Volume 8 Issue 3 (pdf) - Andrew John Publishing Inc

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If our goal is to maximize our patients’
ability to communicate, we must consider
the role of cognitive processing in AR. It
is impossible to disentangle sensory loss
from cognitive processing in older
listeners, and so effective intervention
must include both amplification (bottomup)
and training (top-down) to improve
auditory skills and teach compensatory
behavioral strategies. Bottom-up strategies
focus on access to a clear signal, while topdown
strategies focus on functional
communication (see Table 3, based on
Ferre, J: Rehabilitation for Auditory
Processing Difficulties in Adults, ASHA
on-line seminar, 2012).
“There’s more than one way to recognize
a word” 13 ; through AR techniques, we can
teach compensatory behavioral communication
strategies to patients and
caregivers, to improve top down
processing and help to compensate for
sensory deficits.
Group AR programs not only help older
adults become more effective
communicators, they also foster their
participation and social interaction. 22 A
group gives an opportunity for repetitive
practice of communication repair
strategies in a meaningful context while
addressing social participation needs.
Social interaction is known to promote
cognitive health and has been shown to
have a protective effect against
dementia. 5,23,24 The Hard of Hearing Club
at Baycrest was designed for seniors with
severe hearing loss at risk for social
isolation and has successfully addressed
both educational and social needs for
many of its members over the 13 years
that it has been running. 25
There is a pressing need for audiologists
to understand how cognitive impairment
interacts with hearing loss so interventions
can be tailored to better suit client needs.
Dr. Lin is conducting another research
project that will follow older adults over
time to see if audiologic interventions will
help delay the onset or slow the
progression of cognitive decline. At
Baycrest, audiologists will be working
with psychologists to look at whether
fitting HAs and providing AR will have a
positive impact for patients with early
dementia and their caregivers. If this is
indeed the case, the implications are huge,
and audiologists could play a critical role
in providing solutions to this pressing
public health concern.
referenCes
1. Alzheimer’s Society of Canada. Rising tide: the
impact of dementia on Canadian society.
Toronto: Author; 2010.
2. Uhlmann RF, Larson EB, Rees TS, et al.
Koepsell. Relationship of hearing impairment to
dementia and cognitive dysfunction in older
adults. .Journal of the American Medical
Association 1989;261:1916–19.
3. Lin FR. Hearing loss and cognition among older
adults in the United States.Journals of
Gerontology A: Biological Sciences and Medical
Sciences 2011;66:1131–36.
4. Gates GA, Beiser A, Rees TS, et al. Central
auditory dysfunction may precede the onset of
clinical dementia in people with probable
Alzheimer’s disease. Journal of the American
Geriatrics Society 2002;50:482–88.
5. Gates GA, Anderson ML, McCurry SM, et al.
Central auditory dysfunction is a harbinger of
Alzheimer’s dementia. Archives of
Otolaryngology-Head and Neck Surgery
2011;137:390–95.
6. Kricos P. Audiologic management of older
adults with hearing loss and compromised
cognitive/psychoacoustic auditory processing
capabilities. Trends in Amplification
2006;10(1):1–28.
7. Pichora-Fuller MK. Effects of age on auditory
and cognitive processing: implications for
hearing aid fitting and audiologic rehabilitation,
Trends in Amplification 2006;10(1) 29–59.
8. Lunner T. Memory systems in relation to
hearing aid use. Cognition, Audition and
Amplification, AAA Conference, Boston; 2012.
9. Musiek F. Assessment of central auditory
dysfunction: The Dichotic Digit Test revisited.
Ear and Hearing 1983;4:79–83.
10. Idrizbegovic E, Hederstierna C, Dahlquist M, et
al.Central auditory function in early Alzheimer's
disease and in mild cognitive impairment.Age
and Ageing 2011;40:249–54.
11. Lin FR, Metter EJ, O’Brien RJ, et al. Hearing loss
and incident dementia.Archives of Neurology
2011;68:214–20.
12. Kricos P. Providing hearing rehabilitation to
people with dementia presents unique
challenges. The Hearing Journal
2009;62(11):39–43.
13. Pichora-Fuller MK. Perceptual effort and
apparent cognitive decline: Implications for
audiologic rehabilitation. Seminars in Hearing
2006;27:4.
14. Kiessling J, Pichora-Fuller MK, Gatehouse S, et
al. Candidature for and delivery of audiological
services: Special needs of older people.
International Journal of Audiology
2003;42(Suppl 2):2S92–101.
15. Pichora-Fuller MK. Audition and cognition:
Where the lab meets clinic. ASHA Leader
2008;13(10):14–17.
16. Humes LE. Modeling and predicting hearingaid
outcome. Trends in Amplification
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17. Gatehouse S, Naylor G, and Elberling C. Linear
and non-linear hearing aid fittings – 2. Patterns
of candidature. International Journal of
Audiology 2006;45:153–71.
18. Lunner T and Sundewall-Thorén E. Interactions
between cognition, compression, and listening
conditions: Effects on speech-in-noise
performance in a two-channel hearing aid.
Journal of the American Academy of Audiology
2007;18:604–17.
19. Walden TC and Walden BE. Unilateral versus
bilateral amplification for adults with impaired
hearing. Journal of the American Academy of
Audiology 2005;16(8):574–84.
20. Kobler S, Lindblad AC, Olofsson A, and
Hagerman B. Successful and unsuccessful users
of bilateral amplification: differences and
similarities in binaural performance.
International Journal of Audiology
2010;49(9):613–27.
21. Sweetow RW, Sabes JH. The need for and
development of an adaptive Listening and
Communication Enhancement (LACE)
Program. Journal of the American Academy of
Audiology 2006;17(8):538–58.
22. Worrall L and Hickson L. Communication
disability in aging: From prevention to
intervention. Clifton Park, NY: Delmar
Learning; 2003.
23. Fratiglioni L, Paillard-Borg S, Winblad B. An
active and socially integrated lifestyle in late life
might protect against dementia. Lancet Neurol
2004;3(6):343–53.
24. Hultsch DF, Hertzog C, Small BJ, and Dixon RA.
(1999). Use it or lose it: Engaged lifestyle as a
buffer of cognitive decline in aging Psychology
and Aging 1999;14:245–63.
25. Reed M. The Hard of Hearing Club: A social
framework for audiologic rehabilitation for
seniors with severe hearing difficulties. In L.
Hickson (Ed), Hearing care for adults: The
challenge of aging. Phonak: Stäfa, Switzerland;
2009
Canadian Hearing Report 2012;8(3):42-45.
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