between Hearing, Cognition and Socia

Transcription

1 A Successful lai Aging Perspective on the Lin between Hearing, Cognition and Socia Participation i over the Lifespan Kathy Pichora Fuller Professor, Dept. of Psychology, Univ. of Toronto Mississauga, Adjunct Scientist, Toronto Rehabilitation Institute and Rotman Research Institute Guest Professor, Linneaus Centre HeAD, Linkoping University, Sweden

2 Outline Question about hearing and healthy aging Define health Lifespan view Hearing and health Successful aging How to apply these ideas with children

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4 Does treating hearing loss slow cognitive decline?

5 Background Facts: Question 1. Health in childhood can affect adult health. 2. Hearing loss is related to poorer health in older adults (dementia, falls, mortality.). Question: How important is it to promote health in children with hearing loss to hl help them age successfully as adults?

6 Outline Question about hearing and healthy aging Define health Lifespan view Hearing and health Successful aging How to apply these ideas with children

7 World Health Organization (WHO) Definition of Health (1948) Health is a complete state of well-being: Physical well being Mental well being Social well being Health is NOT merely the absence of disease or infirmity. State of optimum health is called wellness

8 Issues in Adult Development and Aging g

9 Perspective of an Older Adult who Lives with Hearing Loss When you are hard of hearing you struggle to hear; When you struggle to hear you get tired; Whenyouget tired youget frustrated; When you get frustrated you get bored; When you get bored you quit. I didn t quit today. Avoid by withdrawal from social interaction!

10 A Model of Disability in Later Life Disability: Effects of chronic conditions on people s ability to engage in activities that are necessary, expected, and personally desired in their society. ENABLEMENT

11 Total number of articles cited in PubMed: March 3, Hearing # Publica ations (Pub bmed) s 50s 60s 70s 80s 90s 2000s Hearing + (Cognition or Cognitive or memory or brain) Hearing + (Social or psychosocial or "significant other" or stress or isolation or withdrawal or stigma or stereotype)

12 Health is the capacity of people to adapt to, respond to, or control life s challenges and changes. (Frankish et al., 1997)

13 Health states associated with being isolated: 1. Early mortality 2. Cognitive impairment 3. Cardiovascular disease 4. Depression 5. Physical decline Sources: House et al Am J Epidemiol 1982, Green et al Int J Geriatr 2008, Oxman et al Am J Epidemiol 1992, Strogatz et al 1986

14 Health Promotion is the process of enabling people to increase control over & to improve their health. (WHO, 1986 Canadian Charter on Health Promotion) is any combination of educational, organizational, economic & environmental supports for actions conducive to health. (Green & Kreuter, 1991) programs enhance the FIT between people &. programs enhance the FIT between people & their surroundings (Sokols, 1996)

15 Coping with STRESS People respond differently to stress imbalance in person-environment fit The impact of any potentially stress event is greatly influenced by how a person appraises it (Lazarus & Folkman, 1984) Primary Appraisal: Is the event harmful, threatening, or challenging? Secondary Appraisal: What are my coping resources? Are they adequate? Reappraisal changes in the situation may change the appraisal Coping is the process of trying to manage demands that are appraised as taxing or exceeding one s resources As vulnerability (lack of coping) increases, ittakeslessstressto takes stress to trigger illness

16 Life Cycle Model of Stress Lupien et al., (2009). Nature, 10, Figure 2 The life cycle model of stress. How the effects of chronic or repeated exposure to stress (or a single exposure to severe stress) at different stages in life depend on the brain areas that are developing or declining at the time of the exposure. Stress in the prenatal period affects the development of many of the brain regions that are involved in regulating the hypothalamus pituitary adrenal (HPA) axis that is, the hippocampus, the frontal cortex and the amygdala (programming effects).. In adulthood and during aging the brain regions that undergo the most rapid iddecline as a result of aging (red db bars) are highly hl vulnerable to the effects of stress hormones. Stress during these periods can lead to the manifestation of incubated effects of early adversity on the brain (manifestation effects) or to maintenance of chronic effects of stress (maintenance effects). PTSD, post traumatic stress disorder.

17 Outline Question about hearing and healthy aging Define health Lifespan view Hearing and health Successful aging How to apply these ideas with children

18 What Changes in Cognitive Development over the Lifespan? (Craik & Bialystock, Handbook of Cognitive Aging, 2008) Younger Older Control (PROCESSING) Memory Slowing Representation (KNOWLEDGE) Context (reliance, benefit from SUPPORTIVE ENVIRONMENT)

19 When Does Cognitive Aging Start? Z-Sco ore Synonym Vocabulary Pattern Comparison (Speed) Raven's (Reasoning) Recall (Memory) Perc centile of Population Chronological Age Salthouse (2004) Current Directions in Psychological Science

20 Prevalence of Hearing Loss Depends on measure and criteria Normal for age Median audiometric thresholds (ISO 7029) Women Men 3kHz 3kHz

21 Auditory Aging (Mills, Schmeidt, Schulte, & Dubno, 2006) HF audiometric threshold elevation OHC (also noise-induced hearing loss) Endocochlear potentials ~ stria vascularis Neural loss of synchrony

22 Bottom Up &Top Down Processing Effortful listening Bottom up processing less efficient Top down processing more necessary Knowledge Bottom up (ear to brain) Analysis of acoustic signal Better signal (faster) Poorer signal amount & type of distortion Top Down Meaning Top down (brain to ear) Priming (pre signal) expectations facilitate recognition (faster) Disambiguation (post signal) knowledge constrains alternatives (slower) Repair (post signal) Fill in gaps or correct errors (l (slower) Sound Bottom up

23 1995 Low context sentences: John did not talk about the feast High context sentences: The wedding banquet was a feast Task: Repeat the last word of the sentence Old need 3 db better S:N 3 db 3 db 6dB Good audiogram Context helps old 3 db more Cohen (1987). Speech comprehension in the elderly. The effects of cognitive changes. BJA, 21, Rabbit (1990). Mild hearing loss can cause apparent memory failures which increase with ageand and reducewith IQ. Acta Otolryn., 476, S Wingfield (1996). Cognitive factors in auditory performance: Context, speecd of processing and constraints of memory. JAAA, 7,

24 Effect of Simulated Auditory Aging on W ki M S Working Memory Span (Pichora Fuller, IJA, 2008; Brown & Pichora Fuller, Canadian Acoustics, 2000)

25 Context, Intelligibility & Brain Activation (Obleser, Wise, Dresner & Scott, 2006) High vs. low predictability at intermediate signal quality for younger adults listening to distorted (noise vocoded) SPIN sentences Activation to HIGH CONTEXT > LOW CONTEXT speech Various areas activated including the left dorsolateral prefrontal cortex (working memory & semantic processing)

26 Cognitive Neuroscience of Aging Same performance achieved with different processing More widespread activation ~ brain reorganization Young brain activity more lateralized Old brain activity more distributed Deterioration or compensation? HAROLD: Hemispheric asymmetry reduction in older adults (Cabeza, 2002) PASA: Posterior anterior shift in aging g (Davis, Dennis, Daselaar, Fleck & Cabeza, 2008)

27 Compensation (Grady, 2012, Nature Reviews Neuroscience, 13, ) low high

28 7.0 Cognitive Aging g 6.0 (Pichora Fuller, IJA, 2008; Brown & Pichora Fuller, Canadian Acoustics, ) Gains: 1.0 Knowledge is preserved 0.0 and context is helpful SNR) enefit from Context (db B Younger Intact 2 3 db Younger Jitter Older Intact Losses: Processing declines Working memory Slowing Attention/Inhibition

29 Outline Question about hearing and healthy aging Define health Lifespan view Hearing and health Successful aging How to apply these ideas with children

30 All cause mortality ~ Sensory impairment Kaplan Meier plots for all-cause mortality rates by type of sensory impairment adjusted for relevant confounders Males Females % surviva al 80 No sensory impairment 70 Visual impairment only Hearing loss only 60 N=4926 Icelandic individuals aged 67+ Dual sensory loss Years past sensory examination Sources: Fisher et al, Age Ageing 2013, and Feeny et al J Clin Epidemiol 2012

31 Hearing loss is a risk factor for having automobile accidents in a large cohort of male workers in Quebec Hearing status # who had at least 1 accident Normal Prevalence ratio (age-adjusted) adjusted) 95% CI Just noticeable , 1.11 HL Mild HL , 1.21 Moderate HL , Severe HL , 1.42 Total Attributable risk of traffic accident to HL = 5.6% Clear dose-response N=46030 male workers Source: Picard et al, Traffic Injury Prevention 2008

32 The impact of hearing loss on the driving performance of 107 seniors with normal visual acuity and cognitive function tested on a closed road circuit Mean driving score # signs correctly recognized Normal/mild HL Moderate/severe HL None Visual Auditory None Visual Auditory Type of Type of distraction distraction Source: Hickson et al, JAGS 2010

33 Increased perceptual effort drains cognitive resources available for other purposes Hearing loss p p Reduced perception of hazard noise Falls?

34 When Does Cognitive Aging Start? Z-Sco ore Synonym Vocabulary Pattern Comparison (Speed) Raven's (Reasoning) Recall (Memory) Perc centile of Population Chronological Age Salthouse (2004) Current Directions in Psychological Science

35 Figure 1. Estimates of age specific prevalences of Alzheimer s disease (AD), Mild CognitiveImpairment (MCI), andnon Affected (NAs), aged60 85, assuming 1.0% rate for conversion from NA to MCI at age 60. (Adapted with permission from Yesavage JA, O Hara R, Kraemer H, et al. Modeling the prevalence and incidence of Alzheimer s disease and mild cognitive impairment. J Psychiat Res 2002;36: )

36 Hearing Loss Prevalence & Dementia Audiogram Gold, Lightfoot & Hnath-Chisolm (1996) 27 of 30 (90%) patients with Alzheimer s had hearing impairment (pure-tone screen & HHIE) Uhlmann et al. (1989) Case-control study with 100 pairs Prevalence higher in those with Alzheimer s-type dementia Hearing loss significantly correlated with MMSE Central Auditory (DDT) Idrizbegovic i et al. (2011) Performance on DDT worse for those with MCI and worse still for those with DAT

37 Dual Sensory y( (Hearing & Vision) Loss DSI and cognitive decline Dual sensory loss associated with greatest odds for cognitive decline and for functional decline on five everyday activities over a period of four years (Lin, MY et al., 2004)

38 Central Auditory (Speech in Noise) Problems May PRECEDE Dementia Longitudinal epidemiological studies Gates et al. (1996) N >700, speech in competing speech test (SSI-ICM) in those without stroke, dementia, or HL (PTA 40 db HL) MMSE administered 2, 4, 6 years later Those with low scores on SSI-ICM were 6-12 times more likely to develop clinical dementia Gates et al. (2002, 2008) Similar results for longer follow-up pp period (3-12years)

39 Pure-tone HL Related to Incident Dementia Lin, F. R., Metter, E. J., O Brien, R. J., Resnick, S. M., Zonderman, A. B., & Ferrucci, L. (2011). Hearing loss and incident dementia. Archives Neurology, 68(2), Lin FR, Ferrucci L, Metter EJ, et al. (2011). Hearing loss and cognition in the Baltimore Longitudinal Study of Aging. Neuropsychology, 25, Lin FR. (2012). Hearing loss in older adults. Who s listening? JAMA, 307,, Lin FR, Yaffe K, Xia J, et al. (2013). Hearing loss and cognitive decline in older adults. JAMA Intern Med, 173,

40 Hearing loss and cognitive decline 94 Health ABC cohort, 2013 Modified mini-men ntal state score* Normal hearing group Hearing loss group p=.004 for difference in change over time Study year * Note: very similar results for the digit-symbol substitution test

41 Hearing loss and Incident Dementia Baltimore Longitudinal Study of Aging cohort, 2011 Hazard of inciden nt demen ntia n= Mild Mod Severe Hearing loss, db HL severity HR (95% CI) mild 1.89 ( ) moderate 3.00 ( ) severe or more 4.94 ( ) Cox proportional hazards model adjusted for age, sex, race, education, diabetes, smoking and HTN. Hazard ratios relative to normal hearing. Source: Lin et al, Arch Neurol 2011

42 MoCA Montreal Cognitive Assessment Visuo spatial/executive Naming Memory Attention Language Abstraction ti Repetition Orientation

43 MoCA Repeat & Recall (Dupuis et al., submitted) 30 Repeated_Recalled 80 All Participants Repeated_Forgotten 70 Not Repeated_Forgotten Face Velvet Church Daisy Red 0 0 Good Hearing Hearing Loss Good Hearing Face Velvet Church Daisy Red Hearing Loss Face Velvet Church Daisy Red

44 Increased perceptual effort drains cognitive resources available for other purposes Hearing loss Social Isolation Dementia Unknown common neurodegenerative pathology Frank Lin

45 Mild Cognitive Impairment (e.g, Troyer & Murphy, 2007) Active lifestyle ~ risk of future dementia Cognitive engagement Tasks involving problem solving, decision making, learning, remembering new information Physical activity it Some activities are done in groups, with music Social interaction Rich social stimulation and active social network Participating in group activities and interactions Enriched environments Group interventions Communication related disorders??? Kelly Murphy

46 Interactive Effects of Physical Activity and Diet High exercise + great diet No exercise + poor diet Scarmeas et al. (2009) JAMA, 302,

47 Cognitive Benefits of Better Hearing Arlinger, Lunner, Lyxell, & Pichora Fuller, Scandinavian J Psych, 2009 Slower cognitive decline in Alzheimer s cases with better hearing (Peters, Potter, & Scholer, 1988; Wahl & Heyl, 2003) Reduced rate of decline in scores on a cognitive screening test over a six month period following intervention with hearing aids (Allenet et al., 2003) Hearing aid use reduced problem behaviours judged by caregivers of adults with dementia (Palmer et al., 1998) Older adults using hearing aids havebetter emotional andsocial well being and Older adults using hearing aids have better emotional and social well being and greater longevity (Appolonio et al., 1996; Cacciatore et al., 1999; Naramura et al., 1999; Seniors Research Group, 1999)

48 Sensory Cognitive Communication Communication Trio 1. Hearing loss is associated with incident dementia (e.g., Gates et al., 2002, 2010,2011; Lin, 2011; Lin et al., 2011a, 2011b, 2013; Peters et al., 1988; Uhlmann et al., 1989) 2. Hearing loss reduces communication functioning, increasing risk for social isolation (e.g., Appollonio et al., 1996; Bess et al., 1989; Crews & Campbell, 2004; Keller et al., 1999; Laforgeet al., 1992; Mulrow et al., 1990a, 1990b; Rudberg et al., 1993; Reuben et al., 1999; Sindhusake et al., 2001; Weinstein & Ventry, 1982) 3. Engagement in leisure activities is related to cognition and health (e.g., Bassuk et al, 1999; Fabrigoule et al., 1995; Fratiglioni et al., 2000; Hultsch et al., 1993; Mousavi Nasab, 2012; Strawbridge et al., 1998; Wang et al. 2002)

49 1. Social withdrawal mediates the association iti bt between hearing loss and cognitive decline 2. Cognitive functioning mediates the association between hearing loss and social withdrawal 3. Social withdrawal can be caused by hearing loss and/or cognitive decline (all effects of aging) Hypotheses (Danielsson, Dupuis, Pichora Fuller, in prep) Hearing Loss Cognitive Decline Social Withdrawal

50 Participants Betula, Sweden Stigma, Toronto N Age (years) M = 67 (35 90) M = 71 (56 96) Education M = 14 YoE M = 16 YoE (36% > secondary) (81% > secondary) Employed 62% 76% Female 45% 64% Married 73% 54% Good General Health 84% 82%

51 Hearing Variables Used in Models Hearing Variables Used in Models Pure tone thresholds (worse ear; 3,4,6,8 khz)

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54 Summary Gradual gains and losses in aging More signal to offset auditory loss (Technologies) Compensate using contextual support (AR) Downstream consequences of HL on memory Information degradation (immediate) Deprivation (long term) Social participation: HL mediated by memory

55 Outline Question about hearing and healthy aging Define health Lifespan view Hearing and health Successful aging How to apply these ideas with children

56 Overview of Self Management Approach Self lfmanagement A person s active participation in achieving their own best health and wellness through gaining confidence, knowledge, and skills to manage physical, social and emotionalaspects aspects of life Self Management Support The range of organizational, community and provider strategies to support the active participation of individuals in achieving their best health and wellness

57 CLSA: Conceptual framework: Models of healthy/successful u agingg Literature dominated by two models: Rowe and Kahn Differentiates successful aging from usual aging Based on the assumption that successful agers engage in behaviours that modify risk factors to allow them to meet a high degree of physical, mental and social functioning Baltes and Baltes Selection, Optimization, Compensation Based on the assumption that decline is an inevitable part of aging, and that successful agers are those who engage in processes that help them to adapt to change in order to meet ttheir own goals

58 A Framework for Maintaining and Enhancing Competence (Pp ) How to optimize the overall sense of competence Apply three key adaptive mechanisms for aging Selection Select subset of options to focus resources on (priorities) Optimization Find best way to achieve goal (improve by practice) Compensation Use alternative route to find solution (vision, context) Th SOC d l The SOC model

59 Good Hearing Health Could Promote Good (Cognitive) Health PRESERVE communication and social interaction stave off social ilisolation i slow cognitive decline

60 Outline Question about hearing and healthy aging Define health Lifespan view Hearing and health Successful aging How to apply these ideas with children

61 Hearing Not having illness Hearing Hearing Exercise Diet HEALTHY AGING Productive pursuits Genes Hearing Social activity Hearing

62 Health Promotion & Disease Prevention (Pp ) Adopt a healthful lifestyle make it part of your daily routine (exercise, diet) Stay active cognitively keep an optimistic outlook and maintain your interest in things cognitive reserve Maintain a social network and stay engaged with others

63 mulcher/2010/07/12/genius radio the nerve/ear brain/

64 Vancouver, British Columbia World Congress of Audiology September 18 22, 2016

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66 Age and Modality Issues MoCA total score 7 ~ PTA(W) (p <.000) 6 ~ Age (p =.051) 5 Correlations (p <.0005) MoCA DR x Aud FR.38 MoCA DR x Vis FR.42 Aud FR x Vis FR.45 Aud Recall Vis Recall MoCA DR NH HL ANOVA for FR: Good vision only (N = 122) Group (NH, HL): F(1,108) = 5.66, p =.019 Modality (A,V): F(1,108) = 10.66, p =.001 Group x Modality: F(1,108) =.53, p =.47

67 Lexical ldecision i reaction time in younger and older listeners: The effects of semantic context and the type and amount of acoustical distortion Preceding context distorted or intact Congruent Stir your coffee with a spoon. Neutral Its name is feast. Incongruent Stiryour coffee witha risk. Measure RT when lexicaldecision correct Facilitation (RT neutral context RT congruent context) Target intact Goy H Pelletier M Coletta M & Pichora Fuller M K (2013) Journal of Goy, H., Pelletier, M., Coletta, M., & Pichora-Fuller, M.K. (2013). Journal of Speech, Language and Hearing Research.

68 Effects of Context and Distorting It on Lexical Decision RT More Some None

69 Effects of Distorting Context on Speed of Lexical Decision Older listeners RTs are more facilitated by context. y Signal distortion reduces facilitation.

70 Spectrograms for Jittered and Intact Sentence in Babble