10/15/2016. Hearing loss. Aging. Cognition. Aging, Cognition, and Hearing Loss: Clinical Implications

Transcription

1 Aging, Cognition, and Loss: Clinical Implications Samira Anderson, Au.D., Ph.D. MAC Conference Aging loss Cognition Frank Lin, M.D., Ph.D., Baltimore Longitudinal Study of Aging 2 Cognitive ability declines more rapidly in individuals with hearing loss Working memory score Dementia screening score 3 Lin et al. JAMA Int Med

2 Why is hearing ability related to cognitive ability in older adults? 4? 5 Today s topics COG SIN Aging HAs/ CIs Training Summary 6 2

3 I can hear you but I can t understand you. Older adults often have difficulty understanding speech in noise. 7 Traditional audiologic test measures do not predict performance in noise 8 Killion et al Several factors may contribute to these difficulties Sensory Auditory Visual Speech understanding Cognition Working memory Attention Speed of processing Processing Synaptopathy Brainstem Cortex 9 3

4 Publications involving cognitive ability and speech perception 10 Fullgrabe & Rosen, 2016 In older normal hearing older adults, high scores on the QuickSIN relate to better working memory and temporal processing 11 Parbery Clark et al Frontal superior gyrus: working memory Prefrontal cortex: Memory Attention Pars triangularis: cognitive control of memory Temporal cortex: Auditory speech processing 12 4

5 Cortical activation in response to speech: Young adults: activation of primary auditory cortex Older adults: activation of working memory and attention areas 13 Wong et al. Neuropsychologia 2009 Left pars triangularis Left frontal superior gyrus Older adults Speech in noise performance Younger adults volume thickness (mm) 14 Wong et al. Ear Hear 2010 Decline Compensation Hypothesis: Age related declines in sensory processing are accompanied by recruitment of cognitive areas to compensate Cabeza & Dennis (2007) Neuroimaging of health cognitive aging in The Handbook of Cognitive Aging, 3 rd Edition 15 5

6 Magnetoencephalography to investigate connections between cognitive ability and listening in noise 16 Older adults recruit more brain resources to hear Brain processing accuracy Older adults can hear better when the background noise is meaningless 17 Presacco et al. J Neurophysiol 2016 Attention relates to cognitive processing, but only in older adults Brain processing accuracy r Attention scores Attention score 18 Presacco et al. J Neurophysiol

7 COG SIN Aging Training Aids Summary 19 Older adults experience greater difficulty hearing in background noise than younger adults (Gordon-Salant, 2005; Souza et al., 2007) Why is hearing in noise so difficult for some people? 20 Precise timing Important role for speech understanding, especially in noise Precise neural timing: important for perceiving rapidly changing temporal components of speech Aging: decreased temporal precision (Caspary et al, 2008; Gordon Salant et al., 2006, 2008; Grose & Marmo, 2010; Harris et al., 2010; Lister et al., 2011; Ross et al., 2010; Walton et al., 2010; Humes et al., 2010) 21 7

8 Medial geniculate body Primary auditory cortex Stimulus Evoked responses to speech stimuli Response Cortical 300 ms Inferior colliculus Stimulus Superior olivary nuclei Cochlear nuclei Response Cochlea 180 ms Frequency following response (FFR) 22 Adapted from Patel & Iversen, 2007 The envelope of the response follows the envelope of the speech signal 23 The envelope is reduced with aging 24 8

9 FFR collection DVD player LCD projector movie electrically shielded, sound proof booth 25 Analysis soundwave X1000 s Filtered to isolate brainstem/midbrain ~ Hz FFR 26 Participants: yrs Assigned to Top (N=14) and Bottom (N=14) SIN groups based on in Noise Test Matched on age, IQ, sex, hearing Recorded responses to 170 ms da presented in quiet and in six talker babble 27 Anderson et al., Ear Hear,

10 * * Top SIN: Larger amplitudes Larger fundamental frequency Greater resistance to noise 28 Anderson et al., Ear Hear, 2011 Effects of noise Greater effects in bottom SIN group Change in morphology (affected by imprecise timing) related to SIN 29 Anderson et al., Ear Hear, 2011 Individual examples Good SIN: Poor SIN Male Female Age: 60 Age: 61 NH thru 8 khz NH thru 8 khz QuickSIN: 0.5 QuickSIN:

11 COG SIN Aging Training Aids Summary 31 What accounts for variability in neural processing and speech in noise performance in older adults? 32 Chronological age vs Biological age Does the FFR reflect biological aging? 33 11

12 Aging and the FFR Younger adults: N = 17 (4 males) PTA = 6.5 Age (18 30) Older adults: N = 17 (2 males) PTA = 9.0 Age (60 67) Anderson et al, J Neurosci ** p < 0.01 Smaller amplitudes ** p < 0.01 Anderson et al, J Neurosci weaker phase locking Phase locking power Anderson et al. J Neurosci

13 Speech sound da complexity frequency less (vowel) Did you say da or ba? time Anderson et al, J Neurosci 2012 Frequency more (consonantto vowel) (consonantto vowel) stimulus vowel vowel Delayed neural timing Anderson et al, J Neurosci 2012 ** p < 0.01 Smaller amplitudes ** p < 0.01 Anderson et al, J Neurosci

14 Why was there a latency delay in the CV transition? CV transition Vowel Presacco et al. Ear Hear 2015 Time (ms) Delayed peak timing in responses to the /da/ but not to the /a/ Presacco et al. Ear Hear 2015 Because of the high frequency energy in the /da/ Peak latencies should occur earlier for the /da/ than for the /a/ But the latencies are only earlier in the younger adults So, the latency difference may be due to loss of audibility, even though the older adults had normal hearing Presacco et al. Ear Hear

15 Older adults cannot sustain phase locking to a steady state stimulus Presacco et al. Ear Hear 2015 New Project Did you say Ditch or Dish? based on Gordon Salant et al Younger Older Did you say Ditch or Dish? 45 15

16 Younger Older Delayed Onset Delayed Offset 46 COG SIN Aging Training Aids Summary 47 Effects of hearing loss on neural encoding 48 16

17 F 0 Amplitude Older normal hearing HINT in Noise Test Anderson et al. Ear Hear 2011 F 0 Amplitude in Noise Test Older hearing impaired But greater F0 relates to worse SIN in individuals with HI 49 r = p = A relationship between F 0 and hearing is driving the relationship with hearing in noise performance 50 Stimulus Components of a stimulus waveform Time Envelope cues adequate for hearing in quiet. Fine structure cues may be important for localization, understanding speech in fluctuating noise. 51 (Qin & Oxenham, 2003; Zeng et al., 2005) 17

18 How does hearing loss affect representation of temporal envelope and fine structure? Perceptual experiments HI: Deficits in the response to temporal fine structure (Ardoint et al, 2010; Lorenzi et al., 2006; Hopkins et al., 2007) Enhanced responses to fluctuating amplitude (temporal envelope) in HI vs NH (Fullgrabe et al., 2003; Moore et al., 1996) 52 Kale and Heinz JARO 2010 chinchillas with noise-induced hearing loss measured encoding of sinusoidally amplitude-modulated stimuli in the auditory nerve Amplitude 53 Amplitude Characteristic frequency VIIIth nerve envelope coding is greater in fibers of chinchillas with hearing loss than control fibers, but no differences in fine structure

19 TFS Strength Normal Impaired Fiber characteristic frequency 55 Henry & Heinz, 2012 Effects of hearing loss neural mechanisms Broadened auditory filters Sensory deprivation Increased excitability (Kotak et al., J Neurosci, 2005) Decreased inhibition (Dong et al., Eur J Neurosci 2010) Central gain mechanism (Munro & Blount, JASA 2009) Tonotopic reorganization (Thai Van et al., Acta Otolaryngologica 2010) 56 stimulating electrode Excitatory post synaptic currents Neural Mechanisms Normal recording electrode 20 pa SNHL larger amplitudes but less frequent thalamocortical brain slice SNHL: greater excitability 57 Kotak et al., J Neurosci

20 Decreased inhibition and increased excitation may lead to larger EEG amplitudes normal hearing (PTA 15 db) and 15 with hearing loss (PTA 25 db) Participants matched on age, sex, and IQ 59 Anderson et al. J Acoust Soc Am 2013 SNHL subjects had larger amplitudes 60 20

21 Responses to envelope: HI > NH; responses to TFS: NH < HI 61 Anderson et al. Front Syst Neurosci 2013 COG SIN Aging Training Aids Summary 62 Central Cognition Lifestyle How do these interacting factors influence ability to hear in noise? 63 21

22 Central Processing Structural equation modeling Life Experiences * in Noise * Cognition 120 older adults (ages 55 to 79) We hear with our brains, not just with our ears! 64 Music history: 1 or more years of training Less than 1 year of training N = 68 N = 52 Central Processing Central Processing Life Experiences * Cognition * Life Experiences * * Cognition in Noise Different processing algorithms in musicians vs nonmusicans in Noise 65 Ramifications for treatment?? Difficulty hearing in noise Successful hearing in noise Perceptual Training Cognitive Training Increase volume 22

23 Reductions in flow of information from sensory to cognitive systems can lead to cognitive decline. Performance of sensory systems can be improved with practice Changes in neural networks influence these improvements 67 Smith et al hrs in home training Auditory Training Brainstem responses to speech in quiet and noise Speech innoise tests (QuickSIN) Testing at lab Cogntive tests (Memory, Attention) Eight weeks Active Control Brainstem responses to speech in quiet and noise Speech innoise tests (QuickSIN) Cogntive Testing at tests lab (Memory, Attention) Training protocol 68 Neuroplasticity in auditory aging: Can training improve temporal processing? 40 hrs of auditory based cognitive training: earlier latencies in responses to a speech syllable, especially in noise Anderson et al. PNAS

24 Responses are less delayed in noise after training Pre Post 70 Neuroplasticity in auditory aging: Can training improve temporal processing? Sandra Gordon Salant Matthew J. Goupell Stefanie Kuchinsky Shihab Shamma Jonathan Fritz Jonathan Z. Simon Patrick Kanold After training, both older and younger groups stop phase locking earlier into the gap in ditch Pre Post 72 24

25 COG SIN Aging Training Aids Summary 73 Clinical Implications What are the ramifications for older adults who use hearing aids or CIs? 74 The primary objective method of hearing aid verification, real ear measurement, ensures appropriate sound levels at the eardrum, but cannot provide information about what the brain does with the signal

26 FFR: Amplification increases detection of speech components in older adults with hearing loss Stimulus: /susaʃi/ 76 Easwar et al. Ear Hear 2015 FFR: increasing hearing aid bandwidth increases detectability in older adults with hearing loss 77 Easwar et al. Ear Hear 2015 Higher detection and amplitude relate to improved speech discrimination and sound quality ratings 78 Easwar et al. Ear Hear

27 Effects of amplification on suprathreshold processing Widex Dream BTE receiver in the ear hearing aids bilaterally Increased phase locking in the CV transition 65 db SPL Earlier latencies and increased amplitudes in the transition Does hearing aid use enhance neural encoding over time? 81 27

28 aid use for six months improves working memory *p < 0.05, **p < aid use leads to: Increased accuracy But decreased amplitude in transition Responses in Noise

29 New project: Effects of hearing aid compression on neural representation Recruitment Neural response to "ditch more closely resembles the stimulus for the slow than for the fast condition Tag a correlation r Fast: 0.67 Slow: 0.66 Ditch correlation r Fast: 0.36 Slow: 0.47 Effects of aging on cortical responses in CI subjects Presacco et al. in revision Matthew J. Goupell, Ph.D. Sandra Gordon Salant, Ph.D. 29

30 Older Younger Middle aged > Older and younger? Sentence recognition scores relate to correlation values in young adults COG SIN Aging Training Aids Summary 90 30

31 Aging affects temporal precision of neural encoding Important role for speech understanding, especially in noise May affect performance with hearing aids and cochlear implants in older adults However, performance may improve over time or with training Graduate students: PhD: Katlyn Bostic AuD: Lindsay Roque Eve Kronzek Jen Chisholm SLP: Erica Thomas Post doctoral: Hanin Karawani, PH.D. Collaborators: Jonathan Simon, Ph.D., Matt Goupell, Ph.D., Sandra Gordon Salant, Ph.D., Undergraduate students: Alyson Schapira Alanna Schloss Kaitlyn Sheapp Danielle King Julie Mehta Andrea Kaplanges Miranda Velasquez 92 Acknowledgments 93 31