A novel study on association between untreated hearing loss and cognitive functions of older adults: Baseline non-verbal cognitive assessment results

A Comparison of Montreal Cognitive Assessment Scores among Individuals with Normal Hearing and Cochlear Implants

OBJECTIVES

The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool that has 4 of 10 test items heavily dependent on auditory input, potentially leaving hearing-impaired (HI) individuals at a disadvantage. Previous work found that HI individuals scored lower than normal-hearing (NH) individuals on the MoCA, potentially attributed to the degraded auditory signals negatively impacting the ability to commit auditory information to memory. However, there is no research comparing how cochlear implant (CI) recipients perform on the MoCA relative to NH and HI individuals. This study aimed to (1) examine the effect of implementing three different hearing-adjusted scoring methods for a group of age-matched CI recipients and NH individuals, (2) determine if there is a difference between the two groups in overall scores and hearing-adjusted scores, and (3) compare scores across our CI and NH data to the published HI data for all scoring methods. We hypothesized that (1) scores for CI recipients would improve with implementation of the hearing-adjusted scoring methods over the original method, (2) CI recipients would score lower than NH participants for both original and adjusted scoring methods, and (3) the difference in scores between NH and CI listeners for both adjusted and unadjusted scores would be greater than that reported in the literature between NH and HI individuals due to the greater severity of hearing loss and relatively poor spectral resolution of CIs.

DESIGN

A total of 94 adults with CIs and 105 adults with NH were initially enrolled. After age-matching the two groups and excluding those who self-identified as NH but failed a hearing screening, a total of 75 CI participants (mean age 61.2 y) and 74 NH participants (mean age 58.8 y) were administered the MoCA. Scores were compared between the NH and CI groups, as well as to published HI data, using the original MoCA scoring method and three alternative scoring methods that excluded various auditory-dependent test items.

RESULTS

MoCA scores improved for all groups when two of the three alternative scoring methods were used, with no significant interaction between scoring method and group. Scores for CI recipients were significantly poorer than those for age-matched NH participants for all scoring methods. CI recipients scored better than the published data for HI individuals; however, the HI group was not age matched to the CI and NH groups.

CONCLUSIONS

MoCA scores are only partly affected by the potentially greater cognitive processing required to interpret degraded auditory signals. Even with the removal of the auditory-dependent items, CI recipients still did not perform as well as the age-matched NH group. Importantly, removing auditory-dependent items significantly and fundamentally alters the test, thereby reducing its sensitivity. This has important limitations for administration and interpretation of the MoCA for people with hearing loss.

Hearing loss and psychosocial outcomes: Influences of social emotional aspects and personality

The aim of this study was to examine the effects of social isolation, loneliness, anxiety, depression, higher stress, and memory complaints interacting with personality traits as a function of hearing loss. Personality traits have previously been shown to correlate with anxiety and depression, as well as hearing loss, suggesting an effect of personality on the relationship between social emotional outcomes and hearing loss. A cross-sectional survey including validated screening measures was anonymously administered. Measures included personality (Big Five Index-2 Extra-Short Form), stress (Perceived Stress Scale), anxiety and depression (Patient Health Questionnaire for Depression and Anxiety), loneliness (Three-Item Loneliness Scale), social engagement (Lubben Social Network Scale-6), and self-perceived memory complaints (Subjective Cognitive Function). Eight hundred and ninety-one responses were obtained from adults between the ages of 18 and 90 years old (M = 50 years old). Hearing loss was positively correlated with subjective memory complaints only when not accounting for demographic variables, personality traits, psychosocial outcomes, and social emotional outcomes. There were additive effects of hearing loss and negative emotionality on increases in memory complaints in those who self-identified as maybe having hearing loss. Higher degrees of hearing loss also increased loneliness, with greater hearing loss negating the positive correlation between extraversion and social engagement. Overall, our results suggest that hearing loss significantly interacts with personality traits and other social emotional measures. Our results suggest that the impact of hearing loss on memory complaints, social isolation, and loneliness may differ across patients with hearing loss in comparison with those who think they maybe have hearing loss. Information from this study may provide insights for hearing healthcare and mental healthcare professionals to better serve persons with hearing loss who may require additional support or interventions.

Screening and Recognition of Cognitive Impairment in Older People Visiting Hearing Aid Dispensers in the Netherlands

OBJECTIVES

This study aims to determine how prevalent suspected cognitive impairment is in older people visiting hearing aid dispensers, and to assess whether hearing aid dispensers' judgment on cognition was in accordance with the outcome of a cognitive screening.

DESIGN

This observational study was conducted between April and May 2022.

SETTING AND PARTICIPANTS

Four private hearing aid retail stores in the Netherlands, where cognitive impairment was screened in people aged ≥60 years.

METHODS

The Mini-Cog was used for cognitive screening. In addition, hearing aid dispensers were asked to provide their professional judgment if they suspected cognitive impairment.

RESULTS

Of the total 239 older individuals screened, 133 were men [56%, mean age: 79 years (SD 8.6)], and 51 (21.3%) had abnormal outcomes on the Mini-Cog test. The recognition of possible cognitive impairment by the hearing aid dispensers compared to the outcome of the Mini-Cog resulted in correct predictions for 183 of the 239 individuals.

CONCLUSION AND IMPLICATIONS

Cognitive screening in hearing-impaired older adults who visit a hearing aid dispenser suggests that cognitive impairment might be present in approximately 1 in 5 individuals. Hearing aid dispensers' response to the presence of a cognitive impairment was in 2 of 3 in accordance with an abnormal outcome on cognitive screening. To improve hearing care for people with cognitive impairment, it might be important to enhance hearing care professionals' recognition of cognitive impairment in older individuals.

The successful use of a search strategy improves with visuospatial working memory in 2- to 4.5-year-olds

Using spatial cues such as shape, orientation, and pattern aids visuospatial working memory because it allows strategies that reduce the load on this cognitive resource. One such strategy, namely taking advantage of patterned spatial distributions, remains understudied to date. This strategy demands keeping track of already-searched locations and excluding them from further search and so correlates with visuospatial working memory. The use of such strategies should, in principle, develop in early childhood, but because most studies focus on chunking, the development of other strategies reducing the load on working memory is understudied in young children. Therefore, in this study we tested whether children aged 2 to 4.5 years (N = 97) could take advantage of spatial cues in their search and whether this ability correlated with their age, verbal ability, and visuospatial working memory. The results showed that the ability to use a patterned spatial distribution (searching a row of locations from one side to the other instead of a random search) significantly improved with visuospatial working memory but not with age or verbal ability. These results suggest that visuospatial abilities may rapidly develop from 2 to 4.5 years of age, and given their impact on later mathematic achievement, demand increased attention in cognitive developmental research and early childhood education.

The Impact of Age-Related Hearing Loss on Working Memory among Older Individuals: An Event-Related Potential Study

Introduction

Age-related hearing loss (ARHL) may affect working memory (WM), which impacts problem-solving, decision-making, language comprehension, and learning. Limited research exists on how ARHL affects WM using N-back tasks, but studying this is crucial for understanding neural markers and associated cognitive processes. Our study explores the impact of ARHL on WM using behavioral and electrophysiological measures and how it correlates with speech-in-noise scores in older individuals with ARHL.

Method

The study involved two groups, each with 20 participants aged 60-80. Group 1 had individuals with mild to moderate sensorineural hearing loss, while Group 2 had age- and education-matched controls with normal or near-normal hearing. Participants underwent audiological assessments and completed cognitive tests, including simple reaction time and N-back tests. During the performance of cognitive tasks, a simultaneous electroencephalography was recorded. Data analysis included behavioral and event-related potentials, source estimation, and functional connectivity analysis.

Results

The study revealed significantly poor accuracy, longer reaction time, and smaller P300 amplitude among individuals with ARHL, even after controlling for general slowing. Individuals with ARHL experience compromised neural activity, particularly in the temporal and parietal regions, which are vital for cognition and WM. Furthermore, individuals with ARHL exhibited poor communication between the superior temporal gyrus and insulae regions among the brain regions mediating WM during the 1-back task. Also, the study found a strong correlation between hearing measures and WM outcomes.

Conclusion

The study findings suggest that individuals with ARHL have impaired WM compared to those with normal hearing. This indicates a potential link between ARHL and cognitive decline, which could significantly affect daily life and quality of life. The widely used WM test with simultaneous EEG recording and source estimation analysis would further validate the usefulness of the study in assessing WM in this population.

Clinical Assessment Tools for the Detection of Cognitive Impairment and Hearing Loss in the Ageing Population: A Scoping Review

Objective

There is a strong association between cognitive impairment and hearing loss, both highly prevalent in the ageing population. Early detection of both hearing loss and cognitive impairment is essential in the management of these conditions to ensure effective and informed decisions on healthcare. The main objective was to identify existing and emerging cognitive and auditory assessment tools used in clinical settings (eg, memory clinics, audiology clinics), which manage the ageing population.

Methods

A scoping review of peer-reviewed publications and results were reported according to the PRISMA-ScR guidelines.

Results

A total of 289 articles were selected for data extraction. The majority of studies (76.1%) were conducted in 2017 or later. Tests of global cognitive function (ie, Mini-Mental State Exam, Montreal Cognitive Assessment) were the most commonly used method to detect cognitive impairment in hearing healthcare settings. Behavioral hearing testing (ie, pure-tone audiometry) was the most commonly used method to detect hearing loss in cognitive healthcare settings. Objective, physiological measures were seldom used across disciplines.

Conclusion

Preferences among clinicians for short, accessible tests likely explain the use of tests of global cognitive function and behavioral hearing tests. Rapidly evolving literature has identified inherent limitations of administering global cognitive function tests and pure-tone testing in an ageing population. Using electrophysiological measures as an adjunct to standard methods of assessment may provide more reliable information for clinical recommendations in those with cognitive and hearing impairment, and subsequently achieve better healthcare outcomes.

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

Background and Aim

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

Methods

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

Results

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

Conclusion

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

Cognitive control in age-related hearing loss: A narrative review

Recent evidence suggests links between hearing loss and cognitive impairment in older adults with peripheral age-related hearing loss (ARHL). Earliest cognitive changes have been observed in cognitive control; however, a cohesive account of cognitive control alterations in older adults with peripheral ARHL is lacking. Cognitive control refers to cognitive processes that manage and regulate one's behavior to achieve desired goals. This review summarizes behavioral evidence on alterations in three cognitive control processes, including cognitive flexibility, inhibitory control, and working memory updating, in individuals with ARHL. Of the three processes, cognitive flexibility and working memory updating have been most extensively studied, with relatively fewer studies examining inhibitory control. Most consistent evidence is observed for long-term changes in cognitive flexibility, particularly in individuals with greater severity of ARHL. Equivocal evidence is seen for alterations in inhibitory control and working memory updating, with various factors contributing to inconsistencies across studies. Our review summarizes the emerging body of research on cognitive control in individuals with ARHL to guide future work in this area and considerations related to the management of cognitive issues in this population.

Extended Preoperative Audiometry for Outcome Prediction and Risk Analysis in Patients Receiving Cochlear Implants

BACKGROUND

The outcome of cochlear implantation has improved over the last decades, but there are still patients with less benefit. Despite numerous studies examining the cochlear implant (CI) outcome, variations in speech comprehension with CI remains incompletely explained. The aim of this study was therefore to examine preoperative pure-tone audiogram and speech comprehension as well as aetiology, to investigate their relationship with postoperative speech comprehension in CI recipients.

METHODS

A retrospective study with 664 ears of 530 adult patients was conducted. Correlations between the target variable postoperative word comprehension with the preoperative speech and sound comprehension as well as aetiology were investigated. Significant correlations were inserted into multivariate models. Speech comprehension measured as word recognition score at 70 dB with CI was analyzed as (i) a continuous and (ii) a dichotomous variable.

RESULTS

All variables that tested preoperative hearing were significantly correlated with the dichotomous target; with the continuous target, all except word comprehension at 65 dB with hearing aid. The strongest correlation with postoperative speech comprehension was seen for monosyllabic words with hearing aid at 80 dB. The preoperative maximum word comprehension was reached or surpassed by 97.3% of CI patients. Meningitis and congenital diseases were strongly negatively associated with postoperative word comprehension. The multivariate model was able to explain 40% of postoperative variability.

CONCLUSION

Speech comprehension with hearing aid at 80 dB can be used as a supplementary preoperative indicator of CI-aided speech comprehension and should be measured regularly in the clinical routine. Combining audiological and aetiological variables provides more insights into the variability of the CI outcome, allowing for better patient counselling.

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

Introduction

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

Methods

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

Results

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

Discussion

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

Cochlear Implant Adult Speech Perception Outcomes: Seniors Have Similar Good Outcomes

OBJECTIVE

The primary aim was to analyze the speech perception outcomes of patients with cochlear implants 65 years and older, compared with those younger than 65 years. The secondary aim was to analyze if preoperative hearing levels, severe compared with profound, had an effect on speech perception outcomes in senior citizens.

STUDY DESIGN

Retrospective case review of 785 patients, between 2009 and 2016.

SETTING

A large cochlear implant program.

PATIENTS

Cochlear implant adult recipients younger than 65 years and 65 years and older at the time of surgery.

INTERVENTIONS

Therapeutic-cochlear implant.

MAIN OUTCOME MEASURES

Speech perception outcomes, using City University of New York (CUNY) sentences and Consonant-Nucleus-Consonant (CNC) words. Outcomes were measured preoperatively and postoperatively at 3, 6and 12 months for cohorts younger than 65 years and 65 years and older.

RESULTS

Adult recipients younger than 65 years compared with those 65 years and older had comparable outcomes for CUNY sentence scores outcomes (p = 0.11) and CNC word scores (p = 0.69). The preoperative four-frequency average severe hearing loss (HL) cohort was significantly better compared with the profound HL cohort, for both the CUNY sentence scores (p < 0.001) and CNC word scores (p < 0.0001). The four-frequency average severe HL cohort had better outcomes irrespective of age.

CONCLUSIONS

Senior citizens have similarly good speech perception outcomes as adults younger than 65 years. Those with preoperative severe HL have better outcomes than profound loss. These finds are reassuring and can be used when counseling older cochlear implant candidates.

Cognitive, physical, and mental profiles of older adults with misplaced self-evaluation of hearing loss

BACKGROUND

Although inconsistency between objective and subjective hearing loss among older adults has been suggested, a systematic examination of the cognitive and physical functioning among such older adults is lacking. Our objective was to assess the cognitive, physical, and mental profiles associated with the discrepancy.

METHODS

The auditory acuity of 696 community-dwelling older adults was evaluated using a pure-tone average of hearing thresholds at 1.0 and 4.0 kHz in the better-hearing ear. Participants were then stratified as follows: normal hearing ≤ 25 dB, mild loss >25 dB and ≤40 dB, and moderate loss >40 dB and ≤70 dB. Global cognition, gait speed, and depressive symptoms were also assessed.

RESULTS

Among older adults, 63.5% of those with mild hearing loss and 22.2% of those with moderate hearing loss did not recognize hearing difficulties. Significantly lower cognition and gait performance were observed in those with moderate hearing loss without subjective hearing loss (i.e., overestimation of hearing acuity) than in those with subjective hearing loss. Furthermore, older adults with subjective hearing loss showed a higher tendency toward depression than those without subjective hearing loss, irrespective of objective hearing loss.

CONCLUSIONS

Our results suggest that failure to recognize a high level of age-related hearing loss may be related to impaired cognition and gait performance among older adults. Subjective hearing loss may indicate a tendency toward depression.

The impact of untreated hearing loss on depression, anxiety, stress, and loneliness in tonal language-speaking older adults in China

BACKGROUND

Age-related hearing loss, mental health conditions, and loneliness commonly affect older adults. This study aimed to determine whether untreated hearing loss is independently associated with depression, anxiety, stress, and loneliness in tonal language-speaking older adults in China.

STUDY DESIGN

Observational, cross-sectional study.

METHODS

293 older adults (111 males, M = 70.33 ± 4.90 years; 182 females, M = 69.02 ± 4.08 years) were recruited. All participants completed a pure tone audiometric hearing assessment, and provided information on living arrangements, marital status, leisure activities, tobacco and alcohol use, and medical history. The Mandarin version of the De Jong Gierveld Loneliness Scale was used to measure loneliness, and the Mandarin version of the 21-item Depression Anxiety Stress Scale (DASS-21) was used to assess a range of symptoms common to depression, stress, and anxiety of the participants. The analysis focused on determining the predictors of depression, anxiety, and stress, and the predictors of measures of loneliness.

RESULTS

Multiple stepwise regression analyses revealed that the emotional loneliness (β = 0.303, p < 0.001) and living status (β = 0.110, p = 0.048) significantly predicted DASS depression scores; emotional loneliness (β = 0.276, p < 0.001) and a history of vascular disease (β = 0.148, p = 0.009) were significantly related to DASS anxiety scores; emotional loneliness (β = 0.341, p < 0.001) and a history of vascular disease (β = 0.129, p = 0.019) significantly predicted DASS stress scores. Furthermore, multiple stepwise regression analyses showed that DASS stress scores (β = 0.333, p < 0.001), education years (β = -0.126, p = 0.020), marriage status (β = 0.122, p = 0.024), and a history of vascular disease (β = 0.111, p = 0.044) significantly predicted emotional loneliness; four-frequency average hearing loss (β = 0.149, p = 0.010) and DASS stress scores (β = 0.123, p = 0.034) significantly predicted social loneliness scale; and four-frequency average hearing loss (β = 0.167, p = 0.003) and DASS stress scores (β = 0.279, p < 0.001) also significantly predicted overall loneliness. There were no significant associations with high-frequency hearing loss.

CONCLUSION

This study revealed that loneliness has a significant relationship both with hearing loss and aspects of mental health in an older adult Mandarin-speaking population. However, mental health was not significantly associated with hearing loss in this population.

Investigating the Provision and Context of Use of Hearing Aid Listening Programs From Real-world Data: Observational Study

BACKGROUND

Listening programs enable hearing aid (HA) users to change device settings for specific listening situations and thereby personalize their listening experience. However, investigations into real-world use of such listening programs to support clinical decisions and evaluate the success of HA treatment are lacking.

OBJECTIVE

We aimed to investigate the provision of listening programs among a large group of in-market HA users and the context in which the programs are typically used.

METHODS

First, we analyzed how many and which programs were provided to 32,336 in-market HA users. Second, we explored 332,271 program selections from 1312 selected users to investigate the sound environments in which specific programs were used and whether such environments reflect the listening intent conveyed by the name of the used program. Our analysis was based on real-world longitudinal data logged by smartphone-connected HAs.

RESULTS

In our sample, 57.71% (18,663/32,336) of the HA users had programs for specific listening situations, which is a higher proportion than previously reported, most likely because of the inclusion criteria. On the basis of association rule mining, we identified a primary additional listening program, Speech in Noise, which is frequent among users and often provided when other additional programs are also provided. We also identified 2 secondary additional programs (Comfort and Music), which are frequent among users who get ≥3 programs and usually provided in combination with Speech in Noise. In addition, 2 programs (TV and Remote Mic) were related to the use of external accessories and not found to be associated with other programs. On average, users selected Speech in Noise, Comfort, and Music in louder, noisier, and less-modulated (all P<.01) environments compared with the environment in which they selected the default program, General. The difference from the sound environment in which they selected General was significantly larger in the minutes following program selection than in the minutes preceding it.

CONCLUSIONS

This study provides a deeper insight into the provision of listening programs on a large scale and demonstrates that additional listening programs are used as intended and according to the sound environment conveyed by the program name.

Social Media Use in Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review

Background:

People are increasingly using social media outlets for gathering health-related information. There has also been considerable interest from researchers and clinicians in understanding how social media is used by the general public, patients, and health professionals to gather health-related information. Interest in the use of social media for audiovestibular disorders has also received attention, although published evidence synthesis of this use is lacking. The objective of this review article was to synthesize existing research studies related to social media use concerning hearing loss, tinnitus, and vestibular disorders.

Method:

Comprehensive searches were performed in multiple databases between October and November 2020 and again in June 2021 and March 2022, with additional reports identified from article citations and unpublished literature. This review article was presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results:

A total of 1,512 articles were identified. Of these, 16 publications met the inclusion criteria. Overall, social media offered people the platform to learn about hearing loss, tinnitus, and vestibular disorders via advice and support seeking, personal experience sharing, general information sharing, and relationship building. Research studies were more common on information and user activities seen on Facebook Pages, Twitter, and YouTube videos. Misinformation was identified across all social media platforms for each of these conditions.

Conclusions:

Online discussions about audiovestibular disorders are evident, although inconsistencies in study procedures make it difficult to compare these discussion groups. Misinformation is a concern needing to be addressed during clinical consultations as well as via other public health means. Uniform guidelines are needed for research regarding the use of social media so that outcomes are comparable. Moreover, clinical studies examining how exposure to and engagement with social media information may impact outcomes (e.g., help seeking, rehabilitation uptake, rehabilitation use, and satisfaction) require exploration.

Supplemental Material:

https://doi.org/10.23641/asha.20667672

Working Memory-Based Cognitive Rehabilitation: Spoken Language of Deaf and Hard-of-Hearing Children

This research examined the effect of the Working Memory-based Cognitive Rehabilitation (WMCR) intervention on the spoken language development of deaf and hard-of-hearing (DHH) children. In this clinical trial study, 28 DHH children aged between 5 and 6 years were selected by random sampling method. The participants were randomly assigned to experimental and control groups. The experimental group participated in the WMCR intervention involving 11 sessions. All participants were assessed pre-and postintervention. Data were collected by the Newsha Development Scale and analyzed through MANCOVA. The results revealed a significant difference between the scores of the receptive and expressive language of the experimental group that were exposed to the WMCR intervention compared with the control group. The receptive and expressive language skills of the experimental group indicated a significant improvement after the intervention. Therefore, the WMCR intervention is an effective method that affects the spoken language skills of DHH children. These findings have critical implications for teachers, parents, and therapists in supporting DHH young children to develop their language skills.

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

ETHICS AND DISSEMINATION

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

PROSPERO REGISTRATION NUMBER

CRD42021235310.

Central Auditory Functions of Alzheimer's Disease and Its Preclinical Stages: A Systematic Review and Meta-Analysis

In 2020, 55 million people worldwide were living with dementia, and this number is projected to reach 139 million in 2050. However, approximately 75% of people living with dementia have not received a formal diagnosis. Hence, they do not have access to treatment and care. Without effective treatment in the foreseeable future, it is essential to focus on modifiable risk factors and early intervention. Central auditory processing is impaired in people diagnosed with Alzheimer's disease (AD) and its preclinical stages and may manifest many years before clinical diagnosis. This study systematically reviewed central auditory processing function in AD and its preclinical stages using behavioural central auditory processing tests. Eleven studies met the full inclusion criteria, and seven were included in the meta-analyses. The results revealed that those with mild cognitive impairment perform significantly worse than healthy controls within channel adaptive tests of temporal response (ATTR), time-compressed speech test (TCS), Dichotic Digits Test (DDT), Dichotic Sentence Identification (DSI), Speech in Noise (SPIN), and Synthetic Sentence Identification-Ipsilateral Competing Message (SSI-ICM) central auditory processing tests. In addition, this analysis indicates that participants with AD performed significantly worse than healthy controls in DDT, DSI, and SSI-ICM tasks. Clinical implications are discussed in detail.

High-Frequency Hearing Loss Is Associated With Anxiety and Brain Structural Plasticity in Older Adults

Age-related hearing loss (ARHL) is a kind of symmetrical and slow sensorineural hearing loss, which is a common condition in older adults. The characteristic of ARHL is hearing loss beginning in the high-frequency region and spreading toward low-frequency with age. Previous studies have linked it to anxiety, suggesting that brain structure may be involved in compensatory plasticity after partial hearing deprivation. However, the neural mechanisms of underlying ARHL-related anxiety remain unclear. The purpose of this cross-sectional study was to explore the interactions among high-frequency hearing loss and anxiety as well as brain structure in older adults. Sixty-seven ARHL patients and 68 normal hearing (NH) controls participated in this study, and the inclusion criterion of ARHL group was four-frequency (0.5, 1, 2, and 4 kHz) pure tone average (PTA) > 25 decibels hearing level of the better hearing ear. All participants performed three-dimensional T1-weighted magnetic resonance imaging (MRI), pure tone audiometry tests, anxiety and depression scales. Our results found gray matter volume (GMV) decreased in 20 brain regions in the ARHL group compared with the NH group, and a positive correlation existed between high-frequency pure tone audiometry (H-PT) and anxiety scores in the ARHL group. Among 20 brain regions, we also found the GMVs of the middle cingulate cortex (MCC), and the hippocampal/parahippocampal (H-P) regions were associated with H-PT and anxiety scores in all participants separately. However, the depressive symptoms indicated no relationship with hearing assessment or GMVs. Our findings revealed that the crucial role of MCC and H-P in a link of anxiety and hearing loss in older adults.

Listen Carefully protocol: an exploratory case-control study of the association between listening effort and cognitive function

INTRODUCTION

A growing body of evidence suggests that hearing loss is a significant and potentially modifiable risk factor for cognitive impairment. Although the mechanisms underlying the associations between cognitive decline and hearing loss are unclear, listening effort has been posited as one of the mechanisms involved with cognitive decline in older age. To date, there has been a lack of research investigating this association, particularly among adults with mild cognitive impairment (MCI).

METHODS AND ANALYSIS

15-25 cognitively healthy participants and 15-25 patients with MCI (age 40-85 years) will be recruited to participate in an exploratory study investigating the association between cognitive functioning and listening effort. Both behavioural and objective measures of listening effort will be investigated. The sentence-final word identification and recall (SWIR) test will be administered with single talker non-intelligible speech background noise while monitoring pupil dilation. Evaluation of cognitive function will be carried out in a clinical setting using a battery of neuropsychological tests. This study is considered exploratory and proof of concept, with information taken to help decide the validity of larger-scale trials.

ETHICS AND DISSEMINATION

Written approval exemption was obtained by the Scientific Ethics Committee in the central region of Denmark (De Videnskabsetiske Komiteer i Region Hovedstaden), reference 19042404, and the project is registered pre-results at clinicaltrials.gov, reference NCT04593290, Protocol ID 19042404. Study results will be disseminated in peer-reviewed journals and conferences.

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

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

Hearing loss, cognition, and risk of neurocognitive disorder: evidence from a longitudinal cohort study of older adult Australians

Addressing midlife hearing loss could prevent up to 9% of new cases of dementia, the highest of any potentially modifiable risk factor identified in the 2017 commissioned report in The Lancet. In Australia, hearing loss is the second-most common chronic health condition in older people, affecting 74% of people aged over 70. Estimates indicate that people with severe hearing loss are up to 5-times more likely to develop dementia, but these estimates vary between studies due to methodological limitations. Using data from the Sydney Memory and Aging Study, in which 1,037 Australian men and women aged between 70 and 90 years were enrolled and completed biennial assessments from 2005-2017, investigations between hearing loss and baseline cognitive performance as well as longitudinal risk of neurocognitive disorder were undertaken. Individuals who reported moderate-to-severe hearing difficulties had poorer cognitive performances in the domains of Attention/Processing Speed and Visuospatial Ability, and on an overall index of Global Cognition, and had a 1.5-times greater risk for the neurocognitive disorder during 6-years' follow-up. Hearing loss independently predicted risk for MCI but not dementia. The presence of hearing loss is an important consideration for neuropsychological case formulation in older adults with cognitive impairment. Hearing loss may increase cognitive load, resulting in observable cognitive impairment on neuropsychological testing. Individuals with hearing loss who demonstrate impairment in non-amnestic domains may experience benefits from the provision of hearing devices; This study provides support for a randomized control trial of hearing devices for improvement of cognitive function in this group.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

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

Clustering Users Based on Hearing Aid Use: An Exploratory Analysis of Real-World Data

While the assessment of hearing aid use has traditionally relied on subjective self-reported measures, smartphone-connected hearing aids enable objective data logging from a large number of users. Objective data logging allows to overcome the inaccuracy of self-reported measures. Moreover, data logging enables assessing hearing aid use with a greater temporal resolution and longitudinally, making it possible to investigate hourly patterns of use and to account for the day-to-day variability. This study aims to explore patterns of hearing aid use throughout the day and assess whether clusters of users with similar use patterns can be identified. We did so by analyzing objective hearing aid use data logged from 15,905 real-world users over a 4-month period. Firstly, we investigated the daily amount of hearing aid use and its within-user and between-user variability. We found that users, on average, used the hearing aids for 10.01 h/day, exhibiting a substantial between-user (SD = 2.76 h) and within-user (SD = 3.88 h) variability. Secondly, we examined hearing aid use hourly patterns by clustering 453,612 logged days into typical days of hearing aid use. We identified three typical days of hearing aid use: full day (44% of days), afternoon (27%), and sporadic evening (26%) day of hearing aid use. Thirdly, we explored the usage patterns of the hearing aid users by clustering the users based on the proportion of time spent in each of the typical days of hearing aid use. We found three distinct user groups, each characterized by a predominant (i.e., experienced ~60% of the time) typical day of hearing aid use. Notably, the largest user group (49%) of users predominantly had full days of hearing aid use. Finally, we validated the user clustering by training a supervised classification ensemble to predict the cluster to which each user belonged. The high accuracy achieved by the supervised classifier ensemble (~86%) indicated valid user clustering and showed that such a classifier can be successfully used to group new hearing aid users in the future. This study provides a deeper insight into the adoption of hearing care treatments and paves the way for more personalized solutions.

Screening Tools and Assessment Methods of Cognitive Decline Associated With Age-Related Hearing Loss: A Review

Strong links between hearing and cognitive function have been confirmed by a growing number of cross-sectional and longitudinal studies. Seniors with age-related hearing loss (ARHL) have a significantly higher cognitive impairment incidence than those with normal hearing. The correlation mechanism between ARHL and cognitive decline is not fully elucidated to date. However, auditory intervention for patients with ARHL may reduce the risk of cognitive decline, as early cognitive screening may improve related treatment strategies. Currently, clinical audiology examinations rarely include cognitive screening tests, partly due to the lack of objective quantitative indicators with high sensitivity and specificity. Questionnaires are currently widely used as a cognitive screening tool, but the subject's performance may be negatively affected by hearing loss. Numerous electroencephalogram (EEG) and magnetic resonance imaging (MRI) studies analyzed brain structure and function changes in patients with ARHL. These objective electrophysiological tools can be employed to reveal the association mechanism between auditory and cognitive functions, which may also find biological markers to be more extensively applied in assessing the progression towards cognitive decline and observing the effects of rehabilitation training for patients with ARHL. In this study, we reviewed clinical manifestations, pathological changes, and causes of ARHL and discussed their cognitive function effects. Specifically, we focused on current cognitive screening tools and assessment methods and analyzed their limitations and potential integration.

Changes of the Brain Causal Connectivity Networks in Patients With Long-Term Bilateral Hearing Loss

It remains poorly understood how brain causal connectivity networks change following hearing loss and their effects on cognition. In the current study, we investigated this issue. Twelve patients with long-term bilateral sensorineural hearing loss [mean age, 55.7 ± 2.0; range, 39–63 years; threshold of hearing level (HL): left ear, 49.0 ± 4.1 dB HL, range, 31.25–76.25 dB HL; right ear, 55.1 ± 7.1 dB HL, range, 35–115 dB HL; the duration of hearing loss, 16.67 ± 4.5, range, 3–55 years] and 12 matched normally hearing controls (mean age, 52.3 ± 1.8; range, 42–63 years; threshold of hearing level: left ear, 17.6 ± 1.3 dB HL, range, 11.25–26.25 dB HL; right ear, 19.7 ± 1.3 dB HL, range, 8.75–26.25 dB HL) participated in this experiment. We constructed and analyzed the causal connectivity networks based on functional magnetic resonance imaging data of these participants. Two-sample t-tests revealed significant changes of causal connections and nodal degrees in the right secondary visual cortex, associative visual cortex, right dorsolateral prefrontal cortex, left subgenual cortex, and the left cingulate cortex, as well as the shortest causal connectivity paths from the right secondary visual cortex to Broca’s area in hearing loss patients. Neuropsychological tests indicated that hearing loss patients presented significant cognitive decline. Pearson’s correlation analysis indicated that changes of nodal degrees and the shortest causal connectivity paths were significantly related with poor cognitive performances. We also found a cross-modal reorganization between associative visual cortex and auditory cortex in patients with hearing loss. Additionally, we noted that visual and auditory signals had different effects on neural activities of Broca’s area, respectively. These results suggest that changes in brain causal connectivity network are an important neuroimaging mark of cognitive decline. Our findings provide some implications for rehabilitation of hearing loss patients.

Age-Related Hearing Loss and the Development of Cognitive Impairment and Late-Life Depression: A Scoping Overview

Age-related hearing loss (ARHL) has been connected to both cognitive decline and late-life depression. Several mechanisms have been offered to explain both individual links. Causal and common mechanisms have been theorized for the relationship between ARHL and impaired cognition, including dementia. The causal mechanisms include increased cognitive load, social isolation, and structural brain changes. Common mechanisms include neurovascular disease as well as other known or as-yet undiscovered neuropathologic processes. Behavioral mechanisms have been used to explain the potentially causal association of ARHL with depression. Behavioral mechanisms include social isolation, loneliness, as well as decreased mobility and impairments of activities of daily living, all of which can increase the risk of depression. The mechanisms underlying the associations between hearing loss and impaired cognition, as well as hearing loss and depression, are likely not mutually exclusive. ARHL may contribute to both impaired cognition and depression through overlapping mechanisms. Furthermore, ARHL may contribute to impaired cognition which may, in turn, contribute to depression. Because ARHL is highly prevalent and greatly undertreated, targeting this condition is an appealing and potentially influential strategy to reduce the risk of developing two potentially devastating diseases of later life. However, further studies are necessary to elucidate the mechanistic relationship between ARHL, depression, and impaired cognition.

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

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

Impact of Hearing Loss on Geriatric Assessment

Background

Due to the aging society, the incidence of age-related hearing loss (ARHL) is strongly increasing. Hearing loss has a high impact on various aspects of life and may lead to social isolation, depression, loss of gain control, frailty and even mental decline. Comorbidity of cognitive and sensory impairment is not rare. This might have an impact on diagnostics and treatment in the geriatric setting.

Objective

The aim of the study was to evaluate the impact of hearing impairment on geriatric assessment and cognitive testing routinely done in geriatrics.

Material and Methods

This review is based on publications retrieved by a selective search in Medline, including individual studies, meta-analyses, guidelines, Cochrane reviews, and other reviews from 1960 until August 2020.

Results

Awareness of sensory impairment is low among patients and health professionals working with elderly people. The evaluation of the hearing status is not always part of the geriatric assessment and not yet routinely done in psychiatric settings. However, neurocognitive testing as an important part can be strongly influenced by auditory deprivation. Misunderstanding of verbal instructions, cognitive changes, and delayed central processes may lead to a false diagnosis in up to 16% of subjects with hearing loss. To minimize this bias, several neurocognitive assessments were transformed into non-auditory versions recently, eg the most commonly used Hearing-Impaired Montreal Cognitive Assessment (HI-MoCA). However, most of them still lack normative data for elderly people with hearing loss.

Conclusion

Hearing loss should be taken into consideration when performing geriatric assessment and cognitive testing in elderly subjects. Test batteries suitable for ARLH should be applied.

Hearing aids to support cognitive functions of older adults at risk of dementia: the HearCog trial- clinical protocols

Background

Globally, about 50 million people were living with dementia in 2015, with this number projected to triple by 2050. With no cure or effective treatment currently insight, it is vital that factors are identified which will help prevent or delay both age-related and pathological cognitive decline and dementia. Observational data have suggested that hearing loss is a potentially modifiable risk factor for dementia, but no conclusive evidence from randomised controlled trials is currently available.

Methods

The HearCog trial is a 24-month, randomised, controlled clinical trial aimed at determining whether a hearing loss intervention can delay or arrest the cognitive decline. We will randomise 180 older adults with hearing loss and mild cognitive impairment to a hearing aid or control group to determine if the fitting of hearing aids decreases the 12-month rate of cognitive decline compared with the control group. In addition, we will also determine if the expected clinical gains achieved after 12 months can be sustained over an additional 12 months and if losses experienced through the non-correction of hearing loss can be reversed with the fitting of hearing aids after 12 months.

Discussion

The trial will also explore the cost-effectiveness of the intervention compared to the control arm and the impact of hearing aids on anxiety, depression, physical health and quality of life. The results of this trial will clarify whether the systematic correction of hearing loss benefits cognition in older adults at risk of cognitive decline. We anticipate that our findings will have implications for clinical practice and health policy development.

Trial registration

Australian and New Zealand Clinical Trials Registry (ANZCTR: 12618001278224), registered on 30.07.2018.

The Peripheral Hearing and Central Auditory Processing Skills of Individuals With Subjective Memory Complaints

Purpose

This study examined the central auditory processing (CAP) assessment results of adults between 45 and 85 years of age with probable pre-clinical Alzheimer’s disease – i.e., individuals with subjective memory complaints (SMCs) as compared to those who were not reporting significant levels of memory complaints (non-SMCs). It was hypothesized that the SMC group would perform significantly poorer on tests of central auditory skills compared to participants with non-SMCs (control group).

Methods

A total of 95 participants were recruited from the larger Western Australia Memory Study and were classified as SMCs (N = 61; 20 males and 41 females, mean age 71.47 ±7.18 years) and non-SMCs (N = 34; 10 males, 24 females, mean age 68.85 ±7.69 years). All participants completed a peripheral hearing assessment, a CAP assessment battery including Dichotic Digits, Duration Pattern Test, Dichotic Sentence Identification, Synthetic Sentence Identification with Ipsilateral Competing Message (SSI-ICM) and the Quick-Speech-in-Noise, and a cognitive screening assessment.

Results

The SMCs group performed significantly poorer than the control group on SSI-ICM −10 and −20 dB signal-to-noise conditions. No significant differences were found between the two groups on the peripheral hearing threshold measurements and other CAP assessments.

Conclusions

The results suggest that individuals with SMCs perform poorly on specific CAP assessments in comparison to the controls. The poor CAP in SMC individuals may result in a higher cost to their finite pool of cognitive resources. The CAP results provide yet another biomarker that supports the hypothesis that SMCs may be a primary indication of neuropathological changes in the brain. Longitudinal follow up of individuals with SMCs, and decreased CAP abilities should inform whether this group is at higher risk of developing dementia as compared to non-SMCs and those SMC individuals without CAP difficulties.

The Effects of Age-Related Hearing Loss on the Brain and Cognitive Function

Age-related hearing loss (ARHL) is a common problem for older adults, leading to communication difficulties, isolation, and cognitive decline. Recently, hearing loss has been identified as potentially the most modifiable risk factor for dementia. Listening in challenging situations, or when the auditory system is damaged, strains cortical resources, and this may change how the brain responds to cognitively demanding situations more generally. We review the effects of ARHL on brain areas involved in speech perception, from the auditory cortex, through attentional networks, to the motor system. We explore current perspectives on the possible causal relationship between hearing loss, neural reorganisation, and cognitive impairment. Through this synthesis we aim to inspire innovative research and novel interventions for alleviating hearing loss and cognitive decline.

Healthy aging in elderly cochlear implant recipients: a multinational observational study

Background

Given an increase in the aging population and its impact on healthcare systems, policy makers for provision of health and social services are aiming to keep older adults in good health for longer, in other words towards ‘healthy aging’. Our study objective is to show that rehabilitation with cochlear implant treatment in the elderly with hearing impairment improves the overall health-related quality of life and general well-being that translate into healthy aging.

Methods

The multicentre, prospective, repeated measures, single-subject, clinical observational study will accrue 100 elderly, first-time, unilateral CI recipients (≥ 60 years) and analyze changes on specific measurement tools over ca. 20 months from preimplant to postimplant. Evaluations will consist of details collected through case history and interview questionnaires by clinicians, data logging, self-report questionnaires completed by the recipients and a series of commonly used audiometric measures and geriatric assessment tools. The primary indicator of changes in overall quality of life will be the HUI-3.

Discussion

The protocol is designed to make use of measurement tools that have already been applied to the hearing-impaired population in order to compare effects of CI rehabilitation in adults immediately before their implantation, (pre-implant) and after gaining 1–1.5 years of experience (post-implant). The broad approach will lead to a greater understanding of how useful hearing impacts the quality of life in elderly individuals, and thus improves potentials for healthy aging. Outcomes will be described and analyzed in detail.

Trial registration

This research has been registered in ClinicalTrials.gov (http://www.clinicaltrials.gov/), 7 March 2017 under the n° NCT03072862.

Cognitive Screening of Adults With Postlingual Hearing Loss: A Systematic Review

Objective

To systematically review the evidence for the use of cognitive screening tools for adults with postlingual hearing loss.

Data Sources

PubMed, Embase, Scopus, PsycINFO (EBSCO), CINAHL (EBSCO), and CENTRAL (Cochrane Library) electronic databases were searched from inception until October 4, 2018.

Review Methods

Articles were reviewed for inclusion by 2 independent reviewers. The references of included articles were hand-searched for additional relevant articles. Data were extracted by 2 independent extractors.

Results

Of 2092 articles imported from the search, 81 were included for the review. Nearly a third (31%, n = 25) included patients with profound hearing loss. In total, 23 unique tools were used for 105 unique applications. The Mini Mental Status Exam (MMSE) was the most commonly used (54%, n = 55), followed by the Montreal Cognitive Assessment (MoCA) (19%, n = 10). Nearly half of the tools were used to define patient inclusion or exclusion in a study (48%, n = 50), followed by examination of a change after an intervention (26%, n = 27). Two articles attempted to study the validity of the MMSE and MoCA for screening patients with mild to moderate hearing loss and found mixed effects of the auditory components. There were no validation studies identified from the search.

Conclusion

Many different cognitive screening tools have been used to study patients with postlingual hearing loss. The effects of the auditory components of these tools may be deleterious but ultimately remain unclear from the available evidence. To date, there has been no validation of any cognitive screening tool to be used for adults with postlingual hearing loss.

The effect of hearing loss configuration on cochlear implantation uptake rates: an Australian experience

Objective: Recent changes to cochlear implant (CI) candidacy criteria have led to the inclusion of candidates with greater levels of hearing in the contralateral and/or implanted ear. This study assessed the impact of various hearing loss configurations on CI uptake rates (those assessed as eligible for CI, who proceed to CI).Design: Retrospective cohort study.Study sample: Post-lingually deaf adult CI candidates (n = 619) seen at a Western Australian cochlear implant clinic.Results: An overall CI uptake rate of 44% was observed. Hearing loss configuration significantly impacted uptake rates. Uptake rates of 62% for symmetrical hearing loss, 48% for asymmetrical hearing loss (four-frequency average hearing loss (4FAHL) asymmetry ≤60 dB), 25% for highly asymmetrical hearing loss (4FAHL asymmetry >60 dB), 38% for hearing losses eligible for electric-acoustic stimulation, and 22% for individuals with single-sided hearing loss were observed. Hearing loss configuration and age were both significant factors in relation to CI uptake although the impact of age was limited.Conclusion: CI clinics who apply or are considering applying expanded CI candidacy criteria within their practice should be aware that candidates with greater levels of residual hearing in at least the contralateral ear are less likely to proceed to CI.

The Effect of Hearing Aid Use on Cognition in Older Adults: Can We Delay Decline or Even Improve Cognitive Function?

Hearing loss is a modifiable risk factor for dementia in older adults. Whether hearing aid use can delay the onset of cognitive decline is unknown. Participants in this study (aged 62–82 years) were assessed before and 18 months after hearing aid fitting on hearing, cognitive function, speech perception, quality of life, physical activity, loneliness, isolation, mood, and medical health. At baseline, multiple linear regression showed hearing loss and age predicted significantly poorer executive function performance, while tertiary education predicted significantly higher executive function and visual learning performance. At 18 months after hearing aid fitting, speech perception in quiet, self-reported listening disability and quality of life had significantly improved. Group mean scores across the cognitive test battery showed no significant decline, and executive function significantly improved. Reliable Change Index scores also showed either clinically significant improvement or stability in executive function for 97.3% of participants, and for females for working memory, visual attention and visual learning. Relative stability and clinically and statistically significant improvement in cognition were seen in this participant group after 18 months of hearing aid use, suggesting that treatment of hearing loss with hearing aids may delay cognitive decline. Given the small sample size, further follow up is required.

The Impact of Self-Reported Hearing Difficulties on Memory Collaboration in Older Adults

Cognitive scientists and philosophers recently have highlighted the value of thinking about people at risk of or living with dementia as intertwined parts of broader cognitive systems that involve their spouse, family, friends, or carers. By this view, we rely on people and things around us to "scaffold" mental processes such as memory. In the current study, we identified 39 long-married, older adult couples who are part of the Australian Imaging Biomarkers and Lifestyle (AIBL) Study of Ageing; all were cognitively healthy but half were subjective memory complainers. During two visits to their homes 1 week apart, we assessed husbands' and wives' cognitive performance across a range of everyday memory tasks working alone (Week 1) versus together (Week 2), including a Friends Task where they provided first and last names of their friends and acquaintances. As reported elsewhere, elderly couples recalled many more friends' names working together compared to alone. Couples who remembered successfully together used well-developed, rich, sensitive, and dynamic communication strategies to boost each other's recall. However, if one or both spouses self-reported mild-to-moderate or severe hearing difficulties (56% of husbands, 31% of wives), couples received less benefit from collaboration. Our findings imply that hearing loss may disrupt collaborative support structures that couples (and other intimate communicative partners) hone over decades together. We discuss the possibility that, cut off from the social world that scaffolds them, hearing loss may place older adults at greater risk of cognitive decline and dementia.

The Effect of Cochlear Implants on Cognitive Function in Older Adults: Initial Baseline and 18-Month Follow Up Results for a Prospective International Longitudinal Study

In older adults, hearing loss is independently associated with an increased rate of cognitive decline, and has been identified to be a modifiable risk factor for dementia. The mechanism underlying the cognitive decline associated with hearing loss is not understood, but it is known that the greater the hearing loss, the faster the rate of decline. It is unknown whether remediation of hearing loss with hearing devices can delay cognitive decline. This 5-year international longitudinal study is investigating the impact of cochlear implants on cognitive function in older people with severe-profound hearing loss, and whether remediation of hearing loss could delay the onset of cognitive impairment. This is the first study to examine the major primary risk factors associated with dementia in the same cohort. Participants were assessed before cochlear implantation and 18 months later using an identical battery including a visually presented cognitive assessment tool (Cogstate battery) that is highly sensitive to small changes in cognition and suitable for use with people with hearing loss. Hearing and speech perception ability were assessed in sound-treated conditions by an audiologist, and a range of questionnaire tools was administered to assess self-perceived ease of listening, quality of life, physical activity, diet, social and emotional loneliness, isolation, anxiety, and depression. A detailed medical health history was taken. Pre-operatively, despite the small initial sample size (n = 59), increased hearing loss and age predicted significantly poorer executive function and visual attention, while tertiary education predicted better executive function. Better self-reported quality of life was correlated with better visual learning performance, and engaging in frequent vigorous physical activity was correlated with poorer visual learning performance. At 18 months, for the first 20 participants, significant benefits of cochlear implants were seen in terms of speech perception, communication ability, and quality of life. Multiple linear regression modeling showed executive function improved significantly for non-tertiary educated males, while cognitive function remained stable for other participants. Further follow-up at 18 month intervals with a larger sample will reveal the effects of cochlear implant intervention on all outcomes, and whether this can delay cognitive decline.

Auditory and Cognitive Training for Cognition in Adults With Hearing Loss: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis examined the efficacy of auditory training and cognitive training to improve cognitive function in adults with hearing loss. A literature search of academic databases (e.g., MEDLINE, Scopus) and gray literature (e.g., OpenGrey) identified relevant articles published up to January 25, 2018. Randomized controlled trials (RCTs) or repeated measures designs were included. Outcome effects were computed as Hedge’s g and pooled using random-effects meta-analysis (PROSPERO: CRD42017076680). Nine studies, five auditory training, and four cognitive training met the inclusion criteria. Following auditory training, the pooled effect was small and statistically significant for both working memory (g = 0.21; 95% CI [0.05, 0.36]) and overall cognition (g = 0.19; 95% CI [0.07, 0.31]). Following cognitive training, the pooled effect for working memory was small and statistically significant (g = 0.34; 95% CI [0.16, 0.53]), and the pooled effect for overall cognition was large and significant (g = 1.03; 95% CI [0.41, 1.66]). However, this was dependent on the classification of training approach. Sensitivity analyses revealed no statistical difference between the effectiveness of auditory and cognitive training for improving cognition upon removal of a study that used a combined auditory–cognitive approach, which showed a very large effect. Overall certainty in the estimation of effect was “low” for auditory training and “very low” for cognitive training. High-quality RCTs are needed to determine which training stimuli will provide optimal conditions to improve cognition in adults with hearing loss.

Hearing Loss and Depression in Older Adults: A Systematic Review and Meta-analysis

Background and Objectives

Studies reporting an association between hearing loss and depression in older adults are conflicting and warrant a systematic review and meta-analysis of the evidence.

Research Design and Methods

A search of academic databases (e.g., MEDLINE) and gray literature (e.g., OpenGrey) identified relevant articles published up to July 17, 2018. Cross-sectional or cohort designs were included. Outcome effects were computed as odds ratios (ORs) and pooled using random-effects meta-analysis (PROSPERO: CRD42018084494).

Results

A total of 147,148 participants from 35 studies met inclusion criteria. Twenty-four studies were cross-sectional and 11 were cohort designs. Overall, hearing loss was associated with statistically significantly greater odds of depression in older adults (OR = 1.47, 95% confidence interval [CI] = 1.31−1.65). When studies were stratified by design, hearing loss was associated with greater odds of depression in cross-sectional studies (OR = 1.54, 95% CI = 1.31−1.80) and cohort studies (OR = 1.39, 95% CI = 1.16 − 1.67), and there was no difference between cross-sectional or cohort effect estimates (Q = 0.64, p = .42). There was no effect of moderator variables (i.e., hearing aid use) on the association between hearing loss and depression, but these findings must be interpreted with caution. There was no presence of publication bias but certainty in the estimation of the overall effect was classified as “low.”

Discussion and Implications

Older adults may experience increased odds of depression associated with hearing loss, and this association may not be influenced by study or participant characteristics.

Sensorial frailty: age-related hearing loss and the risk of cognitive impairment and dementia in later life

The peripheral hearing alterations and central auditory processing disorder (CAPD) associated with age-related hearing loss (ARHL), may impact cognitive disorders in older age. In older age, ARHL is also a significant marker for frailty, another age-related multidimensional clinical condition with a nonspecific state of vulnerability, reduced multisystem physiological reserve, and decreased resistance to different stressors (i.e. sensorial impairments, psychosocial stress, diseases, injuries). The multidimensional nature of frailty required an approach based on different pathogeneses because this clinical condition may include sensorial, physical, social, nutritional, cognitive, and psychological phenotypes. In the present narrative review, the cumulative epidemiological evidence coming from several longitudinal population-based studies, suggested convincing links between peripheral ARHL and incident cognitive decline and dementia. Moreover, a few longitudinal case-control and population-based studies also suggested that age-related CAPD in ARHL, may be central in determining an increased risk of incident cognitive decline, dementia, and Alzheimer's disease (AD). Cumulative meta-analytic evidence confirmed cross-sectional and longitudinal association of both peripheral ARHL and age-related CAPD with different domains of cognitive functions, mild cognitive impairment, and dementia, while the association with dementia subtypes such as AD and vascular dementia remained unclear. However, ARHL may represent a modifiable condition and a possible target for secondary prevention of cognitive impairment in older age, social isolation, late-life depression, and frailty. Further research is required to determine whether broader hearing rehabilitative interventions including coordinated counseling and environmental accommodations could delay or halt cognitive and global decline in the oldest old with both ARHL and dementia.

Can cochlear implantation improve neurocognition in the aging population?

Introduction

The relationship between cognition and the ability to hear is well known. Due to changes in demographics, the number of people with sensorineural hearing loss and cognitive impairment is increasing. The aim of this study was to identify the impact of hearing rehabilitation via cochlear implantation on cognitive decline among the aging population.

Patients and methods

This prospective study included 60 subjects aged between 50 and 84 years (mean 65.8 years, SD=8.9) with a severe to profound bilateral hearing impairment. A computer-based evaluation of short- and long-term memory, processing speed, attention, working memory and inhibition was performed prior to surgery as well as 6 and 12 months after cochlear implantation. Additionally, speech perception at 65 and 80 dB (Freiburger monosyllabic speech test) as well as disease-related (Nijmegen Cochlear Implant Questionnaire) and general (WHOQOL-OLD) quality of life were assessed.

Results

Six months postimplantation, speech perception, quality of life and also neurocognitive abilities significantly increased. The most remarkable improvement after 6 months was detected in executive functions such as attention (p<0.001), inhibition (p=0.025) and working memory (n-back: p=0.002; operation span task: p=0.008), followed by delayed recall (p=0.03). In contrast, long-term memory showed a significant change of performance only after 12 months (p=0.021). After 6 months, most cognitive domains remained stable, except working memory assessed by the operation span task, which significantly improved between 6 and 12 months (p<0.001). No correlation was found between cognitive results and duration of deafness, speech perception or quality of life.

Conclusion

Cochlear implantation does not only lead to better speech perception and quality of life, but has also been shown to improve cognitive skills in hearing impaired adults aged 50 years or more. These effects seem to be independent of each other.