Only Behavioral But Not Self-Report Measures of Speech Perception Correlate with Cognitive Abilities

Relationship between self-reported listening and communication difficulties and executive function: a protocol for a systematic review and meta-analysis

INTRODUCTION

Listening and communication difficulties can limit people's participation in activity and adversely affect their quality of life. Hearing, as well as listening and communication difficulties, can be measured either by using behavioural tests or self-report measures, and the outcomes are not always closely linked. The association between behaviourally measured and self-reported hearing is strong, whereas the association between behavioural and self-reported measures of listening and communication difficulties is much weaker, suggesting they assess different aspects of listening. While behavioural measures of listening and communication difficulties have been associated with poorer cognitive performance including executive functions, the same association has not always been shown for self-report measures. The objective of this systematic review and meta-analysis is to understand the relationship between executive function and self-reported listening and communication difficulties in adults with hearing loss, and where possible, potential covariates of age and pure-tone audiometric thresholds.

METHODS AND ANALYSIS

Studies will be eligible for inclusion if they report data from both a self-report measure of listening difficulties and a behavioural measure of executive function. Eight databases are to be searched: MEDLINE (via Ovid SP), EMBASE (via Ovid SP), PsycINFO (via Ovid SP), ASSIA (via ProQuest), Cumulative Index to Nursing and Allied Health Literature or CINAHL (via EBSCO Host), Scopus, PubMed and Web of Science (Science and Social Science Citation Index). The JBI critical appraisal tool will be used to assess risk of bias for included studies. Results will be synthesised primarily using a meta-analysis, and where sufficient quantitative data are not available, a narrative synthesis will be carried out to describe key results.

ETHICS AND DISSEMINATION

No ethical issues are foreseen. Data will be disseminated via academic publication and conference presentations. Findings may also be published in scientific newsletters and magazines.

PROSPERO REGISTRATION NUMBER

CRD42022293546.

Development of Mandarin Lexical Tone Identification in Noise and Its Relation With Working Memory

PURPOSE

This study aimed to examine the developmental trajectory of Mandarin tone identification in quiet and two noisy conditions: speech-shaped noise (SSN) and multitalker babble noise. In addition, we evaluated the relationship between tonal identification development and working memory capacity.

METHOD

Ninety-three typically developing children aged 5-8 years and 23 young adults completed categorical identification of two tonal continua (Tone 1-4 and Tone 2-3) in quiet, SSN, and babble noise. Their working memory was additionally measured using auditory digit span tests. Correlation analyses between digit span scores and boundary widths were performed.

RESULTS

Six-year-old children have achieved the adultlike ability of categorical identification of Tone 1-4 continuum under both types of noise. Moreover, 6-year-old children could identify Tone 2-3 continuum as well as adults in SSN. Nonetheless, the child participants, even 8-year-olds, performed worse when tokens from Tone 2-3 continuum were masked by babble noise. Greater working memory capacity was associated with better tone identification in noise for preschoolers aged 5-6 years; however, for school-age children aged 7-8 years, such correlation only existed in Tone 2-3 continuum in SSN.

CONCLUSIONS

Lexical tone perception might take a prolonged time to achieve adultlike competence in babble noise relative to SSN. Moreover, a significant interaction between masking type and stimulus difficulty was found, as indicated by Tone 2-3 being more susceptible to interference from babble noise than Tone 1-4. Furthermore, correlations between working memory capacity and tone perception in noise varied with developmental stage, stimulus difficulty, and masking type.

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

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

Objective and Subjective Hearing Difficulties Are Associated With Lower Inhibitory Control

OBJECTIVE

Evidence suggests that hearing loss increases the risk of cognitive impairment. However, the relationship between hearing loss and cognition can vary considerably across studies, which may be partially explained by demographic and health factors that are not systematically accounted for in statistical models.

DESIGN

Middle-aged to older adult participants (N = 149) completed a web-based assessment that included speech-in-noise (SiN) and self-report measures of hearing, as well as auditory and visual cognitive interference (Stroop) tasks. Correlations between hearing and cognitive interference measures were performed with and without controlling for age, sex, education, depression, anxiety, and self-rated health.

RESULTS

The risk of having objective SiN difficulties differed between males and females. All demographic and health variables, except education, influenced the likelihood of reporting hearing difficulties. Small but significant relationships between objective and reported hearing difficulties and the measures of cognitive interference were observed when analyses were controlled for demographic and health factors. Furthermore, when stratifying analyses for males and females, different relationships between hearing and cognitive interference measures were found. Self-reported difficulty with spatial hearing and objective SiN performance were better predictors of inhibitory control in females, whereas self-reported difficulty with speech was a better predictor of inhibitory control in males. This suggests that inhibitory control is associated with different listening abilities in males and females.

CONCLUSIONS

The results highlight the importance of controlling for participant characteristics when assessing the relationship between hearing and cognitive interference, which may also be the case for other cognitive functions, but this requires further investigations. Furthermore, this study is the first to show that the relationship between hearing and cognitive interference can be captured using web-based tasks that are simple to implement and administer at home without any assistance, paving the way for future online screening tests assessing the effects of hearing loss on cognition.

Comparing the Outcomes of a Personalized Versus Nonpersonalized Home-Based Auditory Training Program for Cochlear Implant Users

OBJECTIVES

Audiological rehabilitation includes sensory management, auditory training (AT), and counseling and can alleviate the negative consequences associated with (untreated) hearing impairment. AT aims at improving auditory skills through structured analytical (bottom-up) or synthetic (top-down) listening exercises. The evidence for AT to improve auditory outcomes of postlingually deafened adults with a cochlear implant (CI) remains a point of debate due to the relatively limited number of studies and methodological shortcomings. There is a general agreement that more rigorous scientific study designs are needed to determine the effectiveness, generalization, and consolidation of AT for CI users. The present study aimed to investigate the effectiveness of a personalized AT program compared to a nonpersonalized Active Control program with adult CI users in a stratified randomized controlled clinical trial.

DESIGN

Off-task outcomes were sentence understanding in noise, executive functioning, and health-related quality of life. Participants were tested before and after 16 weeks of training and after a further 8 months without training. Participant expectations of the training program were assessed before the start of training.

RESULTS

The personalized and nonpersonalized AT programs yielded similar results. Significant on-task improvements were observed. Moreover, AT generalized to improved speech understanding in noise for both programs. Half of the CI users reached a clinically relevant improvement in speech understanding in noise of at least 2 dB SNR post-training. These improvements were maintained 8 months after completion of the training. In addition, a significant improvement in quality of life was observed for participants in both treatment groups. Adherence to the training programs was high, and both programs were considered user-friendly.

CONCLUSIONS

Training in both treatments yielded similar results. For half of the CI users, AT transferred to better performance with generalization of learning for speech understanding in noise and quality of life. Our study supports the previous findings that AT can be beneficial for some CI users.

Synchrony in Old Age: Playing the Mirror Game Improves Cognitive Performance

OBJECTIVES

Studies have shown that synchronized motion between people positively affects a range of emotional and social functions. The mirror-game is a synchrony-based paradigm, common to theater, performance arts, and therapy, which includes dyadic synchronized motion, playfulness, and spontaneity. The goal of the current study is to examine the effects of the mirror-game on subjective and cognitive indices in late life.

METHODS

Thirty-four older adults (aged 71-98) participated in a within-group study design. Participants conducted two sessions of 9-minute movement activities: the mirror-game and the control condition - a physical exercise class. Several measures were taken before and after experimental sessions to assess socio-emotional and attentional functions.

RESULTS

The mirror-game enhanced performance on the attention sub-scale and led to faster detections of spoken words in noise. Further, it enhanced perceived partner responsiveness and led to an increase in positive reported experience.

CONCLUSIONS

Our preliminary findings suggest that the mirror-game, rather than the exercise class, may have an immediate impact on mood and some attentional functions.

CLINICAL IMPLICATIONS

The mirror-game is a novel intervention, with potential benefits of social-emotional and cognitive functioning, which can be easily implemented into the daily routine care of older adults. Future studies should explore the effect of the mirror-game on additional cognitive and socio-emotional aspects.

Cogmed Training Does Not Generalize to Real-World Benefits for Adult Hearing Aid Users: Results of a Blinded, Active-Controlled Randomized Trial

Objectives:

Performance on working memory tasks is positively associated with speech-in-noise perception performance, particularly where auditory inputs are degraded. It is suggested that interventions designed to improve working memory capacity may improve domain-general working memory performance for people with hearing loss, to benefit their real-world listening. We examined whether a 5-week training program that primarily targets the storage component of working memory (Cogmed RM, adaptive) could improve cognition, speech-in-noise perception and self-reported hearing in a randomized controlled trial of adult hearing aid users with mild to moderate hearing loss, compared with an active control (Cogmed RM, nonadaptive) group of adults from the same population.

Design:

A preregistered randomized controlled trial of 57 adult hearing aid users (n = 27 experimental, n = 30 active control), recruited from a dedicated database of research volunteers, examined on-task learning and generalized improvements in measures of trained and untrained cognition, untrained speech-in-noise perception and self-reported hearing abilities, pre- to post-training. Participants and the outcome assessor were both blinded to intervention allocation. Retention of training-related improvements was examined at a 6-month follow-up assessment.

Results:

Per-protocol analyses showed improvements in trained tasks (Cogmed Index Improvement) that transferred to improvements in a trained working memory task tested outside of the training software (Backward Digit Span) and a small improvement in self-reported hearing ability (Glasgow Hearing Aid Benefit Profile, Initial Disability subscale). Both of these improvements were maintained 6-month post-training. There was no transfer of learning shown to untrained measures of cognition (working memory or attention), speech-in-noise perception, or self-reported hearing in everyday life. An assessment of individual differences showed that participants with better baseline working memory performance achieved greater learning on the trained tasks. Post-training performance for untrained outcomes was largely predicted by individuals’ pretraining performance on those measures.

Conclusions:

Despite significant on-task learning, generalized improvements of working memory training in this trial were limited to (a) improvements for a trained working memory task tested outside of the training software and (b) a small improvement in self-reported hearing ability for those in the experimental group, compared with active controls. We found no evidence to suggest that training which primarily targets storage aspects of working memory can result in domain-general improvements that benefit everyday communication for adult hearing aid users. These findings are consistent with a significant body of evidence showing that Cogmed training only improves performance for tasks that resemble Cogmed training. Future research should focus on the benefits of interventions that enhance cognition in the context in which it is employed within everyday communication, such as training that targets dynamic aspects of cognitive control important for successful speech-in-noise perception.

Effects of Cognitive Load on Pure-Tone Audiometry Thresholds in Younger and Older Adults

Supplemental Digital Content is available in the text.

Cognitive load (CL) impairs listeners’ ability to comprehend sentences, recognize words, and identify speech sounds. Recent findings suggest that this effect originates in a disruption of low-level perception of acoustic details. Here, we attempted to quantify such a disruption by measuring the effect of CL (a two-back task) on pure-tone audiometry (PTA) thresholds. We also asked whether the effect of CL on PTA was greater in older adults, on account of their reduced ability to divide cognitive resources between simultaneous tasks. To specify the mechanisms and representations underlying the interface between auditory and cognitive processes, we contrasted CL requiring visual encoding with CL requiring auditory encoding. Finally, the link between the cost of performing PTA under CL, working memory, and speech-in-noise (SiN) perception was investigated and compared between younger and older participants.

The Role of Lexical Tone Information in the Recognition of Mandarin Sentences in Listeners With Hearing Aids

OBJECTIVES

Lexical tone information provides redundant cues for the recognition of Mandarin sentences in listeners with normal hearing in quiet conditions. The contribution of lexical tones to Mandarin sentence recognition in listeners with hearing aids (HAs) is unclear. This study aimed to remove lexical tone information and examine the effects on Mandarin sentence intelligibility in HA users. The second objective was to investigate the contribution of cognitive abilities (i.e., general cognitive ability, working memory, and attention) on Mandarin sentence perception when the presentation of lexical tone information was mismatched.

DESIGN

A text-to-speech synthesis engine was used to manipulate Mandarin sentences into three test conditions: (1) a Normal Tone test condition, where no alterations were made to lexical tones within sentences; (2) a Flat Tone test condition, where lexical tones were all changed into tone 1 (i.e., the flat tone); and (3) a Random Tone test condition, where each word in test sentences was randomly assigned one of four Mandarin lexical tones. The manipulated sentence signals were presented to 32 listeners with HAs in both quiet and noisy environments at an 8 dB signal to noise ratio.

RESULTS

Speech intelligibility was reduced significantly (by approximately 40 percentage points) in the presence of mismatched lexical tone information in both quiet and noise. The difficulty in correctly identifying sentences with mismatched lexical tones among adults with hearing loss was significantly greater than that of adults with normal hearing. Cognitive function was not significantly related to a decline in speech recognition scores.

CONCLUSIONS

Contextual and other phonemic cues (i.e., consonants and vowels) are inadequate for HA users to perceive sentences with mismatched lexical tone contours in quiet or noise. Also, HA users with better cognitive function could not compensate for the loss of lexical tone information. These results highlight the importance of accurately representing lexical tone information for Mandarin speakers using HAs.

Contributions of Age-Related and Audibility-Related Deficits to Aided Consonant Identification in Presbycusis: A Causal-Inference Analysis

The decline of speech intelligibility in presbycusis can be regarded as resulting from the combined contribution of two main groups of factors: (1) audibility-related factors and (2) age-related factors. In particular, there is now an abundant scientific literature on the crucial role of suprathreshold auditory abilities and cognitive functions, which have been found to decline with age even in the absence of audiometric hearing loss. However, researchers investigating the direct effect of aging in presbycusis have to deal with the methodological issue that age and peripheral hearing loss covary to a large extent. In the present study, we analyzed a dataset of consonant-identification scores measured in quiet and in noise for a large cohort (n = 459, age = 42-92) of hearing-impaired (HI) and normal-hearing (NH) listeners. HI listeners were provided with a frequency-dependent amplification adjusted to their audiometric profile. Their scores in the two conditions were predicted from their pure-tone average (PTA) and age, as well as from their Extended Speech Intelligibility Index (ESII), a measure of the impact of audibility loss on speech intelligibility. We relied on a causal-inference approach combined with Bayesian modeling to disentangle the direct causal effects of age and audibility on intelligibility from the indirect effect of age on hearing loss. The analysis revealed that the direct effect of PTA on HI intelligibility scores was 5 times higher than the effect of age. This overwhelming effect of PTA was not due to a residual audibility loss despite amplification, as confirmed by a ESII-based model. More plausibly, the marginal role of age could be a consequence of the relatively little cognitively-demanding task used in this study. Furthermore, the amount of variance in intelligibility scores was smaller for NH than HI listeners, even after accounting for age and audibility, reflecting the presence of additional suprathreshold deficits in the latter group. Although the non-sense-syllable materials and the particular amplification settings used in this study potentially restrict the generalization of the findings, we think that these promising results call for a wider use of causal-inference analysis in audiology, e.g., as a way to disentangle the influence of the various cognitive factors and suprathreshold deficits associated to presbycusis.

Serial Recall Predicts Vocoded Sentence Recognition Across Spectral Resolutions

Purpose The goal of this study was to determine how various aspects of cognition predict speech recognition ability across different levels of speech vocoding within a single group of listeners. Method We tested the ability of young adults (N = 32) with normal hearing to recognize Perceptually Robust English Sentence Test Open-set (PRESTO) sentences that were degraded with a vocoder to produce different levels of spectral resolution (16, eight, and four carrier channels). Participants also completed tests of cognition (fluid intelligence, short-term memory, and attention), which were used as predictors of sentence recognition. Sentence recognition was compared across vocoder conditions, predictors were correlated with individual differences in sentence recognition, and the relationships between predictors were characterized. Results PRESTO sentence recognition performance declined with a decreasing number of vocoder channels, with no evident floor or ceiling performance in any condition. Individual ability to recognize PRESTO sentences was consistent relative to the group across vocoder conditions. Short-term memory, as measured with serial recall, was a moderate predictor of sentence recognition (ρ = 0.65). Serial recall performance was constant across vocoder conditions when measured with a digit span task. Fluid intelligence was marginally correlated with serial recall, but not sentence recognition. Attentional measures had no discernible relationship to sentence recognition and a marginal relationship with serial recall. Conclusions Verbal serial recall is a substantial predictor of vocoded sentence recognition, and this predictive relationship is independent of spectral resolution. In populations that show variable speech recognition outcomes, such as listeners with cochlear implants, it should be possible to account for the independent effects of spectral resolution and verbal serial recall in their speech recognition ability. Supplemental Material https://doi.org/10.23641/asha.12021051.

Listening effort and working memory capacity in hearing impaired individuals: an integrative literature review

ABSTRACT Purpose: to review the literature on the behavioral methods of listening effort assessment and the working memory capacity recommended for the hearing impaired. Methods: this review was developed through the search of articles in national and international journals, in English and Portuguese, available in Pubmed/Medline, Cochrane Library, Biblioteca Vitual em Saúde - Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online, between 2007 and 2017. The articles were selected based on the inclusion criteria: articles that used behavioral methods to assess listening effort in hearing-impaired adults, involving the measurement of working memory and its relationship with the listening effort, published in the last 10 years. Results: Twelve articles in which behavioral measures were used to measure listening effort and working memory capacity in the hearing-impaired individuals were reviewed. Their main findings refer to the purpose(s) of the research, participants, behavioral method composed of a primary task (speech perception) and a secondary task (memorization) and results of the studies. Conclusion:the findings of this review allow us to infer that this paradigm is sensitive to measure the listening effort, considering the different instruments used and the population assessed.

Hearing in Real-Life Environments (HERE): Structure and Reliability of a Questionnaire on Perceived Hearing for Older Adults

Supplemental Digital Content is available in the text.

Objectives:

The ability to hear in a variety of social situations and environments is vital for social participation and a high quality of life. One way to assess hearing ability is by means of self-report questionnaire. For questionnaires to be useful, their measurement properties, based on careful validation, have to be known. Only recently has consensus been reached concerning how to perform such validation and been published as COSMIN (consensus-based standards for the selection of health status measurement instruments) guidelines. Here the authors use these guidelines to evaluate the measurement properties of the “Hearing in Real-Life Environments” (HERE) questionnaire, a newly developed self-report measure that assesses speech perception, spatial orientation, and the social-emotional consequences of hearing impairment in older adults. The aim is to illustrate the process of validation and encourage similar examinations of other frequently used questionnaires.

Design:

The HERE questionnaire includes 15 items with a numeric rating scale from 0 to 10 for each item and allows the assessment of hearing with and without hearing aids. The evaluation was performed in two cohorts of community-dwelling older adults from Finland (n = 581, mean 82 years) and the United Kingdom (n = 50, mean 69 years). The internal structure of the questionnaire and its relationship to age, hearing level, and self-reported and behavioral measures of speech perception was assessed and, when possible, compared between cohorts.

Results:

The results of the factor analysis showed that the HERE’s internal structure was similar across cohorts. In both cohorts, the factor analysis showed a satisfactory solution for three factors (speech hearing, spatial hearing, and socio-emotional consequences), with a high internal consistency for each factor (Cronbach’s α’s for the factors from 0.90 to 0.97). Test–retest analysis showed the HERE overall mean score to be stable and highly replicable over time (intraclass correlation coefficient = 0.86, standard error of measurement of the test score = 0.92). The HERE overall mean score correlated highly with another self-report measure of speech perception, the Speech Spatial Qualities of Hearing questionnaire (standardized regression coefficient [β] = −0.75, p < 0.001), moderately highly with behaviorally assessed hearing level (best-ear average: β = 0.45 to 0.46), and moderately highly with behaviorally measured intelligibility of sentences in noise (β = −0.50, p < 0.001).

Conclusions:

Using the COSMIN guidelines, the authors show that the HERE is a valid, reliable, and stable questionnaire for the assessment of self-reported speech perception, sound localization, and the socio-emotional consequences of hearing impairment in the context of social functioning. The authors also show that cross-cultural data collected using different data collection strategies can be combined with a range of statistical methods to validate a questionnaire.

Exploring the Link Between Cognitive Abilities and Speech Recognition in the Elderly Under Different Listening Conditions

Elderly listeners are known to differ considerably in their ability to understand speech in noise. Several studies have addressed the underlying factors that contribute to these differences. These factors include audibility, and age-related changes in supra-threshold auditory processing abilities, and it has been suggested that differences in cognitive abilities may also be important. The objective of this study was to investigate associations between performance in cognitive tasks and speech recognition under different listening conditions in older adults with either age appropriate hearing or hearing-impairment. To that end, speech recognition threshold (SRT) measurements were performed under several masking conditions that varied along the perceptual dimensions of dip listening, spatial separation, and informational masking. In addition, a neuropsychological test battery was administered, which included measures of verbal working and short-term memory, executive functioning, selective and divided attention, and lexical and semantic abilities. Age-matched groups of older adults with either age-appropriate hearing (ENH, n = 20) or aided hearing impairment (EHI, n = 21) participated. In repeated linear regression analyses, composite scores of cognitive test outcomes (evaluated using PCA) were included to predict SRTs. These associations were different for the two groups. When hearing thresholds were controlled for, composed cognitive factors were significantly associated with the SRTs for the ENH listeners. Whereas better lexical and semantic abilities were associated with lower (better) SRTs in this group, there was a negative association between attentional abilities and speech recognition in the presence of spatially separated speech-like maskers. For the EHI group, the pure-tone thresholds (averaged across 0.5, 1, 2, and 4 kHz) were significantly associated with the SRTs, despite the fact that all signals were amplified and therefore in principle audible.

Reading Behind the Lines: The Factors Affecting the Text Reception Threshold in Hearing Aid Users

PURPOSE

The visual Text Reception Threshold (TRT) test (Zekveld et al., 2007) has been designed to assess modality-general factors relevant for speech perception in noise. In the last decade, the test has been adopted in audiology labs worldwide. The 1st aim of this study was to examine which factors best predict interindividual differences in the TRT. Second, we aimed to assess the relationships between the TRT and the speech reception thresholds (SRTs) estimated in various conditions.

METHOD

First, we reviewed studies reporting relationships between the TRT and the auditory and/or cognitive factors and formulated specific hypotheses regarding the TRT predictors. These hypotheses were tested using a prediction model applied to a rich data set of 180 hearing aid users. In separate association models, we tested the relationships between the TRT and the various SRTs and subjective hearing difficulties, while taking into account potential confounding variables.

RESULTS

The results of the prediction model indicate that the TRT is predicted by the ability to fill in missing words in incomplete sentences, by lexical access speed, and by working memory capacity. Furthermore, in line with previous studies, a moderate association between higher age, poorer pure-tone hearing acuity, and poorer TRTs was observed. Better TRTs were associated with better SRTs for the correct perception of 50% of Hagerman matrix sentences in a 4-talker babble, as well as with better subjective ratings of speech perception. Age and pure-tone hearing thresholds significantly confounded these associations. The associations of the TRT with SRTs estimated in other conditions and with subjective qualities of hearing were not statistically significant when adjusting for age and pure-tone average.

CONCLUSIONS

We conclude that the abilities tapped into by the TRT test include processes relevant for speeded lexical decision making when completing partly masked sentences and that these processes require working memory capacity. Furthermore, the TRT is associated with the SRT of hearing aid users as estimated in a challenging condition that includes informational masking and with experienced difficulties with speech perception in daily-life conditions. The current results underline the value of using the TRT test in studies involving speech perception and aid in the interpretation of findings acquired using the test.

Clear speech and lexical competition in younger and older adult listeners

This study investigated whether clear speech reduces the cognitive demands of lexical competition by crossing speaking style with lexical difficulty. Younger and older adults identified more words in clear versus conversational speech and more easy words than hard words. An initial analysis suggested that the effect of lexical difficulty was reduced in clear speech, but more detailed analyses within each age group showed this interaction was significant only for older adults. The results also showed that both groups improved over the course of the task and that clear speech was particularly helpful for individuals with poorer hearing: for younger adults, clear speech eliminated hearing-related differences that affected performance on conversational speech. For older adults, clear speech was generally more helpful to listeners with poorer hearing. These results suggest that clear speech affords perceptual benefits to all listeners and, for older adults, mitigates the cognitive challenge associated with identifying words with many phonological neighbors.

Auditory and Non-Auditory Contributions for Unaided Speech Recognition in Noise as a Function of Hearing Aid Use

Differences in understanding speech in noise among hearing-impaired individuals cannot be explained entirely by hearing thresholds alone, suggesting the contribution of other factors beyond standard auditory ones as derived from the audiogram. This paper reports two analyses addressing individual differences in the explanation of unaided speech-in-noise performance among n = 438 elderly hearing-impaired listeners (mean = 71.1 ± 5.8 years). The main analysis was designed to identify clinically relevant auditory and non-auditory measures for speech-in-noise prediction using auditory (audiogram, categorical loudness scaling) and cognitive tests (verbal-intelligence test, screening test of dementia), as well as questionnaires assessing various self-reported measures (health status, socio-economic status, and subjective hearing problems). Using stepwise linear regression analysis, 62% of the variance in unaided speech-in-noise performance was explained, with measures Pure-tone average (PTA), Age, and Verbal intelligence emerging as the three most important predictors. In the complementary analysis, those individuals with the same hearing loss profile were separated into hearing aid users (HAU) and non-users (NU), and were then compared regarding potential differences in the test measures and in explaining unaided speech-in-noise recognition. The groupwise comparisons revealed significant differences in auditory measures and self-reported subjective hearing problems, while no differences in the cognitive domain were found. Furthermore, groupwise regression analyses revealed that Verbal intelligence had a predictive value in both groups, whereas Age and PTA only emerged significant in the group of hearing aid NU.

The Association Between Cognitive Performance and Speech-in-Noise Perception for Adult Listeners: A Systematic Literature Review and Meta-Analysis

Published studies assessing the association between cognitive performance and speech-in-noise (SiN) perception examine different aspects of each, test different listeners, and often report quite variable associations. By examining the published evidence base using a systematic approach, we aim to identify robust patterns across studies and highlight any remaining gaps in knowledge. We limit our assessment to adult unaided listeners with audiometric profiles ranging from normal hearing to moderate hearing loss. A total of 253 articles were independently assessed by two researchers, with 25 meeting the criteria for inclusion. Included articles assessed cognitive measures of attention, memory, executive function, IQ, and processing speed. SiN measures varied by target (phonemes or syllables, words, and sentences) and masker type (unmodulated noise, modulated noise, >2-talker babble, and ≤2-talker babble. The overall association between cognitive performance and SiN perception was r = .31. For component cognitive domains, the association with (pooled) SiN perception was as follows: processing speed ( r = .39), inhibitory control ( r = .34), working memory ( r = .28), episodic memory ( r = .26), and crystallized IQ ( r = .18). Similar associations were shown for the different speech target and masker types. This review suggests a general association of r≈.3 between cognitive performance and speech perception, although some variability in association appeared to exist depending on cognitive domain and SiN target or masker assessed. Where assessed, degree of unaided hearing loss did not play a major moderating role. We identify a number of cognitive performance and SiN perception combinations that have not been tested and whose future investigation would enable further fine-grained analyses of these relationships.