老年人噪声下言语识别的影响因素及听觉认知训练
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摘要
老年人多存在噪声下交流困难的情况,无论是否存在听力下降。噪声下言语识别能力下降是听觉中枢处理能力下降的主要表现。同时,外周听力水平和认知水平与其明显相关,彼此相互影响。三者相互作用的机制包括:共同原因、降低-补偿假说、信息退化假说、感觉剥夺假说和认知负荷假说。简而言之,听觉中枢处理能力同认知水平有明确的关系,随年龄的增长同时下降。降级的感觉输入(听力下降或者在噪声下交流)给认知系统带来更多的负荷,占据更多的认知资源,影响认知即时的处理。随着时间的流逝,长期的感觉剥夺会导致认知能力的全面下降。认知水平下降反过来从上而下影响对听觉中枢处理的补偿作用。明确三者之间的相互关系后,再探讨听觉训练和认知训练对噪声下言语识别能力的康复效果。大量研究证实,听觉训练程序在改善听力损失患者的听觉中枢处理和认知功能方面的治疗意义,同时认知训练可以通过训练认知的部分领域(记忆能力)改善认知和听觉中枢处理能力。
The elderly are more likely to have difficulty in communicating in noise, regardless of hearing loss. The decline of speech perception ability in noise is the main manifestation of the decline of central auditory processing ability. Hearing and cognition are significantly correlated with central auditory processing. The mechanisms of interaction among them are common cause, reduction-compensation hypothesis, information degradation hypothesis, sensory deprivation hypothesis and cognitive load hypothesis. In short, central auditory processing is clearly related with cognition, which decreases with age. The sensory input of degradation(hearing loss or communication in noise) brings more loads to the cognitive system, occupies more cognitive resources and affects the immediate processing of cognition. Over time, chronic sensory deprivation causes an overall decline in cognitive ability. Cognitive decline in turn affects the compensatory effect on perception from top to down, thereby affecting central auditory processing ability. After confirming the mutual relations between them, the effects of auditory and cognitive training on speech resolution in noise were explored. A number of studies have confirmed that the hearing training programs can improve central auditory processing and cognitive func-tion in patients with hearing loss, and cognitive training can be trained part of the cognitive domain(memory) to improve cognition and auditory perception.
The elderly are more likely to have difficulty in communicating in noise, regardless of hearing loss. The decline of speech perception ability in noise is the main manifestation of the decline of central auditory processing ability. Hearing and cognition are significantly correlated with central auditory processing. The mechanisms of interaction among them are common cause, reduction-compensation hypothesis, information degradation hypothesis, sensory deprivation hypothesis and cognitive load hypothesis. In short, central auditory processing is clearly related with cognition, which decreases with age. The sensory input of degradation(hearing loss or communication in noise) brings more loads to the cognitive system, occupies more cognitive resources and affects the immediate processing of cognition. Over time, chronic sensory deprivation causes an overall decline in cognitive ability. Cognitive decline in turn affects the compensatory effect on perception from top to down, thereby affecting central auditory processing ability. After confirming the mutual relations between them, the effects of auditory and cognitive training on speech resolution in noise were explored. A number of studies have confirmed that the hearing training programs can improve central auditory processing and cognitive func-tion in patients with hearing loss, and cognitive training can be trained part of the cognitive domain(memory) to improve cognition and auditory perception.
引文
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[28]Roberts K L,Allen H A.Perception and cognition in the ageing brain:a brief review of the short-and long-term links between perceptu-al and cognitive decline[J].Front Aging Neurosci,2016,8:39.
[29]Pichora-Fuller M K,Schneider B A.Masking-level differences in the elderly:a comparison of antiphasic and time-delay dichotic conditions[J].J Speech Hear Res,1991,34(6):1410-1422.
[30]Kim E Y,Kim K W.A theoretical framework for cognitive and noncognitive interventions for older adults:stimulation versus compensa-tion[J].Aging Ment Health,2014,18(3):304-315.
[31]Olson A D,Preminger J E,Shinn J B.The effect of LACE DVDtraining in new and experienced hearing aid users[J].J Am Acad Audi-ol,2013,24(3):214-230.
[32]Shanks J E,Wilson R H,Larson V,et al.Speech recognition perfor-mance of patients with sensorineural hearing loss under unaided and aided conditions using linear and compression hearing AIDS[J].Ear Hear,2002,23(4):280-290.
[33]Humes L E,Wilson D L.An examination of changes in hearing-aid performance and benefit in the elderly over a 3-year period of hearingaid use[J].J Speech Lang Hear Res,2003,46(1):137-145.
[34]Dawes P,Munro K J,Kalluri S,et al.Auditory acclimatization and hearing aids:late auditory-evoked potentials and speechrecognition fol-lowing unilateral and bilateral amplification[J].J Acoust Soc Am,2014,135(6):3560-3569.
[35]Sergeyenko Y,Lall K,Liberman M C,et al.Age-related cochlear synaptopathy:an early-onset contributor to auditory functional decline[J].J Neurosci,2013,33(34):13686-13694.
[36]Walton J P,Frisina R D,O'Neill W E.Age-related alteration in pro-cessing of temporal sound features in the auditory midbrain of the CBAmouse[J].J Neurosci,1998,18(7):2764-2776.
[37]Anderson S,White-Schwoch T,Parbery-Clark A,et al.Reversal of age-related neural timing delays with training[J].Proc Natl Acad Sci US A,2013,110(11):4357-4362.
[38]Rao A,Rishiq D,Yu L,et al.Neural correlates of selective attetion with hearing aid use followed by ReadMyQuips Auditory Training Pro-gram[J].Ear Hear,2017,38(1):28-41.
[39]Karawani H,Jenkins K A,Anderson S.Neural and behavioral chang-es after the use of hearing aids[J].Clin Neurophysiol,2018,129(6):1254-1267.
[40]Lampit A,Hallock H,Valenzuela M.Computerized cognitive train-ing in cognitively healthy older adults:a systematic review and metaanalysis of effect modifiers[J].PLoS Med,2014,11(11):e1001756.
[41]Wall J T,Xu J,Wang X.Human brain plasticity:an emerging view of the multiple substrates and mechanisms that cause cortical changes and related sensory dysfunctions after injuries of sensory inputs from the body[J].Brain Res Brain Res Rev,2002,39(2):181-215.
[42]Shah T M,Weinborn M,Verdile G,et al.Enhancing cognitive func-tioning in healthly older adults:a systematic review of the clinical sig-nificance of commercially available computerized cognitive training in preventing cognitive decline[J].Neuropsychol Rev,2017,27(1):62-80.
[43]Ferguson M A,Henshaw H,Clark D P A,et al.Benefits of phoneme discrimination training in a randomized controlled trial of 50-to 74-year-olds with mild hearing loss[J].Ear Hear,2014,35(4):e110-e121.
[44]Sweetow R W,Sabes J H.The need for and development of an adap-tive Listening and Communication Enhancement(LACE)Program[J].J Am Acad Audiol,2006,17(8):538-558.
[45]Henshaw H,Clark D P,Kang S,et al.Computer skills and internet use in adults aged 50-74 years:influence of hearing difficulties[J].JMed Internet Res,2012,14(4):e113.
[46]Lawrence B J,Jayakody D M P,Henshaw H,et al.Auditory and cog-nitive training for cognition in adults with hearing loss:a systematic re-view and meta-analysis[J].Trends Hear,2018,22:2331216518792096.
[47]Saunders G H,Smith S L,Chisolm T H,et al.A randomized control trial:supplementing hearing aid use with Listening and Communication Enhancement(LACE)auditory training[J].Ear Hear,2016,37(4):381-396.
[48]Hill N T,Mowszowski L,Naismith S L,et al.Computerized cogni-tive training in older adults with mild cognitive impairment or demen-tia:a systematic review and meta-analysis[J].Am J Psychiatry,2017,174(4):329-340.
[49]Lawrence B J,Gasson N,Bucks R S,et al.Cognitive training and noninvasive brain stimulation for cognition in parkinson's disease:a meta-analysis[J].Neurorehabil Neural Repair,2017,31(7):597-608.
[50]Akeroyd M A.Are individual differences in speech reception related to individual differences in cognitive ability?A survey of twenty experi-mental studies with normal and hearing-impaired adults[J].Int J Audi-ol,2008,47(Suppl 2):S53-S71.
[51]Lunner T,Rudner M,R?nnberg J.Cognition and hearing aids[J].Scand J Psychol,2010,50(5):395-403.
[2]Kathleen Pichora-Fuller M.Use of supportive context by younger and older adult listeners:balancing bottom-up and top-down information processing[J].Int J Audiol,2008,47(Suppl 2):S72-S82.
[3]Nelson P B,Jin S H.Factors affecting speech understanding in gated in-terference:cochlear implant users and normal-hearing listeners[J].JAcoust Soc Am,2004,115(1):2286-2294.
[4]Price C,Thierry G,Griffiths T.Speech-specific auditory processing:where is it?[J].Trends Cogn Sci,2005,9(6):271-276.
[5]Pichorafuller M K,Singh G.Effects of age on auditory and cognitive processing:implications for hearing aid fitting and audiologic rehabili-tation[J].Trends Amplif,2006,10(1):29-59.
[6]Jerker R,Thomas L,Adriana Z,et al.The Ease of Language Under-standing(ELU)model:theoretical,empirical,and clinical advances[J].Front Syst Neurosci,2013,7:31.
[7]Ahissar M,Nahum M,Nelken I,et al.Reverse hierarchies and sensory learning[J].Philos Trans R Soc Lond B Biol Sci,2009,364(1515):285-299.
[8]Karawani H,Bitan T,Attias J,et al.Auditory perceptual learning in adults with and without age-related hearing loss[J].Front Psychol,2016,6:2066.
[9]Davis M H,Johnsrude I S.Hearing speech sounds:top-down influenc-es on the interface between audition and speech perception[J].Hear Res,2007,229(1):132-147.
[10]Hickok G,Poeppel D.The cortical organization of speech processing[J].Nat Rev Neurosci,2007,8(5):393-402.
[11]Pathai S,Shiels P G,Lawn S D,et al.The eye as a model of ageing in translational research-molecular,epigenetic and clinical aspects[J].Ageing Res Rev,2013,12(2):490-508.
[12]Shargorodsky J,Curhan S G,Eavey R,et al.A prospective study of cardiovascular risk factors and incident hearing loss in men[J].Laryn-goscope,2010,120(9):1887-1891.
[13]Knopman D,Boland L L,Mosley T,et al.Cardiovascular risk factors and cognitive decline in middle-aged adults[J].Neurology,2001,56(1):42-48.
[14]Humes L E,Busey T A,Craig J,et al.Are age-related changes in cognitive function driven by age-related changes in sensory process-ing?[J].Atten Percept Psychophys,2013,75(3):508-524.
[15]Wong P C,Uppunda A K,Parrish T B,et al.Cortical mechanisms of speech perception in noise[J].Neuropsychologia,2009,47(3):693-703.
[16]Wong P C,Ettlinger M,Sheppard J P,et al.Neuroanatomical charac-teristics and speech perception in noise in older adults[J].Ear Hear,2010,31(4):471-479.
[17]Zekveld A A,Heslenfeld D J,Festen J M,et al.Top-down and bot-tom-up processes in speech comprehension[J].Neuroimage,2006,32(4):1826-1836.
[18]Zekveld A A,Kramer S E,Festen J M.Cognitive load during speech perception in noise:the influence of age,hearing loss,and cognition on the pupil response[J].Ear Hear,2011,32(4):498-510.
[19]Ng E H,Rudner M,Lunner T,et al.Effects of noise and working memory capacity on memory processing of speech for hearing-aid us-ers[J].Int Audiol,2013,52(7):433-441.
[20]Tun P A,McCoy S,Wingfield A.Aging,hearing acuity,and the at-tentional costs of effortful listening[J].Psychol Aging,2009,24(3):761-766.
[21]Rabbitt P.Mild hearing loss can cause apparent memory failures which increase with age and reduce with IQ[J].Acta Otolaryngol Sup-pl,1990,476:167-175;discussion 176.
[22]Füllgrabe C,Rosen S.Investigating the role of working memory in speech-in-noise identification for listeners with normal hearing[J].Adv Exp Med Biol,2016,894:29-36.
[23]Rudner M,Lunner T.Cognitive spare capacity and speech communi-cation:a narrative overview[J].Biomed Res Int,2014,2014:869726.
[24]Lin F R,Yaffe K,Xia J,et al.Hearing loss and cognitive decline in older adults[J].JAMA Intern Med,2013,173(4):293-299.
[25]Taljaard D S,Olaithe M,Brennan-Jones C G,et al.The relationship between hearing impairment and cognitive function:a meta-analysis in adults[J].Clin Otolaryngol,2016,41(6):718-729.
[26]R?nnberg J,Danielsson H,Rudner M,et al.Hearing loss is negative-ly related to episodic and semantic long-term memory but not to shortterm memory[J].J Speech Lang Hear Res,2011,54(2):705-726.
[27]Valentijn S A,van Boxtel M P,van Hooren S A,et al.Change in sen-sory functioning predicts change in cognitive functioning:results from a 6-year follow-up in the maastricht aging study[J].J Am Geriatr Soc,2005,53(3):374-380.
[28]Roberts K L,Allen H A.Perception and cognition in the ageing brain:a brief review of the short-and long-term links between perceptu-al and cognitive decline[J].Front Aging Neurosci,2016,8:39.
[29]Pichora-Fuller M K,Schneider B A.Masking-level differences in the elderly:a comparison of antiphasic and time-delay dichotic conditions[J].J Speech Hear Res,1991,34(6):1410-1422.
[30]Kim E Y,Kim K W.A theoretical framework for cognitive and noncognitive interventions for older adults:stimulation versus compensa-tion[J].Aging Ment Health,2014,18(3):304-315.
[31]Olson A D,Preminger J E,Shinn J B.The effect of LACE DVDtraining in new and experienced hearing aid users[J].J Am Acad Audi-ol,2013,24(3):214-230.
[32]Shanks J E,Wilson R H,Larson V,et al.Speech recognition perfor-mance of patients with sensorineural hearing loss under unaided and aided conditions using linear and compression hearing AIDS[J].Ear Hear,2002,23(4):280-290.
[33]Humes L E,Wilson D L.An examination of changes in hearing-aid performance and benefit in the elderly over a 3-year period of hearingaid use[J].J Speech Lang Hear Res,2003,46(1):137-145.
[34]Dawes P,Munro K J,Kalluri S,et al.Auditory acclimatization and hearing aids:late auditory-evoked potentials and speechrecognition fol-lowing unilateral and bilateral amplification[J].J Acoust Soc Am,2014,135(6):3560-3569.
[35]Sergeyenko Y,Lall K,Liberman M C,et al.Age-related cochlear synaptopathy:an early-onset contributor to auditory functional decline[J].J Neurosci,2013,33(34):13686-13694.
[36]Walton J P,Frisina R D,O'Neill W E.Age-related alteration in pro-cessing of temporal sound features in the auditory midbrain of the CBAmouse[J].J Neurosci,1998,18(7):2764-2776.
[37]Anderson S,White-Schwoch T,Parbery-Clark A,et al.Reversal of age-related neural timing delays with training[J].Proc Natl Acad Sci US A,2013,110(11):4357-4362.
[38]Rao A,Rishiq D,Yu L,et al.Neural correlates of selective attetion with hearing aid use followed by ReadMyQuips Auditory Training Pro-gram[J].Ear Hear,2017,38(1):28-41.
[39]Karawani H,Jenkins K A,Anderson S.Neural and behavioral chang-es after the use of hearing aids[J].Clin Neurophysiol,2018,129(6):1254-1267.
[40]Lampit A,Hallock H,Valenzuela M.Computerized cognitive train-ing in cognitively healthy older adults:a systematic review and metaanalysis of effect modifiers[J].PLoS Med,2014,11(11):e1001756.
[41]Wall J T,Xu J,Wang X.Human brain plasticity:an emerging view of the multiple substrates and mechanisms that cause cortical changes and related sensory dysfunctions after injuries of sensory inputs from the body[J].Brain Res Brain Res Rev,2002,39(2):181-215.
[42]Shah T M,Weinborn M,Verdile G,et al.Enhancing cognitive func-tioning in healthly older adults:a systematic review of the clinical sig-nificance of commercially available computerized cognitive training in preventing cognitive decline[J].Neuropsychol Rev,2017,27(1):62-80.
[43]Ferguson M A,Henshaw H,Clark D P A,et al.Benefits of phoneme discrimination training in a randomized controlled trial of 50-to 74-year-olds with mild hearing loss[J].Ear Hear,2014,35(4):e110-e121.
[44]Sweetow R W,Sabes J H.The need for and development of an adap-tive Listening and Communication Enhancement(LACE)Program[J].J Am Acad Audiol,2006,17(8):538-558.
[45]Henshaw H,Clark D P,Kang S,et al.Computer skills and internet use in adults aged 50-74 years:influence of hearing difficulties[J].JMed Internet Res,2012,14(4):e113.
[46]Lawrence B J,Jayakody D M P,Henshaw H,et al.Auditory and cog-nitive training for cognition in adults with hearing loss:a systematic re-view and meta-analysis[J].Trends Hear,2018,22:2331216518792096.
[47]Saunders G H,Smith S L,Chisolm T H,et al.A randomized control trial:supplementing hearing aid use with Listening and Communication Enhancement(LACE)auditory training[J].Ear Hear,2016,37(4):381-396.
[48]Hill N T,Mowszowski L,Naismith S L,et al.Computerized cogni-tive training in older adults with mild cognitive impairment or demen-tia:a systematic review and meta-analysis[J].Am J Psychiatry,2017,174(4):329-340.
[49]Lawrence B J,Gasson N,Bucks R S,et al.Cognitive training and noninvasive brain stimulation for cognition in parkinson's disease:a meta-analysis[J].Neurorehabil Neural Repair,2017,31(7):597-608.
[50]Akeroyd M A.Are individual differences in speech reception related to individual differences in cognitive ability?A survey of twenty experi-mental studies with normal and hearing-impaired adults[J].Int J Audi-ol,2008,47(Suppl 2):S53-S71.
[51]Lunner T,Rudner M,R?nnberg J.Cognition and hearing aids[J].Scand J Psychol,2010,50(5):395-403.
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