including an intact capacity for auditory perceptual learning, but a limited transfer of learning to untrained stimuli.

The Listening Network and Cochlear Implant Benefits in Hearing-Impaired Adults

Older adults with mild or no hearing loss make more errors and expend more effort listening to speech. Cochlear implants (CI) restore hearing to deaf patients but with limited fidelity. We hypothesized that patient-reported hearing and health-related quality of life in CI patients may similarly vary according to age. Speech Spatial Qualities (SSQ) of hearing scale and Health Utilities Index Mark III (HUI) questionnaires were administered to 543 unilaterally implanted adults across Europe, South Africa, and South America. Data were acquired before surgery and at 1, 2, and 3 years post-surgery. Data were analyzed using linear mixed models with visit, age group (18–34, 35–44, 45–54, 55–64, and 65+), and side of implant as main factors and adjusted for other covariates. Tinnitus and dizziness prevalence did not vary with age, but older groups had more preoperative hearing. Preoperatively and postoperatively, SSQ scores were significantly higher (Δ0.75–0.82) for those aged <45 compared with those 55+. However, gains in SSQ scores were equivalent across age groups, although postoperative SSQ scores were higher in right-ear implanted subjects. All age groups benefited equally in terms of HUI gain (0.18), with no decrease in scores with age. Overall, younger adults appeared to cope better with a degraded hearing before and after CI, leading to better subjective hearing performance.

When Hearing Does Not Mean Understanding: On the Neural Processing of Syntactically Complex Sentences by Listeners With Hearing Loss

Purpose Adults with mild-to-moderate age-related hearing loss typically exhibit issues with speech understanding, but their processing of syntactically complex sentences is not well understood. We test the hypothesis that listeners with hearing loss' difficulties with comprehension and processing of syntactically complex sentences are due to the processing of degraded input interfering with the successful processing of complex sentences. Method We performed a neuroimaging study with a sentence comprehension task, varying sentence complexity (through subject-object order and verb-arguments order) and cognitive demands (presence or absence of a secondary task) within subjects. Groups of older subjects with hearing loss (n = 20) and age-matched normal-hearing controls (n = 20) were tested. Results The comprehension data show effects of syntactic complexity and hearing ability, with normal-hearing controls outperforming listeners with hearing loss, seemingly more so on syntactically complex sentences. The secondary task did not influence off-line comprehension. The imaging data show effects of group, sentence complexity, and task, with listeners with hearing loss showing decreased activation in typical speech processing areas, such as the inferior frontal gyrus and superior temporal gyrus. No interactions between group, sentence complexity, and task were found in the neuroimaging data. Conclusions The results suggest that listeners with hearing loss process speech differently from their normal-hearing peers, possibly due to the increased demands of processing degraded auditory input. Increased cognitive demands by means of a secondary visual shape processing task influence neural sentence processing, but no evidence was found that it does so in a different way for listeners with hearing loss and normal-hearing listeners.

Association between the severity of hearing loss and the risk of dementia within the 2010-2017 national insurance service survey in South Korea

Hearing loss and dementia are highly prevalent neurologic conditions in older adults that can considerably impact the quality of life and create social and familial burdens. To investigate the impact of hearing loss on the risk of developing dementia in a nationwide long-term follow-up study using data obtained from the South Korean National Health Information Database. Retrospective medical data for patients of all ages were extracted from the database between January 2010 and December 2017. According to the national disability registry, the degree of severe-profound hearing loss is classified into six grades. We categorized hearing loss into three groups based on the disability registry severity: (1) severe hearing disability (HD), defined as 1st to 3rd grade disabling hearing loss; (2) non-severe HD, 4th and 5th grade disabling hearing loss; and (3) ipsilateral HD, 6th grade disabling hearing loss. After adjusting for potential confounding variables, the hazard ratio (HR) for all dementia types was 1.336 (95% CI 1.306–1.367) in the severe HD group, 1.312 (95% CI 1.286–1.338) in the non-severe HD group, and 1.257 (95% CI 1.217–1.299) in the ipsilateral HD group. On assessing by the age group, the risk of all dementia types in patients younger than 65 years was as follows: HR 1.933 (95% CI 1.779–2.101), 1.880 (95% CI 1.732–2.041), and 1.601 (95% CI 1.435–1.787) in the severe, non-severe, and ipsilateral HD groups, respectively. This study demonstrates that the impact of hearing loss on dementia incidence is severity-dependent, and the risk increases in patients younger than 65 years of age.

Associations of Hearing Sensitivity, Higher-Order Auditory Processing, and Cognition Over Time in Middle-Aged Adults

BACKGROUND

Age-related hearing loss (impairment in hearing sensitivity and/or higher-order auditory processing) and cognitive decline are common co-occurring impairments in elderly adults. Their relation in the process of aging remains insufficiently understood. We aim to assess the temporal relations of decline in hearing sensitivity, higher-order auditory processing, and cognition in middle-aged adults.

METHODS

This study included 1,274 Beaver Dam Offspring Study participants who participated in three examinations (baseline, 5-year, and 10-year follow-up). We assessed hearing sensitivity through pure-tone audiometry (PTA, averaged thresholds of 0.5, 1, 2, 4 kHz of the better ear), higher-order auditory processing as word recognition in competing message (WRCM) using the Northwestern University 6 word list in the better ear, and cognition through trail-making test performance (TMT). Linear mixed-effects models and linear regression models were used to determine associations over time and to what extent these measures influence each other over time.

RESULTS

The longitudinal decline between all functions was associated with the strongest relationships between PTA and WRCM. The effect of baseline PTA on WRCM 10 years later (standardized ß = -.30) was almost twice as big as the effect of baseline WRCM on PTA 10 years later (standardized ß = -.18). The effect of baseline WRCM on TMT 10 years later and vice versa were small (standardized ß = -.05). No directional relationship between PTA and TMT was identified (standardized ß ≤ .02).

CONCLUSIONS

While hearing sensitivity might affect higher-order auditory processing, associations between hearing and cognition appear bidirectional and weak in midlife. We need to be cautious before inferring causal effects of hearing on cognition.

Absorption and Enjoyment During Listening to Acoustically Masked Stories

Comprehension of speech masked by background sound requires increased cognitive processing, which makes listening effortful. Research in hearing has focused on such challenging listening experiences, in part because they are thought to contribute to social withdrawal in people with hearing impairment. Research has focused less on positive listening experiences, such as enjoyment, despite their potential importance in motivating effortful listening. Moreover, the artificial speech materials-such as disconnected, brief sentences-commonly used to investigate speech intelligibility and listening effort may be ill-suited to capture positive experiences when listening is challenging. Here, we investigate how listening to naturalistic spoken stories under acoustic challenges influences the quality of listening experiences. We assess absorption (the feeling of being immersed/engaged in a story), enjoyment, and listening effort and show that (a) story absorption and enjoyment are only minimally affected by moderate speech masking although listening effort increases, (b) thematic knowledge increases absorption and enjoyment and reduces listening effort when listening to a story presented in multitalker babble, and (c) absorption and enjoyment increase and effort decreases over time as individuals listen to several stories successively in multitalker babble. Our research indicates that naturalistic, spoken stories can reveal several concurrent listening experiences and that expertise in a topic can increase engagement and reduce effort. Our work also demonstrates that, although listening effort may increase with speech masking, listeners may still find the experience both absorbing and enjoyable.

Cognitive and neural predictors of speech comprehension in noisy backgrounds in older adults

Older adults often experience difficulties comprehending speech in noisy backgrounds, which hearing loss does not fully explain. It remains unknown how cognitive abilities, brain networks, and age-related hearing loss may uniquely contribute to speech in noise comprehension at the sentence level. In 31 older adults, using cognitive measures and resting-state fMRI, we investigated the cognitive and neural predictors of speech comprehension with energetic (broadband noise) and informational masking (multi-speakers) effects. Better hearing thresholds and greater working memory abilities were associated with better speech comprehension with energetic masking. Conversely, faster processing speed and stronger functional connectivity between frontoparietal and language networks were associated with better speech comprehension with informational masking. Our findings highlight the importance of the frontoparietal network in older adults' ability to comprehend speech in multi-speaker backgrounds, and that hearing loss and working memory in older adults contributes to speech comprehension abilities related to energetic, but not informational masking.

Neuroanatomical changes associated with age-related hearing loss and listening effort

Age-related hearing loss is associated with a decrease in hearing abilities for high frequencies and therefore leads to impairments in understanding speech—in particular, under adverse listening conditions. Growing evidence suggests that age-related hearing loss is related to various neural changes, for instance, affecting auditory and frontal brain regions. How the decreased auditory input and the increased listening effort in daily life are associated with structural changes is less clear, since previous evidence is scarce and mostly involved low sample sizes. Hence, the aim of the current study was to investigate the impact of age-related untreated hearing loss and subjectively rated daily life listening effort on grey matter and white matter changes in a large sample of participants (n = 71). For that aim, we conducted anatomical MRI and diffusion tensor imaging (DTI) in elderly hard-of-hearing and age-matched normal-hearing participants. Our results showed significantly lower grey matter volume in the middle frontal cortex in hard-of-hearing compared to normal-hearing participants. Further, higher listening effort was associated with lower grey matter volume and cortical thickness in the orbitofrontal cortex and lower grey matter volume in the inferior frontal cortex. No significant relations between hearing abilities or listening effort were obtained for white matter integrity in tracts connecting auditory and prefrontal as well as visual areas. These findings provide evidence that hearing impairment as well as daily life listening effort seems to be associated with grey matter loss in prefrontal brain regions. We further conclude that alterations in cortical thickness seem to be linked to the increased listening effort rather than the hearing loss itself.

Neural modelling of the semantic predictability gain under challenging listening conditions

When speech intelligibility is reduced, listeners exploit constraints posed by semantic context to facilitate comprehension. The left angular gyrus (AG) has been argued to drive this semantic predictability gain. Taking a network perspective, we ask how the connectivity within language-specific and domain-general networks flexibly adapts to the predictability and intelligibility of speech. During continuous functional magnetic resonance imaging (fMRI), participants repeated sentences, which varied in semantic predictability of the final word and in acoustic intelligibility. At the neural level, highly predictable sentences led to stronger activation of left-hemispheric semantic regions including subregions of the AG (PGa, PGp) and posterior middle temporal gyrus when speech became more intelligible. The behavioural predictability gain of single participants mapped onto the same regions but was complemented by increased activity in frontal and medial regions. Effective connectivity from PGa to PGp increased for more intelligible sentences. In contrast, inhibitory influence from pre-supplementary motor area to left insula was strongest when predictability and intelligibility of sentences were either lowest or highest. This interactive effect was negatively correlated with the behavioural predictability gain. Together, these results suggest that successful comprehension in noisy listening conditions relies on an interplay of semantic regions and concurrent inhibition of cognitive control regions when semantic cues are available.

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.

Temporal selectivity declines in the aging human auditory cortex

Current models successfully describe the auditory cortical response to natural sounds with a set of spectro-temporal features. However, these models have hardly been linked to the ill-understood neurobiological changes that occur in the aging auditory cortex. Modelling the hemodynamic response to a rich natural sound mixture in N = 64 listeners of varying age, we here show that in older listeners’ auditory cortex, the key feature of temporal rate is represented with a markedly broader tuning. This loss of temporal selectivity is most prominent in primary auditory cortex and planum temporale, with no such changes in adjacent auditory or other brain areas. Amongst older listeners, we observe a direct relationship between chronological age and temporal-rate tuning, unconfounded by auditory acuity or model goodness of fit. In line with senescent neural dedifferentiation more generally, our results highlight decreased selectivity to temporal information as a hallmark of the aging auditory cortex.

It can often be difficult for an older person to understand what someone is saying, particularly in noisy environments. Exactly how and why this age-related change occurs is not clear, but it is thought that older individuals may become less able to tune in to certain features of sound.

Newer tools are making it easier to study age-related changes in hearing in the brain. For example, functional magnetic resonance imaging (fMRI) can allow scientists to ‘see’ and measure how certain parts of the brain react to different features of sound. Using fMRI data, researchers can compare how younger and older people process speech. They can also track how speech processing in the brain changes with age.

Now, Erb et al. show that older individuals have a harder time tuning into the rhythm of speech. In the experiments, 64 people between the ages of 18 to 78 were asked to listen to speech in a noisy setting while they underwent fMRI. The researchers then tested a computer model using the data. In the older individuals, the brain’s tuning to the timing or rhythm of speech was broader, while the younger participants were more able to finely tune into this feature of sound. The older a person was the less able their brain was to distinguish rhythms in speech, likely making it harder to understand what had been said.

This hearing change likely occurs because brain cells become less specialised overtime, which can contribute to many kinds of age-related cognitive decline. This new information about why understanding speech becomes more difficult with age may help scientists develop better hearing aids that are individualised to a person’s specific needs.

Age-related hearing loss influences functional connectivity of auditory cortex for the McGurk illusion

Age-related hearing loss affects hearing at high frequencies and is associated with difficulties in understanding speech. Increased audio-visual integration has recently been found in age-related hearing impairment, the brain mechanisms that contribute to this effect are however unclear. We used functional magnetic resonance imaging in elderly subjects with normal hearing and mild to moderate uncompensated hearing loss. Audio-visual integration was studied using the McGurk task. In this task, an illusionary fused percept can occur if incongruent auditory and visual syllables are presented. The paradigm included unisensory stimuli (auditory only, visual only), congruent audio-visual and incongruent (McGurk) audio-visual stimuli. An illusionary precept was reported in over 60% of incongruent trials. These McGurk illusion rates were equal in both groups of elderly subjects and correlated positively with speech-in-noise perception and daily listening effort. Normal-hearing participants showed an increased neural response in left pre- and postcentral gyri and right middle frontal gyrus for incongruent stimuli (McGurk) compared to congruent audio-visual stimuli. Activation patterns were however not different between groups. Task-modulated functional connectivity differed between groups showing increased connectivity from auditory cortex to visual, parietal and frontal areas in hard of hearing participants as compared to normal-hearing participants when comparing incongruent stimuli (McGurk) with congruent audio-visual stimuli. These results suggest that changes in functional connectivity of auditory cortex rather than activation strength during processing of audio-visual McGurk stimuli accompany age-related hearing loss.

Changes in Speech-Related Brain Activity During Adaptation to Electro-Acoustic Hearing

Objectives: Hearing improves significantly with bimodal provision, i.e., a cochlear implant (CI) at one ear and a hearing aid (HA) at the other, but performance shows a high degree of variability resulting in substantial uncertainty about the performance that can be expected by the individual CI user. The objective of this study was to explore how auditory event-related potentials (AERPs) of bimodal listeners in response to spoken words approximate the electrophysiological response of normal hearing (NH) listeners. Study Design: Explorative prospective analysis during the first 6 months of bimodal listening using a within-subject repeated measures design. Setting: Academic tertiary care center. Participants: Twenty-seven adult participants with bilateral sensorineural hearing loss who received a HiRes 90K CI and continued use of a HA at the non-implanted ear. Age-matched NH listeners served as controls. Intervention: Cochlear implantation. Main Outcome Measures: Obligatory auditory evoked potentials N1 and P2, and the event-related N2 potential in response to monosyllabic words and their reversed sound traces before, as well as 3 and 6 months post-implantation. The task required word/non-word classification. Stimuli were presented within speech-modulated noise. Loudness of word/non-word signals was adjusted individually to achieve the same intelligibility across groups and assessments. Results: Intelligibility improved significantly with bimodal hearing, and the N1-P2 response approximated the morphology seen in NH with enhanced and earlier responses to the words compared to their reversals. For bimodal listeners, a prominent negative deflection was present between 370 and 570 ms post stimulus onset (N2), irrespective of stimulus type. This was absent for NH controls; hence, this response did not approximate the NH response during the study interval. N2 source localization evidenced extended activation of general cognitive areas in frontal and prefrontal brain areas in the CI group. Conclusions: Prolonged and spatially extended processing in bimodal CI users suggests employment of additional auditory-cognitive mechanisms during speech processing. This does not reduce within 6 months of bimodal experience and may be a correlate of the enhanced listening effort described by CI listeners.

Increased world knowledge in older adults does not prevent decline in world knowledge comprehension: An ERP study

A meaningful sentence might not be sensible according to world knowledge. In aging, world knowledge continues to increase, but semantic processing declines. An intriguing question is whether increased world knowledge aids world knowledge comprehension, even in the face of declining semantic processing. The present study collected EEG data from 43 older and 43 younger adults as they read correct sentences, sentences with a semantic violation, and sentences with a world knowledge violation. Compared to younger adults, older adults had a significantly greater reduction in amplitude and delayed peak/onset latency of N400 for both semantic and world knowledge integration. A significant Group by Condition by Region interaction revealed that, although the N400 amplitude under the semantic violation condition was comparable to that under the world knowledge violation condition in younger adults, the N400 amplitude in the posterior brain region was significantly smaller under the world knowledge violation condition than under the semantic violation condition in older adults. The N400 difference between world knowledge and semantic violation conditions was negatively correlated only with vocabulary scores. In conclusion, age-related increases in world knowledge do not help older adults to comprehend world knowledge more effectively.

Neural Signatures of Working Memory in Age-related Hearing Loss

Age-related hearing loss affects the ability to hear high frequencies and therefore leads to difficulties in understanding speech, particularly under adverse listening conditions. This decrease in hearing can be partly compensated by the recruitment of executive functions, such as working memory. The compensatory effort may, however, lead to a decrease in available neural resources compromising cognitive abilities. We here aim to investigate whether mild to moderate hearing loss impacts prefrontal functions and related executive processes and whether these are related to speech-in-noise perception abilities. Nineteen hard of hearing and nineteen age-matched normal-hearing participants performed a working memory task to drive prefrontal activity, which was gauged with functional magnetic resonance imaging. In addition, speech-in-noise understanding, cognitive flexibility and inhibition control were assessed. Our results showed no differences in frontoparietal activation patterns and working memory performance between normal-hearing and hard of hearing participants. The behavioral assessment of further executive functions, however, provided evidence of lower cognitive flexibility in hard of hearing participants. Cognitive flexibility and hearing abilities further predicted speech-in-noise perception. We conclude that neural and behavioral signatures of working memory are intact in mild to moderate hearing loss. Moreover, cognitive flexibility seems to be closely related to hearing impairment and speech-in-noise perception and should, therefore, be investigated in future studies assessing age-related hearing loss and its implications on prefrontal functions.

Age-related hearing loss associated with altered response efficiency and variability on a visual sustained attention task

This study investigated the association between age-related hearing loss (ARHL) and differences in response efficiency and variability on a sustained attention task. The study population comprised 32 participants in a hearing loss group (HLG) and 34 controls without hearing loss (CG). Mean reaction time (RT) and accuracy were recorded to assess response efficiency. RT variability was decomposed to examine temporal aspects of variability associated with neural arousal and top-down executive control of vigilant attention. The HLG had a significantly longer mean RT, possibly reflecting a strategic approach to maintain accuracy. The HLG also demonstrated altered variability (indicative of greater decline in neural arousal) but maintained executive control that was significantly predictive of poorer response efficiency. Adults with ARHL may rely on higher-order attention networks to compensate for decline in both peripheral sensory function and in subcortical arousal systems which mediate lower-order automatic neurocognitive processes.

Functional Connectivity of Heschl's Gyrus Associated With Age-Related Hearing Loss: A Resting-State fMRI Study

A large proportion of older adults experience hearing loss. Yet, the impact of hearing loss on the aging brain, particularly on large-scale brain networks that support cognition and language, is relatively unknown. We used resting-state functional magnetic resonance imaging (fMRI) to identify hearing loss-related changes in the functional connectivity of primary auditory cortex to determine if these changes are distinct from age and cognitive measures known to decline with age (e.g., working memory and processing speed). We assessed the functional connectivity of Heschl's gyrus in 31 older adults (60-80 years) who expressed a range of hearing abilities from normal hearing to a moderate hearing loss. Our results revealed that both left and right Heschl's gyri were significantly connected to regions within auditory, sensorimotor, and visual cortices, as well as to regions within the cingulo-opercular network known to support attention. Participant age, working memory, and processing speed did not significantly correlate with any connectivity measures once variance due to hearing loss was removed. However, hearing loss was associated with increased connectivity between right Heschl's gyrus and the dorsal anterior cingulate in the cingulo-opercular network even once variance due to age, working memory, and processing speed was removed. This greater connectivity was not driven by high frequency hearing loss, but rather by hearing loss measured in the 0.5-2 kHz range, particularly in the left ear. We conclude that hearing loss-related differences in functional connectivity in older adults are distinct from other aging-related differences and provide insight into a possible neural mechanism of compensation for hearing loss in older adults.

Cingulo-opercular adaptive control for younger and older adults during a challenging gap detection task

Cingulo-opercular activity is hypothesized to reflect an adaptive control function that optimizes task performance through adjustments in attention and behavior, and outcome monitoring. While auditory perceptual task performance appears to benefit from elevated activity in cingulo-opercular regions of frontal cortex before stimuli are presented, this association appears reduced for older adults compared to younger adults. However, adaptive control function may be limited by difficult task conditions for older adults. An fMRI study was used to characterize adaptive control differences while 15 younger (average age = 24 years) and 15 older adults (average age = 68 years) performed a gap detection in noise task designed to limit age-related differences. During the fMRI study, participants listened to a noise recording and indicated with a button-press whether it contained a gap. Stimuli were presented between sparse fMRI scans (TR = 8.6 s) and BOLD measurements were collected during separate listening and behavioral response intervals. Age-related performance differences were limited by presenting gaps in noise with durations calibrated at or above each participant's detection threshold. Cingulo-opercular BOLD increased significantly throughout listening and behavioral response intervals, relative to a resting baseline. Correct behavioral responses were significantly more likely on trials with elevated pre-stimulus cingulo-opercular BOLD, consistent with an adaptive control framework. Cingulo-opercular adaptive control estimates appeared higher for participants with better gap sensitivity and lower response bias, irrespective of age, which suggests that this mechanism can benefit performance across the lifespan under conditions that limit age-related performance differences.

Age-Related Atrophy and Compensatory Neural Networks in Reading Comprehension

OBJECTIVES

Despite changes to brain integrity with aging, some functions like basic language processes remain remarkably preserved. One theory for the maintenance of function in light of age-related brain atrophy is the engagement of compensatory brain networks. This study examined age-related changes in the neural networks recruited for simple language comprehension.

METHODS

Sixty-five adults (native English-speaking, right-handed, and cognitively normal) aged 17-85 years underwent a functional magnetic resonance imaging (fMRI) reading paradigm and structural scanning. The fMRI data were analyzed using independent component analysis to derive brain networks associated with reading comprehension.

RESULTS

Two typical frontotemporal language networks were identified, and these networks remained relatively stable across the wide age range. In contrast, three attention-related networks showed increased activation with increasing age. Furthermore, the increased recruitment of a dorsal attention network was negatively correlated to gray matter thickness in temporal regions, whereas an anterior frontoparietal network was positively correlated to gray matter thickness in insular regions.

CONCLUSIONS

We found evidence that older adults can exert increased effort and recruit additional attentional resources to maintain their reading abilities in light of increased cortical atrophy.

Exploring Differences in Speech Processing Among Older Hearing-Impaired Listeners With or Without Hearing Aid Experience: Eye-Tracking and fMRI Measurements

Recently, evidence has been accumulating that untreated hearing loss can lead to neurophysiological changes that affect speech processing abilities in noise. To shed more light on how aiding may impact these effects, this study explored the influence of hearing aid (HA) experience on the cognitive processes underlying speech comprehension. Eye-tracking and functional magnetic resonance imaging (fMRI) measurements were carried out with acoustic sentence-in-noise (SiN) stimuli complemented by pairs of pictures that either correctly (target picture) or incorrectly (competitor picture) depicted the sentence meanings. For the eye-tracking measurements, the time taken by the participants to start fixating the target picture (the 'processing time') was measured. For the fMRI measurements, brain activation inferred from blood-oxygen-level dependent responses following sentence comprehension was measured. A noise-only condition was also included. Groups of older hearing-impaired individuals matched in terms of age, hearing loss, and working memory capacity with (eHA; N = 13) or without (iHA; N = 14) HA experience participated. All acoustic stimuli were presented via earphones with individual linear amplification to ensure audibility. Consistent with previous findings, the iHA group had significantly longer (poorer) processing times than the eHA group, despite no differences in speech recognition performance. Concerning the fMRI measurements, there were indications of less brain activation in some right frontal areas for SiN relative to noise-only stimuli in the eHA group compared to the iHA group. Together, these results suggest that HA experience leads to faster speech-in-noise processing, possibly related to less recruitment of brain regions outside the core sentence-comprehension network. Follow-up research is needed to substantiate the findings related to changes in cortical speech processing with HA use.

Age, Hearing, and the Perceptual Learning of Rapid Speech

The effects of aging and age-related hearing loss on the ability to learn degraded speech are not well understood. This study was designed to compare the perceptual learning of time-compressed speech and its generalization to natural-fast speech across young adults with normal hearing, older adults with normal hearing, and older adults with age-related hearing loss. Early learning (following brief exposure to time-compressed speech) and later learning (following further training) were compared across groups. Age and age-related hearing loss were both associated with declines in early learning. Although the two groups of older adults improved during the training session, when compared to untrained control groups (matched for age and hearing), learning was weaker in older than in young adults. Especially, the transfer of learning to untrained time-compressed sentences was reduced in both groups of older adults. Transfer of learning to natural-fast speech occurred regardless of age and hearing, but it was limited to sentences encountered during training. Findings are discussed within the framework of dynamic models of speech perception and learning. Based on this framework, we tentatively suggest that age-related declines in learning may stem from age differences in the use of high- and low-level speech cues. These age differences result in weaker early learning in older adults, which may further contribute to the difficulty to perceive speech in daily conversational settings in this population.

The effect of age-related hearing loss and listening effort on resting state connectivity

Age-related hearing loss is associated with a decrease in hearing abilities for high frequencies. This increases not only the difficulty to understand speech but also the experienced listening effort. Task based neuroimaging studies in normal-hearing and hearing-impaired participants show an increased frontal activation during effortful speech perception in the hearing-impaired. Whether the increased effort in everyday listening in hearing-impaired even impacts functional brain connectivity at rest is unknown. Nineteen normal-hearing and nineteen hearing-impaired participants with mild to moderate hearing loss participated in the study. Hearing abilities, listening effort and resting state functional connectivity were assessed. Our results indicate no differences in functional connectivity between hearing-impaired and normal-hearing participants. Increased listening effort, however, was related to significantly decreased functional connectivity between the dorsal attention network and the precuneus and superior parietal lobule as well as between the auditory and the inferior frontal cortex. We conclude that already mild to moderate age-related hearing loss can impact resting state functional connectivity. It is however not the hearing loss itself but the individually perceived listening effort that relates to functional connectivity changes.