Contribution of Tinnitus and Hearing Loss to Depression: NHANES Population Study

OBJECTIVES

Hearing loss affects the emotional well-being of adults and is sometimes associated with clinical depression. Chronic tinnitus is highly comorbid with hearing loss and separately linked with depression. In this article, the authors investigated the combined effects of hearing loss and tinnitus on depression in the presence of other moderating influences such as demographic, lifestyle, and health factors.

DESIGN

The authors used the National Health and Nutrition Examination Survey data (2011-2012 and 2015-2016) to determine the effects of hearing loss and tinnitus on depression in a population of US adults (20 to 69 years). The dataset included the Patient Health Questionnaire-9 for depression screening, hearing testing using pure-tone audiometry, and information related to multiple demographic, lifestyle, and health factors (n = 5845).

RESULTS

The statistical analysis showed moderate to high associations between depression and hearing loss, tinnitus, and demographic, lifestyle, and health factors, separately. Results of logistic regression analysis revealed that depression was significantly influenced by hearing loss (adjusted odds ratios [OR] = 3.0), the functional impact of tinnitus (adjusted OR = 2.4), and their interaction, both in the absence or presence of the moderating influences. The effect of bothersome tinnitus on depression was amplified in the presence of hearing loss (adjusted OR = 2.4 in the absence of hearing loss to adjusted OR = 14.9 in the presence of hearing loss). Conversely, the effect of hearing loss on depression decreased when bothersome tinnitus was present (adjusted OR = 3.0 when no tinnitus problem was present to adjusted OR = 0.7 in the presence of bothersome tinnitus).

CONCLUSIONS

Together, hearing loss and bothersome tinnitus had a significant effect on self-reported depression symptoms, but their relative effect when comorbid differed. Tinnitus remained more salient than hearing loss and the latter's contribution to depression was reduced in the presence of tinnitus, but the presence of hearing loss significantly increased the effects of tinnitus on depression, even when the effects of the relevant demographic, lifestyle, or health factors were controlled. Treatment strategies that target depression should screen for hearing loss and bothersome tinnitus and provide management options for the conditions.

Where are caregivers in the clinical trial? Evaluation of caregiver responsibilities in Alzheimer's disease and related dementias clinical trials

INTRODUCTION

Family caregivers of persons with Alzheimer's disease and related dementias (ADRD) have significant responsibilities within health care. They may identify relevant clinical trials and support decision-making about their relative's participation. The objectives of this study were to (a) evaluate the responsibilities of caregivers related to their relative's participation in ADRD clinical trials and (b) examine how these responsibilities are communicated on clinicaltrials.gov.

METHODS

We reviewed ADRD clinical trials completed between 1990 and 2021 using clinicaltrials.gov.

RESULTS

Less than half of clinical trial study information pages included caregiver responsibilities. Nine caregiver responsibilities were provided among those with information (e.g., giving consent, caregiver training and education, monitoring patient's response to intervention, communicating with study team).

DISCUSSION

ADRD clinical trial study information pages should consistently include caregiver responsibilities to help caregivers better prepare for trial responsibilities. This enhanced engagement with caregivers could also facilitate recruitment and retention, including participants from diverse communities.

HIGHLIGHTS

Alzheimer's disease and related dementias (ADRD) clinical trial study information does not consistently include caregiver responsibilities. Caregiver responsibilities in clinical trials span communication, monitoring, and transportation. Robust information provision to caregivers could support participant recruitment and retention. Meaningfully engaging caregivers could support recruitment of diverse participants.

EXPLORING THE POTENTIAL OF VOICE INTERFACES FOR EMERGING TECHNOLOGIES: OPPORTUNITIES AND CHALLENGES

Successful human-technology interactions require that people be able to communicate their intentions to the technology. Emergent technologies such as virtual assistants, digital home assistant, smart phones, robots, and smart appliances are enabling voice activation and communication. This is potentially a positive trend as people often express a preference for using familiar methods of communicating with other people in their interactions with technologies. Presumably they expect these methods to be easier to learn and more effective. However, current voice technology interfaces are often dependent on specific language, cadence, and terminology that pose challenges for older adults to master. Moreover, age-related changes in voice characteristics, speech patterns, and the variability between individuals may lead to comprehension failures on the part of the technology. We have utilized research findings to develop implementation guidelines for use of voice interfaces with older adults. We also identify research gaps to provide a roadmap for future efforts.

AGE-RELATED CHANGES IN CUED TASK SWITCHING

The task switching paradigm is widely used to examine cognitive switching, a critical subcomponent of cognitive control. Studies on aging suggest that switching is particularly vulnerable to age-related changes in cognition. However, the effects of manipulating the stimulus dimension on task switching performance is relatively understudied. In this study, 13 younger adults (YA; 11F; Mean Age= 22.31) and 13 older adults (OA; 8F; Mean Age= 65.85) completed a novel cued task-switching paradigm requiring speeded same-different judgments based on a perceptual (color) or conceptual (animal) dimension of the stimuli. Task switching performance was measured using switch cost, which is the difference in accuracy between switch and repeat trials. Overall both YA and OA exhibited switch costs, indicating increased cognitive demand when switching between judgments compared to repetition of the same judgement. In regard to group differences, YA and OA performed similarly when performance was collapsed across the stimulus dimensions; however, when examined separately, OA exhibited worse performance than YA when making conceptual judgements. These results highlight the importance of examining carefully manipulated stimulus-related factors in task switching paradigms to advance our understanding of cognitive control and aging.

LEVERAGING VIDEO CONFERENCING TECHNOLOGY TO FACILITATE SOCIAL ENGAGEMENT IN OLDER ADULTS

Social engagement is critical for maintaining well-being and quality of life in older adults. However, typical age-related changes across bio-psychosocial dimensions as well as age-related conditions such as mild cognitive impairment (MCI), pose many challenges for older adults to remain socially connected. The development of technologies, specifically video conferencing, can be leveraged as a tool to facilitate the delivery of social engagement opportunities, both enhancing access and minimizing social isolation. For successful adoption of these tools, the needs and preferences of older adult users must be considered. We employed an iterative research process for designing and developing a social-engagement intervention using a platform called OneClick.chat. We provide community-dwelling older adults with opportunities to engage in casual conversations and reminisce with others on topics of shared interests (e.g., nature, food, hobbies). Our iterative design process involved an interdisciplinary team of engineers, human factors specialists, gerontologists, and neuropsychologists. We also evaluated the system with eight participants (aged 50-64) who provided their insights pertaining to the content, delivery, perceived ease of use, usefulness, and potential adoption of this video-conferencing platform. Based on the feedback received, we have optimized the intervention in preparation for a randomized controlled trial. Furthermore, we provide key insights related to the implementation of social engagement through video technologies with the aim of facilitating social connectivity. Our learnings can be used to guide future work involving video-technology-based interventions to facilitate social connectivity for older adults with varying cognitive abilities.

UNDERSTANDING CHALLENGES OF PERSONS WITH COGNITIVE IMPAIRMENTS THROUGH THEIR LIVED EXPERIENCES

Older adults aging with cognitive impairments face a variety of challenges related to their memory, thinking, and concentration in their everyday activities. Understanding their lived experiences s critical to inform the development of technology and supports that can help everyday activities and improve quality of life. We have designed an in-depth interview study to explore the everyday challenges of older adults with cognitive impairments and their response strategies. We will present two case studies to illustrate the richness of the data and its value for guiding intervention design: (1) one older adult with a post-stroke cognitive impairment (PSCI) and (2) one older adult with mild cognitive impairment (MCI). As expected, these individuals reported challenges in different functional activities and described varying solution strategies. The older adult with PSCI noted challenges with completing steps and remembering things when engaging with technology-mediated social activities. This individual reported responding to these challenges by having their own method, such as writing things down or receiving assistance from others. Challenges the older adult with MCI experienced when engaging with technology-mediated social activities, long-distance travel, and caregiving were planning, completing steps, remembering things, and experiencing emotions. This individual responded to their challenges by developing visualizations, methods, routine, and receiving assistance from others. These initial insights about the range of challenges with everyday activities and response strategies highlight the value of qualitative needs assessments in understanding the needs of those aging with cognitive impairment to guide future technology and support.

Inhibitory Control in Age-Related Hearing Loss

Inhibitory control involves suppression of goal irrelevant information and responses. Emerging evidence suggests alterations in inhibitory control in individuals with age-related hearing loss (ARHL), however, few have specifically studied individuals with mild ARHL. We examined behavioral and event related potential (ERP) differences between 14 older adults with mild ARHL (mean age: 69.43 ± 7.73 years) and 14 age- and education-matched normal hearing (NH, mean age: 66.57 ± 5.70 years) controls on two Go/NoGo tasks: a simpler, basic categorization task (Single Car; SC) and a more difficult, superordinate categorization task (Object Animal; OA). The SC task consisted of exemplars of a single car and dog, and the OA task consisted of exemplars of multiple objects and animals. Participants were required to respond to Go trials (e.g., cars in SC) with a button press, and withhold responses on NoGo trials (e.g., dogs in SC task). Behavioral results revealed that ARHL group had worse accuracy on NoGo trials on the OA task, but not on the SC task. ARHL group had longer N2 latency for NoGo compared to Go trials in the simpler SC Task, but no differences were observed on the OA task between Go and NoGo trials. These findings suggest that more prolonged neural effort in the ARHL group on the SC task NoGo trials may have contributed to their ability to successfully suppress false alarms comparable to the NH group. Overall, these findings provide evidence for behavioral and neural changes in inhibitory control in ARHL.

Everyday Needs Assessment for Cognitive Tasks: Challenges for Persons With Cognitive Impairment

ENACT (Everyday Needs Assessment for Cognitive Tasks) is an exploration and discovery project to gather information on challenges in daily and community living experienced by individuals aging with compromised cognition due to mild cognitive impairment, traumatic brain injury, or post-stroke. We are exploring their challenges through a longitudinal needs assessment study involving interviews with older adults with cognitive impairment and their care partners. We will describe the study development process wherein we interviewed subject matter experts, including persons with professional (neurology, rehabilitation, gerontology) or personal experience with individuals who have cognitive impairment. Based on their collective insights, we selected the following categories of activities for the ENACT in-depth interviews: health, social engagement, transportation, domestic life, and leisure/recreation. The ENACT longitudinal data will provide insights to guide development of adaptive, context-sensitive technology-based supports for the AUGMENT, DREAM, and STRUMM projects described in this symposium, as well as other initiatives.

Content Development for a Virtual Social Engagement Intervention

Video technology has the potential to provide older adults with socially and cognitively engaging activities for in-home participation. We are exploring use of OneClick.chat, a video technology platform, to present older adults with and without mild cognitive impairment opportunities for engagement. In collaboration with iN2L we have developed events that will facilitate conversations that do not rely on episodic memory, cover a range of topics, and represent different cultures and interests. We selected event topics that were positive, socially and cognitively engaging, and included a range of pictures based on our previous research. Events were carefully controlled for length of presentation, picture type, and readability. Discussion questions related to the events were designed to stimulate engaging conversations through open-ended questions and to not burden memory recall or enforce stereotypes. Our work highlights potential future avenues for researchers and home and community-based organizations to use technology to promote social engagement.

Early Versus Late Mild Cognitive Impairment: Neural Event-Related Oscillations During a Go/No Go Task

Amnestic mild cognitive impairment (aMCI) is marked by episodic memory deficits, which is used to classify individuals into early MCI (EMCI) and late MCI (LMCI). Growing evidence suggests that individuals with EMCI and LMCI differ in other cognitive functions including cognitive control, but these are less frequently studied. Using a semantic Go/NoGo task, we examined differences in cognitive control between EMCI and LMCI on behavioral (accuracy and reaction time) and neural (scalp-recorded event-related oscillations in theta and alpha band) measures. Although no behavioral differences were observed between the groups, EMCI and LMCI groups differed in patterns of neural oscillations for Go compared to NoGo trials. The EMCI group showed differences in theta power at central electrodes and alpha power at central and centro-parietal electrodes between Go and NoGo trials, while the LMCI group did not exhibit such differences. Furthermore, the LMCI group had higher theta synchronization on Go trials at central electrodes compared to the EMCI group. These findings suggest that while behavioral differences may not be observable, neural changes underlying cognitive control processes may differentiate EMCI and LMCI stages and may be useful to understand the trajectory of aMCI.

Perceptual Versus Conceptual Value-Directed Strategic Processing in Younger and Older Adults

Certain consonant sounds called fricatives (e.g, “s” and “f”) are difficult to hear over the telephone; phones exclude high-frequency sounds that affect their intelligibility. This may be problematic for older adults responding to phone-based memory tests. Many older adults have some degree of hearing loss, and older men have it more in the high-frequency range. Hearing loss, in combination with phone bandwidth restrictions, may reduce older adults’ recall of fricative words. Participants (n=3,612, mean age=64.2, 60% women) in the 1998 wave of the Health and Retirement study (HRS) completed a word list immediate recall task over the phone. List 4 recall was examined because it was evenly split (5 each) between words with and without fricative consonant sounds. Subjective ratings of hearing and health, age, depression, and education were also measured. A Wilcoxon signed-rank test showed participants recalled fewer fricative (M=2.8) than nonfricative (M=3.0) words, Z=-8.47, p<.001. An ordinal regression for fricative word recall indicated a sex by hearing interaction; males with worse hearing were less likely to recall more fricative words, OR=.94, 95% CI [.88, 1.01], p=.076, after controlling for age, education, health, and depression. An ordinal regression for nonfricative word recall did not show a main effect for hearing or a hearing by sex interaction. For both models, age, education, and health were related to recall. Consonant sounds may influence phone-based word recall, particularly for older men. Attention should be paid to word selection when designing phone-based cognitive tests in order to avoid memory impairment overestimation.

EEG Measures of Value-Directed Strategic Processing in Older Adults With and Without Mild Cognitive Impairment

Value-directed strategic processing is important for daily functioning. It allows selective processing of important information and inhibition of irrelevant information. This ability is relatively preserved in normal cognitive aging, but it is unclear if mild cognitive impairment (MCI) affects strategic processing and its underlying neurophysiological mechanisms. The current study examined behavioral and EEG spectral power differences between 16 cognitively normal older adults (CNOA; mean age: 74.5 ± 4.0 years) and 16 individuals with MCI (mean age: 77.1 ± 4.3 years) linked to a value-directed strategic processing task. The task used five unique word lists where words were assigned high- or low-value based on letter case and were presented sequentially while EEG was recorded. Participants were instructed to recall as many words as possible after each list to maximize their score. Results revealed no group differences in recall of low-value words, but individuals with MCI recalled significantly fewer high-value words and total number of words relative to CNOA. Group differences were observed in theta and alpha bands for low-value words, with greater synchronized theta power for CNOA than MCI and greater desynchronized alpha power for MCI than CNOA. Collectively, these findings demonstrate that more effortful neural processing of low-value words in the MCI group, relative to the CNOA group, allowed them to match their behavioral performance to the CNOA group. Individuals with MCI appear to utilize more cognitive resources to inhibit low-value information and might show memory-related benefits if taught strategies to focus on high-value information processing.

SOCIAL ENGAGEMENT THROUGH VIDEO CHAT FOR OLDER INDIVIDUALS WITH AND WITHOUT COGNITIVE IMPAIRMENT

Social engagement is a fundamental component of health and quality-of-life outcomes. However, there is a prevailing view that older adults primarily want to engage socially with current family and friends – that they are not interested in developing new relationships. That is an overgeneralization. We have found that older adults are interested in the opportunity to engage in social interactions with people who have shared interests. Technology can facilitate these interactions. We will describe our research with OneClick.chat, a web-based video chat system. We explored potential benefits of use by adults aged 70-85, including those with mild cognitive impairment (MCI), as well as barriers and facilitators to adoption. Participants saw value of this online social engagement platform and were able to use it with some initial training. They envisioned using OneClick not only for conversations but also for learning and doing activities with like-minded individuals.

Cognitive Training and Transcranial Direct Current Stimulation in Mild Cognitive Impairment: A Randomized Pilot Trial

Background

Transcranial direct current stimulation (tDCS), a non-invasive stimulation, represents a potential intervention to enhance cognition across clinical populations including Alzheimer’s disease and mild cognitive impairment (MCI). This randomized clinical trial in MCI investigated the effects of anodal tDCS (a-tDCS) delivered to left inferior frontal gyrus (IFG) combined with gist-reasoning training (SMART) versus sham tDCS (s-tDCS) plus SMART on measures of cognitive and neural changes in resting cerebral blood flow (rCBF). We were also interested in SMART effects on cognitive performance regardless of the tDCS group.

Methods

Twenty-two MCI participants, who completed the baseline cognitive assessment (T1), were randomized into one of two groups: a-tDCS + SMART and s-tDCS + SMART. Of which, 20 participants completed resting pCASL MRI scan to measure rCBF. Eight SMART sessions were administered over 4 weeks with a-tDCS or s-tDCS stimulation for 20 min before each session. Participants were assessed immediately (T2) and 3-months after training (T3).

Results

Significant group × time interactions showed cognitive gains at T2 in executive function (EF) measure of inhibition [DKEFS- Color word (p = 0.047)], innovation [TOSL (p = 0.01)] and on episodic memory [TOSL (p = 0.048)] in s-tDCS + SMART but not in a-tDCS + SMART group. Nonetheless, the gains did not persist for 3 months (T3) after the training. A voxel-based analysis showed significant increase in regional rCBF in the right middle frontal cortex (MFC) (cluster-wise p = 0.05, k = 1,168 mm³) in a-tDCS + SMART compared to s-tDCS + SMART. No significant relationship was observed between the increased CBF with cognition. Irrespective of group, the combined MCI showed gains at T2 in EF of conceptual reasoning [DKEFS card sort (p = 0.033)] and category fluency [COWAT (p = 0.055)], along with gains at T3 in EF of verbal fluency [COWAT (p = 0.009)].

Conclusion

One intriguing finding is a-tDCS to left IFG plus SMART increased blood flow to right MFC, however, the stimulation seemingly blocked cognitive benefits of SMART on EF (inhibition and innovation) and episodic memory compared to s-tDCS + SMART group. Although the sample size is small, this paper contributes to growing evidence that cognitive training provides a way to significantly enhance cognitive performance in adults showing memory loss, where the role of a-tDCS in augmenting these effects need further study.