人工耳蜗候选者中认知与言语理解之间的关联

文献信息

中文摘要

目的： 正在考虑接受人工耳蜗植入的个体需接受言语理解测试，以评估助听器是否充分，从而判断人工耳蜗（CI）候选资格。得分较低提示CI可能带来获益，且已确立特定阈值（例如正确反应<60%）作为CI的标准。尽管科学文献描述了当信号模糊（例如因听力损失或背景噪声）时认知对言语理解的重要性，但大多数CI诊所或候选资格标准并未考虑认知对言语理解的影响。目前尚不清楚是否存在听力损失的上限（例如由纯音听阈平均值[PTA]确定），超过该上限后，传入信号无法提供足够信息以促进言语理解的认知加工。本研究的目标是确定在因CI候选资格评估就诊的成人中，执行功能和记忆的测量指标与CI诊所常用言语理解测试表现之间的关联程度，以及这些关联在PTA较低（较好）的患者中是否更大。
设计： 招募在三级转诊中心因CI候选资格评估就诊的成人参与者。已存在的痴呆诊断是排除标准。参与者接受了常规CI候选资格评估。认知评估使用简明视空间记忆测验-修订版、心理交替测验、动物流畅性测验、语义流畅性测验和Stroop测验。言语理解测试包括AzBio句子测试（噪声下和安静下）和辅音-核-辅音词测试（安静下）。使用多变量线性回归确定认知与言语理解之间的关联，并校正年龄、性别、耳聋持续时间及PTA。使用乘法交互项检验认知变量与PTA之间的交互作用。
结果： 共有64名参与者（PTA范围70至120+ dB HL）。多变量回归结果如下：心理交替测验与PTA<92 dB HL个体的AzBio噪声下句子表现相关，并与PTA<87 dB HL个体的AzBio安静下句子表现相关。简明视空间记忆测验-修订版与PTA<100 dB HL个体的辅音-核-辅音测试相关（所有关联均符合预期方向）。
结论： 在听力较好（即PTA<87至100 dB HL，取决于言语测试）的潜在CI候选者中，记忆和执行功能测量指标与言语理解呈正相关。结果提示，在PTA较好的CI候选者中，言语理解得分是传入信号充分性和认知加工共同作用的结果。

英文摘要

OBJECTIVES: Individuals who are being considered for cochlear implantation are assessed with tests of speech understanding to estimate hearing aid adequacy and, thus, cochlear implant (CI) candidacy. Lower scores suggest a CI may provide benefit, and specific thresholds (e.g., <60% correct responses) are established as criteria for CI. The influence of cognition on speech understanding is not considered in most CI clinics or in candidacy criteria, despite a scientific literature describing its importance for speech understanding when the signal is ambiguous (e.g., due to hearing loss or background noise). It is unclear if there is an upper limit of hearing loss (e.g., as determined by pure-tone threshold average [PTA]) beyond which the afferent signal does not provide enough information to facilitate cognitive processing for speech understanding. The objectives of the study were to determine, among adults presenting for CI candidacy assessment, the degree to which measures of executive function and memory are associated with performance on common tests of speech understanding used in CI clinics, and whether associations are larger in patients with lower (better) PTA.
DESIGN: Adult participants presenting for CI candidacy assessment at a tertiary referral center were recruited. An existing dementia diagnosis was an exclusion criterion. Participants underwent routine CI candidacy assessments. Cognition was assessed using the Brief Visuospatial Memory Test-Revised, the Mental Alternation Test, the Animal Fluency Test, semantic fluency tests, and the Stroop test. Tests of speech understanding included the AzBio sentence test (in noise and quiet) and the consonant-nucleus-consonant word test (in quiet). Associations between cognition and speech understanding were determined using multivariable linear regression, adjusting for age, sex, deafness duration, and PTA. Multiplicative interaction terms were used to test for interactions between cognitive variables and PTA.
RESULTS: There were 64 participants in total (PTA range 70 to 120+ dB HL). Multivariable regression results were as follows: Mental Alternation Test was associated with AzBio sentence-in-noise performance for individuals with PTA <92 dB HL and with AzBio sentence-in-quiet performance for individuals with PTA <87 dB HL. Brief Visuospatial Memory Test-Revised was associated with consonant-nucleus-consonant for individuals with PTA <100 dB HL (all associations in the expected direction).
CONCLUSIONS: Measures of memory and executive function were positively associated with speech understanding among potential CI candidates with better hearing (i.e., PTA <87 to 100 dB HL, depending on the speech test). The results suggest that speech understanding scores are a function of both the adequacy of the afferent signal and cognitive processing among CI candidates with better PTA.