American Geriatrics Society and National Institute on Aging Bench-to-Bedside conference: sensory impairment and cognitive decline in older adults

This article summarizes the presentations and recommendations of the tenth annual American Geriatrics Society and National Institute on Aging Bench‐to‐Bedside research conference, “Sensory Impairment and Cognitive Decline,” on October 2–3, 2017, in Bethesda, Maryland. The risk of impairment in hearing, vision, and other senses increases with age, and almost 15% of individuals aged 70 and older have dementia. As the number of older adults increases, sensory and cognitive impairments will affect a growing proportion of the population. To limit its scope, this conference focused on sensory impairments affecting vision and hearing. Comorbid vision, hearing, and cognitive impairments in older adults are more common than would be expected by chance alone, suggesting that some common mechanisms might affect these neurological systems. This workshop explored the mechanisms and consequences of comorbid vision, hearing, and cognitive impairment in older adults; effects of sensory loss on the aging brain; and bench‐to‐bedside innovations and research opportunities. Presenters and participants identified many research gaps and questions; the top priorities fell into 3 themes: mechanisms, measurement, and interventions. The workshop delineated specific research questions that provide opportunities to improve outcomes in this growing population.Funding was provided by National Institutes of Health (NIH) Grant U13 AG054139-01. Dr. Whitson's efforts and contributions were supported by R01AG043438, R24AG045050, UH2AG056925, and 5P30AG028716. Dr. Lin's effort and contributions were also supported by R01AG055426, R01HL096812, and R33DC015062. (U13 AG054139-01 - National Institutes of Health (NIH); R01AG043438; R24AG045050; UH2AG056925; 5P30AG028716; R01AG055426; R01HL096812; R33DC015062)Accepted manuscrip

Enhanced activation of the left inferior frontal gyrus in deaf and dyslexic adults during rhyming

Hearing developmental dyslexics and profoundly deaf individuals both have difficulties processing the internal structure of words (phonological processing) and learning to read. In hearing non-impaired readers, the development of phonological representations depends on audition. In hearing dyslexics, many argue, auditory processes may be impaired. In congenitally profoundly deaf individuals, auditory speech processing is essentially absent. Two separate literatures have previously reported enhanced activation in the left inferior frontal gyrus in both deaf and dyslexic adults when contrasted with hearing non-dyslexics during reading or phonological tasks. Here, we used a rhyme judgement task to compare adults from these two special populations to a hearing non-dyslexic control group. All groups were matched on non-verbal intelligence quotient, reading age and rhyme performance. Picture stimuli were used since this requires participants to generate their own phonological representations, rather than have them partially provided via text. By testing well-matched groups of participants on the same task, we aimed to establish whether previous literatures reporting differences between individuals with and without phonological processing difficulties have identified the same regions of differential activation in these two distinct populations. The data indicate greater activation in the deaf and dyslexic groups than in the hearing non-dyslexic group across a large portion of the left inferior frontal gyrus. This includes the pars triangularis, extending superiorly into the middle frontal gyrus and posteriorly to include the pars opercularis, and the junction with the ventral precentral gyrus. Within the left inferior frontal gyrus, there was variability between the two groups with phonological processing difficulties. The superior posterior tip of the left pars opercularis, extending into the precentral gyrus, was activated to a greater extent by deaf than dyslexic participants, whereas the superior posterior portion of the pars triangularis extending into the ventral pars opercularis, was activated to a greater extent by dyslexic than deaf participants. Whether these regions play differing roles in compensating for poor phonological processing is not clear. However, we argue that our main finding of greater inferior frontal gyrus activation in both groups with phonological processing difficulties in contrast to controls suggests greater reliance on the articulatory component of speech during phonological processing when auditory processes are absent (deaf group) or impaired (dyslexic group). Thus, the brain appears to develop a similar solution to a processing problem that has different antecedents in these two populations

Surveying Persons with Disabilities: A Source Guide (Version 1)

As a collaborator with the Cornell Rehabilitation Research and Training Center on Disability Demographics and Statistics, Mathematica Policy Research, Inc. has been working on a project that identifies the strengths and limitations in existing disability data collection in both content and data collection methodology. The intended outcomes of this project include expanding and synthesizing knowledge of best practices and the extent existing data use those practices, informing the development of data enhancement options, and contributing to a more informed use of existing data. In an effort to provide the public with an up-to-date and easily accessible source of research on the methodological issues associated with surveying persons with disabilities, MPR has prepared a Source Guide of material related to this topic. The Source Guide contains 150 abstracts, summaries, and references, followed by a Subject Index, which cross references the sources from the Reference List under various subjects. The Source Guide is viewed as a “living document,” and will be periodically updated

Verbal Learning and Memory After Cochlear Implantation in Postlingually Deaf Adults: Some New Findings with the CVLT-II

OBJECTIVES: Despite the importance of verbal learning and memory in speech and language processing, this domain of cognitive functioning has been virtually ignored in clinical studies of hearing loss and cochlear implants in both adults and children. In this article, we report the results of two studies that used a newly developed visually based version of the California Verbal Learning Test-Second Edition (CVLT-II), a well-known normed neuropsychological measure of verbal learning and memory. DESIGN: The first study established the validity and feasibility of a computer-controlled visual version of the CVLT-II, which eliminates the effects of audibility of spoken stimuli, in groups of young normal-hearing and older normal-hearing (ONH) adults. A second study was then carried out using the visual CVLT-II format with a group of older postlingually deaf experienced cochlear implant (ECI) users (N = 25) and a group of ONH controls (N = 25) who were matched to ECI users for age, socioeconomic status, and nonverbal IQ. In addition to the visual CVLT-II, subjects provided data on demographics, hearing history, nonverbal IQ, reading fluency, vocabulary, and short-term memory span for visually presented digits. ECI participants were also tested for speech recognition in quiet. RESULTS: The ECI and ONH groups did not differ on most measures of verbal learning and memory obtained with the visual CVLT-II, but deficits were identified in ECI participants that were related to recency recall, the buildup of proactive interference, and retrieval-induced forgetting. Within the ECI group, nonverbal fluid IQ, reading fluency, and resistance to the buildup of proactive interference from the CVLT-II consistently predicted better speech recognition outcomes. CONCLUSIONS: Results from this study suggest that several underlying foundational neurocognitive abilities are related to core speech perception outcomes after implantation in older adults. Implications of these findings for explaining individual differences and variability and predicting speech recognition outcomes after implantation are discussed

Psychosocial impact of visual impairment in working age adults

This is an open access article - Copyright @ 2010 BMJ Publishing GroupAim: To review the evidence for the presence of lower levels of psychosocial well-being in working-age adults with visual impairment and for interventions to improve such levels of psychosocial well-being. Methods: Systematic review of quantitative studies published in English from 2001 to July 2008 that measured depression/mental health, anxiety, quality of life, social functioning or social support. Results: Included were 29 studies that measured one or more outcomes (N=52). Working-age adults with visual impairment were significantly more likely to report lower levels of mental health (mean difference=14.51/100), social functioning (MD=11.55/100) and quality of life. Studies regarding the prevalence of depressive symptoms produced inconsistent results but had methodological limitations. Conclusions: Future research is required into the prevalence of loneliness, anxiety and depression in adults with visual impairment, and to evaluate the effectiveness of interventions for improving psychosocial well-being such as counselling, peer support and employment programmes.Funding was obtained from the Thomas Pocklington Trust, 5 Castle Row, Horticultural Place, Chiswick, London W4 4JQ

The influence of facemasks on communication in healthcare settings: a systematic review

PurposeAlthough a well-established aspect of healthcare practice, the impact of facemasks on verbal communication is surprisingly ambiguous.Materials and MethodsA systematic search was conducted in APA PSYCHinfo, CINAHL, NHS Knowledge Network, Medline and SPORTDiscus databases from inception to November 2022 according to the PRISMA guidelines. Studies reporting an objective measure of speech understanding in adults, where information was transmitted or received whilst wearing a facemask were included. Risk of bias of included studies was assessed with the Newcastle-Ottawa score.ResultsFour hundred and thirty-three studies were identified, of which fifteen were suitable for inclusion, incorporating 350 participants with a median age of 49 (range 19 to 74) years. Wide heterogeneity of test parameters and outcome measurement prohibited pooling of data. 93% (14 of 15) studies reported a deleterious effect of facemasks on speech understanding, and 100% (5 of 5) of the included studies reported attenuation of sound with facemask usage. Background noise added further deleterious effects on speech understanding which was particularly problematic within hearing-impaired populations. Risk of bias in included studies varied but overall was modest.ConclusionsDespite considerable complexity and heterogeneity in outcome measure, 93% (14 of 15) articles suggest respiratory protective equipment negatively affects speech understanding in normal hearing and hearing-impaired adults.Implications for Rehabilitation As a result of the covid-19 pandemic, facemask use is now commonplace across all healthcare and rehabilitation settings and has material implications for interpersonal communication. This systematic review of human communicative studies highlights that the use of facemasks does indeed inhibit communication through effects on speech intelligibility and through sound attenuation. These effects are evident in both normal hearing and hearing-impaired adults due to the visual cues required with lipreading and facial expressions during communication. The presence of background noise also produces deleterious effects on speech understanding and is more problematic for hearing-impaired populations. Simple recommendations to reduce background noise (where possible), to step closer (where social-distancing rules permit), to speak louder or to use speech to text applications (if practical) could all mitigate these communicative barriers. Further an awareness of persons with hearing impairments, the function (or otherwise) of hearing aids in those patients that require these, and an ability to use transparent facemasks can be specifically helpful

Disability Employment Policies and Practices in U.S. Federal Government Agencies

A survey of U.S. Federal agencies was initiated by the Presidential Task Force on Employment of Adults with Disabilities, and 403 representatives of U.S. Federal agencies were surveyed to determine their response to the employment nondiscrimination, affirmative action, and accommodation requirements of the Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973, as amended

Auditory training and adult rehabilitation:a critical review of the evidence

Auditory Training (AT) describes a regimen of varied listening exercises designed to improve an individual’s ability to perceive speech. The theory of AT is based on brain plasticity (the capacity of neurones in the central auditory system to alter their structure and function) in response to auditory stimulation. The practice of repeatedly listening to the speech sounds included in AT exercises is believed to drive the development of more efficient neuronal pathways, thereby improving auditory processing and speech discrimination. This critical review aims to assess whether auditory training can improve speech discrimination in adults with mild-moderate SNHL. The majority of patients attending Audiology services are adults with presbyacusis and it is therefore important to evaluate evidence of any treatment effect of AT in aural rehabilitation. Ideally this review would seek to appraise evidence of neurophysiological effects of AT so as to verify whether it does induce change in the CAS. However, due to the absence of such studies on this particular patient group, the outcome measure of speech discrimination, as a behavioural indicator of treatment effect is used instead. A review of available research was used to inform an argument for or against using AT in rehabilitative clinical practice. Six studies were identified and although the preliminary evidence indicates an improvement gained from a range of AT paradigms, the treatment effect size was modest and there remains a lack of large-sample RCTs. Future investigation into the efficacy of AT needs to employ neurophysiological studies using auditory evoked potentials in hearing-impaired adults in order to explore effects of AT on the CAS