Visual Inhibition Measures Predict Speech-in-Noise Perception Only in People With Low Levels of Education

Inhibition—the ability to suppress goal-irrelevant information—is thought to be an important cognitive skill in many situations, including speech-in-noise (SiN) listening. Both inhibition and SiN perception are thought to worsen with age, but attempts to connect age-related declines in these two abilities have produced mixed results even though a clear positive relationship has generally been hypothesized. We suggest that these inconsistencies may occur because listener-based demographic variables such as educational attainment modulate the relationship between inhibition and SiN perception. We tested this hypothesis with a group of 50 older adults (61–86 years, mean: 69.5) with mild-to-moderate age-related hearing loss (8–53 average dB HL, mean: 25.3 dB HL). Participants performed a visual Stroop task and two SiN tasks. In a Stroop task one stimulus dimension is named while a second, more prepotent dimension is ignored. Results show a clear influence of educational attainment on the relationship of visual Stroop scores to SiN performance, but only for those with lower levels of education. These findings highlight for the first time the importance of considering potentially heterogeneous demographic listener variables when analyzing cognitive tasks and their relationship to SiN perception

Un comentario al texto Coneixences de les monedes de los Memoriales de Pere Miquel Carbonell

Published studies assessing the association between cognitive performance and speech-in-noise perception examine different aspects of each, test different listeners, and often report quite variable associations. By examining the published evidence base using a systematic approach, we aim to identify robust patterns across studies and highlight any remaining gaps in knowledge. We limit our assessment to adult non-hearing aid users with audiometric profiles ranging from normal hearing to moderate hearing loss. A total of 253 articles were independently assessed by two researchers, with 25 meeting the criteria for inclusion. Included articles assessed cognitive measures of attention, memory, executive function, IQ and processing speed. Speech-in-noise measures varied by target (phonemes/syllables, words, sentences) and masker type (unmodulated noise, modulated noise, multi (n>2) talker babble, and n<2 talker babble). The overall association between cognitive performance and speech-in-noise perception was r=0.31. For component cognitive domains, the association with (pooled) speech-in-noise perception were; processing speed (r=0.39), inhibitory control (r=0.34), working memory (r=0.28), episodic memory (r=0.26) and crystalized IQ (r=0.18). Similar associations were shown for the different speech target and masker types. This review suggests a general association of r≈0.3 between cognitive performance and speech perception, although some variability in association appeared to exist depending on cognitive domain and speech-in-noise target or masker assessed. Where assessed, degree of unaided hearing loss did not play a major moderating role. We identify a number of cognitive performance and speech-in-noise perception combinations that have not been tested, and whose future investigation would enable further finer-grained analyses of these relationships

A review of auditory processing and cognitive change during normal ageing, and the implications for setting hearing aids for older adults

Throughout our adult lives there is a decline in peripheral hearing, auditory processing and elements of cognition that support listening ability. Audiometry provides no information about the status of auditory processing and cognition, and older adults often struggle with complex listening situations, such as speech in noise perception, even if their peripheral hearing appears normal. Hearing aids can address some aspects of peripheral hearing impairment and improve signal-to-noise ratios. However, they cannot directly enhance central processes and may introduce distortion to sound that might act to undermine listening ability. This review paper highlights the need to consider the distortion introduced by hearing aids, specifically when considering normally-ageing older adults. We focus on patients with age-related hearing loss because they represent the vast majority of the population attending audiology clinics. We believe that it is important to recognize that the combination of peripheral and central, auditory and cognitive decline make older adults some of the most complex patients seen in audiology services, so they should not be treated as “standard” despite the high prevalence of age-related hearing loss. We argue that a primary concern should be to avoid hearing aid settings that introduce distortion to speech envelope cues, which is not a new concept. The primary cause of distortion is the speed and range of change to hearing aid amplification (i.e., compression). We argue that slow-acting compression should be considered as a default for some users and that other advanced features should be reconsidered as they may also introduce distortion that some users may not be able to tolerate. We discuss how this can be incorporated into a pragmatic approach to hearing aid fitting that does not require increased loading on audiology services

Sign Comprehension in Young Adults, the Healthy Elderly, and Older People with Varying Levels of Cognitive Impairment - Report Series # 5

This study, conducted in the fall of 2004 and the winter of 2005, sought to determine whether sign comprehension suffers in healthy aging and in the presence of cognitive impairment. Sign comprehension is critical for effective driving, response to warnings and way-finding. If signs are poorly comprehended by older people including those with cognitive impairment, accident risk will be increased and independence may be compromised. Groups of young adults, healthy older adults and older adults with varying levels of cognitive impairment were asked the meaning of 65 signs used for driving, warning and way-finding. Healthy older adults were generally good at sign comprehension, but had some difficulty with way-finding signs. Older adults with cognitive impairments had poorer sign comprehension overall and were particularly poor with way-finding signage. Testing of sign comprehension needs to involve a more heterogeneous sampling of older adults. As well, signs that include text would be beneficial to those with cognitive impairment

The German version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): psychometric properties and diagnostic utility

Background: The Posttraumatic Stress Disorder (PTSD) Checklist (PCL, now PCL-5) has recently been revised to reflect the new diagnostic criteria of the disorder. Methods: A clinical sample of trauma-exposed individuals (N = 352) was assessed with the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and the PCL-5. Internal consistencies and test-retest reliability were computed. To investigate diagnostic accuracy, we calculated receiver operating curves. Confirmatory factor analyses (CFA) were performed to analyze the structural validity. Results: Results showed high internal consistency (α = .95), high test-retest reliability (r = .91) and a high correlation with the total severity score of the CAPS-5, r = .77. In addition, the recommended cutoff of 33 on the PCL-5 showed high diagnostic accuracy when compared to the diagnosis established by the CAPS-5. CFAs comparing the DSM-5 model with alternative models (the three-factor solution, the dysphoria, anhedonia, externalizing behavior and hybrid model) to account for the structural validity of the PCL-5 remained inconclusive. Conclusions: Overall, the findings show that the German PCL-5 is a reliable instrument with good diagnostic accuracy. However, more research evaluating the underlying factor structure is needed

Effective communication as a fundamental aspect of active aging and well-being: paying attention to the challenges older adults face in noisy environments

Successful communication is vital to active aging and well-being, yet virtually all older adults find it challenging to communicate effectively in noisy environments. The resulting discomfort and frustration can prompt withdrawal or avoidance of social situations, which, in turn, can severely limit the range of activities available to older adults and lead to a less active and satisfying lifestyle, and, in some cases, depression. Using the International Classification of Functioning, Disability and Health’s (ICF) multifactorial model (WHO, 2001), we review the wider aspects of functioning and disability as they relate to hearing difficulties and communication, placing a particular emphasis on the work we, an international and interdisciplinary group of researchers, have done in the context of the ERA-NET funded interdisciplinary HEARATTN project. The ICF model is particularly fitting because it allows us to consider how physiological changes in hearing and cognition affect listening in various situations, what the consequences of these changes are for communicative abilities and social participation, and how this in turn affects life-space mobility, self-reported well-being, and, ultimately, quality of life. We will discuss how environmental conditions (both physical and social) and personal factors can affect how well older adults can communicate in the situations characteristic of everyday life. In the concluding section we discuss some behaviors, techniques and strategies that can be adopted to maintain or improve effective communication under difficult listening conditions

Clinical Trials and Outcome Measures in Adults With Hearing Loss

From Frontiers via Jisc Publications RouterHistory: collection 2021, received 2021-06-29, accepted 2021-10-20, epub 2021-11-05Publication status: PublishedClinical trials are designed to evaluate interventions that prevent, diagnose or treat a health condition and provide the evidence base for improving practice in health care. Many health professionals, including those working within or allied to hearing health, are expected to conduct or contribute to clinical trials. Recent systematic reviews of clinical trials reveal a dearth of high quality evidence in almost all areas of hearing health practice. By providing an overview of important steps and considerations concerning the design, analysis and conduct of trials, this article aims to give guidance to hearing health professionals about the key elements that define the quality of a trial. The article starts out by situating clinical trials within the greater scope of clinical evidence, then discusses the elements of a PICO-style research question. Subsequently, various methodological considerations are discussed including design, randomization, blinding, and outcome measures. Because the literature on outcome measures within hearing health is as confusing as it is voluminous, particular focus is given to discussing how hearing-related outcome measures affect clinical trials. This focus encompasses how the choice of measurement instrument(s) affects interpretation, how the accuracy of a measure can be estimated, how this affects the interpretation of results, and if differences are statistically, perceptually and/or clinically meaningful to the target population, people with hearing loss

Cogmed training does not generalise to real-world benefits for adult hearing aid users: results of a blinded, active-controlled randomised trial

Objectives: Performance on working memory tasks is positively associated with speech-in-noise perception performance, particularly where auditory inputs are degraded. It is suggested that interventions designed to improve working memory capacity may improve domain-general working memory performance for people with hearing loss, to benefit their real-world listening. We examined whether a 5-week training program that primarily targets the storage component of working memory (Cogmed RM, adaptive) could improve cognition, speech-in-noise perception and self-reported hearing in a randomized controlled trial of adult hearing aid users with mild to moderate hearing loss, compared with an active control (Cogmed RM, nonadaptive) group of adults from the same population. Design: A preregistered randomized controlled trial of 57 adult hearing aid users (n = 27 experimental, n = 30 active control), recruited from a dedicated database of research volunteers, examined on-task learning and generalized improvements in measures of trained and untrained cognition, untrained speech-in-noise perception and self-reported hearing abilities, pre- to post-training. Participants and the outcome assessor were both blinded to intervention allocation. Retention of training-related improvements was examined at a 6-month follow-up assessment. Results: Per-protocol analyses showed improvements in trained tasks (Cogmed Index Improvement) that transferred to improvements in a trained working memory task tested outside of the training software (Backward Digit Span) and a small improvement in self-reported hearing ability (Glasgow Hearing Aid Benefit Profile, Initial Disability subscale). Both of these improvements were maintained 6-month post-training. There was no transfer of learning shown to untrained measures of cognition (working memory or attention), speech-in-noise perception, or self-reported hearing in everyday life. An assessment of individual differences showed that participants with better baseline working memory performance achieved greater learning on the trained tasks. Post-training performance for untrained outcomes was largely predicted by individuals' pretraining performance on those measures. Conclusions: Despite significant on-task learning, generalized improvements of working memory training in this trial were limited to (a) improvements for a trained working memory task tested outside of the training software and (b) a small improvement in self-reported hearing ability for those in the experimental group, compared with active controls. We found no evidence to suggest that training which primarily targets storage aspects of working memory can result in domain-general improvements that benefit everyday communication for adult hearing aid users. These findings are consistent with a significant body of evidence showing that Cogmed training only improves performance for tasks that resemble Cogmed training. Future research should focus on the benefits of interventions that enhance cognition in the context in which it is employed within everyday communication, such as training that targets dynamic aspects of cognitive control important for successful speech-in-noise perception

factor structure and symptom profiles

Background: The proposed ICD-11 criteria for trauma-related disorders define posttraumatic stress disorder (PTSD) and complex posttraumatic stress disorder (cPTSD) as separate disorders. Results of previous studies support the validity of this concept. However, due to limitations of existing studies (e.g. homogeneity of the samples), the present study aimed to test the construct validity and factor structure of cPTSD and its distinction from PTSD using a heterogeneous trauma-exposed sample. Method: Confirmatory factor analyses (CFAs) were conducted to explore the factor structure of the proposed ICD-11 cPTSD diagnosis in a sample of 341 trauma-exposed adults (n = 191 female, M = 37.42 years, SD = 12.04). In a next step, latent profile analyses (LPAs) were employed to evaluate predominant symptom profiles of cPTSD symptoms. Results: The results of the CFA showed that a six-factor structure (i.e. symptoms of intrusion, avoidance, hyperarousal and symptoms of affective dysregulation, negative self-concept, and interpersonal problems) fits the data best. According to LPA, a four-class solution optimally characterizes the data. Class 1 represents moderate PTSD and low symptoms in the specific cPTSD clusters (PTSD group, 30.4%). Class 2 showed low symptom severity in all six clusters (low symptoms group, 24.1%). Classes 3 and 4 both exhibited cPTSD symptoms but differed with respect to the symptom severity (Class 3: cPTSD, 34.9% and Class 4: severe cPTSD, 10.6%). Conclusions: The findings replicate previous studies supporting the proposed factor structure of cPTSD in ICD-11. Additionally, the results support the validity and usefulness of conceptualizing PTSD and cPTSD as discrete mental disorders