Age-related differences in sensitivity to small changes in frequency assessed with cortical evoked potentials.

As part of an ongoing study of age-related changes in auditory processing, sensitivity to small changes in frequency were assessed using the cortical auditory evoked potential, P1-N1-P2, in younger and older adults with normal hearing. Behavioral measures have shown age-related differences in intensity and frequency discrimination that are larger at lower than higher frequencies. However, substantial individual differences and equivocal results among studies have been reported. This variability may reflect differences in tasks and procedures, as well as subject variables, such as hearing sensitivity and level of attention. To minimize these subject variables, the P1-N1-P2 response was investigated using a passive listening paradigm. Subjects were 10 younger and 10 older adults. The P1-N1-P2 was elicited by a 150-ms change in frequency in otherwise continuous 500-Hz and 3000-Hz pure tones presented at 70 dB SPL. P1-N1-P2 threshold was defined as the smallest change in frequency needed to evoke a P1-N1-P2 response. Furthermore, a frequency-dependent aging effect was observed for P1-N1-P2 thresholds, such that older subjects were significantly less sensitive to the frequency change than younger subjects, with significantly larger age-related differences at 500 Hz than at 3000 Hz. Age-related changes in response latencies and amplitude of the P1-N1-P2 response were also evident at 500 and 3000 Hz. These results are consistent with age-related changes in the central auditory system and suggest that changes in frequency discrimination abilities of older adults may be, in part, related to changes in preattentive levels of auditory processing.

Age-related differences in the temporal modulation transfer function with pure-tone carriers.

Detection of amplitude modulation (AM) in 500 and 4000 Hz tonal carriers was measured as a function of modulation frequency from younger and older adults with normal hearing through 4000 Hz. The modulation frequency above which sensitivity to AM increased ("transition frequency") was similar for both groups. Temporal modulation transfer function shapes showed significant age-related differences. For younger subjects, AM detection thresholds were generally constant for low modulation frequencies. For a higher carrier frequency, AM detection thresholds then increased as modulation frequency further increased until the transition frequency. In contrast, AM detection for older subjects continuously increased with increasing modulation frequency, indicating an age-related decline in temporal resolution for faster envelope fluctuations. Significant age-related differences were observed whenever AM detection was dependent on temporal cues. For modulation frequencies above the transition frequency, age-related differences were larger for the lower frequency carrier (where both temporal and spectral cues were available) than for the higher frequency carrier (where AM detection was primarily dependent on spectral cues). These results are consistent with a general age-related decline in the synchronization of neural responses to both the carrier waveform and envelope fluctuation.

Longitudinal changes in speech recognition in older persons.

Recognition of isolated monosyllabic words in quiet and recognition of key words in low- and high-context sentences in babble were measured in a large sample of older persons enrolled in a longitudinal study of age-related hearing loss. Repeated measures were obtained yearly or every 2 to 3 years. To control for concurrent changes in pure-tone thresholds and speech levels, speech-recognition scores were adjusted using an importance-weighted speech-audibility metric (AI). Linear-regression slope estimated the rate of change in adjusted speech-recognition scores. Recognition of words in quiet declined significantly faster with age than predicted by declines in speech audibility. As subjects aged, observed scores deviated increasingly from AI-predicted scores, but this effect did not accelerate with age. Rate of decline in word recognition was significantly faster for females than males and for females with high serum progesterone levels, whereas noise history had no effect. Rate of decline did not accelerate with age but increased with degree of hearing loss, suggesting that with more severe injury to the auditory system, impairments to auditory function other than reduced audibility resulted in faster declines in word recognition as subjects aged. Recognition of key words in low- and high-context sentences in babble did not decline significantly with age.

Electrophysiologic correlates of intensity discrimination in cortical evoked potentials of younger and older adults.

When measured behaviorally, older adults with normal hearing have poorer intensity discrimination thresholds than younger adults, but only at lower frequencies. Poor intensity discrimination at lower but not higher frequencies for older adults can be associated with an age-related decline in temporal processing. The current study was designed to assess age-related effects on intensity discrimination at 500 and 3000 Hz using the cortical auditory evoked potential, N1--P2. Subjects were 10 younger and 10 older adults with normal hearing. The N1--P2 was elicited by an intensity increase in an otherwise continuous pure tone presented at 70 dB SPL. Intensity increments ranged from 0 dB to 5 dB at 500 Hz and from 0 d B to 8 d B at 3000 Hz in 1-dB steps. Intensity discrimination threshold was defined as the smallest intensity change needed to evoke an N1-P2 response. Consistent with behavioral measures, N1-P2 response thresholds were significantly higher for older subjects than younger subjects at 500 Hz but did not differ significantly at 3000 Hz. In addition, N1 and P2 latencies for older subjects were significantly prolonged at 500 Hz, but not at 3000 Hz. As intensity increments increased above threshold, amplitudes tended to be larger in older than in younger subjects, however, these differences were not statistically significant. In older subjects, response latencies and amplitudes were significantly larger at 500 Hz than at 3000 Hz. In younger subjects, response latencies and amplitudes were similar across frequency. Similar intensity discrimination thresholds and age-related differences for behavioral measures and evoked potentials support the notion that the N1-P2 measures reflect the physiological detection of intensity change which in turn relates to intensity discrimination. A possible explanation for the decreased intensity discrimination at low frequencies, and enhanced amplitudes with prolonged latencies in older subjects is an age-related decline in inhibitory control within the central auditory nervous system.

Frequency modulation detection: effects of age, psychophysical method, and modulation waveform.

As part of an ongoing study of auditory aging, detection of sinusoidal and quasitrapezoidal frequency modulation (FM) was measured with a 5-Hz modulation frequency and 500- and 4000-Hz carriers in two experiments. In Experiment 1, psychometric functions for FM detection were measured with several modulation waveform time patterns in younger adults with normal hearing. Detection of a three-cycle modulated signal improved when its duration was extended by a preceding unmodulated cycle, an effect similar to adding a modulated cycle. In Experiment 2, FM detection was measured for younger and older adults with normal hearing using two psychophysical methods. Similar to frequency discrimination, FM detection was poorer in older than younger subjects and age-related differences were larger at 500 Hz than at 4000 Hz, suggesting that FM detection with low modulation frequencies and frequency discrimination may share common underlying mechanisms. One mechanism is likely related to temporal information coded by neural phase locking which is strong at low frequencies and decreases with increasing frequency, as observed in animals. The frequency-dependent aging effect suggests that this temporal mechanism may be affected by age. The effect of psychophysical method was sizable and frequency dependent, whereas the effect of modulation waveform was minimal.

Presbycusis.

The inevitable deterioration in hearing ability that occurs with age--presbycusis--is a multifactorial process that can vary in severity from mild to substantial. Left untreated, presbycusis of a moderate or greater degree affects communication and can contribute to isolation, depression, and, possibly, dementia. These psychological effects are largely reversible with rehabilitative treatment. Comprehensive rehabilitation is widely available but underused because, in part, of social attitudes that undervalue hearing, in addition to the cost and stigma of hearing aids. Remediation of presbycusis is an important contributor to quality of life in geriatric medicine and can include education about communication effectiveness, hearing aids, assistive listening devices, and cochlear implants for severe hearing loss. Primary care physicians should screen and refer their elderly patients for assessment and remediation. Where hearing aids no longer provide benefit, cochlear implantation is the treatment of choice with excellent results even in octogenarians.

The frequency-modulation following response in young and aged human subjects.

The frequency-modulation following response (FMFR) is a steady-state evoked response which may be a neural correlate of frequency discrimination. Aged subjects with normal hearing have abnormal frequency discrimination for low carrier frequencies and thus it might be predicted that aged individuals would have reduced FMFR amplitudes compared to young subjects. In this study, FMFR amplitudes were measured for frequency-modulated sinusoids with a carrier frequency of 0.5 kHz (80 dB SPL). In Experiment 1, the modulation depth was held constant (80%) and the modulation rate was varied (4-38 Hz), whereas in Experiment 2 the modulation rate was held constant (38 Hz) and the modulation depth was varied (0-80%). Aged subjects had significantly larger FMFR amplitudes than young subjects for certain stimulus parameters, although individual variability was large. Such results would not be predicted given previous data regarding frequency discrimination, but are consistent with several reports of larger-than-normal amplitudes of middle latency and late responses in aged subjects.

Longitudinal study of pure-tone thresholds in older persons.

OBJECTIVE: Pure-tone thresholds for conventional and extended high frequencies were analyzed for 188 older adult human subjects (91 females, 97 males). The objectives were to study longitudinal changes in thresholds as well as the effects of initial threshold levels, age, gender, and noise history on these longitudinal changes. DESIGN: At the time of entry into the study, subjects' ages ranged from 60 to 81 years, with a mean age of 68 years. Subjects had between 2 and 21 visits (mean = 9.81 visits) over a period of 3 to 11.5 years (mean = 6.40 years). Conventional pure-tone thresholds at 0.25 to 8 kHz were measured during most visits. Extended high-frequency (EHF) thresholds at 9 to 18 kHz were measured every 2 to 3 years. The slope of a linear regression was used to estimate the rate of change in pure-tone thresholds at 0.25 to 18 kHz for each ear. A questionnaire was used to identify those subjects with a positive noise history. RESULTS: The average rate of change in thresholds was 0.7 dB per year at 0.25 kHz, increasing gradually to 1.2 dB per year at 8 kHz and 1.23 dB per year at 12 kHz. The rate of change for thresholds increased significantly with age, at 0.25 to 3, 10, and 11 kHz for females and at 6 kHz for males. After adjusting for age, females had a significantly slower rate of change at 1 kHz but a significantly faster rate of change at 6 to 12 kHz than males. For 0.25 and 1 kHz, subjects with more hearing loss at higher frequencies had a faster rate of change at these frequencies, whereas for 6 and 8 kHz, subjects with more hearing loss at mid and high frequencies had a slower rate of change at these frequencies. The rates of threshold change for subjects with a positive noise history were not statistically different from those with a negative noise history. CONCLUSIONS: On average, hearing threshold increased approximately 1 dB per year for subjects age 60 and over. Age, gender, and initial threshold levels can affect the rate of change in thresholds. Older female subjects (> or =70 years) had faster rate of change at 0.25 to 3, 10, and 11 kHz than younger female subjects (60 to 69 years). Older male subjects had faster rate of change at 6 kHz than younger male subjects. Females had a slower rate of change at 1 kHz and a faster rate of change at 6 to 12 kHz than males. Subjects with higher initial thresholds at low and mid frequencies tended to have faster rate of threshold change at 0.25 to 2 kHz in the following years. Subjects with higher initial thresholds at mid and higher frequencies tended to have slower rate of change at 6 to 8 kHz in the following years. Noise history did not have a significant effect on the rate of threshold changes.