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Purpose: Hearing loss (HL) is associated with cognitive performance in older adults, including performance on the Montreal Cognitive Assessment (MoCA), a brief cognitive screening test. Yet, despite well-established sex-related differences in both hearing and cognition, very few studies have tested whether there are sex-related differences in auditory-cognitive associations., Method: In the current cross-sectional retrospective analysis, we examined sex-related differences in hearing and cognition in 193 healthy older adults ( M = 69 years, 60% women). Hearing was measured using audiometry (pure-tone average [PTA] of thresholds at 500, 1000, 2000, and 4000 Hz in the worse ear). Cognition was assessed using the MoCA. Additionally, we calculated MoCA scores with hearing-dependent subtests excluded from scoring (MoCA-Modified)., Results: Men and women did not differ in age, education, or history of depression. Women had better hearing than men. Women with normal hearing were more likely to pass the MoCA compared with their counterparts with HL. In contrast, the likelihood of passing the MoCA did not depend on hearing status in men. Linear regression analysis showed an interaction between sex and PTA in the worse ear. PTAs were significantly correlated with both MoCA and MoCA-Modified scores in women, whereas this was not observed in the men., Conclusions: This study is one of the first to demonstrate significant sex-related differences in auditory-cognitive associations even when hearing-related cognitive test items are omitted. Potential mechanisms underlying these female-specific effects are discussed., Supplemental Material: https://doi.org/10.23641/asha.19233297.

Objective: A high prevalence of hearing loss in older adults contrasts with a small proportion of people who seek help. Emerging developments in hearing healthcare (HHC) could reduce costs but may not increase access. This study evaluated older adults' perceptions of current and future HHC services in Australia, England, US and Canada to explore potential levers and system improvements., Methods: Semi-structured focus groups (n = 47) were conducted, and data were analysed using a directed content analysis. Participants were adults 60 years and older with a) no hearing problems; b) hearing problems and hearing aid use; and c) hearing problems and no hearing aid use., Results: Perceived barriers, facilitators and preferences were largely consistent across countries, with stigma and trust in HHC being the barriers most often discussed., Conclusion: Although cost and access were consistently deemed important, there may be limited change in help-seeking and HHC uptake unless the key barriers of trust and stigma are addressed. When seeking to undertake transformative change to healthcare it is important to engage recipients of care to understand existing barriers and coproduce a user-centered solution., Competing Interests: AD has received sponsorship from GN Resound to attend conferences, a fee from Natus for lecturing, and royalties paid to Manchester University (when he was employed there) for the intellectual property for Siemen’s HearCheck Screener. KT has received fees from Lend an Ear Inc. for consultancy and developing educational presentations.

Successful performance of balance-related activities requires the effective integration of sensory, cognitive, and motor processes that can be affected by age-related changes. Of these age-related sensory changes, the effects of declines in hearing on balance have not been well-studied despite the fact that hearing loss has now been acknowledged as a significant risk factor for falls. The goal of this study was to evaluate age-related differences in a "standing while listening" task within increasingly challenging conditions resembling those that are often encountered in realistic, everyday situations. This study used a dual-task paradigm in an immersive Virtual Reality street scene setting in which postural load (firm, compliant), listening load (number of talkers), and visual load (eyes open/closed) were manipulated. A multi-talker divided attention listening task was used. Postural performance was assessed using center of pressure (COP) path length, while listening performance was assessed using spoken word recognition accuracy. Results demonstrated that age-related differences were observed in postural performance when postural demands were the highest and in listening performance when listening demands were the highest. Proportional dual-task costs were more pronounced for postural task performance compared to listening task performance and were more pronounced for older compared to younger adults. Postural dual-task costs increased as a function of increasing listening loads. Removal of visual information improved listening task performance across both groups and reduced the dual-task costs to listening in older adults when listening demands were highest (resulting in dual-task benefits). Taken together, the findings support previously documented age-related declines in postural control and auditory processing, demonstrate that increasing listening demands may result in poorer balance, particularly in older adults, and provide additional insights into the interactive effects of age-related declines when sensory, motor, and cognitive challenges are incremented factorially., (Copyright © 2020 Elsevier B.V. All rights reserved.)

This study examined the effects of age on single- and dual-task listening and walking during virtual street crossing. Seventeen younger and 12 older adults participated. In each listening trial, three sentences were presented simultaneously from separate locations. Participants were instructed to report the target sentence. Predictability of the target sentence location was varied. Treadmill walking was measured using motion analysis. Measures included word recognition accuracy, head and trunk angles, and spatiotemporal gait parameters. Older adults exhibited a more upright head alignment and less variability in stride time during dual-tasking, particularly under less certain target sentence location conditions. Younger adults' walking was unaffected by dual-task demands. Together, the results indicate greater postural prioritization in older adults than young.

Hearing helps us know where we are relative to important events and objects in our environment and it allows us to track our changing position dynamically over space and time. Auditory cues are used in combination with other sensory inputs (visual, vestibular, proprioceptive) to help us perceive our own movements through space, known as self-motion perception. Whether we are maintaining standing balance, walking, or driving, audition can provide unique and important information to help optimize self-motion perception, and consequently to support safe mobility. Recent epidemiological and experimental studies have provided evidence that hearing loss is associated with greater walking difficulties, poorer overall physical functioning, and a significantly increased risk of falling in older adults. Importantly, the mechanisms underlying the associations between hearing status and mobility are poorly understood. It is also critical to consider that age-related hearing loss is often concomitant with declines in other sensory, motor, and cognitive functions and that these declines may interact, particularly during realistic, everyday tasks. Overall, exploring the role of auditory cues and the effects of hearing loss on self-motion perception specifically, and mobility more generally, are important to both building fundamental knowledge about the perceptual processes underlying the ability to perceive our movements through space, as well as to optimizing mobility-related interventions for those with hearing loss so that they can function better when confronted by everyday, real-world, sensory-motor challenges. The goal of this paper is to explore the role of hearing in self-motion perception across a range of mobility-related behaviors. First, we briefly review the ways in which auditory cues are used to perceive self-motion and how sound inputs affect behaviors such as standing balance, walking, and driving. Next, we consider age-related changes in auditory self-motion perception and the potential consequences to performance on mobility-related tasks. We then describe how hearing loss is associated with declines in mobility-related abilities and increased adverse outcomes such as falls. We describe age-related changes to other sensory and cognitive functions and how these may interact with hearing loss in ways that affect mobility. Finally, we briefly consider the implications of the hearing-mobility associations with respect to applied domains such as screening for mobility problems and falls risk in those with hearing loss and developing interventions and training approaches targeting safe and independent mobility throughout the lifespan., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: The effects of directing, switching, and misdirecting auditory spatial attention in a complex listening situation were investigated in 8 younger and 8 older listeners with normal-hearing sensitivity below 4 kHz., Design: In two companion experiments, a target sentence was presented from one spatial location and two competing sentences were presented simultaneously, one from each of two different locations. Pretrial, listeners were informed of the call-sign cue that identified which of the three sentences was the target and of the probability of the target sentence being presented from each of the three possible locations. Four different probability conditions varied in the likelihood of the target being presented at the left, center, and right locations. In Experiment 1, four timing conditions were tested: the original (unedited) sentences (which contained about 300 msec of filler speech between the call-sign cue and the onset of the target words), or modified (edited) sentences with silent pauses of 0, 150, or 300 msec replacing the filler speech. In Experiment 2, when the cued sentence was presented from an unlikely (side) listening location, for half of the trials the listener's task was to report target words from the cued sentence (cue condition); for the remaining trials, the listener's task was to report target words from the sentence presented from the opposite, unlikely (side) listening location (anticue condition)., Results: In Experiment 1, for targets presented from the likely (center) location, word identification was better for the unedited than for modified sentences. For targets presented from unlikely (side) locations, word identification was better when there was more time between the call-sign cue and target words. All listeners benefited similarly from the availability of more compared with less time and the presentation of continuous compared with interrupted speech. In Experiment 2, the key finding was that age-related performance deficits were observed in conditions requiring anticue but not cue responses., Conclusions: The findings from Experiment 1 suggest that for both age groups, stream continuity mediates the process of allocating and maintaining auditory spatial attention when the target originates at an expected location, but that time is needed for the reallocation of auditory spatial attention when the target originates at an unexpected location. The findings from Experiment 2 suggest that when attention is momentarily misdirected, difficulties disengaging attention may help explain why older adults with good hearing report difficulty communicating in multi-talker listening situations.

Background: Age-related declines in auditory and cognitive processing may contribute to the difficulties with listening in noise that are often reported by older adults. Such difficulties are reported even by those who have relatively good audiograms that could be considered "normal" for their age (ISO 7029-2000 [ISO, 2000]). The Speech, Spatial, and Qualities of Hearing Scale (SSQ; Gatehouse and Noble, 2004) is a questionnaire developed to measure a listener's self-reported ability to hear in a variety of everyday situations, such as those that are challenging for older adults, and it can provide insights into the possible contributions of auditory and cognitive factors to their listening difficulties. The SSQ has been shown to be a sensitive and reliable questionnaire to detect benefits associated with the use of different hearing technologies and potentially other forms of intervention. Establishing how age-matched listeners with audiograms "normal" for their age rate the items on the SSQ could enable an extension of its use in audiological assessment and in setting rehabilitative goals., Purpose: The main purpose of this study was to investigate how younger and older adults who passed audiometric screening and who had thresholds considered to be "normal" for their age responded on the SSQ. It was also of interest to compare these results to those reported previously for older listeners with hearing loss in an attempt to tease out the relative effects of age and hearing loss., Study Sample: The SSQ was administered to 48 younger (mean age = 19 yr; SD = 1.0) and 48 older (mean age = 70 yr, SD = 4.1) adults with clinically normal audiometric thresholds below 4 kHz. The younger adults were recruited through an introductory psychology course, and the older adults were volunteers from the local community., Data Collection and Analysis: Both age groups completed the SSQ. The differences between the groups were analyzed. Correlations were used to compare the pattern of results across items for the two age groups in the present study and to assess the relationship between SSQ scores and objective measures of hearing. Comparisons were also made to published results for older adults with hearing loss., Results: The pattern of reported difficulty across items was similar for both age groups, but younger adults had significantly higher scores than older adults on 42 of the 46 items. On average, younger adults scored 8.8 (SD = 0.6) out of 10 and older adults scored 7.7 (SD = 1.2) out of 10. By comparison, scores of 5.5 (SD = 1.9) have been reported for older adults (mean age = 71 yr, SD = 8.1) with moderate hearing loss (Gatehouse and Noble, 2004)., Conclusions: By establishing the best scores that could reasonably be expected from younger and older adults with "normal" hearing thresholds, these results provide clinicians with information that should assist them in setting realistic targets for interventions for adults of different ages., (American Academy of Audiology.)

The purposes of the study were to examine the test-retest properties of the speech, spatial, and qualities of hearing scale (SSQ) and to determine if the method of test administration affected these properties. Four groups of 40 older adult participants completed the SSQ twice at an interval of about a half year, using either the same or different administration methods at the two test times. The SSQ was administered using an interview method and/or it was self-administered and then returned by mail. Although the method of test administration did not systematically affect scores on the SSQ, the highest test-retest correlation (r = 0.83) was observed using the interview method at both test times, making it the best choice for the purpose of demonstrating the effectiveness of interventions. The other three combinations of dual-administration in this study also provided reliable results and may be preferable because the self-administration method is less time-consuming and labour-intensive.

This study investigates whether temporally jittered stimuli will produce performance-intensity, phonetically balanced (PI-PB) rollover in young adults with normal hearing. Although not yet explicitly stated in the literature, there is clinical and theoretical evidence to suggest that PI-PB rollover, such as that found in cases of acoustic neuroma, is caused by neural dyssynchrony in the auditory system. Sixteen participants were tested with intact and temporally jittered word lists in quiet at 40, 55, 65, and uncomfortable listening level -5 dB HL. The results show significant rollover in the jittered but not the intact conditions. The results are consistent with the existing evidence that suggests that neural PI-PB rollover is caused by decreased neural synchrony and support the claim that temporal jitter simulates neural dyssynchrony. Furthermore, these results are consistent with the hypothesis that synchrony coding plays an important role in the perception of high-level speech.

Four dichotic thresholds (S pi N0, S0 N pi, S0 N tau, and S pi N pi tau) were measured for young and old subjects using both burst and continuous broadband maskers. Masking-level differences (MLDs) were determined by subtracting dichotic thresholds from homophasic thresholds (S0 N0 or S pi N pi). The S0 N0 thresholds for the old subjects did not differ significantly from those for the young subjects in either the continuous or the burst masking noise conditions. The S pi N pi thresholds for the old subjects did not differ significantly from those for the young subjects in the continuous masking noise condition, but there was a significant age effect (3 dB) when burst masking noise was used. Both young and old subjects obtained larger MLDs in continuous masking noise than in burst masking noise. MLDs for old subjects were smaller than MLDs for young subjects by 4.3, 5.0, 2.7, and 1.6 dB in burst masking noise and by 4.9, 3.5, 2.5, and 1.4 dB in continuous masking noise, respectively in the S pi N0, S pi N pi tau, S0 N tau, and S0 N pi conditions. Four young subjects there was a hierarchy in the size of the MLD obtained in the four dichotic conditions, with the MLD being significantly larger in the S pi N0 and S pi N pi tau conditions; however, the size of the MLD was the same in all four conditions for the old subjects. Compared to young subjects, the performance of the old subjects was characterized by decreased ability to use homophasic cues in burst masking noise and decreased ability to use interaural difference cues. These findings were observed at four signal frequencies.

This study’s main objective was to assess the sensitivity and specificity of the interRAI Community Health Assessment (CHA) for detecting the presence of vision loss (VL), hearing loss (HL) or both (Dual Sensory Loss, DSL) when compared against performance-based measures of vision and hearing. The interRAI CHA and the Montreal Cognitive Assessment (MoCA) were administered to 200 adults (61+ years of age) who had VL, HL or DSL. We calculated the sensitivity and specificity of the interRAI CHA for detecting sensory impairments using as the gold standard performance based measurements of hearing (pure-tone audiogram) and vision (distance acuity) as determined from the rehabilitation centre record. Results were divided according to participants’ cognitive status, as measured by the MoCA and the Cognitive Performance Scale (CPS, embedded within the interRAI CHA). Overall, sensitivity was 100% for VL, 97.1% for HL, and 96.9% for DSL. Specificity was at least 93% in all three groups. In participants who failed the MoCA (i.e., at risk of mild cognitive impairment), the sensitivity was 100% for VL, 96.8% for HL and 96.2% for DSL; in those who were not at risk, the sensitivity was 100% for VL, and 97.4% for HL and DSL. In participants classified by the CPS as borderline intact or mild cognitively impaired, sensitivity was 100% in all groups; in those classified as cognitively intact, sensitivity was 100% for VL, 97.0% for HL, and 96.8% for DSL. These results suggest that the interRAI CHA detects VL, HL, and DSL in high agreement with performance-based measurements of vision and hearing. The interRAI CHA shows high accuracy even in participants with mild cognitive difficulties. Since results were found in a specific population of older rehabilitation clients who all had sensory difficulties, further research is needed to understand its role in screening in other more diverse groups. [ABSTRACT FROM AUTHOR]

Memory and hearing are critical domains that interact during older adults' daily communication and social encounters. To develop a more comprehensive picture of how aging influences performance in these domains, the roles of social variables such as views of aging and self-perceived abilities need greater examination. The present study investigates the linkages between views of aging, self-perceived abilities, and performance within and across the domains of memory and hearing, connections that have never been examined together within the same sample of older adults. For both domains, 301 older adults completed measures of their views of aging, their self-perceived abilities and behavioral tests. Using structural equation modeling, we tested a hypothesized model in which older adults' negative views of aging predicted their performance in the domains of memory and hearing through negatively affecting their self-perceived abilities in those domains. Although this model achieved adequate fit, an alternative model in which hearing performance predicted self-perceived hearing also was supported. Both models indicate that hearing influences memory with respect to both behavioral and self-perception measures and that negative views of aging influence self-perceptions in both domains. These results highlight the importance of views of aging and self-perceptions of abilities within and across these domains. [ABSTRACT FROM AUTHOR]

Sensory input provides the signals used by the brain when listeners understand speech and participate in social activities with other people in a range of everyday situations. When sensory inputs are diminished, there can be short-term consequences to brain functioning, and long-term deprivation can affect brain neuroplasticity. Indeed, the association between hearing loss and cognitive declines in older adults is supported by experimental and epidemiologic evidence, although the causal mechanisms remain unknown. These interactions of auditory and cognitive aging play out in the challenges confronted by people with age-related hearing problems when understanding speech and engaging in social interactions. In the present article, we use the World Health Organization's International Classification of Functioning, Disability and Health and the Selective Optimization with Compensation models to highlight the importance of adopting a healthy aging perspective that focuses on facilitating active social participation by older adults. First, we examine epidemiologic evidence linking ARHL to cognitive declines and other health issues. Next, we examine how social factors influence and are influenced by auditory and cognitive aging and if they may provide a possible explanation for the association between ARHL and cognitive decline. Finally, we outline how audiologists could reposition hearing health care within the broader context of healthy aging. [ABSTRACT FROM AUTHOR]

Cognitive Hearing Science or Auditory Cognitive Science is an emerging field of interdisciplinary research concerning the interactions between hearing and cognition. It follows a trend over the last half century for interdisciplinary fields to develop, beginning with Neuroscience, then Cognitive Science, then Cognitive Neuroscience, and then Cognitive Vision Science. A common theme is that an interdisciplinary approach is necessary to understand complex human behaviors, to develop technologies incorporating knowledge of these behaviors, and to find solutions for individuals with impairments that undermine typical behaviors. Accordingly, researchers in traditional academic disciplines, such as Psychology, Physiology, Linguistics, Philosophy, Anthropology, and Sociology benefit from collaborations with each other, and with researchers in Computer Science and Engineering working on the design of technologies, and with health professionals working with individuals who have impairments. The factors that triggered the emergence of Cognitive Hearing Science include the maturation of the component disciplines of Hearing Science and Cognitive Science, new opportunities to use complex digital signal-processing to design technologies suited to performance in challenging everyday environments, and increasing social imperatives to help people whose communication problems span hearing and cognition. Cognitive Hearing Science is illustrated in research on three general topics: (1) language processing in challenging listening conditions; (2) use of auditory communication technologies or the visual modality to boost performance; (3) changes in performance with development, aging, and rehabilitative training. Future directions for modeling and the translation of research into practice are suggested. [ABSTRACT FROM AUTHOR]

The contributions of auditory and cognitive factors to age-dependent differences in auditory spatial attention were investigated. In conditions of real spatial separation, the target sentence was presented from a central location and competing sentences were presented from left and right locations. In conditions of simulated spatial separation, different apparent spatial locations of the target and competitors were induced using the precedence effect. The identity of the target was cued by a callsign presented either prior to or following each target sentence, and the probability that the target would be presented at the three locations was specified at the beginning of each block. Younger and older adults with normal hearing sensitivity below 4 kHz completed all 16 conditions (2-spatial separation method × 2-callsign conditions × 4-probability conditions). Overall, younger adults performed better than older adults. For both age groups, performance improved with target location certainty, with a priori target cueing, and when location differences were real rather than simulated. For both age groups, the contributions of natural spatial cues were most pronounced when the target occurred at “unlikely” spatial listening locations. This suggests that both age groups benefit similarly from richer acoustical cues and a priori information in difficult listening environments. [ABSTRACT FROM AUTHOR]

Abstract: We disrupted periodicity cues by temporally jittering the speech signal to explore how such distortion might affect word identification. Jittering distorts the fine structure of the speech signal with negligible alteration of either its long-term spectral or amplitude envelope characteristics. In Experiment 1, word identification in noise was significantly reduced in young, normal-hearing adults when sentences were temporally jittered at frequencies below 1.2kHz. The accuracy of the younger adults in identifying jittered speech in noise was similar to that found previously for older adults with good audiograms when they listened to intact speech in noise. In Experiment 2, to rule out the possibility that the reductions in word identification were due to spectral distortion, we also tested a simulation of cochlear hearing loss that produced spectral distortion equivalent to that produced by jittering, but this simulation had significantly less temporal distortion than was produced by jittering. There was no significant reduction in the accuracy of word identification when only the frequency region below 1.2kHz was spectrally distorted. Hence, it is the temporal distortion rather than the spectral distortion of the low-frequency components that disrupts word identification. [Copyright &y& Elsevier]

Recent advances in research and clinical practice concerning aging and auditory communication have been driven by questions about age-related differences in peripheral hearing, central auditory processing, and cognitive processing. A "site-of-lesion" view based on anatomic levels inspired research to test competing hypotheses about the contributions of changes at these three levels of the nervous system. A "processing" view based on psychologic functions inspired research to test alternative hypotheses about how lower-level sensory processes and higher-level cognitive processes interact. In the present paper, we suggest that these two views can begin to be unified following the example set by the cognitive neuro- science of aging. The early pioneers of audiology anticipated such a unified view, but today, advances in science and technology make it both possible and necessary. Specifically, we argue that a synthesis of new knowledge concerning the functional neuroscience of auditory cognition is necessary to inform the design and fitting of digital signal processing in "intelligent" hearing devices, as well as to inform best practices for resituating hearing aid fitting in a broader context of audiologic rehabilitation. Long-standing approaches to rehabilitative audiology should be revitalized to emphasize the important role that training and therapy play in promoting compensatory brain reorganization as older adults acclimatize to new technologies. The purpose of the present paper is to provide an integrated framework for understanding how auditory and cognitive processing interact when older adults listen, comprehend, and communicate in realistic situations, to review relevant models and findings, and to suggest how new knowledge about age-related changes in audition and cognition may influence future developments in hearing aid fitting and audiologic rehabilitation. [ABSTRACT FROM AUTHOR]

This section introduces a series of articles published within the issue including one which explores the interplay between audition and cognition in challenging listening conditions in research and another which provides a tutorial on how event-related potentials have given new insights into the relative contributions of lower-level auditory and higher-level attentional processes to auditory scene analysis.

Hearing loss and diminished visual acuity are associated with poorer cognition, but the underlying mechanisms are not understood. The apolipoprotein (APOE) ε4 allelic variant may drive the associations. We tested whether APOE -ε4 allele count (0, 1, or 2) was associated with declines in memory, executive function, pure-tone hearing threshold averages, and pinhole-corrected visual acuity among participants in the Canadian Longitudinal Study on Aging (CLSA). Multivariable linear mixed regression models were utilized to assess associations between APOE -ε4 allele count and each of the outcome variables. For each main effects model, interactions between APOE -ε4 and sex and age group (45–54-, 55–64-, 65–74-, and 75–85 years) respectively, were analyzed. Significant associations were not observed in main effects models. Models including APOE- ε4 * age (but not APOE- ε4 * sex) interaction terms better fit the data compared to main effects models. In age group-stratified models, however, there were minimal differences in effect estimates according to allele count. APOE -ε4 allele count does not appear to be a common cause of sensory-cognitive associations in this large cohort. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to introduce and provide an overview of the 3 articles presented in the invited forum "The Brain and Hearing Aids." Method: The main ideas of the articles presented by the 3 panelists are identified, and a commentary is provided to synthesize the ideas. Conclusions: Benefits from hearing aids and auditory training entail higher-level cortical and cognitive processing involved in categorizing and remembering sound. New approaches to predicting, designing, and evaluating technological and behavioral interventions will need to consider the brain and not just the ears of listeners. [ABSTRACT FROM AUTHOR]