Are age-related changes in cognitive function driven by age-related changes in sensory processing?

Effects of Temporal Processing on Speech-in-Noise Perception in Middle-Aged Adults

Auditory temporal processing is a vital component of auditory stream segregation, or the process in which complex sounds are separated and organized into perceptually meaningful objects. Temporal processing can degrade prior to hearing loss, and is suggested to be a contributing factor to difficulties with speech-in-noise perception in normal-hearing listeners. The current study tested this hypothesis in middle-aged adults-an under-investigated cohort, despite being the age group where speech-in-noise difficulties are first reported. In 76 participants, three mechanisms of temporal processing were measured: peripheral auditory nerve function using electrocochleography, subcortical encoding of periodic speech cues (i.e., fundamental frequency; F0) using the frequency following response, and binaural sensitivity to temporal fine structure (TFS) using a dichotic frequency modulation detection task. Two measures of speech-in-noise perception were administered to explore how contributions of temporal processing may be mediated by different sensory demands present in the speech perception task. This study supported the hypothesis that temporal coding deficits contribute to speech-in-noise difficulties in middle-aged listeners. Poorer speech-in-noise perception was associated with weaker subcortical F0 encoding and binaural TFS sensitivity, but in different contexts, highlighting that diverse aspects of temporal processing are differentially utilized based on speech-in-noise task characteristics.

Sound-localization-related activation and functional connectivity of dorsal auditory pathway in relation to demographic, cognitive, and behavioral characteristics in age-related hearing loss

Background

Patients with age-related hearing loss (ARHL) often struggle with tracking and locating sound sources, but the neural signature associated with these impairments remains unclear.

Materials and methods

Using a passive listening task with stimuli from five different horizontal directions in functional magnetic resonance imaging, we defined functional regions of interest (ROIs) of the auditory "where" pathway based on the data of previous literatures and young normal hearing listeners (n = 20). Then, we investigated associations of the demographic, cognitive, and behavioral features of sound localization with task-based activation and connectivity of the ROIs in ARHL patients (n = 22).

Results

We found that the increased high-level region activation, such as the premotor cortex and inferior parietal lobule, was associated with increased localization accuracy and cognitive function. Moreover, increased connectivity between the left planum temporale and left superior frontal gyrus was associated with increased localization accuracy in ARHL. Increased connectivity between right primary auditory cortex and right middle temporal gyrus, right premotor cortex and left anterior cingulate cortex, and right planum temporale and left lingual gyrus in ARHL was associated with decreased localization accuracy. Among the ARHL patients, the task-dependent brain activation and connectivity of certain ROIs were associated with education, hearing loss duration, and cognitive function.

Conclusion

Consistent with the sensory deprivation hypothesis, in ARHL, sound source identification, which requires advanced processing in the high-level cortex, is impaired, whereas the right-left discrimination, which relies on the primary sensory cortex, is compensated with a tendency to recruit more resources concerning cognition and attention to the auditory sensory cortex. Overall, this study expanded our understanding of the neural mechanisms contributing to sound localization deficits associated with ARHL and may serve as a potential imaging biomarker for investigating and predicting anomalous sound localization.

Neuronal ageing is promoted by the decay of the microtubule cytoskeleton

Natural ageing is accompanied by a decline in motor, sensory, and cognitive functions, all impacting quality of life. Ageing is also the predominant risk factor for many neurodegenerative diseases, including Parkinson's disease and Alzheimer's disease. We need to therefore gain a better understanding of the cellular and physiological processes underlying age-related neuronal decay. However, gaining this understanding is a slow process due to the large amount of time required to age mammalian or vertebrate animal models. Here, we introduce a new cellular model within the Drosophila brain, in which we report classical ageing hallmarks previously observed in the primate brain. These hallmarks include axonal swellings, cytoskeletal decay, a reduction in axonal calibre, and morphological changes arising at synaptic terminals. In the fly brain, these changes begin to occur within a few weeks, ideal to study the underlying mechanisms of ageing. We discovered that the decay of the neuronal microtubule (MT) cytoskeleton precedes the onset of other ageing hallmarks. We showed that the MT-binding factors Tau, EB1, and Shot/MACF1, are necessary for MT maintenance in axons and synapses, and that their functional loss during ageing triggers MT bundle decay, followed by a decline in axons and synaptic terminals. Furthermore, genetic manipulations that improve MT networks slowed down the onset of neuronal ageing hallmarks and confer aged specimens the ability to outperform age-matched controls. Our work suggests that MT networks are a key lesion site in ageing neurons and therefore the MT cytoskeleton offers a promising target to improve neuronal decay in advanced age.

Elderly Individuals Residing in Nursing Homes in Western Romania Who Have Been Diagnosed with Hearing Loss are at a Higher Risk of Experiencing Cognitive Impairment

Purpose

The objective of this research was to determine if there is any correlation between the severity of neurocognitive disorder and hearing impairment in the elderly.

Patients and Methods

This is a population-based observational study that included subjects aged ≥ 65 years. They were evaluated for the existence of cardiovascular risk factors, diabetes, stroke, alcohol abuse, and smoking. Hearing impairment was diagnosed by an audiologist, using behavioral audiometric examination. These evaluations might have been performed in response to concerns about hearing loss, or they could have been a routine component of yearly comprehensive health screenings that included a Mini-Mental State Examination 2nd Edition (MMSE-2) test. According to the results of the MMSE-2 scale, we divided the individuals into two groups, Group I for those who had cognitive impairment and severe neurocognitive disorder, and Group II for those who did not have cognitive impairment.

Results

The study enrolled 203 patients with a mean age of 77 ± 7.5 years (range 65-98), 99 (48%) were males. When comparing the two groups, group I patients presented more often cardiovascular risk factors, stroke, diabetes, and impaired hearing. The univariable logistic regression found that cognitive impairment was significantly more frequent in the elderly with cardiovascular disease, diabetes, and stroke (p<0.0001). The multivariate regression analysis found that stroke (p<0.0001) diabetes (p=0.0008), cardiovascular disease (p=0.0004), and impaired hearing (p=0.0011) were significantly linked to cognitive impairment. The occurrence of hearing impairment in the elderly was related to having an MMSE-2 score of 14 or below.

Conclusion

According to the findings of this research, the elderly who have trouble hearing in addition to other conditions might have an increased risk for severe neurocognitive disorder.

Association between sleep hours and changes in cognitive function according to the morningness-eveningness type: A population-based study

OBJECTIVE

The aim of this study was to investigate proper sleep hours to reduce the risk of cognitive decrease considering morningness-eveningness type.

METHODS

The Korean Community Health Survey was used, which includes adults aged over 19 years old. These data were obtained from a cross-sectional study and assessed sleep hours using questionnaire of Pittsburgh Sleep Quality Index. Based on the wake-up time of each participant, they were classified into the morningness, intermediate, eveningness, and none groups. The change in cognitive function was determined by a single question about memory loss experience.

RESULTS

A total of 224,714 participants were included in the analysis. Of the participants, 55.6 % and 5.0 % of whom had morningness and eveningness, respectively. The risk of cognitive decline was significantly different by sleep hours and morningness-eveningness type. Without considering sleep quality, the intermediate and eveningness groups showed a higher risk of cognitive decline than the morningness group, and the risk was lowest in those with 7-9 sleep hours. However, when sleep quality showing significant effect was included in the analysis, sleep hours showing the lowest risk were different among morningness, intermediate, eveningness groups, and it was the shortest in the morningness type at 5-6 h and the longest in the eveningness type at 7-8 h.

CONCLUSION

Proper sleep hours to decrease the risk of cognitive decline may be different by morningness-eveningness types. However, when considering sleep quality, sleep duration had little influence on cognitive decline. Future studies investigating healthy sleep hours need to consider sleep quality as well as the habitual sleep schedules.

LIMITATIONS

The morningness-eveningness types were classified based on wake-up time not morningness-eveningness types. The morningness-eveningness types in this study would be interpreted as habitual sleep schedule rather than chronotype.

Abnormal white and gray matter functional connectivity is associated with cognitive dysfunction in presbycusis

Presbycusis is characterized by high-frequency hearing loss and is closely associated with cognitive decline. Previous studies have observed functional reorganization of gray matter in presbycusis, but the information transmission between gray matter and white matter remains ill-defined. Using resting-state functional magnetic resonance imaging, we investigated differences in functional connectivity (GM-GM, WM-WM, and GM-WM) between 60 patients with presbycusis and 57 healthy controls. Subsequently, we examined the correlation between these connectivity differences with high-frequency hearing loss as well as cognitive impairment. Our results revealed significant alterations in functional connectivity involving the body of the corpus callosum, posterior limbs of the internal capsule, retrolenticular region of the internal capsule, and the gray matter regions in presbycusis. Notably, disrupted functional connectivity was observed between the body of the corpus callosum and ventral anterior cingulate cortex in presbycusis, which was associated with impaired attention. Additionally, enhanced functional connectivity was found in presbycusis between the internal capsule and the ventral auditory processing stream, which was related to impaired cognition in multiple domains. These two patterns of altered functional connectivity between gray matter and white matter may involve both bottom-up and top-down regulation of cognitive function. These findings provide novel insights into understanding cognitive compensation and resource redistribution mechanisms in presbycusis.

An Exploration of the Memory Performance in Older Adult Hearing Aid Users on the Integrated Digit-in-Noise Test

This study aimed to preliminarily investigate the associations between performance on the integrated Digit-in-Noise Test (iDIN) and performance on measures of general cognition and working memory (WM). The study recruited 81 older adult hearing aid users between 60 and 95 years of age with bilateral moderate to severe hearing loss. The Chinese version of the Montreal Cognitive Assessment Basic (MoCA-BC) was used to screen older adults for mild cognitive impairment. Speech reception thresholds (SRTs) were measured using 2- to 5-digit sequences of the Mandarin iDIN. The differences in SRT between five-digit and two-digit sequences (SRT5-2), and between five-digit and three-digit sequences (SRT5-3), were used as indicators of memory performance. The results were compared to those from the Digit Span Test and Corsi Blocks Tapping Test, which evaluate WM and attention capacity. SRT5-2 and SRT5-3 demonstrated significant correlations with the three cognitive function tests (rs ranging from -.705 to -.528). Furthermore, SRT5-2 and SRT5-3 were significantly higher in participants who failed the MoCA-BC screening compared to those who passed. The findings show associations between performance on the iDIN and performance on memory tests. However, further validation and exploration are needed to fully establish its effectiveness and efficacy.

Compressed primary-to-transmodal gradient is accompanied with subcortical alterations and linked to neurotransmitters and cellular signatures in major depressive disorder

Major depressive disorder (MDD) has been shown to involve widespread changes in low-level sensorimotor and higher-level cognitive functions. Recent research found that a primary-to-transmodal gradient could capture a cortical hierarchical organization ranging from perception and action to cognition in healthy subjects, but a prominent gradient dysfunction in MDD patients. However, whether and how this cortical gradient is linked to subcortical impairments and whether it is reflected in the microscale neurotransmitter systems and cell type-specific transcriptional signatures remain largely unknown. Data were acquired from 323 MDD patients and 328 sex- and age-matched healthy controls derived from the REST-meta-MDD project, and the human brain neurotransmitter systems density maps and gene expression data were drawn from two publicly available datasets. We investigated alterations of the primary-to-transmodal gradient in MDD patients and their correlations with clinical symptoms of depression and anxiety, as well as  their paralleled subcortical impairments. The correlations between MDD-related gradient alterations and densities of the neurotransmitter systems and gene expression information were assessed, respectively. The results demonstrated that MDD patients had a compressed primary-to-transmodal gradient accompanied by paralleled alterations in subcortical regions including the caudate, amygdala, and thalamus. The case-control gradient differences were spatially correlated with the densities of the neurotransmitter systems including the serotonin and dopamine receptors, and meanwhile with gene expression enriched in astrocytes, excitatory and inhibitory neuronal cells. These findings mapped the paralleled subcortical impairments in cortical hierarchical organization and also helped us understand the possible molecular and cellular substrates of the co-occurrence of high-level cognitive impairments with low-level sensorimotor abnormalities in MDD.

Testing the Informativeness of Diverse Measures of Auditory Processing for Clinical Audiological Practice in Middle-Aged Adults in Mexico

PURPOSE

Standard clinical audiologic assessment is limited in its ability to capture variance in self-reported hearing difficulty. Additionally, the costs associated with clinical testing in audiology create financial barriers for hearing health care in developing countries like Mexico. This study used an open-source Spanish-language tool called PART (Portable Automated Rapid Testing) to test the hypothesis that a battery of assessments of auditory processing can complement standard clinical audiological assessment to better capture the variance of self-reported hearing difficulty.

METHOD

Forty-three adults between 40 and 69 years of age were tested in Mexico City using a traditional clinical pure-tone audiogram, cognitive screening, and a battery of PART-based auditory processing assessments including a speech-on-speech competition spatial release from masking task. Results were compared to self-reported hearing difficulty, assessed with a Spanish-language adaptation of the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S).

RESULTS

Several measures from the PART battery exhibited stronger correlations with self-reported hearing difficulties than the pure-tone audiogram. The spatial release from masking task best captured variance in HHIE-S scores and remained significant after controlling for the effects of age, audibility, and cognitive score.

CONCLUSIONS

The spatial release from masking task can complement traditional clinical measures to better account for patient's self-reported hearing difficulty. Open-source access to this test in PART supports its implementation for Spanish speakers in clinical settings around the world at low cost.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24470140.

Implicit auditory memory in older listeners: From encoding to 6-month retention

Any listening task, from sound recognition to sound-based communication, rests on auditory memory which is known to decline in healthy ageing. However, how this decline maps onto multiple components and stages of auditory memory remains poorly characterised. In an online unsupervised longitudinal study, we tested ageing effects on implicit auditory memory for rapid tone patterns. The test required participants (younger, aged 20-30, and older adults aged 60-70) to quickly respond to rapid regularly repeating patterns emerging from random sequences. Patterns were novel in most trials (REGn), but unbeknownst to the participants, a few distinct patterns reoccurred identically throughout the sessions (REGr). After correcting for processing speed, the response times (RT) to REGn should reflect the information held in echoic and short-term memory before detecting the pattern; long-term memory formation and retention should be reflected by the RT advantage (RTA) to REGr vs REGn which is expected to grow with exposure. Older participants were slower than younger adults in detecting REGn and exhibited a smaller RTA to REGr. Computational simulations using a model of auditory sequence memory indicated that these effects reflect age-related limitations both in early and long-term memory stages. In contrast to ageing-related accelerated forgetting of verbal material, here older adults maintained stable memory traces for REGr patterns up to 6 months after the first exposure. The results demonstrate that ageing is associated with reduced short-term memory and long-term memory formation for tone patterns, but not with forgetting, even over surprisingly long timescales.

Syntactic complexity differentially affects auditory sentence comprehension performance for individuals with age-related hearing loss

Objectives

This study examined whether older adults with hearing loss (HL) experience greater difficulties in auditory sentence comprehension compared to those with typical-hearing (TH) when the linguistic burdens of syntactic complexity were systematically manipulated by varying either the sentence type (active vs. passive) or sentence length (3- vs. 4-phrases).

Methods

A total of 22 individuals with HL and 24 controls participated in the study, completing sentence comprehension test (SCT), standardized memory assessments, and pure-tone audiometry tests. Generalized linear mixed effects models were employed to compare the effects of sentence type and length on SCT accuracy, while Pearson correlation coefficients were conducted to explore the relationships between SCT accuracy and other factors. Additionally, stepwise regression analyses were employed to identify memory-related predictors of sentence comprehension ability.

Results

Older adults with HL exhibited poorer performance on passive sentences than on active sentences compared to controls, while the sentence length was controlled. Greater difficulties on passive sentences were linked to working memory capacity, emerging as the most significant predictor for the comprehension of passive sentences among participants with HL.

Conclusion

Our findings contribute to the understanding of the linguistic-cognitive deficits linked to age-related hearing loss by demonstrating its detrimental impact on the processing of passive sentences. Cognitively healthy adults with hearing difficulties may face challenges in comprehending syntactically more complex sentences that require higher computational demands, particularly in working memory allocation.

The effect of unisensory and multisensory information on lexical decision and free recall in young and older adults

Studies using simple low-level stimuli show that multisensory stimuli lead to greater improvements in processing speed for older adults than young adults. However, there is insufficient evidence to explain how these benefits influence performance for more complex processes such as judgement and memory tasks. This study examined how presenting stimuli in multiple sensory modalities (audio-visual) instead of one (audio-only or visual-only) may help older adults to improve their memory and cognitive processing compared to young adults. Young and older adults completed lexical decision (real word vs. pseudoword judgement) and word recall tasks, either independently, or in combination (dual-task), with and without perceptual noise. Older adults were better able to remember words when encoding independently. In contrast, young adults were better able to remember words when encoding in combination with lexical decisions. Both young and older adults had better word recall in the audio-visual condition compared with the audio-only condition. The findings indicate significant age differences when dealing with multiple tasks during encoding. Crucially, there is no greater multisensory benefit for older adults compared to young adults in more complex processes, rather multisensory stimuli can be useful in enhancing cognitive performance for both young and older adults.

Association of age-related hearing loss with cognitive impairment and dementia: an umbrella review

Background

Hearing loss, cognitive impairment and dementia have become common problems for older adults. Currently, systematic reviews and meta-analyses of the association between age-related hearing loss (ARHL) with cognitive impairment and dementia may have inconsistent results. To explore and validate the association between ARHL with cognitive impairment and dementia through summarizing and evaluating existing evidence.

Methods

From inception to February 01, 2023, PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched. AMSTAR 2 was used to evaluate methodological quality and GRADE system was used to evaluate evidence quality. We summarized the basic characteristics of the included studies and extracted effect data for ARHL with cognitive impairment and dementia. Forest plots were used to describe the relative risk associated with ARHL and cognitive impairment, and the relative risk associated with ARHL and dementia, respectively.

Results

A total of 11 systematic reviews and meta-analyses met the inclusion criteria. Overall, the methodological quality of the included SRs/MAs was moderate and the quality of the evidence was low. The combined results found that the pooled risk ratio of ARHL and cognitive impairment was 1.30 (random-effects; 95% CI 1.16 to 1.45), and the pooled risk ratio of ARHL and dementia was 1.59 (random-effects; 95% CI 1.34 to 1.90).

Conclusion

Based on the evidence reported in this umbrella review, age-related hearing loss is significantly associated with cognitive impairment and dementia. Hearing loss may be a high risk factor for cognitive impairment and dementia in older adults.

Does age-related hearing loss deteriorate attentional resources?

Recent work suggests that age-related hearing loss (HL) is a possible risk factor for cognitive decline in older adults. Resulting poor speech recognition negatively impacts cognitive, social and emotional functioning and may relate to dementia. However, little is known about the consequences of hearing loss on other non-linguistic domains of cognition. The aim of this study was to investigate the role of HL on covert orienting of attention, selective attention and executive control. We compared older adults with and without mild to moderate hearing loss (26-60 dB) performing (1) a spatial cueing task with uninformative central cues (social vs. nonsocial cues), (2) a flanker task and (3) a neuropsychological assessment of attention. The results showed that overall response times and flanker interference effects were comparable across groups. However, in spatial cueing of attention using social and nonsocial cues, hearing impaired individuals were characterized by reduced validity effects, though no additional group differences were found between social and nonsocial cues. Hearing impaired individuals also demonstrated diminished performance on the Montreal Cognitive Assessment (MoCA) and on tasks requiring divided attention and flexibility. This work indicates that while response speed and response inhibition appear to be preserved following mild-to-moderate acquired hearing loss, orienting of attention, divided attention and the ability to flexibly allocate attentional resources are more deteriorated in older adults with HL. This work suggests that hearing loss might exacerbate the detrimental influences of aging on visual attention.

Functional topography of the neocortex predicts covariation in complex cognitive and basic motor abilities

Although higher-order cognitive and lower-order sensorimotor abilities are generally regarded as distinct and studied separately, there is evidence that they not only covary but also that this covariation increases across the lifespan. This pattern has been leveraged in clinical settings where a simple assessment of sensory or motor ability (e.g. hearing, gait speed) can forecast age-related cognitive decline and risk for dementia. However, the brain mechanisms underlying cognitive, sensory, and motor covariation are largely unknown. Here, we examined whether such covariation in midlife reflects variability in common versus distinct neocortical networks using individualized maps of functional topography derived from BOLD fMRI data collected in 769 45-year-old members of a population-representative cohort. Analyses revealed that variability in basic motor but not hearing ability reflected individual differences in the functional topography of neocortical networks typically supporting cognitive ability. These patterns suggest that covariation in motor and cognitive abilities in midlife reflects convergence of function in higher-order neocortical networks and that gait speed may not be simply a measure of physical function but rather an integrative index of nervous system health.

Probability Distributions for Associations Between Cognitive Screening and Pure-tone Thresholds in Older Adults

OBJECTIVES

Lower general cognitive function is frequently reported in older adults with elevated pure-tone thresholds. Here, we examined reason(s) for this association, including whether this relationship is dependent on the frequency range or extent of hearing loss and cognitive screening performance.

DESIGN

Linear regression was used to examine associations between better-ear pure-tone thresholds and Mini-Mental Status Exam (MMSE) performance in a cross-sectional sample of relatively healthy older adults (N = 508; 68% women, 60-89+ years; M age = 72). Quantile regression was also used to identify the ranges of 0.5 and 4.0 kHz thresholds and MMSE scores where these variables exhibited significant associations.

RESULTS

MMSE scores and pure-tone thresholds exhibited small but significant associations, particularly for better-ear 0.5 kHz thresholds. This hearing threshold and cognitive screening association was present among participants with better hearing, including the oldest older adults. There was limited evidence for mediating health condition effects on this association. An item analysis of the MMSE revealed that the MMSE and pure-tone threshold associations were largely due to the delayed recall item of the MMSE.

CONCLUSIONS

Together, the small effect results are consistent with the extant literature and suggest that there are multiple reasons for modest pure-tone threshold and cognitive screening performance associations.

Effect of Age and Hearing Loss on Auditory Processing Skills

Background: The present study aimed to evaluate the effect of age and hearing loss on auditory processing abilities. For this purpose, auditory processing abilities were compared among young and older adults with normal hearing sensitivity and older adults with and without hearing loss. Method: The study comprised 20 normal-hearing young adults (18-25 years), 20 older adults with normal hearing sensitivity (50-70 years), and 20 older adults with mild to moderate sensorineural hearing impairment (50-70 years). All 60 participants underwent gap detection (GDT), dichotic consonant-vowe (DCV)l, speech in noise (SPIN), duration pattern (DPT), and working memory (forward and backward span) tests in a sound treated test room. Results: Results showed that young normal-hearing adults performed significantly better than normal-hearing older adults in SPIN, GDT, DCV, working memory, and DPT. Futher, normal-hearing older individuals performed better than older individuals with hearing impairment on all the auditory processing tests except on the forward span test and DPT. Conclusion: Auditory processing abilities deteriorate with age and hearing loss also has a pronounced effect on most auditory processing abilities.

Risk of Subsequent Dementia or Alzheimer Disease Among Patients With Age-Related Macular Degeneration: A Systematic Review and Meta-analysis

PURPOSE

Alzheimer disease (AD), a common form of dementia, shares several clinical and pathologic features with age-related macular degeneration (AMD). Epidemiologic reports on the association of AMD with subsequent dementia or AD are inconsistent.

DESIGN

Systematic review and meta-analysis.

METHODS

The Meta-analysis of Observational Studies in Epidemiology reporting guidelines were applied. The Newcastle-Ottawa Scale was used to evaluate the risk of bias in the included cohort studies that examined the association of AMD with subsequent dementia or AD. We estimated the pooled hazard ratios (HRs) of dementia or AD using random effects model meta-analysis and subgroup analysis on different follow-up periods, AMD subtype, gender, age, study design, and methods to ascertain dementia or AD.

RESULTS

A total of 8 223 581 participants were included in 8 studies published during 2000-2021. The meta-analysis showed that AMD was significantly associated with subsequent dementia (pooled HR 1.22, 95% CI 1.01-1.47) or AD (pooled HR 1.21, 95% CI 1.03-1.43). Our secondary analysis revealed that the association was more noticeable in dry AMD than wet AMD.

CONCLUSIONS

Patients with AMD have higher risks of developing dementia or AD, and therefore identifying related comorbidities and retinal biomarkers is much warranted for older adults with AMD in ophthalmologic practice.

Different neuroanatomical correlates for temporal and spectral supra-threshold auditory tasks and speech in noise recognition in older adults with hearing impairment

Varying degrees of pure-tone hearing loss in older adults are differentially associated with cortical volume (CV) and thickness (CT) within and outside of the auditory pathway. This study addressed the question to what degree supra-threshold auditory performance (i.e., temporal compression and frequency selectivity) as well as speech in noise (SiN) recognition are associated with neurostructural correlates in a sample of 59 healthy older adults with mild to moderate pure-tone hearing loss. Using surface-based morphometry on T1-weighted MRI images, CT, CV, and surface area (CSA) of several regions-of-interest were obtained. The results showed distinct neurostructural patterns for the different tasks in terms of involved regions as well as morphometric parameters. While pure-tone averages (PTAs) positively correlated with CT in a right hemisphere superior temporal sulcus and gyrus cluster, supra-threshold auditory perception additionally extended significantly to CV and CT in left and right superior temporal clusters including Heschl's gyrus and sulcus, the planum polare and temporale. For SiN recognition, we found significant correlations with an auditory-related CT cluster and furthermore with language-related areas in the prefrontal cortex. Taken together, our results show that different auditory abilities are differently associated with cortical morphology in older adults with hearing impairment. Still, a common pattern is that greater PTAs and poorer supra-threshold auditory performance as well as poorer SiN recognition are all related to cortical thinning and volume loss but not to changes in CSA. These results support the hypothesis that mostly CT undergoes alterations in the context of auditory decline, while CSA remains stable.

Cortical thickness of the left parahippocampal cortex links central hearing and cognitive performance in aging

Hearing impairment is considered a leading modifiable risk factor of cognitive decline and dementia. While most evidence has been established on clinical assessment of peripheral hearing loss, understanding of how central hearing in real-world conditions is associated with cognitive aging is limited. This study analyzed the data of 473 unrelated healthy adults aged 36-100 years old from the Lifespan Human Connectome Project in Aging. Central hearing was evaluated using the Words-in-Noise decibel threshold. Cognitive functions were evaluated by the performance on cognitive tests, and cortical thickness was estimated from magnetic resonance imaging (MRI) data. Here, we show that a higher hearing threshold was associated with a lower performance on immediate and delayed episodic memory retrieval, switching aspect of executive function, working memory, reading decoding, and vocabulary comprehension. Cortical thickness in the left parahippocampal cortex (lPHC) was negatively associated with the hearing threshold and acted as a significant partial mediator in the association of central hearing with immediate recall, switching, reading decoding, and vocabulary comprehension. These findings suggest that cortical thickness in the lPHC, an early target of dementia, partially links central hearing and performance in multiple cognitive domains in aging.

Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia: A Systematic Review and Meta-analysis

Importance

Hearing loss is associated with cognitive decline. However, it is unclear if hearing restorative devices may have a beneficial effect on cognition.

Objective

To evaluate the associations of hearing aids and cochlear implants with cognitive decline and dementia.

Data Sources

PubMed, Embase, and Cochrane databases for studies published from inception to July 23, 2021.

Study Selection

Randomized clinical trials or observational studies published as full-length articles in peer-reviewed journals relating to the effect of hearing interventions on cognitive function, cognitive decline, cognitive impairment, and dementia in patients with hearing loss.

Data Extraction and Synthesis

The review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) reporting guidelines. Two authors independently searched the PubMed, Embase, and Cochrane databases for studies relating to the effect of hearing interventions on cognitive decline and dementia in patients with hearing loss.

Main Outcomes and Measures

Maximally adjusted hazard ratios (HRs) were used for dichotomous outcomes and ratio of means for continuous outcomes. Sources of heterogeneity were investigated using sensitivity and subgroup analyses, and publication bias was assessed using visual inspection, the Egger test, and trim and fill.

Results

A total of 3243 studies were screened; 31 studies (25 observational studies, 6 trials) with 137 484 participants were included, of which 19 (15 observational studies, 4 trials) were included in quantitative analyses. Meta-analysis of 8 studies, which had 126 903 participants, had a follow-up duration ranging from 2 to 25 years, and studied long-term associations between hearing aid use and cognitive decline, showed significantly lower hazards of any cognitive decline among hearing aid users compared with participants with uncorrected hearing loss (HR, 0.81; 95% CI, 0.76-0.87; I2 = 0%). Additionally, meta-analysis of 11 studies with 568 participants studying the association between hearing restoration and short-term cognitive test score changes revealed a 3% improvement in short-term cognitive test scores after the use of hearing aids (ratio of means, 1.03; 95% CI, 1.02-1.04, I2 = 0%).

Conclusions and Relevance

In this meta-analysis, the usage of hearing restorative devices by participants with hearing loss was associated with a 19% decrease in hazards of long-term cognitive decline. Furthermore, usage of these devices was significantly associated with a 3% improvement in cognitive test scores that assessed general cognition in the short term. A cognitive benefit of hearing restorative devices should be further investigated in randomized trials.

Functional Topography of the Neocortex Predicts Covariation in Complex Cognitive and Basic Motor Abilities

Although higher-order cognitive and lower-order sensorimotor abilities are generally regarded as distinct and studied separately, there is evidence that they not only covary but also that this covariation increases across the lifespan. This pattern has been leveraged in clinical settings where a simple assessment of sensory or motor ability (e.g., hearing, gait speed) can forecast age-related cognitive decline and risk for dementia. However, the brain mechanisms underlying cognitive, sensory, and motor covariation are largely unknown. Here, we examined whether such covariation in midlife reflects variability in common versus distinct neocortical networks using individualized maps of functional topography derived from BOLD fMRI data collected in 769 45-year old members of a population-representative cohort. Analyses revealed that variability in basic motor but not hearing ability reflected individual differences in the functional topography of neocortical networks typically supporting cognitive ability. These patterns suggest that covariation in motor and cognitive abilities in midlife reflects convergence of function in higher-order neocortical networks and that gait speed may not be simply a measure of physical function but rather an integrative index of nervous system health.

Sex-Specific Interactions Between Hearing and Memory in Older Adults With Mild Cognitive Impairment: Findings From the COMPASS-ND Study

OBJECTIVES

Hearing loss (HL) in older adults is associated with a decline in performance on cognitive tasks and the risk of developing dementia. However, very few studies have investigated sex-related effects on these associations. A previous study of cognitively healthy older adults showed an association between HL and lower cognitive performance in females only. In the present study, we examined the effects of sex and hearing on cognition in individuals with mild cognitive impairment (MCI). We predicted that females with HL would be more likely to show poorer performance on the cognitive measures compared to females with normal hearing (NH), while cognitive performance in males would not depend on hearing. We further predicted that these auditory-cognitive associations would not depend on test modality, and would thus be observed in females for both auditory and visual tests.

DESIGN

Participants were 101 older adults with amnestic MCI (M = 71 years, 45% females) in the Canadian Consortium on Neurodegeneration in Aging (CCNA) COMPASS-ND study. Performance on the Montreal Cognitive Assessment (MoCA), Rey Auditory Verbal Learning (RAVLT), and Brief Visuospatial Memory Test-Revised (BVMT-R) was analyzed to investigate sex-related differences and/or hearing-related differences. Participants were categorized as having NH or HL using two different measures: pure-tone hearing screening results (normal based on a pure-tone threshold < 25 dB HL at 2000 Hz in the worse ear) and speech-in-noise speech reception thresholds (SRTs; normal < -10 dB SNR on the Canadian Digit Triplet Test [CDTT]).

RESULTS

Males and female groups did not differ in age, years of education, or other relevant covariates. Yet, females with better hearing on either pure-tone or speech-in-noise measures outperformed their worse hearing counterparts on the MoCA total score. Additionally, females with better hearing were more likely to recall several words on the MoCA delayed recall trial relative to those with worse hearing. Females with NH showed significant correlations between CDTT SRTs and both MoCA and RAVLT scores, while no correlations were observed in males. In contrast, males but not females showed an effect of hearing group on BVMT-R test status.

CONCLUSIONS

There were sex-specific differences in auditory-cognitive associations in individuals with MCI. These associations were mostly observed in females and on auditory tests. Potential mechanisms and implications are discussed.

Can Physical, Psychological, and Social Vulnerabilities Predict Ageism?

Ageism can be expressed as the discrimination, social exclusion, and even abuse of older adults. The literature suggests that certain vulnerabilities could be risk factors affecting people's ageism. Based on the Social Identity Theory, the present study aimed to examine the association of physical/psychological and social vulnerabilities with ageism. The sample consisted of 200 Israelis from the general population who completed self-report questionnaires. Hierarchical regression indicated that low well-being, high post-traumatic distress, and limited social support were associated with ageism. Furthermore, the association of post-traumatic distress with ageism increased with age. The findings expand the knowledge of vulnerabilities as risk factors for ageism, perhaps reflecting its unconscious nature, and can assist in designing interventions for people interacting with older adults.

A dataset of sensory perception of chocolates, guacamoles, ice teas and crisps collected with consumers using six temporal methods

This article describes a dataset providing temporal sensory perception data of four dark chocolates, four guacamoles, four crisps and four ice teas collected from 436 consumers divided in six groups. Each group of consumers has tested all products using only one sensory evaluation method among: Temporal Dominance of Sensations (TDS, n=70), Temporal Check-All-That-Apply (TCATA, n=73), Attack-Evolution-Finish (AEF) dominance (n=74), AEF applicability (n=75), Free-Comment Attack-Evolution-Finish (FC-AEF) dominance (n=72) and FC-AEF applicability (n=72). Each consumer evaluated all the products: guacamoles and ice tea were evaluated in the lab in one session; chocolates and crisps were evaluated at home in two separate sessions. Within each product category, one sample has been replicated. The consumers started with product descriptions, then they gave a hedonic score, and after having tasted all the products related to a same category, they answered questions about product complexity and difficulty of the task. Consumer information included in the dataset is sex, age and frequency of consumption of each product category. This dataset is unique as it addresses several temporal methods applied on four product categories with different textures and levels of complexity. Thus, it could be very useful for the sensometric community to compare the different methods and their parameters: dominance vs. applicability, periods vs. continuous time, simultaneous vs. retrospective measures, list of terms vs. Free-Comment.

Cognitive dysfunctions in high myopia: An overview of potential neural morpho-functional mechanisms

Dementia and cognitive impairment (CIM) carry high levels of mortality. Visual impairment (VI) is linked with CIM risk. High myopia (HM) is a chronic disease frequently leading to irreversible blindness. Current opinion has shifted from retinal injury as the cause of HM to the condition being considered an eye-brain disease. However, the pathogenesis of this disease and the manner in which neural structures are damaged are poorly understood. This review comprehensively discusses the relationship between HM, the central nervous system, and CIM, together with the novel concept of three visual pathways, and possible research perspectives.

Association between age-related hearing loss with tinnitus and cognitive performance in older community-dwelling Chinese adults

AIM

To examine how the severity of age-related hearing loss (ARHL) and tinnitus or the presentation of ARHL with tinnitus is associated with overall cognition, in terms of specific cognitive domains in older community-dwelling Chinese adults.

METHODS

The study recruited 429 participants aged ≥58 years (mean age, 72.91 ± 7.014 years; female proportion, 57.30%), excluding those with dementia, disability, and severe mental illness. Patients were classified into normal cognition, pre-mild cognitive impairment (pre-MCI), and MCI according to the normative z-scores of neuropsychological test battery. The severity of ARHL and tinnitus was measured by pure-tone audiometry and the Tinnitus Handicap Inventory. Cognitive impairment and low functions in specific cognitive domains were used as dependent variables in multiple regression analyses adjusted for covariates.

RESULTS

ARHL severity was positively associated with MCI and low executive function, delayed memory, and language function. Only individuals with mild (odds ratio (OR) 1.791; CI, 0.952-3.373; P = 0.071), and moderate and the disaster tinnitus (OR, 2.493; CI, 0.982-6.328; P = 0.055) were marginally associated with increased odds of MCI in model 1. Individuals with ARHL and tinnitus (OR, 3.888, CI = 1.481-10.205; OR, 4.471, CI = 1.636-12.219) were independently associated with high risk for MCI in models 1 and 2.

CONCLUSIONS

ARHL severity and the presentation of ARHL or ARHL with tinnitus were associated with overall cognition. ARHL severity was independently associated with executive function, delayed memory, and language function. The association between tinnitus severity and cognition is not clear. But the group with ARHL and tinnitus is a high-risk group with cognitive impairment.

CLINICALTRIALS

gov identifier: NCT2017K020.

Changes in sensory, postural stability and gait functions depending on cognitive decline, and possible markers for detection of cognitive status

Background

Numerous people never receive a formal dementia diagnosis. This issue can be addressed by early detection systems that utilize alternative forms of classification, such as gait, balance, and sensory function parameters. In the present study, said functions were compared between older adults with healthy cognition, older adults with low executive function, and older adults with cognitive impairment, to determine which parameters can be used to distinguish these groups.

Results

A group of cognitively healthy older men was found to have a significantly greater gait cadence than both the low executive function group (113.1 ± 6.8 vs. 108.0 ± 6.3 steps/min, p = 0.032) and the cognitively impaired group (113.1 ± 6.8 vs. 107.1 ± 7.4 steps/min, p = 0.009). The group with low executive function was found to have more gait stability than the impaired cognition group, represented by the single limb support phase (39.7 ± 1.2 vs. 38.6 ± 1.3%, p = 0.027). Additionally, the healthy cognition group had significantly greater overall postural stability than the impaired cognition group (0.6 ± 0.1 vs. 1.1 ± 0.1, p = 0.003), and the low executive function group had significantly greater mediolateral postural stability than the impaired cognition group (0.2 ± 0.1 vs. 0.6 ± 0.6, p = 0.012). The low executive function group had fewer mistakes on the sentence recognition test than the cognitively impaired (2.2 ± 3.6 vs. 5.9 ± 6.4, p = 0.005). There were no significant differences in visual capacity, however, the low executive function group displayed an overall greatest ability.

Conclusions

Older adults with low executive function showcased a lower walking pace, but their postural stability and sensory functions did not differ from those of the older adults with healthy cognition. The variables concluded as good cognitive status markers were (1) gait cadence for dividing cognitively healthy from the rest and (2) single limb support portion, mediolateral stability index, and the number of mistakes on the sentence recognition test for discerning between the low executive function and cognitive impairment groups.

The effects of aging and musicianship on the use of auditory streaming cues

Auditory stream segregation, or separating sounds into their respective sources and tracking them over time, is a fundamental auditory ability. Previous research has separately explored the impacts of aging and musicianship on the ability to separate and follow auditory streams. The current study evaluated the simultaneous effects of age and musicianship on auditory streaming induced by three physical features: intensity, spectral envelope and temporal envelope. In the first study, older and younger musicians and non-musicians with normal hearing identified deviants in a four-note melody interleaved with distractors that were more or less similar to the melody in terms of intensity, spectral envelope and temporal envelope. In the second study, older and younger musicians and non-musicians participated in a dissimilarity rating paradigm with pairs of melodies that differed along the same three features. Results suggested that auditory streaming skills are maintained in older adults but that older adults rely on intensity more than younger adults while musicianship is associated with increased sensitivity to spectral and temporal envelope, acoustic features that are typically less effective for stream segregation, particularly in older adults.

Is Having Hearing Loss Fundamentally Different? Multigroup Structural Equation Modeling of the Effect of Cognitive Functioning on Speech Identification

OBJECTIVES

Previous research suggests that there is a robust relationship between cognitive functioning and speech-in-noise performance for older adults with age-related hearing loss. For normal-hearing adults, on the other hand, the research is not entirely clear. Therefore, the current study aimed to examine the relationship between cognitive functioning, aging, and speech-in-noise, in a group of older normal-hearing persons and older persons with hearing loss who wear hearing aids.

DESIGN

We analyzed data from 199 older normal-hearing individuals (mean age = 61.2) and 200 older individuals with hearing loss (mean age = 60.9) using multigroup structural equation modeling. Four cognitively related tasks were used to create a cognitive functioning construct: the reading span task, a visuospatial working memory task, the semantic word-pairs task, and Raven's progressive matrices. Speech-in-noise, on the other hand, was measured using Hagerman sentences. The Hagerman sentences were presented via an experimental hearing aid to both normal hearing and hearing-impaired groups. Furthermore, the sentences were presented with one of the two background noise conditions: the Hagerman original speech-shaped noise or four-talker babble. Each noise condition was also presented with three different hearing processing settings: linear processing, fast compression, and noise reduction.

RESULTS

Cognitive functioning was significantly related to speech-in-noise identification. Moreover, aging had a significant effect on both speech-in-noise and cognitive functioning. With regression weights constrained to be equal for the two groups, the final model had the best fit to the data. Importantly, the results showed that the relationship between cognitive functioning and speech-in-noise was not different for the two groups. Furthermore, the same pattern was evident for aging: the effects of aging on cognitive functioning and aging on speech-in-noise were not different between groups.

CONCLUSION

Our findings revealed similar cognitive functioning and aging effects on speech-in-noise performance in older normal-hearing and aided hearing-impaired listeners. In conclusion, the findings support the Ease of Language Understanding model as cognitive processes play a critical role in speech-in-noise independent from the hearing status of elderly individuals.

Effect of Occupational Noise Exposure on Cognition and Suprathreshold Auditory Skills in Normal-Hearing Individuals

OBJECTIVES

Adverse effects of noise exposure on hearing and cognition are well documented in the literature. Recently, it has becoming increasingly evident that noise exposure deteriorates suprathreshold auditory skills, even though the hearing sensitivity is intact. This condition is termed as cochlear synaptopathy or hidden hearing loss, which is apparent in animal models. However, equivocal findings are reported in humans. This study aimed at assessing the working memory, attention abilities, and suprathreshold hearing abilities in normal-hearing individuals with and without occupational noise exposure. We also explored the relationship between cognitive measures and suprathreshold auditory measures.

DESIGN

The study participants were divided into two groups. All the participants had normal-hearing thresholds. The control group consisted of 25 individuals with no occupational noise exposure, whereas the noise exposure group had 25 individuals exposed to occupational noise of 85 dBA for a minimum period of 1 year. Working memory was assessed using auditory digit span (forward and backward), operation span, and reading span. The Erikson flanker test was used to evaluate attention abilities. The suprathreshold hearing was assessed in terms of gap detection thresholds and sentence identification in noise.

RESULTS

The results showed that the noise exposure group performed poorly compared to the control group on all auditory and cognitive tasks except the reading span.

CONCLUSION

The results of the study suggest that occupational noise exposure may hamper the cognitive skills and suprathreshold hearing abilities of the individual despite having normal peripheral hearing.

Categorical Perception of Lexical Tones in Mandarin-Speaking Seniors

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Effect of Age on Informational Masking: Differential Effects of Phonetic and Semantic Information in the Masker

PURPOSE

Speech recognition in noise is a ubiquitous problem in older listeners. Speech, the most commonly encountered noise in the real world, causes greater masking than noise maskers, a phenomenon called informational masking (IM). This is due to the lexical-semantic and/or acoustic-phonetic information present in speech maskers. In this study, we aimed to observe the age-related differences in speech recognition and the magnitudes of IM when the maskers varied in the type of linguistic information.

METHOD

In 30 young and 30 older individuals, we measured the signal-to-noise ratio required to obtain 50% correct identification under four-talker babble (lexical-semantic and acoustic-phonetic information), four-talker reverse babble (predominantly acoustic-phonetic information), and speech-shaped noise (SSN; energetic).

RESULTS

In both groups, the four-talker babble caused the greatest masking effect (worst performances), whereas the SSN resulted in the least masking effect (best performances). The effectiveness of IM due to the lexical-semantic information was comparable between the two groups. However, the effectiveness of IM due to the acoustic-phonetic information was significantly higher in the older listeners, causing worse performances.

CONCLUSIONS

The greater effectiveness of IM due to the acoustic-phonetic information (worse performance) could be due to the minimal-to-mild high-frequency hearing loss and the consequent temporal processing deficits observed in the older listeners. However, it is possible that the older listeners can employ compensatory mechanisms (such as life experiences, contextual cues, employing higher listening efforts, among many possible other mechanisms) to overcome some of these deficits.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20405730.

Rapid Effects of Vagus Nerve Stimulation on Sensory Processing Through Activation of Neuromodulatory Systems

After sensory information is encoded into neural signals at the periphery, it is processed through multiple brain regions before perception occurs (i.e., sensory processing). Recent work has begun to tease apart how neuromodulatory systems influence sensory processing. Vagus nerve stimulation (VNS) is well-known as an effective and safe method of activating neuromodulatory systems. There is a growing body of studies confirming VNS has immediate effects on sensory processing across multiple sensory modalities. These immediate effects of VNS on sensory processing are distinct from the more well-documented method of inducing lasting neuroplastic changes to the sensory pathways through repeatedly delivering a brief VNS burst paired with a sensory stimulus. Immediate effects occur upon VNS onset, often disappear upon VNS offset, and the modulation is present for all sensory stimuli. Conversely, the neuroplastic effect of pairing sub-second bursts of VNS with a sensory stimulus alters sensory processing only after multiple pairing sessions, this alteration remains after cessation of pairing sessions, and the alteration selectively affects the response properties of neurons encoding the specific paired sensory stimulus. Here, we call attention to the immediate effects VNS has on sensory processing. This review discusses existing studies on this topic, provides an overview of the underlying neuromodulatory systems that likely play a role, and briefly explores the potential translational applications of using VNS to rapidly regulate sensory processing.

Auditory Perceptual Exercises in Adults Adapting to the Use of Hearing Aids

Older adults with age-related hearing loss often use hearing aids (HAs) to compensate. However, certain challenges in speech perception, especially in noise still exist, despite today's HA technology. The current study presents an evaluation of a home-based auditory exercises program that can be used during the adaptation process for HA use. The home-based program was developed at a time when telemedicine became prominent in part due to the COVID-19 pandemic. The study included 53 older adults with age-related symmetrical sensorineural hearing loss. They were divided into three groups depending on their experience using HAs. Group 1: Experienced users (participants who used bilateral HAs for at least 2 years). Group 2: New users (participants who were fitted with bilateral HAs for the first time). Group 3: Non-users. These three groups underwent auditory exercises for 3 weeks. The auditory tasks included auditory detection, auditory discrimination, and auditory identification, as well as comprehension with basic (syllables) and more complex (sentences) stimuli, presented in quiet and in noisy listening conditions. All participants completed self-assessment questionnaires before and after the auditory exercises program and underwent a cognitive test at the end. Self-assessed improvements in hearing ability were observed across the HA users groups, with significant changes described by new users. Overall, speech perception in noise was poorer than in quiet. Speech perception accuracy was poorer in the non-users group compared to the users in all tasks. In sessions where stimuli were presented in quiet, similar performance was observed among new and experienced uses. New users performed significantly better than non-users in all speech in noise tasks; however, compared to the experienced users, performance differences depended on task difficulty. The findings indicate that HA users, even new users, had better perceptual performance than their peers who did not receive hearing aids.

Longitudinal Changes in Hearing and Visual Impairments and Risk of Dementia in Older Adults in the United States

IMPORTANCE

Hearing and vision problems are individually associated with increased dementia risk, but the impact of having concurrent hearing and vision deficits, ie, dual sensory impairment (DSI), on risk of dementia, including its major subtypes Alzheimer disease (AD) and vascular dementia (VaD), is not well known.

OBJECTIVE

To evaluate whether DSI is associated with incident dementia in older adults.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study from the Cardiovascular Health Study (CHS) was conducted between 1992 and 1999, with as many as 8 years of follow-up. The multicenter, population-based sample was recruited from Medicare eligibility files in 4 US communities with academic medical centers. Of 5888 participants aged 65 years and older in CHS, 3602 underwent cranial magnetic resonance imaging and completed the modified Mini-Mental State Examination in 1992 to 1994 as part of the CHS Cognition Study. A total of 227 participants were excluded due to prevalent dementia, leaving a total of 3375 participants without dementia at study baseline. The study hypothesis was that DSI would be associated with increased risk of dementia compared with no sensory impairment. The association between the duration of DSI with risk of dementia was also evaluated. Data analysis was conducted from November 2019 to February 2020.

EXPOSURES

Hearing and vision impairments were collected via self-report at baseline and as many as 5 follow-up visits.

MAIN OUTCOMES AND MEASURES

All-cause dementia, AD, and VaD, classified by a multidisciplinary committee using standardized criteria.

RESULTS

A total of 2927 participants with information on hearing and vision at all available study visits were included in the analysis (mean [SD] age, 74.6 [4.8] years; 1704 [58.2%] women; 455 [15.5%] African American or Black; 2472 [85.5%] White). Compared with no sensory impairment, DSI was associated with increased risk of all-cause dementia (hazard ratio [HR], 2.60; 95% CI, 1.66-2.06; P < .001), AD (HR, 3.67; 95% CI, 2.04-6.60; P < .001) but not VaD (HR, 2.03; 95% CI, 1.00-4.09; P = .05).

CONCLUSIONS AND RELEVANCE

In this cohort study, DSI was associated with increased risk of dementia, particularly AD. Evaluation of hearing and vision in older adults may help to identify those at high risk of developing dementia.

The Association Between Hearing Impairment, Vision Impairment, Dual Sensory Impairment, and Serious Cognitive Impairment: Findings from a Population-Based Study of 5.4 million Older Adults

Background:

Sensory impairments and cognitive impairment are increasing in scope due to the aging population.

Objective:

To investigate the association between hearing impairment, vision impairment, and dual sensory impairment with cognitive impairment among older adults.

Methods:

Secondary analysis of a combination of ten consecutive waves (2008–2017) of the nationally representative American Community Survey. The sample included 5.4 million community-dwelling and institutionalized older adults aged 65 and older. Bivariate and logistic regression models were conducted to examine the association hearing impairment, vision impairment, and dual sensory impairment with cognitive impairment.

Results:

After controlling for age, race, education, and income, older adults with only hearing impairment had more than double the odds of cognitive impairment (OR = 2.66, 95% CI = 2.64, 2.68), while older adults with only vision impairment had more than triple the odds of cognitive impairment (OR = 3.63; 95% CI = 3.59, 3.67). For older adults with dual sensory impairment, the odds of cognitive impairment were eight-fold (OR = 8.16; 95% CI = 8.07, 8.25). Similar trends were apparent in each sex and age cohort.

Conclusion:

Hearing and vision impairment are both independently associated with cognitive impairment. However, dual sensory impairment is associated with substantially higher odds of cognitive impairment, even after controlling for sociodemographic characteristics. Practitioners working with older adults may consider treatment for sensory impairments and cognitive impairment concurrently. Future research is needed to determine if the association is causal, and to investigate the effectiveness of common methods of treatment for sensory impairment for reducing the prevalence of cognitive impairment.

The Associations of Hearing Sensitivity and Different Cognitive Functions with Perception of Speech-in-Noise

OBJECTIVES

Impaired speech-in-noise perception affects individuals' daily lives and is a frequent symptom of age-related hearing loss, which is a common disabling condition and a health concern in aging populations. The relative impact of hearing sensitivity loss and different cognitive functions on speech-in-noise perception is not well understood. We aimed to assess to what extent hearing sensitivity and different cognitive functions were associated with sentence-in-noise performance across the adult lifespan.

DESIGN

This study is based on data of 2585 participants of the Rhineland Study, which is a German community-based cohort study of persons of age 30 years and older. We assessed speech-in-noise with a sentence-in-noise test (Göttinger Satztest), hearing sensitivity thresholds (air conduction pure-tone audiometry [PTA] average of 0.5, 1, 2, and 4 kHz), and the following cognitive domains: crystallized intelligence (German Mehrfachwahl-Wortschatz-Intelligenztest, MWT-B), executive functioning (Trail Making Test B, TMT), working memory (Digit Span forward, DS), and long-term memory (Verbal Learning and Memory Test delayed recall; VLMT). We examined the association between hearing sensitivity and cognitive functions with sentence-in-noise perception using a multivariable linear regression model adjusted for age, sex, and multiple potential confounders.

RESULTS

Better hearing sensitivity was associated with better speech-in-noise perception (0.25 signal noise ratio [SNR] dB HL decrease per 5 dB HL decrease in PTA; 95% confidence interval [CI]: 0.20 to 0.25; p < 0.001). Better cognitive performance was also associated with better speech-in-noise perception, but to a lesser extent. Crystallized intelligence (MWT-B) showed an effect size of -0.10 SNR dB HL decrease per SD (95% CI: -0.14 to -0.06; p < 0.001), executive functioning (TMT) of -0.08 SNR dB HL decrease per SD (95% CI: -0.13 to -0.03; p = 0.002), working memory (DS) of -0.04 SNR dB HL decrease per SD (95% CI: -0.08 to -0.003; p = 0.03), and long-term memory (VLMT) of -0.03 SNR dB HL decrease per SD (95% CI: -0.07 to 0.01; p = 0.12). The standardized effect of hearing sensitivity (ß = 0.34) on speech-in-noise perception was four to five times larger than the effects of crystallized intelligence (ß = -0.08) and executive functioning (ß = -0.06).

CONCLUSIONS

Hearing sensitivity was the strongest determinant of sentence-in-noise perception in adults above the age of 30. We determined the relative effect of different cognitive functions on sentence-in-noise perception. Crystallized intelligence and executive functions showed stronger associations while working and long-term memory functions had much smaller independent effects. Our results contribute to the understanding of determinants of speech-in-noise perception in aging adults.

Hearing Loss and Cognition: What We Know and Where We Need to Go

Although a causal association remains to be determined, epidemiologic evidence suggests an association between hearing loss and increased risk of dementia. If we determine the association is causal, opportunity for targeted intervention for hearing loss may play a fundamental role in dementia prevention. In this discussion, we summarize current research on the association between hearing loss and dementia and review potential casual mechanisms behind the association (e.g., sensory-deprivation hypothesis, information-degradation hypothesis, common cause). We emphasize key areas of research which might best inform our investigation of this potential casual association. These selected research priorities include examination of the causal mechanism, measurement of co-existing hearing loss and cognitive impairment and determination of any bias in testing, potential for managing hearing loss for prevention of dementia and cognitive decline, or the potential to reduce dementia-related symptoms through the management of hearing loss. Addressing these research gaps and how results are then translated for clinical use may prove paramount for dementia prevention, management, and overall health of older adults.

Overview of (f)MRI Studies of Cognitive Aging for Non-Experts: Looking through the Lens of Neuroimaging

This special issue concerning Brain Functional and Structural Connectivity and Cognition aims to expand our understanding of brain connectivity. Herein, I review related topics including the principle and concepts of functional MRI, brain activation, and functional/structural connectivity in aging for uninitiated readers. Visuospatial attention, one of the well-studied functions in aging, is discussed from the perspective of neuroimaging.

Speech Perception and Dichotic Listening Are Associated With Hearing Thresholds and Cognition, Respectively, in Unaided Presbycusis

Presbycusis or age-related hearing loss is a prevalent condition in the elderly population, which affects oral communication, especially in background noise, and has been associated with social isolation, depression, and cognitive decline. However, the mechanisms that relate hearing loss with cognition are complex and still elusive. Importantly, recent studies show that the use of hearing aids in presbycusis, which is its standard management, can induce neuroplasticity and modify performance in cognitive tests. As the majority of the previous studies on audition and cognition obtained their results from a mixed sample of subjects, including presbycusis individuals fitted and not fitted with hearing aids, here, we revisited the associations between hearing loss and cognition in a controlled sample of unaided presbycusis. We performed a cross-sectional study in 116 non-demented Chilean volunteers aged ≥65 years from the Auditory and Dementia study cohort. Specifically, we explored associations between bilateral sensorineural hearing loss, suprathreshold auditory brain stem responses, auditory processing (AP), and cognition with a comprehensive neuropsychological examination. The AP assessment included speech perception in noise (SIN), dichotic listening (dichotic digits and staggered spondaic words), and temporal processing [frequency pattern (FP) and gap-in-noise detection]. The neuropsychological evaluations included attention, memory, language, processing speed, executive function, and visuospatial abilities. We performed an exploratory factor analysis that yielded four composite factors, namely, hearing loss, auditory nerve, midbrain, and cognition. These four factors were used for generalized multiple linear regression models. We found significant models showing that hearing loss is associated with bilateral SIN performance, while dichotic listening was associated with cognition. We concluded that the comprehension of the auditory message in unaided presbycusis is a complex process that relies on audition and cognition. In unaided presbycusis with mild hearing loss (<40 dB HL), speech perception of monosyllabic words in background noise is associated with hearing levels, while cognition is associated with dichotic listening and FP.

Differences Between Young and Older Adults in Working Memory and Performance on the Test of Basic Auditory Capabilities†

The Test of Basic Auditory Capabilities (TBAC) is a battery of auditory-discrimination tasks and speech-identification tasks that has been normed on several hundred young normal-hearing adults. Previous research with the TBAC suggested that cognitive function may impact the performance of older adults. Here, we examined differences in performance on several TBAC tasks between a group of 34 young adults with a mean age of 22.5 years (SD = 3.1 years) and a group of 115 older adults with a mean age of 69.2 years (SD = 6.2 years) recruited from the local community. Performance of the young adults was consistent with prior norms for this age group. Not surprisingly, the two groups differed significantly in hearing loss and working memory with the older adults having more hearing loss and poorer working memory than the young adults. The two age groups also differed significantly in performance on six of the nine measures extracted from the TBAC (eight test scores and one average test score) with the older adults consistently performing worse than the young adults. However, when these age-group comparisons were repeated with working memory and hearing loss as covariates, the groups differed in performance on only one of the nine auditory measures from the TBAC. For eight of the nine TBAC measures, working memory was a significant covariate and hearing loss never emerged as a significant factor. Thus, the age-group deficits observed initially on the TBAC most often appeared to be mediated by age-related differences in working memory rather than deficits in auditory processing. The results of these analyses of age-group differences were supported further by linear-regression analyses with each of the 9 TBAC scores serving as the dependent measure and age, hearing loss, and working memory as the predictors. Regression analyses were conducted for the full set of 149 adults and for just the 115 older adults. Working memory again emerged as the predominant factor impacting TBAC performance. It is concluded that working memory should be considered when comparing the performance of young and older adults on auditory tasks, including the TBAC.

Face mask use in healthcare settings: effects on communication, cognition, listening effort and strategies for amelioration

Aim

To investigate mask use and the difficulties it may pose during communication in healthcare settings.

Methods

A survey utilizing a series of Likert scales was administered. Mask use challenges between clinicians and their patients were examined in the domains of communication, listening effort, cognition, and rehabilitation.

Results

Across 243 participants, mask use significantly increased listening effort, with hearing loss having an additive effect on listening effort. Listening effort was also significantly associated with more trouble understanding conversation, decreased interest in conversation, more difficulty connecting with patients, changes in cognition for both providers and patients, and changes in the clinical efficiency of providers. Hearing loss had an additive effect for trouble understanding conversations and changes in clinical efficiency.

Conclusion

These results provide information about the clinical strain introduced from mask use in healthcare settings. Overall, results show that in healthcare settings there is increased cognitive load and listening effort for both patients and providers, as well as changes in clinical efficiency for providers when utilizing masks. These effects are often greater with hearing loss. Results showed that patients reported written and visual instructions would be most beneficial to include in appointments among the other rehabilitative strategies which are discussed.

Multisensory integration precision is associated with better cognitive performance over time in older adults: A large-scale exploratory study

Age-related sensory decline impacts cognitive performance and exposes individuals to a greater risk of cognitive decline. Integration across the senses also changes with age, yet the link between multisensory perception and cognitive ageing is poorly understood. We explored the relationship between multisensory integration and cognitive function in 2875 adults aged 50 + from The Irish Longitudinal Study on Ageing. Multisensory integration was assessed at several audio-visual temporal asynchronies using the Sound Induced Flash Illusion (SIFI). More precise integration (i.e. less illusion susceptibility with larger temporal asynchronies) was cross-sectionally associated with faster Choice Response Times and Colour Trail Task performance, and fewer errors on the Sustained Attention to Response Task. We then used k-means clustering to identify groups with different 10-year cognitive trajectories on measures available longitudinally; delayed recall, immediate recall and verbal fluency. Across measures, groups with consistently higher performance trajectories had more precise multisensory integration. These findings support broad links between multisensory integration and several cognitive measures, including processing speed, attention and memory, rather than association with any specific subdomain.

Binaural processing deficit and cognitive impairment in Alzheimer's disease

Speech comprehension in noisy environments depends on central auditory functions, which are vulnerable in Alzheimer's disease (AD). Binaural processing exploits two ear sounds to optimally process degraded sound information; its characteristics are poorly understood in AD. We studied behavioral and electrophysiological alterations in binaural processing among 121 participants (AD = 27; amnestic mild cognitive impairment [aMCI] = 33; subjective cognitive decline [SCD] = 30; cognitively normal [CN] = 31). We observed impairment of binaural processing in AD and aMCI, and detected a U-shaped curve change in phase synchrony (declining from CN to SCD and to aMCI, but increasing from aMCI to AD). This improvement in phase synchrony accompanying more severe cognitive stages could reflect neural adaptation for binaural processing. Moreover, increased phase synchrony is associated with worse memory during the stages when neural adaptation apparently occurs. These findings support a hypothesis that neural adaptation for binaural processing deficit may exacerbate cognitive impairment, which could help identify biomarkers and therapeutic targets in AD.

What Is Social about Autism? The Role of Allostasis-Driven Learning

Scientific research on neuro-cognitive mechanisms of autism often focuses on circuits that support social functioning. However, autism is a heterogeneous developmental variation in multiple domains, including social communication, but also language, cognition, and sensory-motor control. This suggests that the underlying mechanisms of autism share a domain-general foundation that impacts all of these processes. In this Perspective Review, we propose that autism is not a social deficit that results from an atypical "social brain". Instead, typical social development relies on learning. In social animals, infants depend on their caregivers for survival, which makes social information vitally salient. The infant must learn to socially interact in order to survive and develop, and the most prominent learning in early life is crafted by social interactions. Therefore, the most prominent outcome of a learning variation is atypical social development. To support the hypothesis that autism results from a variation in learning, we first review evidence from neuroscience and developmental science, demonstrating that typical social development depends on two domain-general processes that determine learning: (a) motivation, guided by allostatic regulation of the internal milieu; and (b) multi-modal associations, determined by the statistical regularities of the external milieu. These two processes are basic ingredients of typical development because they determine allostasis-driven learning of the social environment. We then review evidence showing that allostasis and learning are affected among individuals with autism, both neurally and behaviorally. We conclude by proposing a novel domain-general framework that emphasizes allostasis-driven learning as a key process underlying autism. Guided by allostasis, humans learn to become social, therefore, the atypical social profile seen in autism can reflect a domain-general variation in allostasis-driven learning. This domain-general view raises novel research questions in both basic and clinical research and points to targets for clinical intervention that can lower the age of diagnosis and improve the well-being of individuals with autism.

The search for correlates of age-related cochlear synaptopathy: Measures of temporal envelope processing and spatial release from speech-on-speech masking

Older adults often experience difficulties understanding speech in adverse listening conditions. It has been suggested that for listeners with normal and near-normal audiograms, these difficulties may, at least in part, arise from age-related cochlear synaptopathy. The aim of this study was to assess if performance on auditory tasks relying on temporal envelope processing reveal age-related deficits consistent with those expected from cochlear synaptopathy. Listeners aged 20 to 66 years were tested using a series of psychophysical, electrophysiological, and speech-perception measures using stimulus configurations that promote coding by medium- and low-spontaneous-rate auditory-nerve fibers. Cognitive measures of executive function were obtained to control for age-related cognitive decline. Results from the different tests were not significantly correlated with each other despite a presumed reliance on common mechanisms involved in temporal envelope processing. Only gap-detection thresholds for a tone in noise and spatial release from speech-on-speech masking were significantly correlated with age. Increasing age was related to impaired cognitive executive function. Multivariate regression analyses showed that individual differences in hearing sensitivity, envelope-based measures, and scores from nonauditory cognitive tests did not significantly contribute to the variability in spatial release from speech-on-speech masking for small target/masker spatial separation, while age was a significant contributor.

Atypical Integration of Sensory-to-Transmodal Functional Systems Mediates Symptom Severity in Autism

A notable characteristic of autism spectrum disorder (ASD) is co-occurring deficits in low-level sensory processing and high-order social interaction. While there is evidence indicating detrimental cascading effects of sensory anomalies on the high-order cognitive functions in ASD, the exact pathological mechanism underlying their atypical functional interaction across the cortical hierarchy has not been systematically investigated. To address this gap, here we assessed the functional organisation of sensory and motor areas in ASD, and their relationship with subcortical and high-order trandmodal systems. In a resting-state fMRI data of 107 ASD and 113 neurotypical individuals, we applied advanced connectopic mapping to probe functional organization of primary sensory/motor areas, together with targeted seed-based intrinsic functional connectivity (iFC) analyses. In ASD, the connectopic mapping revealed topological anomalies (i.e., excessively more segregated iFC) in the motor and visual areas, the former of which patterns showed association with the symptom severity of restricted and repetitive behaviors. Moreover, the seed-based analysis found diverging patterns of ASD-related connectopathies: decreased iFCs within the sensory/motor areas but increased iFCs between sensory and subcortical structures. While decreased iFCs were also found within the higher-order functional systems, the overall proportion of this anomaly tends to increase along the level of cortical hierarchy, suggesting more dysconnectivity in the higher-order functional networks. Finally, we demonstrated that the association between low-level sensory/motor iFCs and clinical symptoms in ASD was mediated by the high-order transmodal systems, suggesting pathogenic functional interactions along the cortical hierarchy. Findings were largely replicated in the independent dataset. These results highlight that atypical integration of sensory-to-high-order systems contributes to the complex ASD symptomatology.

Improvement of Working Memory and Processing Speed in Patients over 70 with Bilateral Hearing Impairment Following Unilateral Cochlear Implantation

Several studies demonstrated the association of hearing disorders with neurocognitive deficits and dementia disorders, but little is known about the effects of auditory rehabilitation on the cognitive performance of the elderly. Therefore, the research question of the present study was whether cochlear implantation, performed in 21 patients over 70 with bilateral severe hearing impairment, could influence their cognitive skills. The measuring points were before implantation and 12 months after the first cochlear implant (CI) fitting. Evaluation of the working memory (WMI) and processing speed (PSI) was performed using the Wechsler Adult Intelligence Scale 4th edition (WAIS-IV). The audiological assessment included speech perception (SP) in quiet (Freiburg monosyllabic test; FMT), noise (Oldenburg sentence test; OLSA), and self-assessment inventory (Oldenburg Inventory; OI). Twelve months after the first CI fitting, not only the auditory parameters (SP and OI), but also the WMI and PSI, improved significantly (p < 0.05) in the cohort. The presented results imply that cochlear implantation of bilaterally hearing-impaired patients over 70 positively influences their cognitive skills.