Speech Perception and High Cognitive Demand

Official title

Auditory-cognitive Training Paradigm (NIH P01 Project - Speech Perception With High Cognitive Demand)

Overview

With advancing age, adults experience increasing speech understanding difficulties in challenging situations. Currently, speech-in-noise difficulties are rehabilitated by providing hearing aids. For older normal-hearing adults, however, hearing devices do not provide much benefit since these adults do not have decreased hearing sensitivity. The goal of the "Speech Perception and High Cognitive Demand" project is to evaluate the benefit of a new auditory-cognitive training paradigm. In the present study neural (as measured by pupillometry and magnetoencephalography) and behavioral changes of speech-in-noise perception from pretest to posttest will be examined in older adults (age 65 - 85 years) assigned to one of three training groups: 1) Active Control Group: sessions of watching informational videos, 2) Auditory Training Group: sessions of auditory training listening to one of two speakers in everyday scenarios (e.g., driving directions) and needing to recall what one speaker said in the previous sentence, and 3) Auditory-cognitive training group: identical to the auditory training group, except participants will be asked to remember information from two previous sentences. Changes in speech-in-noise perception will be examined for the three groups of older adults and gains will be compared to a control group of young, normal hearing adults (18-30 years) that is not part of the clinical trial and will not undergo any training.

Detailed description

With advancing age, adults experience increasing difficulties in understanding speech in challenging situations, such as difficulty with understanding others in a noisy restaurant. Speech-in-noise difficulties are typically rehabilitated by providing hearing aids. For older normal-hearing adults, however, hearing devices do not provide much benefit since these adults do not have decreased hearing sensitivity. For these adults, communication difficulties persist in everyday life situations and can even lead to social withdrawal, isolation, and depression. A growing body of studies demonstrates that combined auditory-cognitive training paradigms can offer speech-in-noise benefits to adults with hearing loss that could prevent the consequences listed above.

The goal of the "Speech Perception with High Cognitive Demand" project is to evaluate the benefit of a new auditory-cognitive training paradigm for older normal-hearing adults. The investigators developed an American English version of the Nottingham (UK) PLUS training paradigm in which listeners are asked to focus and listen to one speaker while ignoring another speaker. Although it cannot ensure that every participant will experience direct significant benefit from the training, the paradigm is being designed to optimally enhance the possibility of benefit: an adaptive procedure is employed to train each individual at their own level and to make the task challenging. In a separate training condition, a short-term memory component is added to the original training paradigm to also enhance the cognitive skills of the participants. In addition, the training is implemented on touch-screen laptops, making at-home training possible. This way, training is provided in a realistic setting which will ensure a better transfer of the trained skills to daily communication situations. The trial consists of three conditions: 1) Auditory only training, 2) Auditory-cognitive training, and 3) Active control of informational videos.

Interventions

• Behavioral Auditory-cognitive training paradigm
  The investigators developed an American English version of the Nottingham (UK) PLUS training paradigm in which listeners are asked to focus and listen to one speaker while ignoring another speaker. The paradigm is designed to optimally enhance the possibility of benefit: an adaptive procedure is employed to train each individual at their own level to make the task challenging. A short-term memory component, in which listeners are asked to remember what a designated speaker said two sentences pri
• Behavioral Auditory training paradigm
  The investigators developed an American English version of the Nottingham (UK) PLUS training paradigm in which listeners are asked to focus and listen to one speaker while ignoring another speaker. The paradigm is designed to optimally enhance the possibility of benefit: an adaptive procedure is employed to train each individual at their own level to make the task challenging. Participants will be asked to recall the keywords of the to-be-attended speaker. The sentences will be presented in a tw

Primary outcome measures

• Change in speech-in-noise perception [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• Audiobook - Change in pupillary response [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• Audiobook - Change in magnetoencephalography (MEG) temporal response function [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• Change in Magnetoencephalography (MEG) stimulus reconstruction accuracies and integration window analysis [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• Audiobook - Change in frequency following response (FFR) [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• Audiobook - Change in Magnetoencephalography (MEG) network localized granger causality [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]

Secondary outcome measures (6)

• Audiobook - Change in subjective ratings [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• Tone cloud - Change in auditory stream segregation accuracy [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• Tone cloud - Change in auditory stream segregation reaction time (RT) [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• N-back task - Change in accuracy [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• N-back task - Change in response time (RT) [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]
• Reading Span (RSpan) - Change in working memory (WM) [Time frame: Week 1-2 (pretest) and Week 5-6 (posttest)]

Eligibility criteria

Inclusion criteria

• Aged between 65 - 85 years
• Normal hearing (pure tone thresholds ≤ 25 dB HL from 250 - 8000 Hz)
• Self-reported normal or corrected-to-normal vision
• Dominant language: American English
• Education: a high school diploma or higher education level

Exclusion criteria

• Middle-ear or inner-ear pathology
• Non-native speaker of English
• Inability to complete all training sessions within a pre-specified time window (e.g., due to unexpected schedule restrictions)
• Learning disorders
• Metal in body that induces a data artifact for MEG recording (e.g., excessive metal dental work) or that poses a safety issue in the MRI portion (e.g., pacemakers, neural implants, metal plates or joints, shrapnel, and surgical staples)
• Claustrophobia or any condition that would be exacerbated by the scanning environment's lighting, sounds, etc. (e.g., migraines)
• A non-removable hairstyle or hair accessory that would prevent the participant from fitting comfortably in the MEG or MRI head coil
• Currently under a medical provider's care for a closed head injury
• Currently taking psychoactive stimulant (e.g., amphetamines), depressant (e.g., benzodiazepines), mood stabilizing (e.g., lithium), anti-psychotic, or anti-seizure medications or drugs of abuse
• Currently pregnant (only for MRI)

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Treatment

Study locations

United States · 2 centers

• Department of Hearing and Speech Sciences — College Park
• Maryland Neuroimaging Center — College Park

Publications

• Ferguson MA, Henshaw H. Auditory training can improve working memory, attention, and communication in adverse conditions for adults with hearing loss. Front Psychol. 2015 May 28;6:556. doi: 10.3389/fpsyg.2015.00556. eCollection 2015. PMID 26074826
• Lawrence BJ, Jayakody DMP, Henshaw H, Ferguson MA, Eikelboom RH, Loftus AM, Friedland PL. Auditory and Cognitive Training for Cognition in Adults With Hearing Loss: A Systematic Review and Meta-Analysis. Trends Hear. 2018 Jan-Dec;22:2331216518792096. doi: 10.1177/2331216518792096. PMID 30092719

Identifiers

NCT: NCT04997577 · P01AG055365 · 5P01AG055365-04

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗