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Introduction: The prevalence of hearing loss is high in older adults. Hearing aids are a common rehabilitative option for improving speech audibility and intelligibility. The evidence is emerging to show improved cognitive functioning in hearing-impaired older adults using hearing aids. Digital hearing aid signal processing strategies have shown variable benefits in individuals which can be attributed to individual differences in hearing loss and cognitive capacity. The interaction between hearing aids and cognition is, therefore, complex and research regarding the immediate effects of hearing aid amplification approaches on decreasing cognitive load have been limited. Objective: To investigate whether a cognitively-focussed hearing aid setting (CogniAid) will improve hearing and cognition more than current, standard practice in experienced elderly hearing aid users. Methods: Twenty experienced hearing aid users (aged 65 or over) participated in the repeated measures study over two sessions. All participants were bilaterally fitted with Phonak Audéo B90 receiver-in-the-ear hearing aids, which were programmed to either the CogniAid or standard hearing aid settings in a counterbalanced order. The CogniAid hearing aid setting received linear signal processing and output limiting compression, while the standard hearing aid setting received wide dynamic range compression signal processing. Objective measures of hearing and cognition were collected for the unaided and the two aided conditions, using the QuickSINTM test to measure speech intelligibility in noise and the NIH Toolbox® to measure speech intelligibility in quiet, working memory and episodic memory. For each aided condition, subjective rating scales were used to evaluate the perceptual aspects of sound quality. Results: Repeated measures ANOVA revealed significantly lower SNR loss scores in the QuickSINTM test, indicating better speech intelligibility in noise with the CogniAid hearing aid setting compared to both the standard hearing aid setting and the unaided condition. For the NIH Toolbox® picture vocabulary test, participants performed significantly better with the CogniAid hearing aid setting compared to the unaided condition, but there were no differences in performance when compared to the standard hearing aid setting. There were no statistically significant differences between the standard hearing aid setting and the unaided condition in any of the hearing or cognitive tests. There were no statistically significant differences between the two aided conditions on any of the subjective measures of sound quality for speech in quiet or speech in noise. Conclusion: The CogniAid improved speech intelligibility in noise but attempts to determine whether the CogniAid hearing aid setting relieved cognitive load and reduced listening effort compared to the standard hearing aid setting were inconclusive. Future research should investigate the use of alternative cognitive assessment tools and field trials to check if the findings differ.
Difference in speech recognition performance with short and long release time processing has been noted in previous research. Recent research has established a connection between hearing aid users' cognitive abilities and release time. Researchers hope to use cognitive ability as a predictor of release time selection. The results from these previous studies have been contradictory. Some researchers hypothesized that linguistic context of speech recognition test materials was one of the factors that accounted for the inconsistency. The goal of the present study was to examine the relationship between hearing aid users' cognitive abilities and their aided speech recognition performance with short and long release time using speech recognition tests with different amounts of linguistic context. Thirty-four experienced hearing aid users participated in the present study. Their cognitive abilities were quantified using a reading span test. Digital behind-the-ear style hearing aids with adjustable release time settings were bilaterally fitted to the participants. Their aided speech recognition performance was evaluated using three tests with different amounts of linguistic context: the Word-In-Noise (WIN) test, the American Four Alternative Auditory Feature (AFAAF) test, and the Bamford-Kowal_Bench Speech-In-Noise (BKB-SIN) test. The present study replicated the results of an earlier study using an equivalent speech recognition test. The results from the present study also showed that hearing aid users with high cognitive abilities performed better on the AFAAF and the BKB-SIN compared to those with low cognitive abilities when using short release time processing. Results showed that none of the speech recognition tests produced significantly different performance between the short and the long release times for either cognitive group. This finding did not support the hypothesis of the effect of linguistic context on aided speech recognition performance with different release time settings. Results from the present study suggest that cognitive ability might not be important in prescribing release time.
We live in an aging world. Illnesses that are prevalent and cause significant morbidity and mortality in older people will consume an increasing share of health care resources. One such illness is depression. This illness has a particularly devastating impact in the elderly because it is often undiagnosed or inadequately treated. Depression not only has a profound impact on quality of life but it is associated with an increased risk of mortality from suicide and vascular disease. In fact for every medical illness studied, e.g. heart disease, diabetes, cancer, individuals who are depressed have a worse prognosis. Research has illuminated the physiological and behavioral effects of depression that accounts for these poor outcomes. The deleterious relationship between depression and other illnesses has changed the concept of late-life depression from a "psychiatric disorder" that is diagnosed and treated by a psychiatrist to a common and serious disorder that is the responsibility of all physicians who care for patients over the age of 60.This is the first volume devoted to the epidemiology, phenomenology, psychobiology, treatment and consequences of late-life depression. Although much has been written about depressive disorders, the focus has been primarily on the illness as experienced in younger adults. The effects of aging on the brain, the physiological and behavioral consequences of recurrent depression, and the impact of other diseases common in the elderly, make late-life depression a distinct entity. There is a compelling need for a separate research program, specialized treatments, and a book dedicated to this disorder. This book will be invaluable to psychiatrists, gerontologists, clinical psychologists, social workers, students, trainees, and others who care for individuals over the age of sixty.
The loss of hearing - be it gradual or acute, mild or severe, present since birth or acquired in older age - can have significant effects on one's communication abilities, quality of life, social participation, and health. Despite this, many people with hearing loss do not seek or receive hearing health care. The reasons are numerous, complex, and often interconnected. For some, hearing health care is not affordable. For others, the appropriate services are difficult to access, or individuals do not know how or where to access them. Others may not want to deal with the stigma that they and society may associate with needing hearing health care and obtaining that care. Still others do not recognize they need hearing health care, as hearing loss is an invisible health condition that often worsens gradually over time. In the United States, an estimated 30 million individuals (12.7 percent of Americans ages 12 years or older) have hearing loss. Globally, hearing loss has been identified as the fifth leading cause of years lived with disability. Successful hearing health care enables individuals with hearing loss to have the freedom to communicate in their environments in ways that are culturally appropriate and that preserve their dignity and function. Hearing Health Care for Adults focuses on improving the accessibility and affordability of hearing health care for adults of all ages. This study examines the hearing health care system, with a focus on non-surgical technologies and services, and offers recommendations for improving access to, the affordability of, and the quality of hearing health care for adults of all ages.
The current study explored the impact of short term auditory training (LACE-Degraded) and auditory-cognitive training (LACE 4.0) on speech perceptual and cognitive measures in older adults with mild-moderate sensorineural hearing loss (SNHL). Thirty five participants, ages 60 to 80 years, with symmetrical mild-moderate SNHL completed a preliminary test battery of speech perceptual, cognitive, and self-report measures. The 35 study participants were randomly placed into one of three training groups (LACE 4.0, LACE-Degraded, or Short-Story Listening Training). Participants completed one week of training followed by post-testing. Multivariate Analysis of Variance was used to determine if significant improvements in speech perceptual, cognitive processing, and/or self-reported communication abilities occurred following the different training conditions. In addition, Pearson Product Moment correlation analyses were used to determine associations between experimental measures. No significant differences were found for initial measures of speech perceptual, cognitive processing, or self-report communication abilities; age or hearing loss between the three groups. The main finding was improvement for the LACE 4.0 group with increased performance on some speech perceptual and self-report measures. No strong correlations were found between changes in speech perception and initial measures of cognition or self-report. However, small to moderate significant correlations were found between selected speech perceptual measures, between cognitive processing measures, and between self-report measures. In the current study, tests sharing more common features tended to show significant correlations. Of interest, was a strong significant positive correlation that occurred between the Words in Noise test (speech perceptual measure) and the Time Compressed Speech test (processing speed measure). These two measures shared three out of five common task features and used words from the NU 6 word list. Unlike others studies, the current study focused on auditory and auditory-cognitive training in non-hearing aid users. These types of trainings may be a valid option for non-hearing aid users. Further confirmation of short-term training benefit is important because there is low compliance for completing the traditional longer training programs.
Age-related sensory loss and major neurocognitive impairment are two of the leading drivers of non-fatal disability burden among the oldest-old, and are often reported to co-occur. Both biological and social explanations have been given to account for links between these two functional domains. This thesis explores inter-associations between age-related hearing-loss with cognitive function. The broad substantive aims of this dissertation are: 1) to document the levels of hearing impairment, dual sensory loss, and co-morbid hearing-loss with cognitive impairment in an older adult population; 2) to identify predictors of decline in hearing acuity and its association with all-cause mortality risk; 3) to investigate longitudinal pathways between hearing thresholds, hearing aid use and processing speed. The Dynamic Analyses to Optimise Ageing (DYNOPTA) project is a collaborative inter-disciplinary project that has pooled nine Australian longitudinal studies of ageing. The DYNOPTA project constitutes an important methodological backdrop to this thesis. Data pooling is advantageous because it can enhance representativeness of a population, increased statistical power and allows for direct replication of effects. However, variability in study protocols and the need to orientate functionally equivalent measures onto a common scale can create analytic challenges. A subsidiary aim of this thesis will be to illustrate and evaluate the use of harmonised longitudinal data pooled from independently designed epidemiological surveys. This research presented in this thesis primarily draws upon data from two contributing DYNOPTA studies that began in the early 1990s and are ongoing. These two studies were selected because they collected functionally equivalent clinical measures of hearing, vision and cognition, as well as a range of comparable contextual variables including data on socio-demographics, health, noise exposure, and hearing aid use. Multistate Markov Chain models estimated transition rates and expected years lived with sensory impairment. Joint Survival-Growth Curve models demonstrated that hearing loss was associated with increased mortality risk in women but not in men. Linear Mixed Models were used to identify predictors of hearing trajectories. Bi-variate Dual Change Score models demonstrated that low levels of hearing were leading indicators of subsequent rates of decline in processing speed. Finally, hearing-aid use was shown to be associated with improved levels of processing speed after adjusting for the effects of hearing thresholds, but did not attenuate rates of decline in processing speed. Hearing loss and cognitive impairment are highly prevalent and contribute to a significant number of years lived with functional impairment in late life. Links between hearing and cognition may be due to common biological processes. Alternatively, hearing loss could limit opportunities to engage in activities that promote and maintain cognitive reserves. Reductions in cognitive resources may also mean that older adults are less well equipped to deal with sensory ageing. In the context of this thesis, the main benefits of pooling and harmonization were the capacity to derive coarse population level estimates and the fostering of inter-disciplinary collaboration. However, it was necessary to return to the use of single study data to facilitate investigations into more fine grained causal pathways between hearing and cognition.
Efficient auditory processing requires the rapid integration of transient sensory inputs. This is exemplified in human speech perception, in which long stretches of a complex acoustic signal are typically processed accurately and essentially in real-time. Spoken language thus presents listeners’ auditory systems with a considerable challenge even when acoustic input is clear. However, auditory processing ability is frequently compromised due to congenital or acquired hearing loss, or altered through background noise or assistive devices such as cochlear implants. How does loss of sensory fidelity impact neural processing, efficiency, and health? How does this ultimately influence behavior? This Research Topic explores the neural consequences of hearing loss, including basic processing carried out in the auditory periphery, computations in subcortical nuclei and primary auditory cortex, and higher-level cognitive processes such as those involved in human speech perception. By pulling together data from a variety of disciplines and perspectives, we gain a more complete picture of the acute and chronic consequences of hearing loss for neural functioning.