Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr-University Bochum, Bochum, Germany,
Department of Otorhinolaryngology, Head and Neck Surgery, Katholisches Klinikum, Ruhr-University Bochum, Bochum, Germany.
Audiol Neurootol. 2021;26(4):236-245. doi: 10.1159/000510855. Epub 2021 Jan 13.
Age-related hearing loss affects about one-third of the population worldwide. Studies suggest that hearing loss may be linked to cognitive decline and auditory rehabilitation may improve cognitive functions. So far, the data are limited, and the underlying mechanisms are not fully understood. The study aimed to analyze the impact of cochlear implantation on cognition in a large homogeneous population of hearing-impaired adults using a comprehensive non-auditory cognitive assessment with regard to normal-hearing (NH) subjects.
Seventy-one cochlear implant (CI) candidates with a postlingual, bilateral severe or profound hearing loss aged 66.3 years (standard deviation [SD] 9.2) and 105 NH subjects aged 65.96 years (SD 9.4) were enrolled. The computer-based neurocognitive tool applied included 11 subtests covering attention (M3), short- and long-term memory (recall and delayed recall), working memory (0- and 2-back, Operation Span [OSPAN] task), processing speed (Trail Making Test [TMT] A), mental flexibility (TMT B), inhibition (cFlanker and iFlanker), and verbal fluency. CI patients underwent a neurocognitive testing preoperatively as well as 12 months postoperatively. Impact of hearing status, age, gender, and education on cognitive subdomains was studied. Additionally, after controlling for education and age, cognitive performance of CI subjects (n = 41) was compared to that of NH (n = 34).
CI users achieved significantly better neurocognitive scores 12 months after cochlear implantation than before in most subtests (M3, [delayed] recall, 2-back, OSPAN, iFlanker, and verbal fluency; all p < 0.05) except for the TMT A and B. A significant correlation could be found between the postoperative improvement in speech perception and in the attentional task M3 (p = 0.01). Hearing status (p = 0.0006) had the strongest effect on attention, whereas education had a high impact on recall (p = 0.002), OSPAN (p = 0.0004), and TMT A (p = 0.005) and B (p = 0.003). Inhibition was mainly age-dependent with better results in younger subjects (p = 0.016). Verbal fluency was predicted by gender as females outperformed men (p = 0.009). Even after controlling for age and education NH subjects showed a significantly better performance than CI candidates in the recall (p = 0.03) and delayed recall (p = 0.01) tasks. Postoperatively, there was no significant difference between the 2 groups anymore.
Impact of cochlear implantation on neurocognitive functions differs according to the cognitive subdomains. Postoperatively, CI recipients performed as good as age- and education-matched NH subjects.
年龄相关性听力损失影响着全球约三分之一的人口。研究表明，听力损失可能与认知能力下降有关，而听觉康复可能改善认知功能。到目前为止，相关数据有限，其潜在机制尚未完全阐明。本研究旨在通过对听力正常（NH）受试者进行全面的非听觉认知评估，分析大样本同质的听力受损成年人工耳蜗植入（CI）患者的认知影响。
共纳入 71 名有后天、双侧重度或极重度听力损失的 CI 候选者（66.3 岁，标准差 [SD] 9.2）和 105 名 NH 受试者（65.96 岁，SD 9.4）。应用的基于计算机的神经认知工具包括 11 个分测验，涵盖注意力（M3）、短和长时记忆（回忆和延迟回忆）、工作记忆（0 回和 2 回，操作跨度 [OSPAN] 任务）、处理速度（TMT A）、心理灵活性（TMT B）、抑制（cFlanker 和 iFlanker）和言语流畅性。CI 患者在术前和术后 12 个月接受神经认知测试。研究了听力状况、年龄、性别和教育对认知子领域的影响。此外，在控制教育和年龄后，将 CI 患者（n = 41）的认知表现与 NH 患者（n = 34）进行比较。
CI 使用者在术后 12 个月的神经认知测试中，在大多数分测验（M3、[延迟]回忆、2 回、OSPAN、iFlanker 和言语流畅性；所有 p < 0.05）中，除 TMT A 和 B 外，均取得了显著更好的神经认知成绩。术后言语感知和注意力任务 M3（p = 0.01）的改善之间存在显著相关性。听力状况（p = 0.0006）对注意力的影响最强，而教育对回忆（p = 0.002）、OSPAN（p = 0.0004）、TMT A（p = 0.005）和 B（p = 0.003）有较高影响。抑制主要受年龄影响，年轻受试者的结果更好（p = 0.016）。言语流畅性由性别预测，女性表现优于男性（p = 0.009）。即使在控制年龄和教育后，NH 受试者在回忆（p = 0.03）和延迟回忆（p = 0.01）任务中的表现也明显优于 CI 候选者。术后，两组之间不再有显著差异。
人工耳蜗植入对神经认知功能的影响因认知子领域而异。术后，CI 受者的表现与年龄和教育相匹配的 NH 受者一样好。
