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Rachman L, Babaoğlu G, Özkişi Yazgan B, Ertürk P, Gaudrain E, Nagels L, Launer S, Derleth P, Singh G, Uhlemayr F, Chatterjee M, Yücel E, Sennaroğlu G, Başkent D. Vocal Emotion Recognition in School-Age Children With Hearing Aids. Ear Hear 2025:00003446-990000000-00413. [PMID: 40111426 DOI: 10.1097/aud.0000000000001645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
OBJECTIVES In individuals with normal hearing, vocal emotion recognition continues to develop over many years during childhood. In children with hearing loss, vocal emotion recognition may be affected by combined effects from loss of audibility due to elevated thresholds, suprathreshold distortions from hearing loss, and the compensatory features of hearing aids. These effects could be acute, affecting the perceived signal quality, or accumulated over time, affecting emotion recognition development. This study investigates if, and to what degree, children with hearing aids have difficulties in perceiving vocal emotions, beyond what would be expected from age-typical levels. DESIGN We used a vocal emotion recognition test with non-language-specific pseudospeech audio sentences expressed in three basic emotions: happy, sad, and angry, along with a child-friendly gamified test interface. The test group consisted of 55 school-age children (5.4 to 17.8 years) with bilateral hearing aids, all with sensorineural hearing loss with no further exclusion based on hearing loss degree or configuration. For characterization of complete developmental trajectories, the control group with normal audiometric thresholds consisted of 86 age-matched children (6.0 to 17.1 years), and 68 relatively young adults (19.1 to 35.0 years). RESULTS Vocal emotion recognition of the control group with normal-hearing children and adults improved across age and reached a plateau around age 20. Although vocal emotion recognition in children with hearing aids also improved with age, it seemed to lag compared with the control group of children with normal hearing. A group comparison showed a significant difference from around age 8 years. Individual data indicated that a number of hearing-aided children, even with severe degrees of hearing loss, performed at age-expected levels, while some others scored lower than age-expected levels, even at chance levels. The recognition scores of hearing-aided children were not predicted by unaided or aided hearing thresholds, nor by previously measured voice cue discrimination sensitivity, for example, related to mean pitch or vocal tract length perception. CONCLUSIONS In line with previous literature, even in normal hearing, vocal emotion recognition develops over many years toward adulthood, likely due to interactions with linguistic and cognitive development. Given the long development period, any potential difficulties for vocal emotion recognition in children with hearing loss can only be identified with respect to what would be realistic based on their age. With such a comparison, we were able to show that, as a group, children with hearing aids also develop in vocal emotion recognition, however, seemingly at a slower pace. Individual data indicated a number of the hearing-aided children showed age-expected vocal emotion recognition. Hence, even though hearing aids have been developed and optimized for speech perception, these data indicate that hearing aids can also support age-typical development of vocal emotion recognition. For the children whose recognition scores were lower than age-expected levels, there were no predictive hearing-related factors. This could be potentially reflecting inherent variations related to development of relevant cognitive mechanisms, but a role from cumulative effects from hearing loss is also a possibility. As follow-up research, we plan to investigate if vocal emotion recognition will improve over time for these children.
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Affiliation(s)
- Laura Rachman
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
- Pento Speech and Hearing Centers, Apeldoorn, the Netherlands
- Research School of Behavioral and Cognitive Neuroscience, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Gizem Babaoğlu
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Başak Özkişi Yazgan
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Pinar Ertürk
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Etienne Gaudrain
- CNRS UMR 5292, Lyon Neuroscience Research Center, Auditory Cognition and Psychoacoustics, Inserm UMRS 1028, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Leanne Nagels
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neuroscience, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Stefan Launer
- Department of Audiology and Health Innovation, Research and Development, Sonova AG, Stäfa, Switzerland
| | - Peter Derleth
- Department of Audiology and Health Innovation, Research and Development, Sonova AG, Stäfa, Switzerland
| | - Gurjit Singh
- Department of Audiology and Health Innovation, Research and Development, Sonova AG, Stäfa, Switzerland
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada; and
| | - Frédérick Uhlemayr
- Department of Audiology and Health Innovation, Research and Development, Sonova AG, Stäfa, Switzerland
| | - Monita Chatterjee
- Auditory Prostheses & Perception Laboratory, Center for Hearing Research, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Esra Yücel
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Gonca Sennaroğlu
- Department of Audiology, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Deniz Başkent
- Department of Otorhinolaryngology/Head and Neck Surgery, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
- Research School of Behavioral and Cognitive Neuroscience, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
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Morgan SD, LaPaugh B. Methodological Stimulus Considerations for Auditory Emotion Recognition Test Design. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2025; 68:1209-1224. [PMID: 39898771 DOI: 10.1044/2024_jslhr-24-00189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2025]
Abstract
PURPOSE Many studies have investigated test design influences (e.g., number of stimuli, open- vs. closed-set tasks) on word recognition ability, but the impact that stimuli selection has on auditory emotion recognition has not been explored. This study assessed the impact of some stimulus parameters and test design methodologies on emotion recognition performance to optimize stimuli to use for auditory emotion recognition testing. METHOD Twenty-five young adult participants with normal or near-normal hearing completed four tasks evaluating methodological parameters that may affect emotion recognition performance. The four conditions assessed (a) word stimuli versus sentence stimuli, (b) the total number of stimuli and number of stimuli per emotion category, (c) the number of talkers, and (d) the number of emotion categories. RESULTS Sentence stimuli yielded higher emotion recognition performance and increased performance variability compared to word stimuli. Recognition performance was independent of the number of stimuli per category, the number of talkers, and the number of emotion categories. Task duration expectedly increased with the total number of stimuli. A test of auditory emotion recognition that combined these design methodologies yielded high performance with low variability for listeners with normal hearing. CONCLUSIONS Stimulus selection influences performance and test reliability for auditory emotion recognition. Researchers should consider these influences when designing future tests of auditory emotion recognition to ensure tests are able to accomplish the study's aims. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.28270943.
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Affiliation(s)
- Shae D Morgan
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, KY
| | - Bailey LaPaugh
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, KY
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Lin Y, Ye X, Zhang H, Xu F, Zhang J, Ding H, Zhang Y. Category-Sensitive Age-Related Shifts Between Prosodic and Semantic Dominance in Emotion Perception Linked to Cognitive Capacities. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:4829-4849. [PMID: 39496066 DOI: 10.1044/2024_jslhr-23-00817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2024]
Abstract
PURPOSE Prior research extensively documented challenges in recognizing verbal and nonverbal emotion among older individuals when compared with younger counterparts. However, the nature of these age-related changes remains unclear. The present study investigated how older and younger adults comprehend four basic emotions (i.e., anger, happiness, neutrality, and sadness) conveyed through verbal (semantic) and nonverbal (facial and prosodic) channels. METHOD A total of 73 older adults (43 women, Mage = 70.18 years) and 74 younger adults (37 women, Mage = 22.01 years) partook in a fixed-choice test for recognizing emotions presented visually via facial expressions or auditorily through prosody or semantics. RESULTS The results confirmed age-related decline in recognizing emotions across all channels except for identifying happy facial expressions. Furthermore, the two age groups demonstrated both commonalities and disparities in their inclinations toward specific channels. While both groups displayed a shared dominance of visual facial cues over auditory emotional signals, older adults indicated a preference for semantics, whereas younger adults displayed a preference for prosody in auditory emotion perception. Notably, the dominance effects observed in older adults for visual and semantic cues were less pronounced for sadness and anger compared to other emotions. These challenges in emotion recognition and the shifts in channel preferences among older adults were correlated with their general cognitive capabilities. CONCLUSION Together, the findings underscore that age-related obstacles in perceiving emotions and alterations in channel dominance, which vary by emotional category, are significantly intertwined with overall cognitive functioning. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.27307251.
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Affiliation(s)
- Yi Lin
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Xiaoqing Ye
- Shanghai Jiao Tong University School of Medicine, China
| | - Huaiyi Zhang
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Fei Xu
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Jingyu Zhang
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Hongwei Ding
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Yang Zhang
- Department of Speech-Language-Hearing Sciences and Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis
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Fan X, Tang E, Zhang M, Lin Y, Ding H, Zhang Y. Decline of Affective Prosody Recognition With a Positivity Bias Among Older Adults: A Systematic Review and Meta-Analysis. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:3862-3879. [PMID: 39324838 DOI: 10.1044/2024_jslhr-23-00775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
PURPOSE Understanding how older adults perceive and interpret emotional cues in speech prosody contributes to our knowledge of cognitive aging. This study provides a systematic review with meta-analysis to investigate the extent of the decline in affective prosody recognition (APR) among older adults in terms of overall and emotion-specific performance and explore potential moderators that may cause between-studies heterogeneity. METHOD The literature search encompassed five electronic databases, with a specific emphasis on studies comparing the APR performance of older adults with that of younger adults. This comparison was focused on basic emotions. Meta-regression analyses were executed to pinpoint potential moderators related to demographic and methodological characteristics. RESULTS A total of 19 studies were included in the meta-analysis, involving 560 older adults with a mean age of 69.15 years and 751 younger adults with a mean age of 23.02 years. The findings indicated a substantial negative effect size (g = -1.21). Furthermore, the magnitude of aggregated effect sizes showed a distinct valence-related recognition pattern with positive prosody exhibiting smaller effect sizes. Language background and years of education were found to moderate the overall and emotion-specific (i.e., disgust and surprise) performance effect estimate, and age and gender significantly influenced the effect estimate of happiness. CONCLUSIONS The results confirmed a significant decline in APR ability among older adults compared to younger adults, but this decline was unbalanced across basic emotions. Language background and educational level emerged as significant factors influencing older adults' APR ability. Moreover, participants with a higher mean age exhibited notably poorer performance in recognizing happy prosody. These findings underscore the need to further investigate the neurobiological mechanisms for APR decline associated with aging. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.26407888.
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Affiliation(s)
- Xinran Fan
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Enze Tang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Minyue Zhang
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Yi Lin
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Hongwei Ding
- Speech-Language-Hearing Center, School of Foreign Languages, Shanghai Jiao Tong University, China
- National Research Centre for Language and Well-Being, Shanghai, China
| | - Yang Zhang
- Department of Speech-Language-Hearing Sciences and Center for Neurobehavioral Development, University of Minnesota, Minneapolis
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Shahouzaei N, Ghayoumi-Anaraki Z, Maleki Shahmahmood T, Torke Ladani N, Shoeibi A. Changes in speech prosody perception during Parkinson's disease: A comprehensive analysis. JOURNAL OF COMMUNICATION DISORDERS 2024; 110:106430. [PMID: 38754316 DOI: 10.1016/j.jcomdis.2024.106430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 04/15/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Parkinson's disease (PD) is a progressive neurodegenerative disorder that affects approximately 1%-2% of individuals aged 60 and above. Communication disorders in PD can significantly impact the overall quality of life. As prosody plays a vital role in verbal communication, the present study examines Persian prosody perception in PD, focusing on linguistic and emotional aspects of prosody. METHODS This cross-sectional study aimed to compare the perception of linguistic and emotional prosody in three groups: middle-aged adults (n = 22; mean age = 50.40 years), healthy older adults (n = 22; mean age = 68.31 years), and individuals with Parkinson's disease (n = 22; mean age = 65years). All individuals with PD were classified in stages 1; 1.5; 2; 2.5, and 3 of the disease using the Hoehn and Yahr scale. All participants had an MMSE score of 24 or above. The Florida Affect Battery (FAB) was used to evaluate prosody perception. This Battery was validated in the Persian language and its reliability and validity were reported as 94 % and 100 % respectively. RESULTS Participants with PD presented significantly lower scores than the older adults in all subtests of the FAB (p < 0.05), while healthy older adults were significantly different only in linguistic discrimination (β = -2.14; -3.68 to -0.61), and linguistic naming of prosody (β = 1.25; 0.17 to 2.33) compared to middle-aged adults. CONCLUSIONS The present study sheds light on the influence of PD on Persian prosody perception. Given the crucial role of prosody in verbal communication, these findings enhance our understanding of communication disorders in PD and could bring attention to consider prosody perception, among other aspects, when assessing individuals affected by PD.
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Affiliation(s)
- Nasrin Shahouzaei
- Department of Speech Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Rehabilitation Sciences Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zahra Ghayoumi-Anaraki
- Department of Speech Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Toktam Maleki Shahmahmood
- Department of Speech Therapy, School of Paramedical and Rehabilitation Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Torke Ladani
- Department of Speech Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Shoeibi
- Department of Neurology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Gedik Toker Ö, Hüsam H, Behmen MB, Bal N, Gültekin M, Toker K. Validity and Reliability of the Turkish Version of the Emotional Communication in Hearing Questionnaire. Am J Audiol 2023:1-13. [PMID: 37956697 DOI: 10.1044/2023_aja-23-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
PURPOSE The Emotional Communication in Hearing Questionnaire (EMO-CHeQ) is designed to evaluate awareness of vocal emotion information and perception of emotion. This study sought to translate the EMO-CHeQ into Turkish in accordance with international standards and to ascertain its validity and reliability statistically by administering it to native Turkish-speaking subjects. METHOD This empirical study involved collecting data from participants using a scale. A total of 460 individuals, comprising 158 women and 302 men (Mage = 33.43 ± 13.14 years), participated. The data encompassed 295 subjects with normal hearing, 101 hearing aid users, and 64 cochlear implant users. Exploratory factor analysis, followed by confirmatory factor analysis, was employed to ensure construct validity. Internal consistency was assessed with Cronbach's alpha reliability analysis, and content validity was applied to examine how effectively the Turkish version of the scale fulfilled its intended purpose. RESULTS The total Cronbach's alpha internal consistency coefficient of the scale was .949, and the explained variance was 74.385%. The Turkish version of the EMO-CHeQ demonstrated high construct validity, internal consistency, and explanatory efficacy. The scale revealed significant differences (p < .05) in emotional communication among the normal-hearing group, hearing aid users, and cochlear implant users. CONCLUSIONS The Turkish adaptation of the EMO-CHeQ is a credible and robust tool for evaluating how individuals perceive emotion in speech. Emotion perception was found to be suboptimal among hearing aid users compared to cochlear implant users, although it was most proficient in those with normal hearing. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24520624.
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Affiliation(s)
- Özge Gedik Toker
- Department of Audiology, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Hilal Hüsam
- Department of Audiology, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Meliha Başöz Behmen
- Department of Audiology, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
| | - Nilüfer Bal
- Department of Audiology, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
- Department of Audiology, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | | | - Kerem Toker
- Department of Health Management, Faculty of Health Sciences, Bezmialem Vakıf University, Istanbul, Turkey
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Baglione H, Coulombe V, Martel-Sauvageau V, Monetta L. The impacts of aging on the comprehension of affective prosody: A systematic review. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-16. [PMID: 37603689 DOI: 10.1080/23279095.2023.2245940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Recent clinical reports have suggested a possible decline in the ability to understand emotions in speech (affective prosody comprehension) with aging. The present study aims to further examine the differences in performance between older and younger adults in terms of affective prosody comprehension. Following a recent cognitive model dividing affective prosody comprehension into perceptual and lexico-semantic components, a cognitive approach targeting these components was adopted. The influence of emotions' valence and category on aging performance was also investigated. A systematic review of the literature was carried out using six databases. Twenty-one articles, presenting 25 experiments, were included. All experiments analyzed affective prosody comprehension performance of older versus younger adults. The results confirmed that older adults' performance in identifying emotions in speech was reduced compared to younger adults. The results also brought out the fact that affective prosody comprehension abilities could be modulated by the emotion category but not by the emotional valence. Various theories account for this difference in performance, namely auditory perception, brain aging, and socioemotional selectivity theory suggesting that older people tend to neglect negative emotions. However, the explanation of the underlying deficits of the affective prosody decline is still limited.
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Affiliation(s)
- Héloïse Baglione
- Département de réadaptation, Université Laval, Québec City, Quebec, Canada
- Département de readaptation, Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec City, Quebec, Canada
| | - Valérie Coulombe
- Département de réadaptation, Université Laval, Québec City, Quebec, Canada
- Département de readaptation, Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec City, Quebec, Canada
| | - Vincent Martel-Sauvageau
- Département de réadaptation, Université Laval, Québec City, Quebec, Canada
- Département de readaptation, Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec City, Quebec, Canada
| | - Laura Monetta
- Département de réadaptation, Université Laval, Québec City, Quebec, Canada
- Département de readaptation, Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Québec City, Quebec, Canada
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Martzoukou M, Nasios G, Kosmidis MH, Papadopoulou D. Aging and the Perception of Affective and Linguistic Prosody. JOURNAL OF PSYCHOLINGUISTIC RESEARCH 2022; 51:1001-1021. [PMID: 35441951 DOI: 10.1007/s10936-022-09875-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 06/14/2023]
Abstract
Investigations of affective prosodic processing have demonstrated a decline with aging. It is unclear, however, whether this decline affects all or specific emotions. Also, little is known about the ability of syntactic resolution ambiguity with the use of prosody in aging. Twenty older (age range = 70-75) and 20 younger adults (age range = 20-25) performed an affective (happiness, neutrality, sadness, surprise, fear, and anger) and a linguistic (subject/object ambiguities) prosody task. Relative to young participants, older participants faced difficulty decoding affective prosody, particularly negative emotions, and syntactic prosody, in particular the subject reading condition. A marginally positive correlation was found between the affective and syntactic prosody tasks in the group of older individuals, but no gender differences in either prosodic task. The findings of the affective prosody task are discussed under the prism of the Socioemotional Selectivity Theory, whereas general parsing strategies can account for the preference for the object reading condition.
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Affiliation(s)
- Maria Martzoukou
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece.
| | - Grigorios Nasios
- Department of Speech and Language Therapy, University of Ioannina, Ioannina, Greece
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Papadopoulou
- Department of Linguistics, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hilviu D, Gabbatore I, Parola A, Bosco FM. A cross-sectional study to assess pragmatic strengths and weaknesses in healthy ageing. BMC Geriatr 2022; 22:699. [PMID: 35999510 PMCID: PMC9400309 DOI: 10.1186/s12877-022-03304-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background Ageing refers to the natural and physiological changes that individuals experience over the years. This process also involves modifications in terms of communicative-pragmatics, namely the ability to convey meanings in social contexts and to interact with other people using various expressive means, such as linguistic, extralinguistic and paralinguistic aspects of communication. Very few studies have provided a complete assessment of communicative-pragmatic performance in healthy ageing. Methods The aim of this study was to comprehensively assess communicative-pragmatic ability in three samples of 20 (N = 60) healthy adults, each belonging to a different age range (20–40, 65–75, 76–86 years old) and to compare their performance in order to observe any potential changes in their ability to communicate. We also explored the potential role of education and sex on the communicative-pragmatic abilities observed. The three age groups were evaluated with a between-study design by means of the Assessment Battery for Communication (ABaCo), a validated assessment tool characterised by five scales: linguistic, extralinguistic, paralinguistic, contextual and conversational. Results The results indicated that the pragmatic ability assessed by the ABaCo is poorer in older participants when compared to the younger ones (main effect of age group: F(2,56) = 9.097; p < .001). Specifically, significant differences were detected in tasks on the extralinguistic, paralinguistic and contextual scales. Whereas the data highlighted a significant role of education (F(1,56) = 4.713; p = .034), no sex-related differences were detected. Conclusions Our results suggest that the ageing process may also affect communicative-pragmatic ability and a comprehensive assessment of the components of such ability may help to better identify difficulties often experienced by older individuals in their daily life activities. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03304-z.
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Affiliation(s)
- Dize Hilviu
- GIPSI Research Group, Department of Psychology, University of Turin, Turin, Italy
| | - Ilaria Gabbatore
- GIPSI Research Group, Department of Psychology, University of Turin, Turin, Italy. .,Research Unit of Logopedics, Faculty of Humanities, University of Oulu, Oulu, Finland.
| | - Alberto Parola
- GIPSI Research Group, Department of Psychology, University of Turin, Turin, Italy.,Department of Linguistics, Cognitive Science and Semiotics, Aarhus University, Aarhus, Denmark
| | - Francesca M Bosco
- GIPSI Research Group, Department of Psychology, University of Turin, Turin, Italy.,Neuroscience Institute of Turin - NIT, University of Turin, Turin, Italy
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10
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Dor YI, Algom D, Shakuf V, Ben-David BM. Age-Related Changes in the Perception of Emotions in Speech: Assessing Thresholds of Prosody and Semantics Recognition in Noise for Young and Older Adults. Front Neurosci 2022; 16:846117. [PMID: 35546888 PMCID: PMC9082150 DOI: 10.3389/fnins.2022.846117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/14/2022] [Indexed: 11/15/2022] Open
Abstract
Older adults process emotions in speech differently than do young adults. However, it is unclear whether these age-related changes impact all speech channels to the same extent, and whether they originate from a sensory or a cognitive source. The current study adopted a psychophysical approach to directly compare young and older adults’ sensory thresholds for emotion recognition in two channels of spoken-emotions: prosody (tone) and semantics (words). A total of 29 young adults and 26 older adults listened to 50 spoken sentences presenting different combinations of emotions across prosody and semantics. They were asked to recognize the prosodic or semantic emotion, in separate tasks. Sentences were presented on the background of speech-spectrum noise ranging from SNR of −15 dB (difficult) to +5 dB (easy). Individual recognition thresholds were calculated (by fitting psychometric functions) separately for prosodic and semantic recognition. Results indicated that: (1). recognition thresholds were better for young over older adults, suggesting an age-related general decrease across channels; (2). recognition thresholds were better for prosody over semantics, suggesting a prosodic advantage; (3). importantly, the prosodic advantage in thresholds did not differ between age groups (thus a sensory source for age-related differences in spoken-emotions processing was not supported); and (4). larger failures of selective attention were found for older adults than for young adults, indicating that older adults experienced larger difficulties in inhibiting irrelevant information. Taken together, results do not support a sole sensory source, but rather an interplay of cognitive and sensory sources for age-related differences in spoken-emotions processing.
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Affiliation(s)
- Yehuda I Dor
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.,Communication, Aging and Neuropsychology Lab (CANlab), Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel
| | - Daniel Algom
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Vered Shakuf
- Department of Communications Disorders, Achva Academic College, Arugot, Israel
| | - Boaz M Ben-David
- Communication, Aging and Neuropsychology Lab (CANlab), Baruch Ivcher School of Psychology, Reichman University (IDC), Herzliya, Israel.,Toronto Rehabilitation Institute, University Health Networks (UHN), Toronto, ON, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
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11
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Age-Related Changes in Voice Emotion Recognition by Postlingually Deafened Listeners With Cochlear Implants. Ear Hear 2022; 43:323-334. [PMID: 34406157 PMCID: PMC8847542 DOI: 10.1097/aud.0000000000001095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Identification of emotional prosody in speech declines with age in normally hearing (NH) adults. Cochlear implant (CI) users have deficits in the perception of prosody, but the effects of age on vocal emotion recognition by adult postlingually deaf CI users are not known. The objective of the present study was to examine age-related changes in CI users' and NH listeners' emotion recognition. DESIGN Participants included 18 CI users (29.6 to 74.5 years) and 43 NH adults (25.8 to 74.8 years). Participants listened to emotion-neutral sentences spoken by a male and female talker in five emotions (happy, sad, scared, angry, neutral). NH adults heard them in four conditions: unprocessed (full spectrum) speech, 16-channel, 8-channel, and 4-channel noise-band vocoded speech. The adult CI users only listened to unprocessed (full spectrum) speech. Sensitivity (d') to emotions and Reaction Times were obtained using a single-interval, five-alternative, forced-choice paradigm. RESULTS For NH participants, results indicated age-related declines in Accuracy and d', and age-related increases in Reaction Time in all conditions. Results indicated an overall deficit, as well as age-related declines in overall d' for CI users, but Reaction Times were elevated compared with NH listeners and did not show age-related changes. Analysis of Accuracy scores (hit rates) were generally consistent with d' data. CONCLUSIONS Both CI users and NH listeners showed age-related deficits in emotion identification. The CI users' overall deficit in emotion perception, and their slower response times, suggest impaired social communication which may in turn impact overall well-being, particularly so for older CI users, as lower vocal emotion recognition scores have been associated with poorer subjective quality of life in CI patients.
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12
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Chen F, Lian J, Zhang G, Guo C. Semantics-Prosody Stroop Effect on English Emotion Word Processing in Chinese College Students With Trait Depression. Front Psychiatry 2022; 13:889476. [PMID: 35733799 PMCID: PMC9207235 DOI: 10.3389/fpsyt.2022.889476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
This study explored the performance of Chinese college students with different severity of trait depression to process English emotional speech under a complete semantics-prosody Stroop effect paradigm in quiet and noisy conditions. A total of 24 college students with high-trait depression and 24 students with low-trait depression participated in this study. They were required to selectively attend to either the prosodic emotion (happy, sad) or semantic valence (positive and negative) of the English words they heard and then respond quickly. Both prosody task and semantic task were performed in quiet and noisy listening conditions. Results showed that the high-trait group reacted slower than the low-trait group in the prosody task due to their bluntness and insensitivity toward emotional processing. Besides, both groups reacted faster under the consistent situation, showing a clear congruency-induced facilitation effect and the wide existence of the Stroop effect in both tasks. Only the Stroop effect played a bigger role during emotional prosody identification in quiet condition, and the noise eliminated such an effect. For the sake of experimental design, both groups spent less time on the prosody task than the semantic task regardless of consistency in all listening conditions, indicating the friendliness of basic emotion identification and the difficulty for second language learners in face of semantic judgment. These findings suggest the unneglectable effects of college students' mood conditions and noise outside on emotion word processing.
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Affiliation(s)
- Fei Chen
- School of Foreign Languages, Hunan University, Changsha, China
| | - Jing Lian
- School of Foreign Languages, Hunan University, Changsha, China
| | - Gaode Zhang
- School of Foreign Languages, Hunan University, Changsha, China
| | - Chengyu Guo
- School of Foreign Languages, Hunan University, Changsha, China
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13
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Rothermich K, Giorio C, Falkins S, Leonard L, Roberts A. Nonliteral language processing across the lifespan. Acta Psychol (Amst) 2021; 212:103213. [PMID: 33220614 DOI: 10.1016/j.actpsy.2020.103213] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 12/13/2022] Open
Abstract
Studies investigating the effects of aging on nonliteral language processing have mainly focused on one sensory modality, for example written vignettes. In the current study, we used a video-based task to examine the effect of healthy aging on social communication perception using a novel database called RISC (Relation Inference in Social Communication). By means of an online recruitment platform, we asked young, middle-aged, and older adults between the ages of 18 and 76 (N = 100) to evaluate videos of actors using different forms of literal and nonliteral language, such as sarcasm or teasing. The participants' task was to infer the speakers' belief and the speakers' intention. Older participants demonstrated lower accuracy in discriminating nonliteral from literal interactions compared to younger and middle-aged groups. When evaluating speaker intentions, older adults judged sarcasm as friendlier compared to literal negative utterances. We also found that the older the participant, the more difficulty they have identifying teasing as insincere. Our results expand on age-related similarities and differences in evaluating speaker intentions and demonstrate the practicality of the RISC database for studying nonliteral language across the lifespan.
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14
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Ruiz R, Fontan L, Fillol H, Füllgrabe C. Senescent Decline in Verbal-Emotion Identification by Older Hearing-Impaired Listeners - Do Hearing Aids Help? Clin Interv Aging 2020; 15:2073-2081. [PMID: 33173288 PMCID: PMC7648619 DOI: 10.2147/cia.s281469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the ability of older-adult hearing-impaired (OHI) listeners to identify verbal expressions of emotions, and to evaluate whether hearing-aid (HA) use improves identification performance in those listeners. Methods Twenty-nine OHI listeners, who were experienced bilateral-HA users, participated in the study. They listened to a 20-sentence-long speech passage rendered with six different emotional expressions (“happiness”, “pleasant surprise”, “sadness”, “anger”, “fear”, and “neutral”). The task was to identify the emotion portrayed in each version of the passage. Listeners completed the task twice in random order, once unaided, and once wearing their own bilateral HAs. Seventeen young-adult normal-hearing (YNH) listeners were also tested unaided as controls. Results Most YNH listeners (89.2%) correctly identified emotions compared to just over half of the OHI listeners (58.7%). Within the OHI group, verbal emotion identification was significantly correlated with age, but not with audibility-related factors. The number of OHI listeners who were able to correctly identify the different emotions did not significantly change when HAs were worn (54.8%). Conclusion In line with previous investigations using shorter speech stimuli, there were clear age differences in the recognition of verbal emotions, with OHI listeners showing a significant reduction in unaided verbal-emotion identification performance that progressively declined with age across older adulthood. Rehabilitation through HAs did not provide compensation for the impaired ability to perceive emotions carried by speech sounds.
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Affiliation(s)
- Robert Ruiz
- Laboratoire de Recherche en Audiovisuel (LARA-SEPPIA), Université Toulouse II Jean Jaurès, Toulouse, France
| | | | - Hugo Fillol
- Service d'Oto-Rhino-Laryngologie, d'Oto-Neurologie et d'ORL Pédiatrique, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Ecole d'Audioprothèse de Cahors, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Christian Füllgrabe
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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15
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Prosodic Perception in Aging Individuals: a Focus on Intonation. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-018-9806-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Daniluk B, Borkowska AR. Pragmatic aspects of verbal communication in elderly people: A study of Polish seniors. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2020; 55:493-505. [PMID: 32185862 DOI: 10.1111/1460-6984.12532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/09/2020] [Accepted: 02/25/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Behavioural and neuropsychological studies on elderly populations concentrate on many aspects of cognitive functioning, but significantly less research concerns communication processes, including aspects of verbal communication skills, pragmatic issues that are important for performing social tasks at every age. AIMS To characterize the variability in changes that occur with age in the domain of pragmatic aspects of verbal communication skills in a group of individuals aged > 65 years and to define their determinants. METHODS & PROCEDURES A group of 109 normally ageing individuals (aged 64.9-90 years) participated in the study (62 women and 47 men). Participants were divided into two age groups: < 70 and > 71 years old. The verbal communication skills were examined using the Polish version of the Right Hemisphere Language Battery (RHLB-PL), and cognitive skills using the Mini Mental State Examination (MMSE). OUTCOMES & RESULTS Comparison between the subgroups showed that there was a significant decline in the older group in all the subtests except for the Discourse Analysis. Age did not differentiate discursive abilities in seniors. These data apparently confirm the hypothesis that discursive competences are stable throughout one's lifespan. In order to compare younger and older seniors in terms of the 11 aspects of pragmatic communication, two performance profiles were prepared for the groups and subjected to comparative analyses. The shape of the two profiles of all communication competences was similar. The biggest differences were identified between the groups in the Comments, Humour and Metaphor comprehension and explanation subtests. Analysis of the determinants of changes in pragmatic aspects of verbal communication skills in elderly individuals revealed that the important factors include age, overall level of cognitive function, higher education and female sex. CONCLUSION & IMPLICATIONS The relationship between age and pragmatic aspects of verbal communication skills is complex. The results indicate that treating seniors as a homogenous group in terms of pragmatic aspects of verbal communication functioning is incorrect. Age differentially affects the various aspects of communication functions. The level of cognitive functioning mediates the relationship between age and pragmatic aspects of verbal communication skills. What this paper adds What is already known on the subject? Behavioural and neuropsychological studies on elderly populations concentrate on many aspects of mnestic functions, executive functions, cognitive flexibility, fluency, cognitive control, working memory, semantic processing, arithmetic competences and perception speed. Significantly less research concerns communication processes, including verbal communication. Older and younger people have usually been compared in particular areas of communication: discourse, understanding of metaphors or prosody. At present there is a paucity of research regarding changes in communication functions at different stages of ageing and profiles of various aspects of verbal communication in old age. What this paper adds to existing knowledge The study indicates that normally ageing individuals are a non-homogeneous group in terms of pragmatic aspects of verbal communication. Various communication functions change at different rate at various stages of ageing. The study clarified the determinants of changes in pragmatic aspects of verbal communication skills in elderly individuals. These aspects are cognitive abilities, age, a high education level and sex. What are the potential or actual clinical implications of this work? The research shows that diagnosis of communication competencies in elderly individuals is necessary. Furthermore, the kind of abilities is very important for social relationships and quality of life. It is essential to inform a senior's family about communication changes that occur in normal ageing. Understanding potential verbal communication difficulties in seniors and their determinants are fundamental issues.
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Affiliation(s)
- Beata Daniluk
- University of Maria Curie Skłodowska, Faculty of Pedagogy and Psychology, Lublin, Poland
| | - Aneta R Borkowska
- University of Maria Curie Skłodowska, Faculty of Pedagogy and Psychology, Lublin, Poland
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17
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Smit I, Szabo D, Kubinyi E. Age-related positivity effect on behavioural responses of dogs to human vocalisations. Sci Rep 2019; 9:20201. [PMID: 31882873 PMCID: PMC6934484 DOI: 10.1038/s41598-019-56636-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/25/2019] [Indexed: 11/09/2022] Open
Abstract
Age-related changes in the brain can alter how emotions are processed. In humans, valence specific changes in attention and memory were reported with increasing age, i.e. older people are less attentive toward and experience fewer negative emotions, while processing of positive emotions remains intact. Little is yet known about this "positivity effect" in non-human animals. We tested young (n = 21, 1-5 years) and old (n = 19, >10 years) family dogs with positive (laugh), negative (cry), and neutral (hiccup, cough) human vocalisations and investigated age-related differences in their behavioural reactions. Only dogs with intact hearing were analysed and the selected sound samples were balanced regarding mean and fundamental frequencies between valence categories. Compared to young dogs, old individuals reacted slower only to the negative sounds and there was no significant difference in the duration of the reactions between groups. The selective response of the aged dogs to the sound stimuli suggests that the results cannot be explained by general cognitive and/or perceptual decline. and supports the presence of an age-related positivity effect in dogs, too. Similarities in emotional processing between humans and dogs may imply analogous changes in subcortical emotional processing in the canine brain during ageing.
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Affiliation(s)
- Iris Smit
- Department of Ethology, Eötvös Loránd University, Budapest, 1117, Hungary.
- HAS University of Applied Sciences, 's-Hertogenbosch, 5223DE, The Netherlands.
| | - Dora Szabo
- Department of Ethology, Eötvös Loránd University, Budapest, 1117, Hungary
| | - Enikő Kubinyi
- Department of Ethology, Eötvös Loránd University, Budapest, 1117, Hungary
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18
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Ben-David BM, Gal-Rosenblum S, van Lieshout PHHM, Shakuf V. Age-Related Differences in the Perception of Emotion in Spoken Language: The Relative Roles of Prosody and Semantics. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:1188-1202. [PMID: 31026192 DOI: 10.1044/2018_jslhr-h-ascc7-18-0166] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose We aim to identify the possible sources for age-related differences in the perception of emotion in speech, focusing on the distinct roles of semantics (words) and prosody (tone of speech) and their interaction. Method We implement the Test for Rating of Emotions in Speech ( Ben-David, Multani, Shakuf, Rudzicz, & van Lieshout, 2016 ). Forty older and 40 younger adults were presented with spoken sentences made of different combinations of 5 emotional categories (anger, fear, happiness, sadness, and neutral) presented in the prosody and semantics. In separate tasks, listeners were asked to attend to the sentence as a whole, integrating both speech channels, or to focus on 1 channel only (prosody/semantics). Their task was to rate how much they agree the sentence is conveying a predefined emotion. Results (a) Identification of emotions: both age groups identified presented emotions. (b) Failure of selective attention: both age groups were unable to selectively attend to 1 channel when instructed, with slightly larger failures for older adults. (c) Integration of channels: younger adults showed a bias toward prosody, whereas older adults showed a slight bias toward semantics. Conclusions Three possible sources are suggested for age-related differences: (a) underestimation of the emotional content of speech, (b) slightly larger failures to selectively attend to 1 channel, and (c) different weights assigned to the 2 speech channels.
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Affiliation(s)
- Boaz M Ben-David
- Communication Aging and Neuropsychology Lab, Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Networks, Ontario, Canada
| | - Sarah Gal-Rosenblum
- Communication Aging and Neuropsychology Lab, Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
| | - Pascal H H M van Lieshout
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Networks, Ontario, Canada
| | - Vered Shakuf
- Communication Aging and Neuropsychology Lab, Baruch Ivcher School of Psychology, Interdisciplinary Center, Herzliya, Israel
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19
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Picou EM, Singh G, Goy H, Russo F, Hickson L, Oxenham AJ, Buono GH, Ricketts TA, Launer S. Hearing, Emotion, Amplification, Research, and Training Workshop: Current Understanding of Hearing Loss and Emotion Perception and Priorities for Future Research. Trends Hear 2018; 22:2331216518803215. [PMID: 30270810 PMCID: PMC6168729 DOI: 10.1177/2331216518803215] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/18/2018] [Accepted: 09/03/2018] [Indexed: 12/19/2022] Open
Abstract
The question of how hearing loss and hearing rehabilitation affect patients' momentary emotional experiences is one that has received little attention but has considerable potential to affect patients' psychosocial function. This article is a product from the Hearing, Emotion, Amplification, Research, and Training workshop, which was convened to develop a consensus document describing research on emotion perception relevant for hearing research. This article outlines conceptual frameworks for the investigation of emotion in hearing research; available subjective, objective, neurophysiologic, and peripheral physiologic data acquisition research methods; the effects of age and hearing loss on emotion perception; potential rehabilitation strategies; priorities for future research; and implications for clinical audiologic rehabilitation. More broadly, this article aims to increase awareness about emotion perception research in audiology and to stimulate additional research on the topic.
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Affiliation(s)
- Erin M. Picou
- Vanderbilt University School of
Medicine, Nashville, TN, USA
| | - Gurjit Singh
- Phonak Canada, Mississauga, ON,
Canada
- Department of Speech-Language Pathology,
University of Toronto, ON, Canada
- Department of Psychology, Ryerson
University, Toronto, ON, Canada
| | - Huiwen Goy
- Department of Psychology, Ryerson
University, Toronto, ON, Canada
| | - Frank Russo
- Department of Psychology, Ryerson
University, Toronto, ON, Canada
| | - Louise Hickson
- School of Health and Rehabilitation
Sciences, University of Queensland, Brisbane, Australia
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20
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Fengler I, Nava E, Villwock AK, Büchner A, Lenarz T, Röder B. Multisensory emotion perception in congenitally, early, and late deaf CI users. PLoS One 2017; 12:e0185821. [PMID: 29023525 PMCID: PMC5638301 DOI: 10.1371/journal.pone.0185821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 09/20/2017] [Indexed: 11/20/2022] Open
Abstract
Emotions are commonly recognized by combining auditory and visual signals (i.e., vocal and facial expressions). Yet it is unknown whether the ability to link emotional signals across modalities depends on early experience with audio-visual stimuli. In the present study, we investigated the role of auditory experience at different stages of development for auditory, visual, and multisensory emotion recognition abilities in three groups of adolescent and adult cochlear implant (CI) users. CI users had a different deafness onset and were compared to three groups of age- and gender-matched hearing control participants. We hypothesized that congenitally deaf (CD) but not early deaf (ED) and late deaf (LD) CI users would show reduced multisensory interactions and a higher visual dominance in emotion perception than their hearing controls. The CD (n = 7), ED (deafness onset: <3 years of age; n = 7), and LD (deafness onset: >3 years; n = 13) CI users and the control participants performed an emotion recognition task with auditory, visual, and audio-visual emotionally congruent and incongruent nonsense speech stimuli. In different blocks, participants judged either the vocal (Voice task) or the facial expressions (Face task). In the Voice task, all three CI groups performed overall less efficiently than their respective controls and experienced higher interference from incongruent facial information. Furthermore, the ED CI users benefitted more than their controls from congruent faces and the CD CI users showed an analogous trend. In the Face task, recognition efficiency of the CI users and controls did not differ. Our results suggest that CI users acquire multisensory interactions to some degree, even after congenital deafness. When judging affective prosody they appear impaired and more strongly biased by concurrent facial information than typically hearing individuals. We speculate that limitations inherent to the CI contribute to these group differences.
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Affiliation(s)
- Ineke Fengler
- Biological Psychology and Neuropsychology, Institute for Psychology, Faculty of Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Elena Nava
- Biological Psychology and Neuropsychology, Institute for Psychology, Faculty of Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Agnes K. Villwock
- Biological Psychology and Neuropsychology, Institute for Psychology, Faculty of Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
| | - Andreas Büchner
- German Hearing Centre, Department of Otorhinolaryngology, Medical University of Hannover, Hannover, Germany
| | - Thomas Lenarz
- German Hearing Centre, Department of Otorhinolaryngology, Medical University of Hannover, Hannover, Germany
| | - Brigitte Röder
- Biological Psychology and Neuropsychology, Institute for Psychology, Faculty of Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
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21
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Martens H, Van Nuffelen G, Wouters K, De Bodt M. Reception of Communicative Functions of Prosody in Hypokinetic Dysarthria due to Parkinson's Disease. JOURNAL OF PARKINSONS DISEASE 2017; 6:219-29. [PMID: 26889630 DOI: 10.3233/jpd-150678] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Mapping adequacy of receptive prosodic abilities in speakers with hypokinetic dysarthria due to Parkinson's disease (PD) is useful, because therapy of disturbed production of prosody relies on adequate reception of prosody. There is evidence for a deficit of reception of emotional prosody in PD. OBJECTIVE The present study aims at presenting a comprehensive picture of the reception of various communicative functions of prosody in hypokinetic dysarthria due to PD. METHODS We assessed perception (using a discrimination task) and comprehension (using an identification task) of five communicative functions of Dutch prosody (lexical stress, boundary marking, focus, sentence mode, and emotional prosody) in a group of adults with hypokinetic dysarthria due to PD (n = 22) and a gender and age matched group of unimpaired adults (n = 22). We also investigated the relationship between age and global test score, and the effect of perception and comprehension subtest sequence on the global test score. RESULTS Between groups, no significant differences in receptive prosodic abilities were found. Within both groups, the comprehension subtest was significantly more difficult than the perception subtest, and there was a significant negative correlation between age and global test score. No subtest sequence effect could be demonstrated. CONCLUSIONS Considering that the older speakers with hypokinetic dysarthria due to PD had receptive prosodic skills inferior to those of the younger speakers, notwithstanding apparently intact cognition and hearing, the findings suggest that age is a factor to be reckoned with in prosody assessment and management in this population.
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Affiliation(s)
- Heidi Martens
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.,Rehabilitation Centre of Communication Disorders, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.,Department of Scientific Coordination and Biostatistics, Antwerp University Hospital, Edegem, Belgium
| | - Marc De Bodt
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.,Rehabilitation Centre of Communication Disorders, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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22
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Picou EM. How Hearing Loss and Age Affect Emotional Responses to Nonspeech Sounds. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2016; 59:1233-1246. [PMID: 27768178 DOI: 10.1044/2016_jslhr-h-15-0231] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 03/25/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of hearing loss and age on subjective ratings of emotional valence and arousal in response to nonspeech sounds. METHOD Three groups of adults participated: 20 younger listeners with normal hearing (M = 24.8 years), 20 older listeners with normal hearing (M = 55.8 years), and 20 older listeners with mild-to-severe acquired hearing loss (M = 65.6 years). Stimuli were presented via headphones at either 35 and 65 dB SPL or 50 and 80 dB SPL on the basis of random assignment within each group. Participants rated the emotional valence and arousal for previously normed nonspeech auditory stimuli. RESULTS Linear mixed model analyses were conducted separately for ratings of valence and arousal. Results revealed that listeners with hearing loss exhibited a reduced range of emotional ratings. Furthermore, for stimuli presented at 80 dB SPL, valence ratings from listeners with hearing loss were significantly lower than ratings from listeners with normal hearing. CONCLUSIONS Acquired hearing loss, not increased age, affected emotional responses by reducing the range of subjective ratings and by reducing the reported valence of the highest intensity stimuli. These results have potentially important clinical implications for aural rehabilitation.
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Affiliation(s)
- Erin M Picou
- Vanderbilt University Medical Center, Nashville, TN
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23
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Sober JD, VanWormer LA, Arruda JE. Age-related differences in recall for words using semantics and prosody. The Journal of General Psychology 2016; 143:67-77. [PMID: 26786734 DOI: 10.1080/00221309.2015.1073138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The positivity effect is a developmental shift seen in older adults to be increasingly influenced by positive information in areas such as memory, attention, and decision-making. This study is the first to examine the age-related differences of the positivity effect for emotional prosody. Participants heard a factorial combination of words that were semantically positive or negative said with either positive or negative intonation. Results showed a semantic positivity effect for older adults, and a prosody positivity effect for younger adults. Additionally, older adults showed a significant decrease in recall for semantically negative words said in an incongruent prosodically positive tone.
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24
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Dupuis K, Pichora-Fuller MK. Aging Affects Identification of Vocal Emotions in Semantically Neutral Sentences. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2015; 58:1061-1076. [PMID: 25810032 DOI: 10.1044/2015_jslhr-h-14-0256] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/10/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The authors determined the accuracy of younger and older adults in identifying vocal emotions using the Toronto Emotional Speech Set (TESS; Dupuis & Pichora-Fuller, 2010a) and investigated the possible contributions of auditory acuity and suprathreshold processing to emotion identification accuracy. METHOD In 2 experiments, younger and older adults with normal hearing listened to and identified vocal emotions in the TESS stimuli. The TESS consists of phrases with controlled syntactic, lexical, and phonological properties spoken by an older female talker and a younger female talker to convey 7 emotion conditions (anger, disgust, fear, sadness, neutral, happiness, and pleasant surprise). Participants in both experiments completed audiometric testing; participants in Experiment 2 also completed 3 tests of suprathreshold auditory processing. RESULTS Identification by both age groups was above chance for all emotions. Accuracy was lower for older adults in both experiments. The pattern of results was similar across age groups and experiments. Auditory acuity did not predict identification accuracy for either age group in either experiment, nor did performance on tests of auditory processing in Experiment 2. CONCLUSIONS These results replicate and extend previous findings concerning age-related differences in ability to identify vocal emotions and suggest that older adults' auditory abilities do not explain their difficulties in identifying vocal emotions.
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Chaby L, Boullay VLD, Chetouani M, Plaza M. Compensating for age limits through emotional crossmodal integration. Front Psychol 2015; 6:691. [PMID: 26074845 PMCID: PMC4445247 DOI: 10.3389/fpsyg.2015.00691] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/10/2015] [Indexed: 12/03/2022] Open
Abstract
Social interactions in daily life necessitate the integration of social signals from different sensory modalities. In the aging literature, it is well established that the recognition of emotion in facial expressions declines with advancing age, and this also occurs with vocal expressions. By contrast, crossmodal integration processing in healthy aging individuals is less documented. Here, we investigated the age-related effects on emotion recognition when faces and voices were presented alone or simultaneously, allowing for crossmodal integration. In this study, 31 young adults (M = 25.8 years) and 31 older adults (M = 67.2 years) were instructed to identify several basic emotions (happiness, sadness, anger, fear, disgust) and a neutral expression, which were displayed as visual (facial expressions), auditory (non-verbal affective vocalizations) or crossmodal (simultaneous, congruent facial and vocal affective expressions) stimuli. The results showed that older adults performed slower and worse than younger adults at recognizing negative emotions from isolated faces and voices. In the crossmodal condition, although slower, older adults were as accurate as younger except for anger. Importantly, additional analyses using the "race model" demonstrate that older adults benefited to the same extent as younger adults from the combination of facial and vocal emotional stimuli. These results help explain some conflicting results in the literature and may clarify emotional abilities related to daily life that are partially spared among older adults.
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Affiliation(s)
- Laurence Chaby
- Institut de Psychologie, Sorbonne Paris Cité, Université Paris Descartes, Boulogne-Billancourt, France
- Groupe Intégration Multimodale, Interaction et Signal Social, Institut des Systèmes Intelligents et de Robotique, CNRS UMR 7222, Paris, France
| | | | - Mohamed Chetouani
- Groupe Intégration Multimodale, Interaction et Signal Social, Institut des Systèmes Intelligents et de Robotique, CNRS UMR 7222, Paris, France
| | - Monique Plaza
- Groupe Intégration Multimodale, Interaction et Signal Social, Institut des Systèmes Intelligents et de Robotique, CNRS UMR 7222, Paris, France
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McIntosh LG, Mannava S, Camalier CR, Folley BS, Albritton A, Konrad PE, Charles D, Park S, Neimat JS. Emotion recognition in early Parkinson's disease patients undergoing deep brain stimulation or dopaminergic therapy: a comparison to healthy participants. Front Aging Neurosci 2015; 6:349. [PMID: 25653616 PMCID: PMC4301000 DOI: 10.3389/fnagi.2014.00349] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 12/28/2014] [Indexed: 01/24/2023] Open
Abstract
Parkinson's disease (PD) is traditionally regarded as a neurodegenerative movement disorder, however, nigrostriatal dopaminergic degeneration is also thought to disrupt non-motor loops connecting basal ganglia to areas in frontal cortex involved in cognition and emotion processing. PD patients are impaired on tests of emotion recognition, but it is difficult to disentangle this deficit from the more general cognitive dysfunction that frequently accompanies disease progression. Testing for emotion recognition deficits early in the disease course, prior to cognitive decline, better assesses the sensitivity of these non-motor corticobasal ganglia-thalamocortical loops involved in emotion processing to early degenerative change in basal ganglia circuits. In addition, contrasting this with a group of healthy aging individuals demonstrates changes in emotion processing specific to the degeneration of basal ganglia circuitry in PD. Early PD patients (EPD) were recruited from a randomized clinical trial testing the safety and tolerability of deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) in early-staged PD. EPD patients were previously randomized to receive optimal drug therapy only (ODT), or drug therapy plus STN-DBS (ODT + DBS). Matched healthy elderly controls (HEC) and young controls (HYC) also participated in this study. Participants completed two control tasks and three emotion recognition tests that varied in stimulus domain. EPD patients were impaired on all emotion recognition tasks compared to HEC. Neither therapy type (ODT or ODT + DBS) nor therapy state (ON/OFF) altered emotion recognition performance in this study. Finally, HEC were impaired on vocal emotion recognition relative to HYC, suggesting a decline related to healthy aging. This study supports the existence of impaired emotion recognition early in the PD course, implicating an early disruption of fronto-striatal loops mediating emotional function.
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Affiliation(s)
- Lindsey G McIntosh
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA ; Department of Psychology, Vanderbilt University Nashville, TN, USA
| | - Sishir Mannava
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
| | - Corrie R Camalier
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
| | | | - Aaron Albritton
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
| | - Peter E Konrad
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
| | - David Charles
- Department of Neurology, Vanderbilt University Medical Center Nashville, TN, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University Nashville, TN, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, Vanderbilt University Medical Center Nashville, TN, USA
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Mitchell RLC, Kingston RA. Age-related decline in emotional prosody discrimination: acoustic correlates. Exp Psychol 2014; 61:215-23. [PMID: 24217140 DOI: 10.1027/1618-3169/a000241] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
It is now accepted that older adults have difficulty recognizing prosodic emotion cues, but it is not clear at what processing stage this ability breaks down. We manipulated the acoustic characteristics of tones in pitch, amplitude, and duration discrimination tasks to assess whether impaired basic auditory perception coexisted with our previously demonstrated age-related prosodic emotion perception impairment. It was found that pitch perception was particularly impaired in older adults, and that it displayed the strongest correlation with prosodic emotion discrimination. We conclude that an important cause of age-related impairment in prosodic emotion comprehension exists at the fundamental sensory level of processing.
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Affiliation(s)
| | - Rachel A Kingston
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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28
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Boals A, Hayslip B, Banks JB. Age Differences in Autobiographical Memories of Negative Events. Int J Aging Hum Dev 2014; 78:47-65. [DOI: 10.2190/ag.78.1.d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined whether older adults recollect autobiographical memories of negative events so as to minimize unpleasant emotions to a greater extent than do younger adults. A sample of healthy older adults ( N = 126) and younger adults ( N = 119) completed the Autobiographical Memory Questionnaire and a measure of PTSD symptoms in response to their most negative recalled event. Results supported the hypothesis that older adults rated their negative memories as having: 1) less of a sense of traveling back to the time the event occurred, 2) less associated visceral emotional reactions, 3) fewer associated negative emotions, and 4) fewer PTSD symptoms, all relative to younger adults. In addition, older adults exhibited higher ratings of belief in accuracy, higher ratings that the memory comes as a coherent story, and more associated positive emotions, again all relative to younger adults. After controlling for differences between the types of events younger and older adults reported and how long ago the event occurred, the above age differences remained statistically significant, though the effect sizes were attenuated in some cases. These results are consistent in their support for the positivity effect, and suggest that older adults modify their recollections of negative events in a manner that is emotionally adaptive for them.
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Mitchell RLC, Ross ED. Attitudinal prosody: what we know and directions for future study. Neurosci Biobehav Rev 2013; 37:471-9. [PMID: 23384530 DOI: 10.1016/j.neubiorev.2013.01.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 01/16/2013] [Accepted: 01/28/2013] [Indexed: 10/27/2022]
Abstract
Prosodic aspects of speech such as pitch, duration and amplitude constitute nonverbal cues that supplement or modify the meaning of the spoken word, to provide valuable clues as to a speakers' state of mind. It can thus indicate what emotion a person is feeling (emotional prosody), or their attitude towards an event, person or object (attitudinal prosody). Whilst the study of emotional prosody has gathered pace, attitudinal prosody now deserves equal attention. In social cognition, understanding attitudinal prosody is important in its own right, since it can convey powerful constructs such as confidence, persuasion, sarcasm and superiority. In this review, it is examined what prosody is, how it conveys attitudes, and which attitudes prosody can convey. The review finishes by considering the neuroanatomy associated with attitudinal prosody, and put forward the hypothesis that this cognition is mediated by the right cerebral hemisphere, particularly posterior superior lateral temporal cortex, with an additional role for the basal ganglia, and limbic regions such as the medial prefrontal cortex and amygdala. It is suggested that further exploration of its functional neuroanatomy is greatly needed, since it could provide valuable clues about the value of current prosody nomenclature and its separability from other types of prosody at the behavioural level.
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Abstract
Recent research on emotion and aging has revealed a stability of emotional experience from adulthood to older age, despite aging-related decrements in the perception and categorization of emotionally relevant stimuli. Research also shows that emotional expression remains intact with aging. In contrast, other studies provide evidence for an age-related decrease in autonomic nervous system physiological arousal, particularly in response to emotionally negative stimuli, and for shifts in central nervous system physiologic response to emotional stimuli, with increased prefrontal cortex activation and decreased amygdala activation in aging. Research on attention and memory for emotional information supports a decreased processing of negative emotional stimuli (i.e., a decrease in the negativity effect seen in younger adults), and a relative increase in the processing of emotionally positive stimuli (positivity effect). These physiological response and attentional/memory preference differences across increasingly older groups have been interpreted, within socioemotional selectivity theory, as reflecting greater motivation for emotion regulation with aging. According to this theory, as persons age, their perceived future time horizon shrinks, and a greater value is placed upon cultivating close, familiar, and meaningful relationships and other situations that give rise to positive emotional experience, and avoiding, or shifting attention from, those people and situations that are likely to elicit negative emotion. Even though there are central nervous system structural changes in emotion-relevant brain regions with aging, this shift in socioemotional selectivity, and perhaps the decreased autonomic nervous system physiological arousal of emotion with aging, facilitate enhanced emotion regulation with aging.
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Affiliation(s)
- Alfred W Kaszniak
- Department of Psychology, University of Arizona, 1503 E. University, Tucson, AZ, 85721, USA,
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31
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Lifespan aging and belief reasoning: Influences of executive function and social cue decoding. Cognition 2011; 120:236-47. [DOI: 10.1016/j.cognition.2011.05.003] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 05/05/2011] [Accepted: 05/06/2011] [Indexed: 11/19/2022]
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33
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Ross ED, Monnot M. Affective prosody: What do comprehension errors tell us about hemispheric lateralization of emotions, sex and aging effects, and the role of cognitive appraisal. Neuropsychologia 2011; 49:866-877. [DOI: 10.1016/j.neuropsychologia.2010.12.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 12/10/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
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Ryan M, Murray J, Ruffman T. Aging and the Perception of Emotion: Processing Vocal Expressions Alone and With Faces. Exp Aging Res 2010; 36:1-22. [DOI: 10.1080/03610730903418372] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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35
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Recognition of Facial, Auditory, and Bodily Emotions in Older Adults. J Gerontol B Psychol Sci Soc Sci 2009; 64:696-703. [DOI: 10.1093/geronb/gbp072] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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