Coebergh J A, McDowell S, van Woerkom T C A M, Koopman J P, Mulder J L, Smink F R E, Blom J D, de Bruijn S F T M
Department of Neurology, Haga Hospital, The Hague, the Netherlands.
Department of Neurology, Ashford and St. Peter's Hospital, Chertsey, UK.
IBRO Neurosci Rep. 2025 Jan 6;18:142-147. doi: 10.1016/j.ibneur.2025.01.006. eCollection 2025 Jun.
Auditory agnosia for environmental sounds is a type of agnosia attributed to central auditory dysfunction. It is common in Alzheimer's disease, and is associated with peripheral hearing loss, although independent of it, and presumed independent of language deficits. The effects of this type of agnosia on daily life in Alzheimer's disease are unknown.
We aimed to assess the impact of auditory agnosia for environmental sounds in people with Alzheimer's disease while also exploring the role of unrecognized hearing loss.
We tested 34 home-dwelling people with Alzheimer's disease and a mean MMSE of 21.9 with the aid of a sound naming and recognition test, the tailor-made EESAA () questionnaire, the ADQRL () scale, and speech and tone audiometry.
Some 57 % of our 34 participants showed clinical signs of auditory agnosia for environmental sounds, and 47 % had undetected hearing loss to such an extent that it made them eligible for a hearing aid. Although the two factors appear to be independent, their joint effect can impact people's daily functioning. Nonetheless, we found them to have only little impact on the participants' quality of life as measured by the ADQRL, possibly because most of them lived in a sheltered environment, and some moreover showed anosognosia for their agnosia.
Difficulties recognizing environmental sounds in daily life are very common in people with Alzheimer's disease. Although we found no direct relation with quality of life as measured by a questionnaire, awareness of auditory agnosia for environmental sounds is still important since it may help explain why function declines. The additional finding that 47 % of people in this group had unrecognized hearing loss shows that self-assessment of hearing is often inaccurate in Alzheimer's disease, with implications for daily practice where clinicians might only explore hearing loss when acknowledged by their patient. On the basis of our findings we advise further longitudinal, multi-year studies of hearing screening and rehabilitation in Alzheimer's disease, if possible starting during its prodromal stage, something supported by findings in a large trials suggesting that hearing interventions might be slowing cognitive decline in an older population at risk of this.
对环境声音的听觉失认症是一种归因于中枢听觉功能障碍的失认症。它在阿尔茨海默病中很常见，并且与外周听力损失有关，尽管与之无关，且推测与语言缺陷无关。这种类型的失认症对阿尔茨海默病患者日常生活的影响尚不清楚。
我们旨在评估对环境声音的听觉失认症对阿尔茨海默病患者的影响，同时探讨未被识别的听力损失的作用。
我们借助声音命名和识别测试、特制的EESAA（）问卷、ADQRL（）量表以及言语和纯音听力测定，对34名居家的阿尔茨海默病患者进行了测试，这些患者的简易精神状态检查表（MMSE）平均分为21.9。
在我们的34名参与者中，约57%表现出对环境声音的听觉失认症的临床症状，47%有未被检测出的听力损失，其程度足以使他们符合佩戴助听器的条件。尽管这两个因素似乎相互独立，但它们的共同作用会影响人们的日常功能。然而，我们发现它们对通过ADQRL测量的参与者生活质量的影响很小，这可能是因为他们中的大多数人生活在受保护的环境中，而且有些人对自己的失认症还表现出疾病感缺失。
日常生活中难以识别环境声音在阿尔茨海默病患者中非常普遍。尽管我们发现与通过问卷测量的生活质量没有直接关系，但对环境声音的听觉失认症的认识仍然很重要，因为它可能有助于解释功能下降的原因。另外一个发现是，该组中47%的人有未被识别的听力损失，这表明在阿尔茨海默病中，听力的自我评估往往不准确，这对日常临床实践有影响，因为临床医生可能只有在患者承认有听力损失时才会去探究。基于我们的研究结果，我们建议对阿尔茨海默病患者的听力筛查和康复进行进一步的纵向、多年研究，如果可能的话，在其前驱期就开始，一项大型试验的结果支持了这一点，该试验表明听力干预可能会减缓有认知衰退风险的老年人群的认知衰退。
