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OBJECTIVES: Despite performing well in standard clinical assessments of speech perception, many cochlear implant (CI) users report experiencing significant difficulties when listening in real-world environments. We hypothesize that this disconnect may be related, in part, to the limited ecological validity of tests that are currently used clinically and in research laboratories. The challenges that arise from degraded auditory information provided by a CI, combined with the listener's finite cognitive resources, may lead to difficulties when processing speech material that is more demanding than the single words or single sentences that are used in clinical tests. DESIGN: Here, we investigate whether speech identification performance and processing effort (indexed by pupil dilation measures) are affected when CI users or normal-hearing control subjects are asked to repeat two sentences presented sequentially instead of just one sentence. RESULTS: Response accuracy was minimally affected in normal-hearing listeners, but CI users showed a wide range of outcomes, from no change to decrements of up to 45 percentage points. The amount of decrement was not predictable from the CI users' performance in standard clinical tests. Pupillometry measures tracked closely with task difficulty in both the CI group and the normal-hearing group, even though the latter had speech perception scores near ceiling levels for all conditions. CONCLUSIONS: Speech identification performance is significantly degraded in many (but not all) CI users in response to input that is only slightly more challenging than standard clinical tests; specifically, when two sentences are presented sequentially before requesting a response, instead of presenting just a single sentence at a time. This potential "2-sentence problem" represents one of the simplest possible scenarios that go beyond presentation of the single words or sentences used in most clinical tests of speech perception, and it raises the possibility that even good performers in single-sentence tests may be seriously impaired by other ecologically relevant manipulations. The present findings also raise the possibility that a clinical version of a 2-sentence test may provide actionable information for counseling and rehabilitating CI users, and for people who interact with them closely.
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Implantes Cocleares , Percepção da Fala , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Estudos de Casos e Controles , Pupila/fisiologia , Adulto Jovem , Implante CoclearRESUMO
BACKGROUND: In spite of declines in working memory and other processes, older adults generally maintain good ability to understand and remember spoken sentences. In part this is due to preserved knowledge of linguistic rules and their implementation. Largely overlooked, however, is the support older adults may gain from the presence of sentence prosody (pitch contour, lexical stress, intra-and inter-word timing) as an aid to detecting the structure of a heard sentence. METHODS: Twenty-four young and 24 older adults recalled recorded sentences in which the sentence prosody corresponded to the clausal structure of the sentence, when the prosody was in conflict with this structure, or when there was reduced prosody uninformative with regard to the clausal structure. Pupil size was concurrently recorded as a measure of processing effort. RESULTS: Both young and older adults' recall accuracy was superior for sentences heard with supportive prosody than for sentences with uninformative prosody or for sentences in which the prosodic marking and causal structure were in conflict. The measurement of pupil dilation suggested that the task was generally more effortful for the older adults, but with both groups showing a similar pattern of effort-reducing effects of supportive prosody. CONCLUSIONS: Results demonstrate the influence of prosody on young and older adults' ability to recall accurately multi-clause sentences, and the significant role effective prosody may play in preserving processing effort.
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Speech prosody, including pitch contour, word stress, pauses, and vowel lengthening, can aid the detection of the clausal structure of a multi-clause sentence and this, in turn, can help listeners determine the meaning. However, for cochlear implant (CI) users, the reduced acoustic richness of the signal raises the question of whether CI users may have difficulty using sentence prosody to detect syntactic clause boundaries within sentences or whether this ability is rescued by the redundancy of the prosodic features that normally co-occur at clause boundaries. Twenty-two CI users, ranging in age from 19 to 77 years old, recalled three types of sentences: sentences in which the prosodic pattern was appropriate to the location of a clause boundary within the sentence (congruent prosody), sentences with reduced prosodic information, or sentences in which the location of the clause boundary and the prosodic marking of a clause boundary were placed in conflict. The results showed the presence of congruent prosody to be associated with superior sentence recall and a reduced processing effort as indexed by the pupil dilation. The individual differences in a standard test of word recognition (consonant-nucleus-consonant score) were related to the recall accuracy as well as the processing effort. The outcomes are discussed in terms of the redundancy of the prosodic features, which normally accompany a clause boundary and processing effort.
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Implantes Cocleares , Percepção da Fala , Idioma , Rememoração Mental , FalaRESUMO
OBJECTIVES: The increasing numbers of older adults now receiving cochlear implants raises the question of how the novel signal produced by cochlear implants may interact with cognitive aging in the recognition of words heard spoken within a linguistic context. The objective of this study was to pit the facilitative effects of a constraining linguistic context against a potential age-sensitive negative effect of response competition on effectiveness of word recognition. DESIGN: Younger (n = 8; mean age = 22.5 years) and older (n = 8; mean age = 67.5 years) adult implant recipients heard 20 target words as the final words in sentences that manipulated the target word's probability of occurrence within the sentence context. Data from published norms were also used to measure response entropy, calculated as the total number of different responses and the probability distribution of the responses suggested by the sentence context. Sentence-final words were presented to participants using a word-onset gating paradigm, in which a target word was presented with increasing amounts of its onset duration in 50 msec increments until the word was correctly identified. RESULTS: Results showed that for both younger and older adult implant users, the amount of word-onset information needed for correct recognition of sentence-final words was inversely proportional to their likelihood of occurrence within the sentence context, with older adults gaining differential advantage from the contextual constraints offered by a sentence context. On the negative side, older adults' word recognition was differentially hampered by high response entropy, with this effect being driven primarily by the number of competing responses that might also fit the sentence context. CONCLUSIONS: Consistent with previous research with normal-hearing younger and older adults, the present results showed older adult implant users' recognition of spoken words to be highly sensitive to linguistic context. This sensitivity, however, also resulted in a greater degree of interference from other words that might also be activated by the context, with negative effects on ease of word recognition. These results are consistent with an age-related inhibition deficit extending to the domain of semantic constraints on word recognition.
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Implantes Cocleares , Percepção da Fala , Estimulação Acústica , Adolescente , Adulto , Fatores Etários , Idoso , Limiar Auditivo , Surdez/fisiopatologia , Surdez/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Semântica , Adulto JovemRESUMO
The rhythms of speech and the time scales of linguistic units (e.g., syllables) correspond remarkably to cortical oscillations. Previous research has demonstrated that in young adults, the intelligibility of time-compressed speech can be rescued by "repackaging" the speech signal through the regular insertion of silent gaps to restore correspondence to the theta oscillator. This experiment tested whether this same phenomenon can be demonstrated in older adults, who show age-related changes in cortical oscillations. The results demonstrated a similar phenomenon for older adults, but that the "rescue point" of repackaging is shifted, consistent with a slowing of theta oscillations.
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Envelhecimento/fisiologia , Encéfalo/fisiologia , Percepção da Fala , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/crescimento & desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ritmo TetaRESUMO
The goal of this article is to trace the evolution of models of working memory and cognitive resources from the early 20th century to today. Linear flow models of information processing common in the 1960s and 1970s centered on the transfer of verbal information from a limited-capacity short-term memory store to long-term memory through rehearsal. Current conceptions see working memory as a dynamic system that includes both maintaining and manipulating information through a series of interactive components that include executive control and attentional resources. These models also reflect the evolution from an almost exclusive concentration on working memory for verbal materials to inclusion of a visual working memory component. Although differing in postulated mechanisms and emphasis, these evolving viewpoints all share the recognition that human information processing is a limited-capacity system with limits on the amount of information that can be attended to, remain activated in memory, and utilized at one time. These limitations take on special importance in spoken language comprehension, especially when the stimuli have complex linguistic structures or listening effort is increased by poor acoustic quality or reduced hearing acuity.
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Atenção , Cognição , Memória de Curto Prazo , Função Executiva , Humanos , Modelos Lineares , Modelos Psicológicos , Percepção da FalaRESUMO
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.
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Atenção , Cognição , Perda Auditiva/psicologia , Percepção da Fala , Percepção Auditiva , Compreensão , HumanosRESUMO
Older adults' normally adaptive use of semantic context to aid in word recognition can have a negative consequence of causing misrecognitions, especially when the word actually spoken sounds similar to a word that more closely fits the context. Word-pairs were presented to young and older adults, with the second word of the pair masked by multi-talker babble varying in signal-to-noise ratio. Results confirmed older adults' greater tendency to misidentify words based on their semantic context compared to the young adults, and to do so with a higher level of confidence. This age difference was unaffected by differences in the relative level of acoustic masking.
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Envelhecimento/fisiologia , Reconhecimento Psicológico/fisiologia , Estimulação Acústica , Adolescente , Idoso , Idoso de 80 Anos ou mais , Humanos , Mascaramento Perceptivo/fisiologia , Semântica , Percepção da Fala/fisiologia , Adulto JovemRESUMO
Recent evidence indicates that sensory and motor changes may precede the cognitive symptoms of Alzheimer's disease (AD) by several years and may signify increased risk of developing AD. Traditionally, sensory and motor dysfunctions in aging and AD have been studied separately. To ascertain the evidence supporting the relationship between age-related changes in sensory and motor systems and the development of AD and to facilitate communication between several disciplines, the National Institute on Aging held an exploratory workshop titled "Sensory and Motor Dysfunctions in Aging and AD." The scientific sessions of the workshop focused on age-related and neuropathologic changes in the olfactory, visual, auditory, and motor systems, followed by extensive discussion and hypothesis generation related to the possible links among sensory, cognitive, and motor domains in aging and AD. Based on the data presented and discussed at this workshop, it is clear that sensory and motor regions of the central nervous system are affected by AD pathology and that interventions targeting amelioration of sensory-motor deficits in AD may enhance patient function as AD progresses.
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Envelhecimento/fisiologia , Doença de Alzheimer/fisiopatologia , Transtornos dos Movimentos/fisiopatologia , Transtornos de Sensação/fisiopatologia , Doença de Alzheimer/diagnóstico , Progressão da Doença , Diagnóstico Precoce , Humanos , Transtornos dos Movimentos/diagnóstico , National Institute on Aging (U.S.) , Transtornos de Sensação/diagnóstico , Estados UnidosRESUMO
Recall of recently heard words is affected by the clarity of presentation: Even if all words are presented with sufficient clarity for successful recognition, those that are more difficult to hear are less likely to be recalled. Such a result demonstrates that memory processing depends on more than whether a word is simply "recognized" versus "not recognized." More surprising is that, when a single item in a list of spoken words is acoustically masked, prior words that were heard with full clarity are also less likely to be recalled. To account for such a phenomenon, we developed the linking-by-active-maintenance model (LAMM). This computational model of perception and encoding predicts that these effects will be time dependent. Here we challenged our model by investigating whether and how the impact of acoustic masking on memory depends on presentation rate. We found that a slower presentation rate causes a more disruptive impact of stimulus degradation on prior, clearly heard words than does a fast rate. These results are unexpected according to prior theories of effortful listening, but we demonstrated that they can be accounted for by LAMM.
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Aprendizagem por Associação/fisiologia , Memória de Curto Prazo/fisiologia , Rememoração Mental/fisiologia , Mascaramento Perceptivo/fisiologia , Percepção da Fala/fisiologia , Adolescente , Adulto , Humanos , Adulto JovemRESUMO
In two experiments, we used an interruption-and-recall (IAR) task to explore listeners' ability to monitor the capacity of working memory as new information arrived in real time. In this task, listeners heard recorded word lists with instructions to interrupt the input at the maximum point that would still allow for perfect recall. Experiment 1 demonstrated that the most commonly selected segment size closely matched participants' memory span, as measured in a baseline span test. Experiment 2 showed that reducing the sound level of presented word lists to a suprathreshold but effortful listening level disrupted the accuracy of matching selected segment sizes with participants' memory spans. The results are discussed in terms of whether online capacity monitoring may be subsumed under other, already enumerated working memory executive functions (inhibition, set shifting, and memory updating).
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Percepção Auditiva/fisiologia , Função Executiva/fisiologia , Memória de Curto Prazo/fisiologia , Rememoração Mental/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Limiar Sensorial/fisiologia , Adulto JovemRESUMO
UNLABELLED: BACKGROUND/STUDY CONTEXT: Older adults, especially those with reduced hearing acuity, can make good use of linguistic context in word recognition. Less is known about the effects of the weighted distribution of probable target and nontarget words that fit the sentence context (response entropy). The present study examined the effects of age, hearing acuity, linguistic context, and response entropy on spoken word recognition. METHODS: Participants were 18 older adults with good hearing acuity (M age = 74.3 years), 18 older adults with mild-to-moderate hearing loss (M age = 76.1 years), and 18 young adults with age-normal hearing (M age = 19.6 years). Participants heard sentence-final words using a word-onset gating paradigm, in which words were heard with increasing amounts of onset information until they could be correctly identified. Degrees of context varied from a neutral context to a high context condition. RESULTS: Older adults with poor hearing acuity required a greater amount of word onset information for recognition of words when heard in a neutral context compared with older adults with good hearing acuity and young adults. This difference progressively decreased with an increase in words' contextual probability. Unlike the young adults, both older adult groups' word recognition thresholds were sensitive to response entropy. Response entropy was not affected by hearing acuity. CONCLUSION: Increasing linguistic context mitigates the negative effect of age and hearing loss on word recognition. The effect of response entropy on older adults' word recognition is discussed in terms of an age-related inhibition deficit.
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Envelhecimento/fisiologia , Perda Auditiva/fisiopatologia , Audição/fisiologia , Percepção da Fala , Adulto , Idoso , Feminino , Humanos , Idioma , Masculino , Adulto JovemRESUMO
Introduction: In spite of its apparent ease, comprehension of spoken discourse represents a complex linguistic and cognitive operation. The difficulty of such an operation can increase when the speech is degraded, as is the case with cochlear implant users. However, the additional challenges imposed by degraded speech may be mitigated to some extent by the linguistic context and pace of presentation. Methods: An experiment is reported in which young adults with age-normal hearing recalled discourse passages heard with clear speech or with noise-band vocoding used to simulate the sound of speech produced by a cochlear implant. Passages were varied in inter-word predictability and presented either without interruption or in a self-pacing format that allowed the listener to control the rate at which the information was delivered. Results: Results showed that discourse heard with clear speech was better recalled than discourse heard with vocoded speech, discourse with a higher average inter-word predictability was better recalled than discourse with a lower average inter-word predictability, and self-paced passages were recalled better than those heard without interruption. Of special interest was the semantic hierarchy effect: the tendency for listeners to show better recall for main ideas than mid-level information or detail from a passage as an index of listeners' ability to understand the meaning of a passage. The data revealed a significant effect of inter-word predictability, in that passages with lower predictability had an attenuated semantic hierarchy effect relative to higher-predictability passages. Discussion: Results are discussed in terms of broadening cochlear implant outcome measures beyond current clinical measures that focus on single-word and sentence repetition.
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Speech that has been artificially accelerated through time compression produces a notable deficit in recall of the speech content. This is especially so for adults with cochlear implants (CI). At the perceptual level, this deficit may be due to the sharply degraded CI signal, combined with the reduced richness of compressed speech. At the cognitive level, the rapidity of time-compressed speech can deprive the listener of the ordinarily available processing time present when speech is delivered at a normal speech rate. Two experiments are reported. Experiment 1 was conducted with 27 normal-hearing young adults as a proof-of-concept demonstration that restoring lost processing time by inserting silent pauses at linguistically salient points within a time-compressed narrative ("time-restoration") returns recall accuracy to a level approximating that for a normal speech rate. Noise vocoder conditions with 10 and 6 channels reduced the effectiveness of time-restoration. Pupil dilation indicated that additional effort was expended by participants while attempting to process the time-compressed narratives, with the effortful demand on resources reduced with time restoration. In Experiment 2, 15 adult CI users tested with the same (unvocoded) materials showed a similar pattern of behavioral and pupillary responses, but with the notable exception that meaningful recovery of recall accuracy with time-restoration was limited to a subgroup of CI users identified by better working memory spans, and better word and sentence recognition scores. Results are discussed in terms of sensory-cognitive interactions in data-limited and resource-limited processes among adult users of cochlear implants.
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Implante Coclear , Implantes Cocleares , Percepção da Fala , Adulto Jovem , Humanos , Fala , Percepção da Fala/fisiologia , RuídoRESUMO
Hearing loss is one of the most common complaints in adults over the age of 60 and a major contributor to difficulties in speech comprehension. To examine the effects of hearing ability on the neural processes supporting spoken language processing in humans, we used functional magnetic resonance imaging to monitor brain activity while older adults with age-normal hearing listened to sentences that varied in their linguistic demands. Individual differences in hearing ability predicted the degree of language-driven neural recruitment during auditory sentence comprehension in bilateral superior temporal gyri (including primary auditory cortex), thalamus, and brainstem. In a second experiment, we examined the relationship of hearing ability to cortical structural integrity using voxel-based morphometry, demonstrating a significant linear relationship between hearing ability and gray matter volume in primary auditory cortex. Together, these results suggest that even moderate declines in peripheral auditory acuity lead to a systematic downregulation of neural activity during the processing of higher-level aspects of speech, and may also contribute to loss of gray matter volume in primary auditory cortex. More generally, these findings support a resource-allocation framework in which individual differences in sensory ability help define the degree to which brain regions are recruited in service of a particular task.
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Córtex Auditivo/fisiopatologia , Compreensão/fisiologia , Perda Auditiva/patologia , Idioma , Fala/fisiologia , Idoso , Audiometria/métodos , Córtex Auditivo/irrigação sanguínea , Mapeamento Encefálico , Feminino , Audição/fisiologia , Perda Auditiva/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Individualidade , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangueRESUMO
OBJECTIVE: Participants in traditional studies of the effects of context on spoken word recognition have been university undergraduates. When older adults have been included, they have typically been matched with these young adults for verbal ability or years of education. Although this may be a good strategy for eliminating confounding variables, it is not clear how results of these studies may extend to the general population of young and older adults. The objective of this study was to examine the effects of adult age, hearing acuity, verbal ability, and cognitive function on the use of linguistic context in spoken word recognition. DESIGN: Fifty-three adults, aged 19 to 89 yr, heard short sentences in which the final word was masked by multitalker babble. The level of babble was progressively reduced in 2 dB steps until the sentence-final word could be correctly identified. Published norms were used to construct sets of sentences in which the same word could be heard with three levels of predictability (low, medium, and high) based on the linguistic context. In a fourth condition (no context), the words were preceded by a neutral carrier phrase. Participants received tests of verbal ability, with an emphasis on vocabulary knowledge, a brief test battery to assess cognitive function, and an assessment of hearing acuity based on pure-tone thresholds. Participants' hearing acuity ranged from normal acuity to moderate hearing loss. RESULTS: Results showed that the signal to noise ratio necessary for correct word recognition varied inversely with the probability of that word occurring in the sentence context. Hearing loss had a significant effect on word recognition for words heard in a neutral context, but the effect of hearing acuity diminished progressively with increasing contextual probability of the target word. Hierarchical multiple regressions showed that hearing acuity accounted for a significant amount of the variance at the lowest three levels of contextual probability but not at the highest probability level tested. Cognitive function contributed significantly to the obtained variance in word recognition performance at all levels of contextual probability tested. Moreover, participant age accounted for a significant amount of variance even after hearing acuity and cognitive function were taken into account. Verbal ability in the range represented by the test participants did not contribute significantly to recognition performance in any of the context conditions. CONCLUSIONS: Peripheral hearing acuity accounted for only a part of the variance in word recognition accuracy, with significant variance also contributed by individual differences in cognitive function and participant age. Results showed the ability to use linguistic context to aid spoken word recognition is sufficiently robust that a relatively wide range in verbal ability among native English speakers had no effect on recognition performance.
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Envelhecimento/fisiologia , Audição/fisiologia , Linguística , Reconhecimento Fisiológico de Modelo/fisiologia , Inteligibilidade da Fala/fisiologia , Percepção da Fala/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Limiar Auditivo/fisiologia , Cognição/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ruído , Mascaramento Perceptivo/fisiologia , Psicoacústica , Análise de Regressão , Adulto JovemRESUMO
OBJECTIVE: The purpose of this research was to determine whether negative effects of hearing loss on recall accuracy for spoken narratives can be mitigated by allowing listeners to control the rate of speech input. DESIGN: Paragraph-length narratives were presented for recall under two listening conditions in a within-participants design: presentation without interruption (continuous) at an average speech-rate of 150 words per minute; and presentation interrupted at periodic intervals at which participants were allowed to pause before initiating the next segment (self-paced). STUDY SAMPLE: Participants were 24 adults ranging from 21 to 33 years of age. Half had age-normal hearing acuity and half had mild- to-moderate hearing loss. The two groups were comparable for age, years of formal education, and vocabulary. RESULTS: When narrative passages were presented continuously, without interruption, participants with hearing loss recalled significantly fewer story elements, both main ideas and narrative details, than those with age-normal hearing. The recall difference was eliminated when the two groups were allowed to self-pace the speech input. CONCLUSION: Results support the hypothesis that the listening effort associated with reduced hearing acuity can slow processing operations and increase demands on working memory, with consequent negative effects on accuracy of narrative recall.
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Perda Auditiva/psicologia , Rememoração Mental , Percepção da Fala , Adulto , Estudos de Casos e Controles , Feminino , Audição , Humanos , Masculino , Fatores de Tempo , Vocabulário , Adulto JovemRESUMO
BACKGROUND: The authors reviewed the evidence regarding the existence of age-related declines in central auditory processes and the consequences of any such declines for everyday communication. PURPOSE: This report summarizes the review process and presents its findings. DATA COLLECTION AND ANALYSIS: The authors reviewed 165 articles germane to central presbycusis. Of the 165 articles, 132 articles with a focus on human behavioral measures for either speech or nonspeech stimuli were selected for further analysis. RESULTS: For 76 smaller-scale studies of speech understanding in older adults reviewed, the following findings emerged: (1) the three most commonly studied behavioral measures were speech in competition, temporally distorted speech, and binaural speech perception (especially dichotic listening); (2) for speech in competition and temporally degraded speech, hearing loss proved to have a significant negative effect on performance in most of the laboratory studies; (3) significant negative effects of age, unconfounded by hearing loss, were observed in most of the studies of speech in competing speech, time-compressed speech, and binaural speech perception; and (4) the influence of cognitive processing on speech understanding has been examined much less frequently, but when included, significant positive associations with speech understanding were observed. For 36 smaller-scale studies of the perception of nonspeech stimuli by older adults reviewed, the following findings emerged: (1) the three most frequently studied behavioral measures were gap detection, temporal discrimination, and temporal-order discrimination or identification; (2) hearing loss was seldom a significant factor; and (3) negative effects of age were almost always observed. For 18 studies reviewed that made use of test batteries and medium-to-large sample sizes, the following findings emerged: (1) all studies included speech-based measures of auditory processing; (2) 4 of the 18 studies included nonspeech stimuli; (3) for the speech-based measures, monaural speech in a competing-speech background, dichotic speech, and monaural time-compressed speech were investigated most frequently; (4) the most frequently used tests were the Synthetic Sentence Identification (SSI) test with Ipsilateral Competing Message (ICM), the Dichotic Sentence Identification (DSI) test, and time-compressed speech; (5) many of these studies using speech-based measures reported significant effects of age, but most of these studies were confounded by declines in hearing, cognition, or both; (6) for nonspeech auditory-processing measures, the focus was on measures of temporal processing in all four studies; (7) effects of cognition on nonspeech measures of auditory processing have been studied less frequently, with mixed results, whereas the effects of hearing loss on performance were minimal due to judicious selection of stimuli; and (8) there is a paucity of observational studies using test batteries and longitudinal designs. CONCLUSIONS: Based on this review of the scientific literature, there is insufficient evidence to confirm the existence of central presbycusis as an isolated entity. On the other hand, recent evidence has been accumulating in support of the existence of central presbycusis as a multifactorial condition that involves age- and/or disease-related changes in the auditory system and in the brain. Moreover, there is a clear need for additional research in this area.
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Audiometria/métodos , Medicina Baseada em Evidências , Perda Auditiva Central/diagnóstico , Presbiacusia/diagnóstico , Doenças do Nervo Vestibulococlear/diagnóstico , Idoso , Envelhecimento , Perda Auditiva Central/classificação , Humanos , Presbiacusia/classificação , Doenças do Nervo Vestibulococlear/classificaçãoRESUMO
We investigated how the aging brain copes with acoustic and syntactic challenges during spoken language comprehension. Thirty-eight healthy adults aged 54 - 80â¯years (Mâ¯=â¯66â¯years) participated in an fMRI experiment wherein listeners indicated the gender of an agent in short spoken sentences that varied in syntactic complexity (object-relative vs subject-relative center-embedded clause structures) and acoustic richness (high vs low spectral detail, but all intelligible). We found widespread activity throughout a bilateral frontotemporal network during successful sentence comprehension. Consistent with prior reports, bilateral inferior frontal gyrus and left posterior superior temporal gyrus were more active in response to object-relative sentences than to subject-relative sentences. Moreover, several regions were significantly correlated with individual differences in task performance: Activity in right frontoparietal cortex and left cerebellum (Crus I & II) showed a negative correlation with overall comprehension. By contrast, left frontotemporal areas and right cerebellum (Lobule VII) showed a negative correlation with accuracy specifically for syntactically complex sentences. In addition, laterality analyses confirmed a lack of hemispheric lateralization in activity evoked by sentence stimuli in older adults. Importantly, we found different hemispheric roles, with a left-lateralized core language network supporting syntactic operations, and right-hemisphere regions coming into play to aid in general cognitive demands during spoken sentence processing. Together our findings support the view that high levels of language comprehension in older adults are maintained by a close interplay between a core left hemisphere language network and additional neural resources in the contralateral hemisphere.
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Speech comprehension remains largely preserved in older adults despite significant age-related neurophysiological change. However, older adults' performance declines more rapidly than that of young adults when listening conditions are challenging. We investigated the cortical network underlying speech comprehension in healthy aging using short sentences differing in syntactic complexity, with processing demands further manipulated through speech rate. Neural activity was monitored using blood oxygen level-dependent functional magnetic resonance imaging. Comprehension of syntactically complex sentences activated components of a core sentence-processing network in both young and older adults, including the left inferior and middle frontal gyri, left inferior parietal cortex, and left middle temporal gyrus. However, older adults showed reduced recruitment of inferior frontal regions relative to young adults; the individual degree of recruitment predicted accuracy at the more difficult fast speech rate. Older adults also showed increased activity in frontal regions outside the core sentence-processing network, which may have played a compensatory role. Finally, a functional connectivity analysis demonstrated reduced coherence between activated regions in older adults. We conclude that decreased activation of specialized processing regions, and limited ability to coordinate activity between regions, contribute to older adults' difficulty with sentence comprehension under difficult listening conditions.