The impact of sensory impairments and eye diseases on cognitive function in elderly Chinese: The mediating effects of social participation

Background

Sensory impairments and eye diseases increase the risk of cognitive decline, but little is known regarding their influence on cognitive function in elderly Chinese and the underlying mechanisms. We aimed to explore these influence mechanism from the social participation perspective.

Methods

We selected 2876 respondents aged ≥60 from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2013, 2015, and 2018. We assessed sensory impairments and eye diseases based on self-reported responses, and evaluated its relation to social participation and cognitive function by fixed-effects regression and mediation effect analysis over a five-year period.

Results

Respondents with visual impairment and cataracts had poor memory and mental status. Compared with near visual impairment, distance visual impairment was associated with a 1.7 times higher likelihood of cognitive decline (correlation coefficient (β) = -0.051; 95% confidence interval (CI) = -0.065, -0.036)). Respondents with hearing impairment had bad memory (β = -0.046; 95% CI = -0.065, -0.036), but not mental status. Social participation partially mediated the relationships of sensory impairments and cataracts with cognitive function in elderly Chinese. Individuals with sensory impairments affected by limited social participation reported a faster cognitive decline compared to those with eye disease.

Conclusions

We found that sensory impairments and eye diseases were negatively associated with cognitive function. Furthermore, sensory impairments and cataracts influence cognitive function partly via social participation. Our results have important theoretical and practical implications and suggests that early interventions for sensory impairments and eye diseases may improve the cognitive function of elderly people.

Health-Related Quality of Life in Turner Syndrome and the Influence of Growth Hormone Therapy: A 20-Year Follow-Up

CONTEXT

The factors that affect the health-related quality of life (HRQoL) of women with Turner syndrome (TS) are controversial.

OBJECTIVE

The aim was to describe the HRQoL of women with TS with a focus on how given GH treatment and comorbidity influence HRQoL in adulthood and to compare HRQoL of women with TS with that of women in the general population.

DESIGN

Longitudinal cohort study, up to 20 years.

SETTING

The Turner Center at the Section for Endocrinology and Department of Reproductive Medicine at Sahlgrenska University Hospital, Gothenburg, Sweden.

PARTICIPANTS

Women with TS (n = 200), age range 16 to 78 years, were included consecutively and monitored every fifth year between 1995 and 2018. Women from the World Health Organization MONItoring of trends and determinants for CArdiovascular disease project were used as reference populations.

INTERVENTIONS AND MAIN OUTCOME MEASURES

HRQoL was measured using the Psychological General Well-Being index and the Nottingham Health Profile. Associations with somatic variables were assessed using longitudinal linear regression models.

RESULTS

HRQoL was not associated with GH treatment in TS in spite of a mean 5.7 cm taller height. HRQoL was only associated with height per se in one of 13 subscales (P < 0.01). HRQoL was negatively affected by higher age, higher age at diagnosis, and hearing impairment in TS. Women with TS reported a similar HRQoL to the reference population.

CONCLUSIONS

No association between previous GH treatment and HRQoL was found during the up to 20 years of follow-up in women with TS. HRQoL of women with TS and the reference population was similar.

[An epidemiological investigation of chronic kidney disease in children with hearing disorder in Hunan province, China]

OBJECTIVE

To investigate the prevalence of chronic kidney disease (CKD) among the children with hearing disorder in Hunan province, China.

METHODS

In this cross-sectional study, the multi-stage cluster sampling method was used to select 1 500 children as subjects. Questionnaire surveys, physical examinations, and laboratory examinations were performed on the spot.

RESULTS

Among the 1 500 children, 1 459 with complete data were included in analysis. Among the 1 459 children, 43 had CKD, with a prevalence rate of 2.95%. The <7 years group had a significantly higher prevalence rate than the 7-14 years group [5.8% (35/604) vs 0.9% (8/855); P<0.05]. Among the 43 children with CKD, 31 (72%) had proteinuria, 27 (63%) had hematuria, and 11 (26%) had a decreased glomerular filtration rate. Among the 43 children with CKD, stage 1, 2, 3a, 3b, 4, and 5 CKD accounted for 30% (13 cases), 44% (19 cases), 12% (5 cases), 7% (3 cases), 7% (3 cases), and 0% (0 case) respectively. The prevalence rate of CKD increased with the severity of hearing disorder (P<0.01).

CONCLUSIONS

The prevalence rate of CKD is higher among the children with hearing disorder in Hunan province. Most children have early-stage CKD. CKD is commonly seen in preschool children. Severity of hearing disorder is associated with the prevalence of CKD.

[An epidemiological investigation of chronic kidney disease in children with hearing disorder in Hunan province, China]

OBJECTIVE

To investigate the prevalence of chronic kidney disease (CKD) among the children with hearing disorder in Hunan province, China.

METHODS

In this cross-sectional study, the multi-stage cluster sampling method was used to select 1 500 children as subjects. Questionnaire surveys, physical examinations, and laboratory examinations were performed on the spot.

RESULTS

Among the 1 500 children, 1 459 with complete data were included in analysis. Among the 1 459 children, 43 had CKD, with a prevalence rate of 2.95%. The <7 years group had a significantly higher prevalence rate than the 7-14 years group [5.8% (35/604) vs 0.9% (8/855); P<0.05]. Among the 43 children with CKD, 31 (72%) had proteinuria, 27 (63%) had hematuria, and 11 (26%) had a decreased glomerular filtration rate. Among the 43 children with CKD, stage 1, 2, 3a, 3b, 4, and 5 CKD accounted for 30% (13 cases), 44% (19 cases), 12% (5 cases), 7% (3 cases), 7% (3 cases), and 0% (0 case) respectively. The prevalence rate of CKD increased with the severity of hearing disorder (P<0.01).

CONCLUSIONS

The prevalence rate of CKD is higher among the children with hearing disorder in Hunan province. Most children have early-stage CKD. CKD is commonly seen in preschool children. Severity of hearing disorder is associated with the prevalence of CKD.

[Hearing loss in adults in older age groups.]

There has been a steady increase in the prevalence of hearing loss among people in many countries around the world. One of the main reasons for this negative trend is an increase in life expectancy and an increase in the proportion of the elderly people, which means an increase in the number of people with age-related changes in the auditory system (presbycusis). Aging is accompanied primarily by damage to the structures of the inner ear, but it can also affect the central parts of the auditory analyzer, causing frustration at all levels of the auditory neural pathway. Presbycusis is accompanied by impaired hearing and speech intelligibility. Along with speech hearing, spatial hearing suffers. Just as in other countries of the world, in Russia the prevalence of age-related hearing loss is increasing year by year. The data on the prevalence of hearing impairment in the Russian Federation vary, due to the lack of uniform approaches to the registration of persons with hearing impairment. Creation of a surdologic register is necessary for information support of complex medical and social rehabilitation of surdological patients. Since hearing loss has a significant negative impact on the quality of life of patients, knowledge of the prevalence of hearing disorders among the population will allow to plan properly the need for technical means of hearing and speech rehabilitation at the state level, to promote social rehabilitation and active longevity of citizens of older age groups.

'Has she seen me?': a multiple methods study of the pharmaceutical care needs of older people with sensory impairment in Scotland

OBJECTIVES

To explore the pharmaceutical care needs of, and service provision to, older people with sensory impairment (visual, hearing and dual impairment) on prescribed polypharmacy (≥4 medicines) in Scotland.

DESIGN

Interviews were conducted with older people with sensory impairment and community pharmacy personnel, which informed the content of a subsequent national cross-sectional survey of community pharmacists.

SETTING

Scotland, 2015-2016.

PARTICIPANTS

Older people with sensory impairment and community pharmacy personnel.

RESULTS

Interviews were completed with 23 older people with sensory impairment (dual impairment n=13, visual or hearing impairment n=5 of each) and 30 community pharmacy personnel from eight of 14 Scottish Health Boards. A total of 171 survey responses were received.Older people reported that they did not always disclose their sensory impairment to pharmacy personnel. They also reported that medicines were difficult to identify particularly when their name, shape or colour changed. Pharmacy personnel relied on visible cues such as white canes or guide dogs to identify visual impairment and suggested that hearing loss was less visible and more difficult to identify. Many assistive aids in support of medicine management, such as dosette boxes, seemed inadequate for complex medication regimens. Few community pharmacy personnel reported receiving training in the care of people with sensory impairment.

CONCLUSIONS

This is the first comprehensive, multistakeholder, in-depth exploration of the pharmaceutical care needs of older people with sensory impairment. Strategies are needed to enable people with sensory impairment to disclose their impairment to pharmacy personnel (and other healthcare providers). Community pharmacy personnel require training to deliver person-centred pharmaceutical care for older people with sensory impairment particularly regarding communication with individuals in this vulnerable population.

Missed opportunities: Do states require screening of children for health conditions that interfere with learning?

METHODS

Investigators reviewed websites of state departments of health and education, and legislation for all 50 states and DC. For states with mandated screenings and a required form, investigators applied structured analysis to assess HBL inclusion.

RESULTS

No state mandated that schools require screening for all 7 HBLs. Less than half (49%) required comprehensive school health examinations and only 12 states plus DC required a specific form. Of these, 12 of the forms required documentation of vision screening, 11 of hearing screening, and 12 of dental screening. Ten forms asked about asthma and 9 required documentation of lead testing. Seven asked about general well-being, emotional problems, or mental health. None addressed hunger. When including states without comprehensive school health examination requirements, the most commonly required HBL screenings were for vision (80% of states; includes DC), hearing (75% of states; includes DC) and dental (24% of state; includes DC).

CONCLUSION

The lack of state mandated requirements for regular student health screening represents a missed opportunity to identify children with HBLs. Without state mandates, accompanying comprehensive forms, and protocols, children continue to be at risk of untreated health conditions that can undermine their success in school.

[Speech audiometry, speech perception and cognitive functions. German version]

Examination of cognitive functions in the framework of speech perception has recently gained increasing scientific and clinical interest. Especially against the background of age-related hearing impairment and cognitive decline potential new perspectives in terms of better individualisation of auditory diagnosis and rehabilitation might arise. This review addresses the relationships of speech audiometry, speech perception and cognitive functions. It presents models of speech perception, discusses associations of neuropsychological with audiometric outcomes and shows recent efforts to consider cognitive functions with speech audiometry.

Prevalence of Auditory Problems in Children With Feeding and Swallowing Disorders

PURPOSE

Although an interdisciplinary approach is recommended for assessment and management of feeding or swallowing difficulties, audiologists are not always included in the interdisciplinary team. The purpose of this study is to report the prevalence of middle ear and hearing problems in children with feeding and swallowing disorders and to compare this prevalence with that in typical children.

METHOD

A total of 103 children were included in the study: 44 children with feeding and swallowing disorders and 59 children without any such disorders. Audiological examinations included case-history information, visualization of the ear canals through otoscopy, middle ear evaluation through tympanometry, and hearing screenings using an audiometer.

RESULTS

The odds of excessive cerumen (p = .0000, small effect size), middle ear dysfunction (p = .0148, small effect size), and hearing screening failure (p = .0000, large effect size) were 22.14%, 2.97%, and 13.5% higher, respectively, in children with feeding and swallowing disorders compared with typically developing children.

CONCLUSION

The significantly higher prevalence of hearing problems in children with feeding and swallowing disorders compared with typically developing children suggests that inclusion of an audiologist on the interdisciplinary team is likely to improve overall interventional outcomes for children with feeding and swallowing disorders.

Association between language and hearing disorders - risk identification

OBJECTIVE:

To identify children at risk for hearing and/or language disorders and to investigate the association between these risks by conducting pre-validated hearing and language screenings.

METHODS:

The study was conducted during a polio vaccination campaign in August of 2013 in basic health units in western São Paulo. Parents of children between 2 and 5 years of age were asked to complete two screening tools: a hearing questionnaire (regarding hearing development) and a language production and comprehension scale (including the major language development milestones). The screening tools were administered by different researchers. We compared the risk of having language disorders among children at risk for hearing loss versus children not at risk, as well as the attributable risk and odds ratios. Chi-squared tests and logistic regression analyses were used.

RESULTS:

The study included 479 children with a mean age of three and one-half years, of whom 26.9% were identified as at risk for deficits in language production, 8.6% were at risk for deficits in language comprehension and 14% were at risk for hearing disorders. The children at risk for hearing disorders were twice as likely as those not at risk to exhibit language production and comprehension deficits.

CONCLUSION:

The results of this study highlight the importance of establishing and adopting low-cost procedures such as screenings to identify children at risk of developing language and/or hearing disorders in early childhood.

Anxiety in Elderly Hearing Impaired Persons

The association between experiences of hearing impairment and signs of anxiety in 42 elderly hearing impaired patients at a hearing aid centre was investigated. Subjects completed the Hearing Coping Assessment, the Beck Anxiety Inventory, and an audiometric test of hearing. Analysis showed low scores on anxiety and hearing problems compared with other studies. Moreover, scores on anxiety did not correlate with pure tone thresholds for hearing but with self-reported hearing problems ( r = .31). Anxiety is important, but it is possible that signs of depression are more strongly related to self-perceived hearing handicap.

Hearing impairment and incident disability and all-cause mortality in older British community-dwelling men

Background and objective: hearing impairment is common in older adults and has been implicated in the risk of disability and mortality. We examined the association between hearing impairment and risk of incident disability and all-cause mortality.

Design and setting: prospective cohort of community-dwelling older men aged 63–85 followed up for disability over 2 years and for all-cause mortality for 10 years in the British Regional Heart Study.

Methods: data were collected on self-reported hearing impairment including hearing aid use, and disability assessed as mobility limitations (problems walking/taking stairs), difficulties with activities of daily living (ADL) and instrumental ADL (IADL). Mortality data were obtained from the National Health Service register.

Results: among 3,981 men, 1,074 (27%) reported hearing impairment. Compared with men with no hearing impairment, men who could hear and used a hearing aid, and men who could not hear despite a hearing aid had increased risks of IADL difficulties (age-adjusted OR 1.86, 95% CI 1.29–2.70; OR 2.74, 95% CI 1.53–4.93, respectively). The associations remained after further adjustment for covariates including social class, lifestyle factors, co-morbidities and social engagement. Associations of hearing impairment with incident mobility limitations, incident ADL difficulties and all-cause mortality were attenuated on adjustment for covariates.

Conclusion: this study suggests that hearing problems in later life could increase the risk of having difficulties performing IADLs, which include more complex everyday tasks such as shopping and light housework. However, further studies are needed to determine the associations observed including the underlying pathways.

Risk for Acute Confusion in Sensory-Impaired, Rural, Long-Term-Care Elders

Acute confusion is a common geriatric syndrome in long-term care (LTC) elders with prevalence rates of 10% to 39%. Sensory impairment, specifically vision and hearing impairment, is even more common in LTC, with prevalence rates of 40% to 90%. The purpose of this study was to investigate the risk relationship between sensory impairment and the development of acute confusion in LTC elders. Each resident (N = 114) underwent sensory screening and then was followed for 28 days to monitor for the onset of acute confusion. Twenty residents (17.5%) developed acute confusion, 60 residents (52.6%) were found to be visually impaired, 49 (44.1%) were hearing impaired, and 28 (24.6%) were found to be dually impaired. Significant relationships between vision impairment, odds ratio (OR) = 3.67, confidence interval (CI) (1.13, 11.92), and dual sensory impairment, OR = 2.88, CI (1.04, 8.26), with the development of acute confusion were identified.

Impact of Sensory Impairments on Functional Disability in Adults With Arthritis

INTRODUCTION

Mobility is reduced in people with sensory impairments and those with arthritis. The combined impact of these conditions may be underappreciated. This study examines the associations between impairments in vision, hearing, and balance and functional ability in adults with versus without arthritis.

METHODS

Using National Health and Nutrition Examination Survey data from 1999-2004, arthritis status, functional ability, and sensory impairments (vision, hearing, and balance) were assessed from self-reported responses by 6,654 individuals aged ≥50 years (mean age, 63.4 years; 46.3% male). Multivariable regression analyses, conducted in 2014, assessed the associations between sensory impairment and arthritis on functional ability and mobility.

RESULTS

Among study participants, 41.8% reported having arthritis; of these, 27.1%, 44.9%, and 35.1% reported impaired vision, hearing, or balance, respectively. Having multiple sensory impairments was significantly associated with reduced functional ability in people with arthritis; individuals with three sensory impairments reported the highest levels of disability for all functional domains (compared with no impairment; lower extremity mobility, 80.2% vs 39.1%; general physical activities, 94.7% vs 75.9%; activities of daily living, 69.7% vs 27.2%; instrumental activities of daily living, 77.2% vs 37.4%; leisure and social activities, 66.3% vs 30.6%; impaired gait speed, 48.1% vs 16.3%; all p<0.001). Importantly, visual deficits, in combination with arthritis, had the greatest impact on mobility, with odds of impaired mobility at least twice as high as for individuals without arthritis.

CONCLUSIONS

Addressing sensory deficits, especially difficulties with vision, may improve functional ability, which may be particularly helpful for adults with arthritis.

Hearing in older adults with exfoliation syndrome/exfoliation glaucoma or primary open-angle glaucoma

PURPOSE

To determine whether adults, aged 66-96 years, with exfoliation syndrome (XFS)/exfoliation glaucoma (XFG), or primary open-angle glaucoma (POAG) have poorer hearing than controls of similar age.

METHODS

Case (XFS/XFG and POAG) and control status was diagnosed in the Reykjavik Glaucoma Studies (RGS) using slit-lamp examination, visual field testing and optic disc photographs; the RGS data were merged with the Age, Gene/Environment Susceptibility-Reykjavik Study that collected hearing data using air-conduction, pure-tone thresholds obtained at 0.5, 1, 2, 3, 4, 6 and 8 kHz categorized by better ear and worse ear, based on pure-tone averages (PTAs) calculated separately for low and middle frequencies (PTA512 - mean of thresholds at 0.5, 1 and 2 kHz) and high frequencies (PTA3468 - mean of thresholds at 3, 4, 6 and 8 kHz). Multivariable linear regression was used to test for differences in PTAs between cases and controls.

RESULTS

The mean age for 158 XFS/XFG cases (30.4% male) was 77.4 years, 95 POAG cases (35.8% male) was 77.9 years, and 123 controls (46.3% male) was 76.8 years. Using multivariable linear regression analysis, there were no consistent, statistically significant differences in PTAs between the two case groups and controls in either the low- or high-frequency range, even when stratified by age group.

CONCLUSION

Among the older individuals examined in this study hearing loss is highly prevalent and strongly associated with male gender and increasing age. As we did not find consistent statistically significant difference in hearing between cases and controls the diagnosis of XFS/XFG or POAG does not as such routinely call for audiological evaluation.

Persistent Language Delay Versus Late Language Emergence in Children With Early Cochlear Implantation

PURPOSE

The purpose of the present investigation is to differentiate children using cochlear implants (CIs) who did or did not achieve age-appropriate language scores by midelementary grades and to identify risk factors for persistent language delay following early cochlear implantation.

MATERIALS AND METHOD

Children receiving unilateral CIs at young ages (12-38 months) were tested longitudinally and classified with normal language emergence (n = 19), late language emergence (n = 22), or persistent language delay (n = 19) on the basis of their test scores at 4.5 and 10.5 years of age. Relative effects of demographic, audiological, linguistic, and academic characteristics on language emergence were determined.

RESULTS

Age at CI was associated with normal language emergence but did not differentiate late emergence from persistent delay. Children with persistent delay were more likely to use left-ear implants and older speech processor technology. They experienced higher aided thresholds and lower speech perception scores. Persistent delay was foreshadowed by low morphosyntactic and phonological diversity in preschool. Logistic regression analysis predicted normal language emergence with 84% accuracy and persistent language delay with 74% accuracy.

CONCLUSION

CI characteristics had a strong effect on persistent versus resolving language delay, suggesting that right-ear (or bilateral) devices, technology upgrades, and improved audibility may positively influence long-term language outcomes.

[Anophthalmia and microphthalmia requires multidisciplinary care. Many of the children also have other medical problems]

Anophthalmia/microphthalmia (A/M) are rare congenital eye malformations. Early intervention with ocular prosthesis can stimulate orbital growth and prevent facial asymmetry. We reviewed medical records from 18 individuals with A/M (0.8-31 years) treated with ocular prosthesis at Sahlgrenska University Hospital between 2000 and 2012. A majority had other ocular findings. Seven had subnormal visual acuity in the fellow eye, one third were in contact with vision support services and half of the group wore glasses. Eleven individuals had extra-ocular findings such as cardiac defect, hearing impairment and neuropsychiatric disorders, possibly indicating syndromic conditions. We suggest that investigation of A/M children should include ultrasound of the eye, optionally visual evoked potential and magnetic resonance imaging of the CNS. The ophthalmologist should initiate treatment with prosthesis, pediatric assessment, hearing tests and genetic counseling, but should also monitor visual development of the fellow eye.

Speech, language, hearing delays: time for early intervention?

A wait-and-see approach may not be best for the child exhibiting delayed development. This review--complete with extensive resource lists--can facilitate an expeditious referral.

Audiometric thresholds and auditory processing in children with early malnutrition: a retrospective cohort study

CONTEXT AND OBJECTIVE

Malnutrition is one of the causes of changes in cell metabolism. The inner ear has few energy reserves and high metabolism. The aim of this study was to analyze whether malnutrition at an early age is related to impairment of auditory processing abilities and hearing abnormalities.

DESIGN AND SETTING

Retrospective cohort study conducted in a tertiary public hospital.

METHODS

45 children participated, divided as follows: G1, children diagnosed with malnutrition in their first two years of life; G2, children without history of malnutrition but with learning difficulties; G3, children without history of malnutrition and without learning difficulties. Tympanometry, pure-tone audiometry and the Staggered Spondaic Word (SSW) test (auditory processing) were performed. Statistical inferences were made using the Kruskal-Wallis test (α = 5%) and the test of equality of proportions between two samples (α = 1.7%).

RESULTS

None of the 45 children participating in this study presented hearing deficiencies. However, at six of the eight frequencies analyzed, the children in G1 presented hearing thresholds lower than those of the other groups. In the auditory processing evaluation test, it was observed that 100% of the children in G1 presented abnormal auditory processing and that G1 and G2 had similar proportions of abnormalities (P-values: G1/G2 = 0.1; G1/G3 > 0.001; G2/G3 = 0.008).

CONCLUSIONS

Malnutrition at an early age caused lowering of the hearing levels, although this impairment could not be considered to be a hearing deficiency. Every child in this group presented abnormalities in auditory processing abilities.

Sensory impairments and their associations with functional disability in a sample of the oldest-old

PURPOSE

Research focusing on the consequences of sensory impairments for the everyday competence of the oldest-old is emerging. The two main goals of this study were to document the prevalence of self-reported vision, hearing, and dual sensory impairment and to explore associations of these impairments with functional disability in near-centenarians and centenarians.

METHODS

Centenarians and near-centenarians (N = 119; average age = 99) were recruited, with about 80% living in the community. In-person interviews included self-ratings of vision and hearing impairment and functional disability conceptualized as having difficulties performing personal and instrumental activities of daily livings (PADLs and IADLs).

RESULTS

Based on self-report ratings, 17% of participants were classified as having a visual impairment only, 18% as having a hearing impairment only, and 38% with both a visual and hearing impairment (dual sensory impairment). Regression analyses demonstrated that having a vision impairment only and being dual sensory impaired were the strongest predictors of functional disability. They were associated with higher levels of functional disability over and above higher levels of depressive symptomatology, interference of health with desired activities, and living in a nursing home.

CONCLUSIONS

Sensory impairments-especially dual sensory impairment-are prevalent in the oldest-old. Having dual sensory impairment or a single visual impairment among other factors are strongly associated with less-optimal everyday functioning in the oldest-old.

Phonology in Swedish-speaking 3-year-olds born with cleft lip and palate and the relationship with consonant production at 18 months

BACKGROUND

Approximately 50% of children born with cleft palate present speech difficulties around 3 years of age, and several studies report on persisting phonological problems after palatal closure. However, studies on early phonology related to cleft palate are few and have so far mainly been carried out on English-speaking children. Studies on phonology related to cleft palate in languages other than English are also warranted.

AIMS

To assess phonology in Swedish-speaking children born with and without unilateral cleft lip and palate (UCLP) at 3 years of age, and to identify variables at 18 months that are associated with restricted phonology at age 3 years.

METHODS & PROCEDURES

Eighteen consecutive children born with UCLP and 20 children without cleft lip and palate were included. Transcriptions of audio recordings at 18 months and 3 years were used. Per cent correct consonants adjusted for age (PCC-A), the number of established phonemes, and phonological simplification processes at 3 years were assessed and compared with different aspects of consonant inventory at 18 months.

OUTCOMES & RESULTS

PCC-A, the number of established phonemes, and the total number of phonological processes differed significantly at 3 years between the two groups. Total number of oral consonants, oral stops, dental/alveolar oral stops and number of different oral stops at 18 months correlated significantly with PCC-A at 3 years in the UCLP group.

CONCLUSIONS & IMPLICATIONS

As a group, children born with UCLP displayed deviant phonology at 3 years compared with peers without cleft lip and palate. Measures of oral consonant and stop production at 18 months might be possible predictors for phonology at 3 years in children born with cleft palate.

Auditory-motor interactions in pediatric motor speech disorders: neurocomputational modeling of disordered development

BACKGROUND/PURPOSE

Differentiating the symptom complex due to phonological-level disorders, speech delay and pediatric motor speech disorders is a controversial issue in the field of pediatric speech and language pathology. The present study investigated the developmental interaction between neurological deficits in auditory and motor processes using computational modeling with the DIVA model.

METHOD

In a series of computer simulations, we investigated the effect of a motor processing deficit alone (MPD), and the effect of a motor processing deficit in combination with an auditory processing deficit (MPD+APD) on the trajectory and endpoint of speech motor development in the DIVA model.

RESULTS

Simulation results showed that a motor programming deficit predominantly leads to deterioration on the phonological level (phonemic mappings) when auditory self-monitoring is intact, and on the systemic level (systemic mapping) if auditory self-monitoring is impaired.

CONCLUSIONS

These findings suggest a close relation between quality of auditory self-monitoring and the involvement of phonological vs. motor processes in children with pediatric motor speech disorders. It is suggested that MPD+APD might be involved in typically apraxic speech output disorders and MPD in pediatric motor speech disorders that also have a phonological component. Possibilities to verify these hypotheses using empirical data collected from human subjects are discussed.

LEARNING OUTCOMES

The reader will be able to: (1) identify the difficulties in studying disordered speech motor development; (2) describe the differences in speech motor characteristics between SSD and subtype CAS; (3) describe the different types of learning that occur in the sensory-motor system during babbling and early speech acquisition; (4) identify the neural control subsystems involved in speech production; (5) describe the potential role of auditory self-monitoring in developmental speech disorders.

Basic auditory processing deficits in dyslexia: systematic review of the behavioral and event-related potential/ field evidence

A review of research that uses behavioral, electroencephalographic, and/or magnetoencephalographic methods to investigate auditory processing deficits in individuals with dyslexia is presented. Findings show that measures of frequency, rise time, and duration discrimination as well as amplitude modulation and frequency modulation detection were most often impaired in individuals with dyslexia. Less consistent findings were found for intensity and gap perception. Additional factors that mediate auditory processing deficits in individuals with dyslexia and their implications are discussed.

Magnetic resonance imaging findings in adult-form myotonic dystrophy type 1

The adult form of myotonic dystrophy type 1 is a neuromuscular disorder with multisystem involvement, including the central nervous system (CNS). The presenting clinical features of this condition include distal muscle weakness, myotonia, intellectual decline, cataract, frontal baldness and testicular atrophy. Magnetic resonance (MR) imaging shows characteristic white matter changes in the CNS. The clinical presentation, characteristic white matter changes in the brain on MR imaging and electromyographic findings aid in the diagnosis of this disorder.

Audiovestibular manifestations in patients with ankylosing spondylitis

Ankylosing spondylitis (AS) is a chronic inflammatory disease of unknown origin affecting up to 1% of the population. Little is known about audiovestibular impairment in patients with AS, especially the presence of cochleovestibular dysfunction in these patients. To investigate audiovestibular manifestations in AS, we studied a series of 50 consecutive patients who fulfilled the modified New York diagnostic criteria for AS and 44 matched controls. Individuals with history of cardiovascular disease, cerebrovascular complications, peripheral artery disease, renal insufficiency, syphilis, Meniere and other vestibular syndromes, infections involving the inner ear, barotrauma, or in treatment with ototoxic drugs were excluded. Most patients with AS were men (80%). The mean age at the time of study was 52.5 years, and mean age at the onset of symptoms was 34.4 years. Twenty-nine (58%) patients showed abnormal hearing loss in the audiogram compared to only 8 (18%) controls (p < 0.001). Values of audiometric tests (pure-tone average and speech reception threshold) yielded significant differences between patients and controls (p < 0.001). It is noteworthy that the audiogram shape disclosed a predominant pattern of high-frequency sensorineural hearing loss in AS patients (50%) compared to controls (18%) (p = 0.002). Also, AS patients exhibited abnormal vestibular tests more commonly than controls. AS patients had an increased frequency of head-shaking nystagmus (20%) compared to controls (0%) (p < 0.001). Moreover, patients (26%) showed a significantly increased frequency of abnormal caloric test compared to controls (0%) (p < 0.001). Finally, a significantly increased frequency of abnormal clinical test of sensory integration and balance with a predominant vestibular loss pattern was observed in patients (36%) compared to controls (5%) (p < 0.001). In conclusion, the current study demonstrates strong evidence for inner ear compromise in patients with AS.

Effects of targeted reading instruction on phonological awareness and phonic decoding in children with down syndrome

This research evaluated the effectiveness of reading instruction targeting oral reading and phonological awareness for children with Down syndrome (affecting chromosome 21). The participants were 7 children ranging in age from 2 years, 11 months to 10 years, 8 months. Each child acted as his/her own control, with assessments of language, cognition, phonological awareness, word and short-passage comprehension, and oral reading ability conducted on four occasions (initially, preintervention, postintervention and delayed postintervention) over approximately a 12-month period. The intervention was conducted over 10 weekly sessions and involved individual instruction. The postintervention assessment results provided evidence that phonic reading instruction was generally effective in improving reading skills and phonological awareness of children with Down syndrome.

[Inaugural audiovisual impairment disclosing specific neurological disorders]

The association of visual and auditory impairments, simultaneously or consecutively, is a rare condition at the onset of neurological diseases. To determine whether audiovisual impairment can be associated with a specific group of neurological disorders at onset, we performed a prospective study of 307 patients over 6 months in a specialized neurological unit in inflammatory diseases. Six patients (2%) experienced inaugural audiovisual impairments. The mean age of patients at onset was 39.5 ± 14.7 years, with a male:female ratio of 1:2. Both deficiencies were reported in three cases, including loss of visual acuity with tinnitus (two cases) or hearing loss (one case). Initial visual dysfunction, characterised by loss of visual acuity, was noted in one patient. Initial auditory impairment, characterised by dizziness and hearing loss, was noted in two patients. The mean interval between the occurrence of visual and auditory impairments was 3.8 ± 4.3 months. A neurological diagnosis was made in four cases (67%) at a mean time of 4.6 ± 4.6 months after disease onset. Visual impairments were optic neuritis for multiple sclerosis, serous retinal detachment for Vogt-Koyanagi-Harada's disease, a central retinal artery occlusion for Susac's syndrome and a retinal vasculitis for Cogan's syndrome. The systematic investigation of inaugural audiovisual impairment in young patients could help shorten the time to a specific neurological diagnosis.

A survey of relationship between rheumatoid arthritis and hearing disorders

RA (rheumatoid arthritis) is a chronic multisystem disease with a variety of systemic manifestations. One of these manifestations, is hearing disorder, so study of the relation between RA and hearing disorders is seem important. This was a case-control study which has done from December 2004 to August 2006. This study compared 50 patients with RA, with age, sex and job-matched as control. Audiometric tests in different frequencies show that hearing threshold in high frequencies specially in 8000 Hz had a significant difference between two groups, also acoustic reflexes were absent in case groups and had significant difference between two groups too. The evaluation of sensory neural hearing loss showed that this hearing loss is sensory not neural. Based on this study, frequent evaluation of audiometric tests is recommended for controlling hearing disorders by therapeutic and rehabilitation procedures in RA patients.

Effects of degraded sensory input on memory for speech: behavioral data and a test of biologically constrained computational models

Poor hearing acuity reduces memory for spoken words, even when the words are presented with enough clarity for correct recognition. An "effortful hypothesis" suggests that the perceptual effort needed for recognition draws from resources that would otherwise be available for encoding the word in memory. To assess this hypothesis, we conducted a behavioral task requiring immediate free recall of word-lists, some of which contained an acoustically masked word that was just above perceptual threshold. Results show that masking a word reduces the recall of that word and words prior to it, as well as weakening the linking associations between the masked and prior words. In contrast, recall probabilities of words following the masked word are not affected. To account for this effect we conducted computational simulations testing two classes of models: Associative Linking Models and Short-Term Memory Buffer Models. Only a model that integrated both contextual linking and buffer components matched all of the effects of masking observed in our behavioral data. In this Linking-Buffer Model, the masked word disrupts a short-term memory buffer, causing associative links of words in the buffer to be weakened, affecting memory for the masked word and the word prior to it, while allowing links of words following the masked word to be spared. We suggest that these data account for the so-called "effortful hypothesis", where distorted input has a detrimental impact on prior information stored in short-term memory.

Childhood autism and auditory system abnormalities

Hearing disorders are common among children with autism, ranging from peripheral and sensorineural hearing deficit or loss to auditory hypersensitivity with bizarre reactions to sounds. The auditory abnormalities and consequent sensory deprivation exacerbate the communication deficit of autism, and early auditory assessment holds an important place in the planning of intervention and the overall prognosis of patients. Physiologic, pathologic, imaging, and neurochemical studies have revealed an array of aberrations in the perception and processing of the audiologic stimuli, including (among others) maturational defects, atypical lateralization, and serotonin dysfunction.

Prevalence of obesity among children with chronic conditions

New evidence suggests that children with chronic conditions may be predisposed to overweight and obesity. This study provides prevalence estimate of obesity for children and adolescents with select chronic conditions. We analyzed reported height and weight and the corresponding BMI from 46,707 subjects aged 10-17 years collected by the National Survey of Children's Health (NSCH-2003). Our main outcome measure was the prevalence of obesity (defined as >/=95th percentile of the sex-specific BMI for age growth charts), adjusted for underlying demographic and socioeconomic factors. We found that the prevalence of obesity among children 10-17 years of age without a chronic condition was 12.2% (95% confidence interval (CI) 11.5-13.0); the prevalence of obesity for children with asthma was 19.7% (19.5-19.9); with a hearing/vision condition was 18.4% (18.2-18.5); with learning disability was 19.3% (19.2-19.4); with autism was 23.4% (23.2-23.6); and with attention-deficit/hyperactivity disorder was 18.9% (18.7-19.0). Our findings suggest that children 10-17 years of age with select chronic conditions were at increased risk for obesity compared to their counterparts without a chronic condition.

A perceptual and electropalatographic study of /integral/ in young people with Down's syndrome

Speech production in young people with Down's syndrome has been found to be variable and inconsistent. Errors tend to be more in the production of sounds that typically develop later, for example, fricatives and affricates, rather than stops and nasals. It has been suggested that inconsistency in production is a result of a motor speech deficit. Late acquired fricatives such as /s/ and /integral/ are complex articulations, which may require more precise motor programming and may therefore show highly inconsistent productions. Other factors potentially affecting speech production in this population are abnormal palatal structure, hearing loss, and hypotonia. A group of 20 young people with Down's syndrome were recorded using Electropalatography (EPG), reading a wordlist containing the phrase 'a sheep'. The wordlist contained seven other phrases and was repeated 10 times. Eight typically developing, cognitively matched children and eight adults were also recorded producing the same data set. Articulatory (EPG pattern analysis) and perceptual analyses of the 10 productions of /integral/ were carried out. /integral/ production was found to be inconsistent in the young people with Down's syndrome, with more errors both in the auditory analysis and articulatory analysis than in the typical sample, which may be due to a motor programming or motor control problem. There were a greater number of errors in the EPG analysis than in the perceptual analysis. This suggests that some young people with DS were able to produce perceptually acceptable /integral/ with atypical EPG patterns. The use of typical, adult-modelled /integral/ EPG patterns in therapy may be inappropriate for some children with DS who present with atypical palatal structures.

Vision and Hearing Impairment in Aged Care Clients

PURPOSE

To determine the frequency of sensory impairments among aged care clients.

METHODS

We examined 188 persons aged 65-99 years being evaluated for aged care services at a geriatric assessment center, west of Sydney, Australia. Visual acuity was measured using a LogMAR chart. Visual impairment was defined in the better eye: mild < 20/40 to > or = 20/80, moderate < 20/80 to > or = 20/200, and severe < 20/200. Hearing function was assessed by portable pure-tone air-conduction audiometry. Hearing loss was defined using average hearing thresholds in the better ear: mild > 25 to < or = 40 decibels (dB), moderate > 40 to < or = 60dB, and severe > 60dB.

RESULTS

Vision, hearing, or both were randomly tested in 96, 93, and 49 aged care clients, respectively. Vision impairment was found in 30.2% of clients. Distance vision could be improved with pinhole in 16.7% of 84 clients with presenting VA < 20/20. Moderate to severe hearing loss was present in 50.5%. Combined sensory impairment was detected in 22.5% of persons having both tests. The age-standardized proportions with vision impairment was 25.6%, higher than the rate (17.4%) found in the Blue Mountains Eye Study (BMES) community population, but lower than the 37.7% prevalence reported from the BMES nursing home sample. Hearing impairment was also more common in aged care clients (28.1% vs 17.5%).

CONCLUSIONS

This study suggests a high prevalence of sensory impairment among older persons transitioning from independent community living to institutionalized care.

The role of sensory and cognitive function in the onset of activity restriction in older people

BACKGROUND

Extending healthy active life expectancy is a priority if we are to achieve gains in both the quality and quantity of life lived at older ages. We investigated the role of sensory (vision and hearing) and cognitive function on the onset of activity restriction in older people.

METHODS

A survey of a total population (N = 1579) of people aged 75 years and older, registered with a large general population in Melton Mowbray, Leicestershire, England, was undertaken in 1988 and linked with subsequent routine health assessments (up to a maximum of five) over 10 years. Activity restriction was defined as having difficulty performing on their own, requiring help or aids or not doing any one of seven Activities of Daily Living (ADLs). The study population comprised the 643 persons who were not restricted at baseline. Cox proportional hazard regression models were fitted to time of onset of activity restriction with those dying before activity restriction was reported being censored at time of death.

RESULTS

After adjustment for confounding factors (socio-demographic and psychosocial factors, physical health and physical functional limitations), difficulty with both vision and hearing conferred a doubling of risk of activity restriction (RR = 2.36, 95% CI 1.31 to 4.28). A unit decrease in the Information/Orientation subtest was associated with a 10% increase in risk (RR = 1.10, 95% CI 1.02 to 1.19), even after adjustment for vision and hearing as well as other confounding factors, though baseline Mini-Mental State Examination score was not indicative of increased risk (RR= 1.02, 95% CI 0.98 to 1.06).

CONCLUSION

Differentiating whether disability is a result of physical, sensory or cognitive functional limitations, is necessary to identify need and the direction in which efforts should be targeted to improve active life expectancy in older people.

Effects of Intensive and Moderate Cellular Phone Use on Hearing Function

The purpose of this study is to investigate the effects of radiation emitted by mobile phones on the hearing of users. The study was carried out on three groups: 1) 20 men who have used a cellular phone frequently and spoken approximately 2 h per day for four years; 2) 20 men who have used a cellular phone for 10-20 min per day for four years; and 3) 20 healthy men who have never used a cellular phone (the control group). Brainstem evoked response audiometric (BERA) and pure tone audiometric (PTA) methods were used to measure the effects of exposure on hearing function of the subjects. In BERA measurements, I-III, III-V, and I-V interpeak latencies were evaluated. Interpeak latency of subjects in two experimental groups was compared to that of subjects in the control group. The BERA results showed no differences among the groups (p > 0.05). In PTA measurements, detection thresholds at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 4000 Hz, and 8000 Hz frequencies were measured in all three groups. No differences were observed between moderate mobile phone users (10-20 min. per day) and control subjects. However, detection thresholds in those who talked approximately 2 h per day were found to be higher than those in either moderate users or control subjects. Differences at 4000 Hz for both bone and air conduction for right ears, and 500 Hz, and 4000 Hz bone and air conduction for left ears were significant for mean hearing threshold. This study shows that a higher degree of hearing loss is associated with long-term exposure to electromagnetic (EM) field generated by cellular phones.

Motor-auditory-visual integration: The role of the human mirror neuron system in communication and communication disorders

The mirror neuron system (MNS) is a trimodal system composed of neuronal populations that respond to motor, visual, and auditory stimulation, such as when an action is performed, observed, heard or read about. In humans, the MNS has been identified using neuroimaging techniques (such as fMRI and mu suppression in the EEG). It reflects an integration of motor-auditory-visual information processing related to aspects of language learning including action understanding and recognition. Such integration may also form the basis for language-related constructs such as theory of mind. In this article, we review the MNS system as it relates to the cognitive development of language in typically developing children and in children at-risk for communication disorders, such as children with autism spectrum disorder (ASD) or hearing impairment. Studying MNS development in these children may help illuminate an important role of the MNS in children with communication disorders. Studies with deaf children are especially important because they offer potential insights into how the MNS is reorganized when one modality, such as audition, is deprived during early cognitive development, and this may have long-term consequences on language maturation and theory of mind abilities.

LEARNING OUTCOMES

Readers will be able to (1) understand the concept of mirror neurons, (2) identify cortical areas associated with the MNS in animal and human studies, (3) discuss the use of mu suppression in the EEG for measuring the MNS in humans, and (4) discuss MNS dysfunction in children with (ASD).

Effect of vision on development of multiply handicapped children

The effect of vision on (abnormal) development was studied in a group of 81 visually and/or hearing impaired rubella children, 18 of whom had bi-lateral cataracts operated between 2-18 months, 3 children had uni-lateral cataract, and 60 children had clear media. In this group of children the effect of visual impairment on (abnormal) behaviour is enormous. Vision has in these children a greater impact on their development than hearing impairment or prenatal variables such as low birthweight. This justifies the conclusion of cataract surgery as early as possible. After surgery the environment should be manipulated in such a way, that it becomes visually attractive for the child. This might prevent strong light-gazing and/or exhibiting the phenomenon of HBE (Hand Before the Eyes). The desire for rocking and jumping should be seen in connection with stimulus deprivation, especially social ones. It is therefore recommended that these children should be offered ample experience and interaction with the environment, such as giving the child proprioceptive stimuli, rocking him in the crib or on the lap. The interest in the world outside his own body should be encouraged by manipulating the children's special interest (such as changing the objects for light gazing). The purpose for this kind of management is to develop orientation reflex, in other words to stimulate the child to give attention to the world around him and therefore learn from it. When this sort of early stimulation is provided the child's development may be not so retarded as without appropriate intervention.

Patterns of language and auditory dysfunction in 6-year-old children with epilepsy

In a previous study we reported difficulty with expressive language and visuoperceptual ability in preschool children with epilepsy and otherwise normal development. The present study analysed speech and language dysfunction for each individual in relation to epilepsy variables, ear preference, and intelligence in these children and described their auditory function. Twenty 6-year-old children with epilepsy (14 females, 6 males; mean age 6:5 y, range 6 y-6 y 11 mo) and 30 reference children without epilepsy (18 females, 12 males; mean age 6:5 y, range 6 y-6 y 11 mo) were assessed for language and auditory ability. Low scores for the children with epilepsy were analysed with respect to speech-language domains, type of epilepsy, site of epileptiform activity, intelligence, and language laterality. Auditory attention, perception, discrimination, and ear preference were measured with a dichotic listening test, and group comparisons were performed. Children with left-sided partial epilepsy had extensive language dysfunction. Most children with partial epilepsy had phonological dysfunction. Language dysfunction was also found in children with generalized and unclassified epilepsies. The children with epilepsy performed significantly worse than the reference children in auditory attention, perception of vowels and discrimination of consonants for the right ear and had more left ear advantage for vowels, indicating undeveloped language laterality.

[Music as an uninvited guest: the auditive variant of the Charles Bonnet syndrome]

Visually handicapped patients can be tormented by complex visual hallucinations (Charles Bonnet syndrome). Likewise, deaf patients and patients with impaired hearing can be plagued by auditory hallucinations, mostly involving music. Our article focuses on three female patients who suffered from musical hallucinations. In one of these patients the hallucinations ceased when her hearing was restored. In the second patient the hallucinations ceased when carbamazepine was prescribed. Quetiapine reduced the musical hallucinations in the third patient. The differential diagnoses and therapeutic options are discussed.

Chronic health problems and risk of accidental injury in the workplace: a systematic literature review

OBJECTIVES

To investigate whether common important health conditions and their treatments increase risks of occupational injury.

METHODS

A systematic search was conducted of MEDLINE, EMBASE and PsycINFO databases from inception to November 2006 employing terms for occupational injury, medications, and a broad range of diseases and impairments. Papers related solely to driving, alcohol, or substance abuse were excluded, as were studies that did not allow analysis of injury risk. For each paper that was retrieved we abstracted standard information on the population, design, exposure(s), outcome(s), response rates, confounders and effect estimates; and rated the quality of information provided.

RESULTS

We found 38 relevant papers (33 study populations): 16 studies were of cross-sectional design, 13 were case-control and 4 were prospective. The overall quality was rated as excellent for only two studies. Most commonly investigated were problems of hearing (15 studies), mental health (11 studies) and vision (10 studies). For impaired hearing, neurotic illness, diabetes, epilepsy and use of sedating medication there were moderate positive associations with occupational injury (odds ratios 1.5-2.0), but there were major gaps in the evidence base. Studies covering vision did not present risks by category of eye disease; no evidence was found on psychotic illness; for diabetes, epilepsy and cardiovascular disease there were remarkably few papers; studies seldom distinguished risks by sub-category of external cause or anatomical site and nature of injury; and exposures and outcomes were mostly ascertained by self-report at a single time point, with a lack of clarity about exposure timings.

CONCLUSION

Improved research is needed to define the risks of occupational injury arising from common health complaints and treatments. Such research should delineate exposures and outcomes in more detail, and ensure by design that the former precede the latter.

Word-learning abilities in deaf and hard-of-hearing preschoolers: effect of lexicon size and language modality

Deaf and hard-of-hearing (DHH) children's ability to rapidly learn novel words through direct reference and through novel mapping (i.e., inferring that a novel word refers to a novel object) was examined. Ninety-eight DHH children, ranging from 27 to 82 months old, drawn from 12 schools in five states participated. In two tasks that differed in how reference was established, word-learning abilities were measured by children's ability to learn novel words after only three exposures. Three levels of word-learning abilities were identified. Twelve children did not rapidly learn novel words. Thirty-six children learned novel words rapidly but only in the direct reference task. Forty-nine children learned novel words rapidly in both direct reference and novel mapping tasks. These levels of word-learning abilities were evident in children who were in oral-only and in signing environments, in children with cochlear implants, and in deaf children of deaf parents. Children's word-learning abilities were more strongly correlated to lexicon size than age, and this relation was similar for children in these different language-learning environments. Acquisition of these word-learning abilities seems based on linguistic mechanisms that are available to children in a wide range of linguistic environments. In addition, the word-learning tasks offer a promising dynamic assessment tool.

Perineurial cells filled with collagen in 'atypical' Cogan's syndrome

Cogan's syndrome is a rare clinical entity characterized by non-infectious interstitial keratitis with vestibuloauditory dysfunction. The clinical course is extremely variable. In the majority of patients, there appears to be an underlying systemic process, often a "vasculitis". We were able to study for the first time a sural nerve biopsy of a 38-year-old female with clinically suggested Cogan's syndrome associated with a severe multiplex type of neuropathy. There were unusual cells in or below the perineurium and along perineurial extensions into the endoneurium which were usually associated with blood vessels and which have thus far not been described in association with any type of peripheral neuropathy. The unusual cells were identified as perineurial cells because (1) they were frequently associated with the perineurium and its endoneurial extensions; (2) they were immunoreactive for antibodies against epithelial membrane antigen (EMA) but did not react with antibodies against protein S100, GFAP, and CD 68; and (3) they showed focally accumulated pinocytotic vesicles and hemidesmosomes. Some of these cells were clearly immunoreactive with antibodies against collagen VI. Electron microscopic examination revealed numerous intracellular bundles of collagen fibers which were surrounded by an amorphous basal lamina-like material, indicating that they were located within intracellular projections of the surface membrane. The number of myelinated and unmyelinated nerve fibers was severely reduced corresponding to the clinical manifestation of the neuropathy and to the atrophy, especially of the distal arm and leg muscles. It is concluded that the changes were caused by a special type of autoimmune reaction involving blood vessels and perineurial cells of peripheral nerves.