Strategies used during the cognitive evaluation of older adults with dual sensory impairment: a scoping review.

BACKGROUND: Dual sensory impairment (DSI), the combination of visual and hearing impairments, is associated with increased risk for age-related cognitive decline and dementia. Administering cognitive tests to individuals with sensory impairment is challenging because most cognitive measures require sufficient hearing and vision. Considering sensory limitations during cognitive test administration is necessary so that the effects of sensory and cognitive abilities on test performance can be differentiated and the validity of test results optimized. OBJECTIVE: To review empirical strategies that researchers have employed to accommodate DSI during cognitive testing of older adults. METHODS: Seven databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, Global Health and the Evidence-Based Medicine Reviews databases) were searched for relevant articles integrating the three concepts of cognitive evaluation, aging, and DSI. Given the inclusion criteria, this scoping review included a total of 67 papers. RESULTS: Twenty-eight studies reported five categories of strategies for cognitive testing of older adult participants with DSI: the assistance of experts, the modification of standardized test scoring procedures, the use of communication strategies, environmental modifications, and the use of cognitive tests without visual and/or auditory items. CONCLUSIONS: The most used strategy reported in the included studies was drawing on the assistance of team members from related fields during the administration and interpretation of cognitive screening measures. Alternative strategies were rarely employed. Future research is needed to explore the knowledge-to-practice gap between research and current clinical practice, and to develop standardized testing strategies.

Does social connection mediate the association between neuroticism and cognition? Cross-sectional analysis of the Canadian Longitudinal Study on Aging.

OBJECTIVES: This study tested the association between neuroticism and six cognitive measures, and examined the potential mediating roles of social connection (social isolation and loneliness) among middle-aged and older adults. METHODS: This cross-sectional study was a secondary analysis of the Canadian Longitudinal Study on Aging (CLSA) Comprehensive Cohort, a sample of Canadians aged 45-85 years at baseline. Respondents with data collected at the first follow-up, between 2015 and 2018, were included (n = 27,765). Structural equation modelling was used to assess the association between neuroticism and six cognitive measures (Rey Auditory Verbal Learning Test immediate recall and delayed recall, Animal Fluency Test, Mental Alternation Test, Controlled Oral Word Association Test and Stroop Test interference ratio), with direct and indirect effects (through social isolation and loneliness). All analyses were stratified by sex, including females (n = 14,133) and males (n = 13,632). RESULTS: In unadjusted models, there was evidence of associations between neuroticism and all cognitive measures, except the Stroop Test interference ratio, suggesting higher neuroticism was associated with lower scores on memory and executive function tests. In the models of these other five outcomes, there was consistent evidence of indirect effects (through social isolation and loneliness) and, in some cases, direct effects. The results are discussed in context with limitations, including the use of cross-sectional design and alternative hypotheses to explain the association between personality and cognition. CONCLUSION: Among middle-aged and older adults, for both males and females, the findings suggest that the association between neuroticism and cognitive outcomes may be mediated by aspects of social connection.

At-home computerized executive-function training to improve cognition and mobility in normal-hearing adults and older hearing aid users: a multi-centre, single-blinded randomized controlled trial.

BACKGROUND: Hearing loss predicts cognitive decline and falls risk. It has been argued that degraded hearing makes listening effortful, causing competition for higher-level cognitive resources needed for secondary cognitive or motor tasks. Therefore, executive function training has the potential to improve cognitive performance, in turn improving mobility, especially when older adults with hearing loss are engaged in effortful listening. Moreover, research using mobile neuroimaging and ecologically valid measures of cognition and mobility in this population is limited. The objective of this research is to examine the effect of at-home cognitive training on dual-task performance using laboratory and simulated real-world conditions in normal-hearing adults and older hearing aid users. We hypothesize that executive function training will lead to greater improvements in cognitive-motor dual-task performance compared to a wait-list control group. We also hypothesize that executive function training will lead to the largest dual-task improvements in older hearing aid users, followed by normal-hearing older adults, and then middle-aged adults. METHODS: A multi-site (Concordia University and KITE-Toronto Rehabilitation Institute, University Health Network) single-blinded randomized controlled trial will be conducted whereby participants are randomized to either 12 weeks of at-home computerized executive function training or a wait-list control. Participants will consist of normal-hearing middle-aged adults (45-60 years old) and older adults (65-80 years old), as well as older hearing aid users (65-80 years old, ≥ 6 months hearing aid experience). Separate samples will undergo the same training protocol and the same pre- and post-evaluations of cognition, hearing, and mobility across sites. The primary dual-task outcome measures will involve either static balance (KITE site) or treadmill walking (Concordia site) with a secondary auditory-cognitive task. Dual-task performance will be assessed in an immersive virtual reality environment in KITE's StreetLab and brain activity will be measured using functional near infrared spectroscopy at Concordia's PERFORM Centre. DISCUSSION: This research will establish the efficacy of an at-home cognitive training program on complex auditory and motor functioning under laboratory and simulated real-world conditions. This will contribute to rehabilitation strategies in order to mitigate or prevent physical and cognitive decline in older adults with hearing loss. TRIAL REGISTRATION: Identifier: NCT05418998. https://clinicaltrials.gov/ct2/show/NCT05418998.

Sex-Specific Interactions Between Hearing and Memory in Older Adults With Mild Cognitive Impairment: Findings From the COMPASS-ND Study.

OBJECTIVES: Hearing loss (HL) in older adults is associated with a decline in performance on cognitive tasks and the risk of developing dementia. However, very few studies have investigated sex-related effects on these associations. A previous study of cognitively healthy older adults showed an association between HL and lower cognitive performance in females only. In the present study, we examined the effects of sex and hearing on cognition in individuals with mild cognitive impairment (MCI). We predicted that females with HL would be more likely to show poorer performance on the cognitive measures compared to females with normal hearing (NH), while cognitive performance in males would not depend on hearing. We further predicted that these auditory-cognitive associations would not depend on test modality, and would thus be observed in females for both auditory and visual tests. DESIGN: Participants were 101 older adults with amnestic MCI (M = 71 years, 45% females) in the Canadian Consortium on Neurodegeneration in Aging (CCNA) COMPASS-ND study. Performance on the Montreal Cognitive Assessment (MoCA), Rey Auditory Verbal Learning (RAVLT), and Brief Visuospatial Memory Test-Revised (BVMT-R) was analyzed to investigate sex-related differences and/or hearing-related differences. Participants were categorized as having NH or HL using two different measures: pure-tone hearing screening results (normal based on a pure-tone threshold < 25 dB HL at 2000 Hz in the worse ear) and speech-in-noise speech reception thresholds (SRTs; normal < -10 dB SNR on the Canadian Digit Triplet Test [CDTT]). RESULTS: Males and female groups did not differ in age, years of education, or other relevant covariates. Yet, females with better hearing on either pure-tone or speech-in-noise measures outperformed their worse hearing counterparts on the MoCA total score. Additionally, females with better hearing were more likely to recall several words on the MoCA delayed recall trial relative to those with worse hearing. Females with NH showed significant correlations between CDTT SRTs and both MoCA and RAVLT scores, while no correlations were observed in males. In contrast, males but not females showed an effect of hearing group on BVMT-R test status. CONCLUSIONS: There were sex-specific differences in auditory-cognitive associations in individuals with MCI. These associations were mostly observed in females and on auditory tests. Potential mechanisms and implications are discussed.

Sex-Linked Biology and Gender-Related Research Is Essential to Advancing Hearing Health.

There is robust evidence that sex (biological) and gender (behavioral/social) differences influence hearing loss risk and outcomes. These differences are noted for animals and humans-in the occurrence of hearing loss, hearing loss progression, and response to interventions. Nevertheless, many studies have not reported or disaggregated data by sex or gender. This article describes the influence of sex-linked biology (specifically sex-linked hormones) and gender on hearing and hearing interventions, including the role of sex-linked biology and gender in modifying the association between risk factors and hearing loss, and the effects of hearing loss on quality of life and functioning. Most prevalence studies indicate that hearing loss begins earlier and is more common and severe among men than women. Intrinsic sex-linked biological differences in the auditory system may account, in part, for the predominance of hearing loss in males. Sex- and gender-related differences in the effects of noise exposure or cardiovascular disease on the auditory system may help explain some of these differences in the prevalence of hearing loss. Further still, differences in hearing aid use and uptake, and the effects of hearing loss on health may also vary by sex and gender. Recognizing that sex-linked biology and gender are key determinants of hearing health, the present review concludes by emphasizing the importance of a well-developed research platform that proactively measures and assesses sex- and gender-related differences in hearing, including in understudied populations. Such research focus is necessary to advance the field of hearing science and benefit all members of society.

Bilinguals Show Proportionally Greater Benefit From Visual Speech Cues and Sentence Context in Their Second Compared to Their First Language.

OBJECTIVES: Speech perception in noise is challenging, but evidence suggests that it may be facilitated by visual speech cues (e.g., lip movements) and supportive sentence context in native speakers. Comparatively few studies have investigated speech perception in noise in bilinguals, and little is known about the impact of visual speech cues and supportive sentence context in a first language compared to a second language within the same individual. The current study addresses this gap by directly investigating the extent to which bilinguals benefit from visual speech cues and supportive sentence context under similarly noisy conditions in their first and second language. DESIGN: Thirty young adult English-French/French-English bilinguals were recruited from the undergraduate psychology program at Concordia University and from the Montreal community. They completed a speech perception in noise task during which they were presented with video-recorded sentences and instructed to repeat the last word of each sentence out loud. Sentences were presented in three different modalities: visual-only, auditory-only, and audiovisual. Additionally, sentences had one of two levels of context: moderate (e.g., "In the woods, the hiker saw a bear.") and low (e.g., "I had not thought about that bear."). Each participant completed this task in both their first and second language; crucially, the level of background noise was calibrated individually for each participant and was the same throughout the first language and second language (L2) portions of the experimental task. RESULTS: Overall, speech perception in noise was more accurate in bilinguals' first language compared to the second. However, participants benefited from visual speech cues and supportive sentence context to a proportionally greater extent in their second language compared to their first. At the individual level, performance during the speech perception in noise task was related to aspects of bilinguals' experience in their second language (i.e., age of acquisition, relative balance between the first and the second language). CONCLUSIONS: Bilinguals benefit from visual speech cues and sentence context in their second language during speech in noise and do so to a greater extent than in their first language given the same level of background noise. Together, this indicates that L2 speech perception can be conceptualized within an inverse effectiveness hypothesis framework with a complex interplay of sensory factors (i.e., the quality of the auditory speech signal and visual speech cues) and linguistic factors (i.e., presence or absence of supportive context and L2 experience of the listener).

Self-report Measures of Hearing and Vision in Older Adults Participating in the Canadian Longitudinal Study of Aging are Explained by Behavioral Sensory Measures, Demographic, and Social Factors.

OBJECTIVES: Our objectives were to (1) determine the prevalence of self-reported hearing, vision, and dual sensory (both vision and hearing) difficulties in older Canadian adults; (2) examine the association between self-report and behavioral sensory measures; and (3) controlling for behavioral sensory measures, examine variables that might explain the self-reported sensory difficulty, including age, sex, cultural background, socioeconomic status, nonsensory comorbidities, cognitive function, and social factors. DESIGN: We used baseline data collected from the 30,097 participants of the comprehensive cohort of the Canadian Longitudinal Study on Aging. Participants who were 45 to 85 years of age (mean age = 63 years, SD = ± 10.25) were recruited using provincial health registries and random-digit dialing. Analyses were conducted for the sample as a whole or stratified by age. Behavioral sensory data for hearing (pure-tone audiometry) and vision (pinhole-corrected visual acuity) were collected at 11 data collection sites. Self-reported sensory and personal data were obtained through in-person interviews. "Difficulty" was defined as a response of "fair" or "poor" (versus "excellent," "very good" or "good") to questions about hearing ability (using a hearing aid if used) and vision (using glasses or corrective lenses if used). Individuals with both hearing and vision difficulties were defined as having dual sensory difficulties. Variables associated with self-reported sensory difficulties were analyzed with multiple regression models. RESULTS: Objective 1. The prevalence of impairments based on behavioral measures was higher than the prevalence of difficulties based on self-report measures. The prevalence based on both types of measures increased with age, but the increase was steeper for behavioral measures. Objective 2. In addition to the expected positive associations between self-report and behavioral measures of hearing [odds ratio (OR) = 2.299)] and vision (OR = 15.247), self-reported sensory difficulty was also explained by other within-modality sensory variables, such as the symmetry of impairment and the use of aids. Objective 3. Controlling for behavioral measures of hearing (better-ear pure-tone average) or vision (better-eye visual acuity), older participants were significantly less likely than younger participants to self-report sensory difficulty. Sensory difficulties were reported more often by males and by those with more comorbid health conditions. Compared to those who did not report vision difficulties, those who did report them were more likely to also report hearing difficulties (OR = 2.921) and vice versa (OR = 2.720). There were modality-specific associations with variables relevant to social participation; for example, independent life space was associated with hearing difficulties, and perceived availability of social support and loneliness with vision difficulties. CONCLUSIONS: The low prevalence of self-reported sensory difficulties relative to the behavioral measures of sensory impairments indicates that (a) a simple screening question about sensory ability may not be sufficient to identify older adults who are in the early stages of sensory decline, and (b) self-reported sensory ability is associated with sensory and nonsensory factors. Age, gender, and comorbidities are the most notable nonsensory predictors for both self-reported hearing and vision. These findings shed light on how the self-reported sensory difficulties of older adults may reflect clinical measures of sensory impairment as well as nonsensory factors.

The Comprehensive Assessment of Neurodegeneration and Dementia: Canadian Cohort Study.

BACKGROUND: The Comprehensive Assessment of Neurodegeneration and Dementia (COMPASS-ND) cohort study of the Canadian Consortium on Neurodegeneration in Aging (CCNA) is a national initiative to catalyze research on dementia, set up to support the research agendas of CCNA teams. This cross-country longitudinal cohort of 2310 deeply phenotyped subjects with various forms of dementia and mild memory loss or concerns, along with cognitively intact elderly subjects, will test hypotheses generated by these teams. METHODS: The COMPASS-ND protocol, initial grant proposal for funding, fifth semi-annual CCNA Progress Report submitted to the Canadian Institutes of Health Research December 2017, and other documents supplemented by modifications made and lessons learned after implementation were used by the authors to create the description of the study provided here. RESULTS: The CCNA COMPASS-ND cohort includes participants from across Canada with various cognitive conditions associated with or at risk of neurodegenerative diseases. They will undergo a wide range of experimental, clinical, imaging, and genetic investigation to specifically address the causes, diagnosis, treatment, and prevention of these conditions in the aging population. Data derived from clinical and cognitive assessments, biospecimens, brain imaging, genetics, and brain donations will be used to test hypotheses generated by CCNA research teams and other Canadian researchers. The study is the most comprehensive and ambitious Canadian study of dementia. Initial data posting occurred in 2018, with the full cohort to be accrued by 2020. CONCLUSION: Availability of data from the COMPASS-ND study will provide a major stimulus for dementia research in Canada in the coming years.

Évaluation complète d'une étude de cohorte canadienne portant sur la démence et la neuro-dégénérescence. Contexte : L'évaluation globale de la neuro-dégénérescence et de la démence (COMPASS-ND), étude de cohorte du Consortium canadien en neuro-dégénérescence associée au vieillissement (CCNV), représente une initiative nationale visant à promouvoir la recherche portant sur la démence et à soutenir les programmes de recherche des équipes du CCNV. Totalisant 2310 sujets recrutés partout au pays, cette cohorte longitudinale regroupe des individus fortement « phénotypés ¼ qui présentent diverses formes de démence et de pertes de mémoire légères. En plus de sujets âgés dont les fonctions cognitives sont intactes, ces 2310 sujets ont permis de valider les hypothèses formulées par les équipes du CCNV. Méthodes : Nous avons utilisé de nombreux documents pour décrire cette étude : le protocole de la COMPASS-ND ; la demande initiale de subvention ; le cinquième rapport d'étape semi-annuel du CCNV soumis aux Instituts de recherche en santé du Canada (IRSC) en décembre 2017 ; ainsi que d'autres documents produits à la suite de modifications consécutives à la mise en œuvre de ce projet. Résultats: L'étude de cohorte COMPASS-ND du CCNV inclut des participants de partout au Canada dont les divers états cognitifs sont associés à des maladies neurodégénératives ou au risque d'en souffrir. Ils feront l'objet d'un large éventail d'examens expérimentaux, cliniques, génétiques et d'imagerie afin d'aborder de manière spécifique les causes, le diagnostic, le traitement et la prévention de ces états cognitifs chez les personnes âgées. Les données obtenues à la suite d'évaluations cliniques et cognitives, ainsi que celles issues d'échantillons biologiques, d'imagerie cérébrale, de tests génétiques et de dons de cerveaux, seront utilisées pour tester les hypothèses générées par les équipes de recherche du CCNV et d'autres chercheurs canadiens. Cette étude constitue donc à ce jour l'étude canadienne la plus complète et la plus ambitieuse au sujet de la démence. La présentation des données initiales ayant eu lieu en 2018, la cohorte devrait atteindre sa taille maximale d'ici à 2020.Conclusion : La disponibilité des données de l'étude COMPASS-ND stimulera considérablement la recherche sur la démence au Canada au cours des prochaines années.

The Implications of Cognitive Aging for Listening and the Framework for Understanding Effortful Listening (FUEL).

This review article considers some of the age-related changes in cognition that are likely to interact with hearing, listening effort, and cognitive energy. The focus of the review is on normative age-related changes in cognition; however, consideration is also given to older adults who experience clinically significant deficits in cognition, such as persons with Alzheimer's disease or who may be in a preclinical stage of dementia (mild cognitive impairment). The article distinguishes between the assessment of cognitive function for clinical versus research purposes. It reviews the goal of cognitive testing in older adults and discusses the challenges of validly assessing cognition in persons with sensory impairments. The article then discusses the goals of assessing specific cognitive functions (processing speed and attentional processes) for the purpose of understanding their relationships with listening effort. Finally, the article highlights certain concepts that are likely to be relevant to listening effort and cognitive energy, including some issues that have not yet received much attention in this context (e.g., conation, cognitive reserve, and second language speech processing).

Hearing Impairment and Cognitive Energy: The Framework for Understanding Effortful Listening (FUEL).

The Fifth Eriksholm Workshop on "Hearing Impairment and Cognitive Energy" was convened to develop a consensus among interdisciplinary experts about what is known on the topic, gaps in knowledge, the use of terminology, priorities for future research, and implications for practice. The general term cognitive energy was chosen to facilitate the broadest possible discussion of the topic. It goes back to who described the effects of attention on perception; he used the term psychic energy for the notion that limited mental resources can be flexibly allocated among perceptual and mental activities. The workshop focused on three main areas: (1) theories, models, concepts, definitions, and frameworks; (2) methods and measures; and (3) knowledge translation. We defined effort as the deliberate allocation of mental resources to overcome obstacles in goal pursuit when carrying out a task, with listening effort applying more specifically when tasks involve listening. We adapted Kahneman's seminal (1973) Capacity Model of Attention to listening and proposed a heuristically useful Framework for Understanding Effortful Listening (FUEL). Our FUEL incorporates the well-known relationship between cognitive demand and the supply of cognitive capacity that is the foundation of cognitive theories of attention. Our FUEL also incorporates a motivation dimension based on complementary theories of motivational intensity, adaptive gain control, and optimal performance, fatigue, and pleasure. Using a three-dimensional illustration, we highlight how listening effort depends not only on hearing difficulties and task demands but also on the listener's motivation to expend mental effort in the challenging situations of everyday life.

A network approach to subjective cognitive decline: Exploring multivariate relationships in neuropsychological test performance across Alzheimer's disease risk states.

Subjective cognitive decline (SCD) is characterized by subjective concerns of cognitive change despite test performance within normal range. Although those with SCD are at higher risk for developing further cognitive decline, we still lack methods using objective cognitive measures that reliably distinguish SCD from cognitively normal aging at the group level. Network analysis may help to address this by modeling cognitive performance as a web of intertwined cognitive abilities, providing insight into the multivariate associations determining cognitive status. Following previous network studies of mild cognitive impairment (MCI) and Alzheimer's dementia (AD), the current study centered upon the novel visualization and analysis of the SCD cognitive network compared to cognitively normal (CN) older adult, MCI, and AD group networks. Cross-sectional neuropsychological data from CIMA-Q and COMPASS-ND cohorts were used to construct Gaussian graphical models for CN (n = 122), SCD (n = 207), MCI (n = 210), and AD (n = 79) groups. Group networks were explored in terms of global network structure, prominent edge weights, and strength centrality indices. CN and SCD group networks were contrasted using the Network Comparison Test. Results indicate that CN and SCD groups did not differ in univariate cognitive performance or global network structure. However, measures of strength centrality, principally in executive functioning and processing speed, showed a CN-SCD-MCI gradient where subtle differences within the SCD network suggest that SCD is an intermediary between CN and MCI stages. Additional results may indicate a distinctiveness of network structure in AD, a reversal in network influence between age and general cognitive status as clinical impairment increases, and potential evidence for cognitive reserve. Together, these results provide evidence that network-specific metrics are sensitive to cognitive performance changes across the dementia risk spectrum and can help to objectively distinguish SCD group cognitive performance from that of the CN group.

Audiovisual speech perception in noise in younger and older bilinguals.

Speech perception in noise becomes increasingly difficult with age. Similarly, bilinguals often have difficulty with speech perception in noise in their second language (L2) due to less developed language knowledge in L2. Little is known about older bilinguals, who experience age-related sensory and cognitive changes but have extensive L2 experience. Furthermore, while audiovisual (AV) speech cues and supportive sentence context facilitate speech perception in noise in native listeners, much less is known for bilingual listeners, particularly older bilinguals. This study investigated how much young (n = 30) and older (n = 31) French-English/English-French bilinguals benefit from AV speech cues and sentence context in their first (L1) and second language during speech perception in noise. Participants completed the task in L1 and L2. Importantly, the level of background noise was individually calibrated for each participant to equate performance during the baseline task. The results suggest that there were no age differences in overall performance during the speech perception in noise task. However, older adults showed smaller language effects and smaller modality effects (i.e., comparing auditory-only speech perception to audiovisual speech perception) compared to younger adults. Furthermore, both young and older bilinguals benefited from AV speech cues and sentence context in both of their languages. However, during L2 speech perception in noise, visual speech cues were particularly important for young adults. In contrast, older adults show equal benefit from visual speech cues in L1 and L2. Taken together, these findings extend current models of AV speech perception to a second language in both younger and older adults. Furthermore, the findings suggest that bilinguals are likely to benefit from visual speech cues and supportive sentence context, although this benefit may differ slightly between younger and older bilinguals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cognitive Speed in Neurodegenerative Disease: Comparing Mean Rate and Inconsistency Within and Across the Alzheimer's and Lewy Body Spectra in the COMPASS-ND Study.

Background: Alzheimer's disease (AD) and Lewy body disease (LBD) are characterized by early and gradual worsening perturbations in speeded cognitive responses. Objective: Using simple and choice reaction time tasks, we compared two indicators of cognitive speed within and across the AD and LBD spectra: mean rate (average reaction time across trials) and inconsistency (within person variability). Methods: The AD spectrum cohorts included subjective cognitive impairment (SCI, n = 28), mild cognitive impairment (MCI, n = 121), and AD (n = 45) participants. The LBD spectrum included Parkinson's disease (PD, n = 32), mild cognitive impairment in PD (PD-MCI, n = 21), and LBD (n = 18) participants. A cognitively unimpaired (CU, n = 39) cohort served as common benchmark. We conducted multivariate analyses of variance and discrimination analyses. Results: Within the AD spectrum, the AD cohort was slower and more inconsistent than the CU, SCI, and MCI cohorts. The MCI cohort was slower than the CU cohort. Within the LBD spectrum, the LBD cohort was slower and more inconsistent than the CU, PD, and PD-MCI cohorts. The PD-MCI cohort was slower than the CU and PD cohorts. In cross-spectra (corresponding cohort) comparisons, the LBD cohort was slower and more inconsistent than the AD cohort. The PD-MCI cohort was slower than the MCI cohort. Discrimination analyses clarified the group difference patterns. Conclusions: For both speed tasks, mean rate and inconsistency demonstrated similar sensitivity to spectra-related comparisons. Both dementia cohorts were slower and more inconsistent than each of their respective non-dementia cohorts.

APOE-ε4 is not associated with pure-tone hearing thresholds, visual acuity or cognition, cross-sectionally or over 3 years of follow up in the Canadian Longitudinal Study on Aging.

INTRODUCTION: 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). METHODS: 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. RESULTS: 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. CONCLUSION: APOE-ε4 allele count does not appear to be a common cause of sensory-cognitive associations in this large cohort.

Olfactory function reflects episodic memory performance and atrophy in the medial temporal lobe in individuals at risk for Alzheimer's disease.

We examined cognitive domains and brain regions associated with olfactory performance in cognitively unimpaired older adults (CU-OAs) and individuals with or at risk for Alzheimer's Disease (AD). We compared CU-OAs (N = 55), individuals with subjective cognitive decline (SCD, N = 55), mild cognitive impairment (MCI, N = 101), and AD (N = 45) on measures of olfactory function (Brief Smell Identification Test), cognition (episodic and semantic memory), and medial temporal lobe thickness and volume. Analyses controlled for age, sex, education, and total intracranial volume. Olfactory function decreased from SCD to MCI to AD. CU-OAs outperformed all groups except SCDs on tests of cognition and olfaction. Although these measures did not differ between the CU-OAs and SCDs, olfactory function correlated with episodic memory tests and with entorhinal cortex atrophy only in the SCD group. Olfactory function also correlated with hippocampal volume and right-hemisphere entorhinal cortex thickness in the MCI group. Olfactory dysfunction reflects medial temporal lobe integrity and memory performance in a group at risk for AD with normal cognition and olfaction.

The profile of executive functioning in amnestic mild cognitive impairment: disproportionate deficits in inhibitory control.

Amnestic mild cognitive impairment (aMCI) represents a group of individuals who are highly likely to develop Alzheimer's disease (AD). Although aMCI is typically conceptualized as involving predominantly deficits in episodic memory, recent studies have demonstrated that deficits in executive functioning may also be present, and thorough categorization of cognitive functioning in MCI may improve early diagnosis and treatment of AD. We first provide an extensive review of neuropsychology studies that examined executive functioning in MCI. We then present data on executive functioning across multiple sub-domains (divided attention, working memory, inhibitory control, verbal fluency, and planning) in 40 aMCI patients (single or multiple domain) and 32 normal elderly controls (NECs). MCI patients performed significantly worse than NECs in all 5 sub-domains, and there was impairment (>1.0 SD below the mean of NECs) in all sub-domains. Impairment on each test was frequent, with 100% of MCI patients exhibiting a deficit in at least one sub-domain of executive functioning. Inhibitory control was the most frequently and severely impaired. These results indicate that executive dysfunction in multiple sub-domains is common in aMCI and highlights the importance of a comprehensive neuropsychological evaluation for fully characterizing the nature and extent of cognitive deficits in MCI.

Social decision-making in Parkinson's disease.

INTRODUCTION: Parkinson's Disease (PD) commonly affects cognition and communicative functions, including the ability to perceive socially meaningful cues from nonverbal behavior and spoken language (e.g., a speaker's tone of voice). However, we know little about how people with PD use social information to make decisions in daily interactions (e.g., decisions to trust another person) and whether this ability rests on intact cognitive functions and executive/decision-making abilities in nonsocial domains. METHOD: Non-demented adults with and without PD were presented utterances that conveyed differences in speaker confidence or politeness based on the way that speakers formulated their statement and their tone of voice. Participants had to use these speech-related cues to make trust-related decisions about interaction partners while playing the Trust Game. Explicit measures of social perception, nonsocial decision-making, and related cognitive abilities were collected. RESULTS: Individuals with PD displayed significant differences from control participants in social decision-making; for example, they showed greater trust in game partners whose voice sounded confident and who explicitly stated that they would cooperate with the participant. The PD patients displayed relative intact social perception (speaker confidence or politeness ratings) and were unimpaired on a nonsocial decision-making task (the Dice game). No obvious relationship emerged between measures of social perception, social decision-making, or cognitive functioning in the PD sample. CONCLUSIONS: Results provide evidence of alterations in decision-making restricted to social contexts in PD individuals with relatively preserved cognition with minimal changes in social perception. Researchers and practitioners interested in how PD affects social perception and cognition should include assessments that emulate social interactions, as non-interactive tasks may fail to detect the full impact of the disease on those affected.

Sex-Related Differences in the Associations Between Montreal Cognitive Assessment Scores and Pure-Tone Measures of Hearing.

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.

Hearing and visual acuity predict cognitive function in adults aged 45-85 years: Findings from the baseline wave of the Canadian Longitudinal Study on Aging (CLSA).

Associations between sensory status and cognitive performance are now widely reported. However, important open questions remain, including whether the associations are similar across sensory modalities, whether sensory status predicts cognitive performance independent of the cognitive task modality, and whether demographic/health variables moderate these associations. We examined data from a population sample of 30,029 Canadians aged 45-85 (the Canadian Longitudinal Study on Aging). Hearing was measured as the better ear pure-tone threshold average and vision as the better-eye pinhole-corrected visual acuity. Controlling for age, education, sex, multilingual status, and the other sensory modality, participants with poorer hearing had poorer auditory verbal learning and memory (Rey Auditory Verbal Learning Test) and executive function (Stroop, phonemic and semantic oral fluency, mental alternation) and those with poorer vision had poorer executive function. The sensory-cognitive associations were largely independent of the modality of test administration. The association between hearing loss and executive function was greater for persons who were older and those who had more health conditions. The association between vision loss and executive function was greater for persons with less than secondary school education. This study is one of the few that considers hearing and vision jointly, allowing us to compare the independent effects of each sensory modality on cognition and to express those effects as age equivalencies. This work demonstrates that hearing and vision are independently associated with cognitive performance in middle-aged to older aged adults (over-and-above key demographic variables) and independent of test modality. Executive functions appear to be particularly sensitive to associations between sensory function and demographic and health variables. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Age of Acquisition Modulates Alpha Power During Bilingual Speech Comprehension in Noise.

Research on bilingualism has grown exponentially in recent years. However, the comprehension of speech in noise, given the ubiquity of both bilingualism and noisy environments, has seen only limited focus. Electroencephalogram (EEG) studies in monolinguals show an increase in alpha power when listening to speech in noise, which, in the theoretical context where alpha power indexes attentional control, is thought to reflect an increase in attentional demands. In the current study, English/French bilinguals with similar second language (L2) proficiency and who varied in terms of age of L2 acquisition (AoA) from 0 (simultaneous bilinguals) to 15 years completed a speech perception in noise task. Participants were required to identify the final word of high and low semantically constrained auditory sentences such as "Stir your coffee with a spoon" vs. "Bob could have known about the spoon" in both of their languages and in both noise (multi-talker babble) and quiet during electrophysiological recording. We examined the effects of language, AoA, semantic constraint, and listening condition on participants' induced alpha power during speech comprehension. Our results show an increase in alpha power when participants were listening in their L2, suggesting that listening in an L2 requires additional attentional control compared to the first language, particularly early in processing during word identification. Additionally, despite similar proficiency across participants, our results suggest that under difficult processing demands, AoA modulates the amount of attention required to process the second language.