Assessing Cognitive Abilities in High-Performing Cochlear Implant Users

Despite being considered one of the most successful neural prostheses, cochlear implants (CIs) provide recipients with a wide range of speech perception performance. While some CI users can understand speech in the absence of visual cues, other recipients exhibit more limited speech perception. Cognitive skills have been documented as a contributor to complex auditory processing, such as language understanding; however, there are no normative data for existing standardized clinical tests assessing cognitive abilities in CI users. Here, we assess the impact of modality of presentation (i.e., auditory-visual versus visual) for the administration of working memory tests in high-performing CI users in addition to measuring processing speed, cognitive efficiency and intelligence quotient (IQ). Second, we relate performance on these cognitive measures to clinical CI speech perception outcomes.Methods: Twenty one post-lingually deafened, high-performing, adult CI users [age range: 52–88 years; 3 unilateral CI, 13 bimodal (i.e., CI with contralateral hearing aid), 5 bilateral CI] with clinical speech perception scores (i.e., AzBio sentences in quiet for the first-ear CI) of ≥60% were recruited. A cognitive test battery assessing auditory-visual working memory (AVWM), visual working memory (VWM), processing speed, cognitive efficiency and IQ was administered, in addition to clinical measures of speech perception in quiet (i.e., AzBio sentences in quiet). AzBio sentences were assessed in two conditions: first-ear CI only, and best-aided everyday wearing condition. Subjects also provided self-reported measures of performance and benefit from their CI using standardized materials, including the Glasgow Benefit Inventory (GBI) and the Nijmegen Cochlear Implant questionnaire (NCIQ).Results: High-performing CI users demonstrated greater VWM than AVWM recall. VWM was positively related to AzBio scores when measured in the first-ear CI only. AVWM, processing speed, cognitive efficiency, and IQ did not relate to either measure of speech perception (i.e., first-ear CI or best-aided conditions). Subjects’ self-reported benefit as measured by the GBI predicted best-aided CI speech perception performance.Conclusion: In high-performing CI recipients, visual presentation of working memory tests may improve our assessment of cognitive function

Musical Experience Limits the Degradative Effects of Background Noise on the Neural Processing of Sound

Musicians have lifelong experience parsing melodies from background harmonies, which can be considered a process analogous to speech perception in noise. To investigate the effect of musical experience on the neural representation of speech-in-noise, we compared subcortical neurophysiological responses to speech in quiet and noise in a group of highly trained musicians and nonmusician controls. Musicians were found to have a more robust subcortical representation of the acoustic stimulus in the presence of noise. Specifically, musicians demonstrated faster neural timing, enhanced representation of speech harmonics, and less degraded response morphology in noise. Neural measures were associated with better behavioral performance on the Hearing in Noise Test (HINT) for which musicians outperformed the nonmusician controls. These findings suggest that musical experience limits the negative effects of competing background noise, thereby providing the first biological evidence for musicians' perceptual advantage for speech-in-noise.</jats:p

Assessing performance on the Montreal Cognitive Assessment (MoCA) in experienced cochlear implant users: use of alternative scoring guidelines.

Although research suggests a relationship between hearing impairment and cognitive decline in older adults, nuances of this relationship remain unclear. This uncertainty could be attributed to verbal administration of standardized cognitive measures to hearing-impaired (HI) individuals. Various strategies for testing HI populations have been suggested. We tested the efficacy of applying alternative scoring methods that systematically removed auditory-based items on the Montreal Cognitive Assessment (MoCA) in 27 cochlear implant patients. We calculated the original MoCA score and three alternative scores. The first alternative removed items from the Attention and Language sections; the second alternative removed the Delayed Recall task, and the third alternative removed the Attention, Language, and Delayed Recall items. QoL was assessed using the Glasgow Benefit Inventory and Nijmegen Cochlear Implant Questionnaire. Results indicate a significant difference in MoCA scores with two alternative scoring methods. The second alternative MoCA score related to self-reported performance on the GBI

Performance on the standard and hearing-impaired Montreal Cognitive Assessment in cochlear implant users.

OBJECTIVES: Commonly used cognitive screening tools were not originally developed for patients with hearing loss (HL) and rely heavily on the ability to hear the instructions and test stimuli. Recently, the Montreal Cognitive Assessment (MoCA) was modified for use with hearing-impaired populations (ie, HI-MoCA). In order to investigate the clinical utility of the HI-MoCA, we assessed performance between the standard MoCA and HI-MoCA among postlingually deafened cochlear implant (CI) users. METHODS: We administered the standard MoCA and HI-MoCA to 21 CI users and compared their performance. We assessed differences in pass/fail status when items from the attention and language sections and the delayed recall task were removed. RESULTS: There was no significant difference in performance between the standard MoCA and HI-MoCA. Participants scored higher on both test versions when the delayed recall task was removed. Participants also performed better on the delayed recall task on the HI-MoCA than on the standard MoCA. CONCLUSIONS: While our findings suggest that the modality of presentation for the MoCA does not influence overall performance for postlingually deafened CI users, visual presentation of stimuli impacted performance on delayed recall. Furthermore, irrespective of presentation modality, our participants scored higher on both MoCA versions when the delayed recall task was removed. Clinically, modifications to the presentation of the MoCA might not be necessary for CI users; however, clinicians should be aware that the delayed recall task is inherently harder for these patients

Biological impact of preschool music classes on processing speech in noise

AbstractMusicians have increased resilience to the effects of noise on speech perception and its neural underpinnings. We do not know, however, how early in life these enhancements arise. We compared auditory brainstem responses to speech in noise in 32 preschool children, half of whom were engaged in music training. Thirteen children returned for testing one year later, permitting the first longitudinal assessment of subcortical auditory function with music training. Results indicate emerging neural enhancements in musically trained preschoolers for processing speech in noise. Longitudinal outcomes reveal that children enrolled in music classes experience further increased neural resilience to background noise following one year of continued training compared to nonmusician peers. Together, these data reveal enhanced development of neural mechanisms undergirding speech-in-noise perception in preschoolers undergoing music training and may indicate a biological impact of music training on auditory function during early childhood