PTA, brain imaging, and cognition with QuickSIN (Jiang et al., 2024)

Purpose: Population-based evidence in the interrelationships among hearing, brain structure, and cognition is limited. This study aims to investigate the cross-sectional associations of peripheral hearing, brain imaging measures, and cognitive function with speech-in-noise performance among older adults.

Method: We studied 602 participants in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) brain magnetic resonance imaging (MRI) ancillary study, including 427 ACHIEVE baseline (2018–2020) participants with hearing loss and 175 Atherosclerosis Risk in Communities Neurocognitive Study Visit 6/7 (2016–2017/2018–2019) participants with normal hearing. Speech-in-noise performance, as outcome of interest, was assessed by the Quick Speech-in-Noise (QuickSIN) test (range: 0–30; higher = better). Predictors of interest included (a) peripheral hearing assessed by pure-tone audiometry; (b) brain imaging measures: structural MRI measures, white matter hyperintensities, and diffusion tensor imaging measures; and (c) cognitive performance assessed by a battery of 10 cognitive tests. All predictors were standardized to z scores. We estimated the differences in QuickSIN associated with every standard deviation (SD) worse in each predictor (peripheral hearing, brain imaging, and cognition) using multivariable-adjusted linear regression, adjusting for demographic variables, lifestyle, and disease factors (Model 1), and, additionally, for other predictors to assess independent associations (Model 2).

Results: Participants were aged 70–84 years, 56% female, and 17% Black. Every SD worse in better-ear 4-frequency pure-tone average was associated with worse QuickSIN (−4.89, 95% confidence interval, CI [−5.57, −4.21]) when participants had peripheral hearing loss, independent of other predictors. Smaller temporal lobe volume was associated with worse QuickSIN, but the association was not independent of other predictors (−0.30, 95% CI [−0.86, 0.26]). Every SD worse in global cognitive performance was independently associated with worse QuickSIN (−0.90, 95% CI [−1.30, −0.50]).

Conclusions: Peripheral hearing and cognitive performance are independently associated with speech-in-noise performance among dementia-free older adults. The ongoing ACHIEVE trial will elucidate the effect of a hearing intervention that includes amplification and auditory rehabilitation on speech-in-noise understanding in older adults.

Supplemental Material S1. Characteristics of participants by cohort (Audiometric Hearing Loss) at ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S2. Protocol details.

Supplemental Material S3. Multivariable-adjusted associations of pure-tone average with speech-in-noise performance, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19) after excluding ACHIEVE participants with hearing loss above 50 dB HL: Multivariable-adjusted linear regression with spline term at mean pure-tone average (PTA), which is 33 dB HL (standardized PTA = 0) to estimate change in the quick speech-in-noise score associated with every standard deviation worse in PTA when PTA <33 dB HL and PTA ≥33 dB HL respectively. (a) Model adjusted for age, sex, race, field center, education, body mass index, smoking, hypertension, diabetes, and stroke (N = 571). (b) Model adjusted for age, sex, race, field center, education, body mass index, smoking, hypertension, diabetes, stroke, intracranial volume, global cognitive performance, total brain volume, fractional anisotropy, mean diffusivity, white matter hyperintensities volume (N = 556).

Supplemental Material S4. Multivariable-adjusted associations of magnetic resonance imaging (MRI) measures with speech-in-noise performance after excluding ACHIEVE participants with hearing loss above 50 dB HL, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S5. Multivariable-adjusted associations of global and domain-specific cognitive performance with speech-in-noise performance after excluding ACHIEVE participants with hearing loss above 50 dB HL, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S6. Multivariable-adjusted associations of magnetic resonance imaging (MRI) measures with speech-in-noise performance considering cohort, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S7. Multivariable-adjusted associations of global and domain-specific cognitive performance with speech-in-noise performance considering cohort, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S8. Multivariable-adjusted associations of magnetic resonance imaging (MRI) measures with speech-in-noise performance by cohort, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S9. Multivariable-adjusted associations of global and domain-specific cognitive performance with speech-in-noise performance by cohort, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S10. Multivariable-adjusted associations of pure-tone average (PTA) with speech-in-noise performance, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S11. Multivariable-adjusted associations of magnetic resonance imaging (MRI) measures with speech-in-noise performance adjusting for pure-tone average (PTA) or cognition only, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S12. Multivariable-adjusted associations of magnetic resonance imaging (MRI) measures with speech-in-noise performance, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S13. Multivariable-adjusted associations of global and domain-specific cognitive performance with speech-in-noise performance, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Supplemental Material S14. Summary of the study findings, ACHIEVE baseline (2018–20) and ARIC-NCS Visit 6/7 (2016–17/2018–19).

Jiang, K., Albert, M. S., Coresh, J., Couper, D. J., Gottesman, R. F., Hayden, K. M., Jack Jr., C. R., Knopman, D. S., Mosley, T. H., Pankow, J. S., Pike, J. R., Reed, N. S., Sanchez, V. A., Richey Sharrett, A., Lin, F. R., & Deal, J. A., for the ACHIEVE Collaborative Study. (2024). Cross-sectional associations of peripheral hearing, brain imaging, and cognitive performance with speech-in-noise performance: The Aging and Cognitive Health Evaluation in Elders brain magnetic resonance imaging ancillary study. American Journal of Audiology, 33(3), 683–694. https://doi.org/10.1044/2024_AJA-23-00108