Rate-of-processing ability in children using cochlear implants and its relevance to speech perception

Assessing Cognitive Abilities in High-Performing Cochlear Implant Users

Despite being considered one of the most successful neural prostheses, cochlear implants (CIs) provide recipients with a wide range of speech perception performance. While some CI users can understand speech in the absence of visual cues, other recipients exhibit more limited speech perception. Cognitive skills have been documented as a contributor to complex auditory processing, such as language understanding; however, there are no normative data for existing standardized clinical tests assessing cognitive abilities in CI users. Here, we assess the impact of modality of presentation (i.e., auditory-visual versus visual) for the administration of working memory tests in high-performing CI users in addition to measuring processing speed, cognitive efficiency and intelligence quotient (IQ). Second, we relate performance on these cognitive measures to clinical CI speech perception outcomes.

Methods: Twenty one post-lingually deafened, high-performing, adult CI users [age range: 52–88 years; 3 unilateral CI, 13 bimodal (i.e., CI with contralateral hearing aid), 5 bilateral CI] with clinical speech perception scores (i.e., AzBio sentences in quiet for the first-ear CI) of ≥60% were recruited. A cognitive test battery assessing auditory-visual working memory (AVWM), visual working memory (VWM), processing speed, cognitive efficiency and IQ was administered, in addition to clinical measures of speech perception in quiet (i.e., AzBio sentences in quiet). AzBio sentences were assessed in two conditions: first-ear CI only, and best-aided everyday wearing condition. Subjects also provided self-reported measures of performance and benefit from their CI using standardized materials, including the Glasgow Benefit Inventory (GBI) and the Nijmegen Cochlear Implant questionnaire (NCIQ).

Results: High-performing CI users demonstrated greater VWM than AVWM recall. VWM was positively related to AzBio scores when measured in the first-ear CI only. AVWM, processing speed, cognitive efficiency, and IQ did not relate to either measure of speech perception (i.e., first-ear CI or best-aided conditions). Subjects’ self-reported benefit as measured by the GBI predicted best-aided CI speech perception performance.

Conclusion: In high-performing CI recipients, visual presentation of working memory tests may improve our assessment of cognitive function.

The impact of cochlear implantation on cognition in older adults: a systematic review of clinical evidence

Background

Hearing loss is the third most prevalent chronic condition faced by older adults and has been linked to difficulties in speech perception, activities of daily living, and social interaction. Recent studies have suggested a correlation between severity of hearing loss and an individual’s cognitive function; however, a causative link has yet to be established. One intervention option for management of the most severe to profound hearing loss in older adults is cochlear implantation. We performed a review to determine the status of the literature on the potential influence of cochlear implantation on cognition in the older adult population.

Methods

Over 3800 articles related to cochlear implants, cognition, and older adults were reviewed. Inclusion criteria were as follows: (1) study population including adults > 65 years, (2) intervention with cochlear implantation, and (3) cognition as the primary outcome measure of implantation.

Results

Out of 3,886 studies selected, 3 met inclusion criteria for the review.

Conclusions

While many publications have shown that cochlear implants improve speech perception, social functioning, and overall quality of life, we found no studies in the English literature that have prospectively evaluated changes in cognitive function after implantation with modern cochlear implants in older adults. The state of the current literature reveals a need for further clinical research on the impact of cochlear implantation on cognition in older adults.

Comparison of memory and meta-memory abilities of children with cochlear implant and normal hearing peers

PURPOSE

This study aimed (1) to compare visual memory and meta-memory abilities, including the use of strategies as context, of children with cochlear implant (CI) and children with normal hearing; (2) to examine the concurrent and construct validity of 'The Contextual Memory Test for Children' (CMT-CH).

METHOD

Twenty children with CI and 20 children with normal hearing, aged 8-10 years, participated in this study. Memory abilities were measured by two subtests of the Children's Memory Scale (CMS) and by CMT-CH, which also measures meta-memory abilities.

RESULTS

Children with CI scored significantly lower in both tests of memory and meta-memory and showed less efficient use of context to memorise. Significant positive correlations were found between CMS and CMT-CH memory tests in both groups.

CONCLUSIONS

Visual memory and meta-memory abilities may be impaired in children with CI. Evaluation and intervention for children with CI should refer to their memory and meta-memory abilities in order to measure the outcomes of CIs, and enhance language development academic achievements. Although more studies on CMT-CH should be performed, the CMT-CH may be used for the evaluation of visual memory of children with CI.