Speech in Noise Perception as a Marker of Cognitive Impairment in HIV Infection
Speech in Noise Perception as a Marker of Cognitive Impairment in HIV Infection
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DOI：
10.1097/aud.0000000000000508
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发表时间：
2018-05-01
期刊：
影响因子：
3.7
通讯作者：
Buckey, Jay C.
中科院分区：
文献类型：
--
作者：
Zhan, Yi;Fellows, Abigail M.;Buckey, Jay C.
目的：人类免疫缺陷病毒阳性（HIV+）个体报告听力困难，但标准听力学测试显示周围听力能力没有或很小的变化。听力抱怨可能反映中枢神经系统（CNS）听觉处理缺陷，而不是中耳或内耳问题，可能是由于艾滋病毒感染或治疗导致的中枢神经系统损伤。如果HIV+个体的中枢听觉任务表现和认知缺陷被证明是相关的，那么中枢听觉测试可能作为研究这些患者中枢神经系统功能的“窗口”。设计：我们在中国上海公共卫生临床中心测量了166名听力正常的HIV+个体（158名男性，8名女性，平均年龄36岁）的认知表现（普通话蒙特利尔认知评估[MoCA]）和噪音感知中的言语（普通话噪音听力测试[HINT]）。数据收集包括听力测量、鼓室测量和阿姆斯特丹听觉障碍量表（AIAH），该量表评估了理解语音和定位声音的主观能力。结果：受试者无中耳疾病，符合正常听力敏感性标准（所有阈值≤20 dB HL）。语音接收阈值（SRT）与MoCA评分呈显著负相关（r(2) = 0.15, F = 28.2, p < 0.001）。逐步线性回归显示，当考虑年龄、MoCA评分、听力阈值和受教育程度等因素时，只有年龄和MoCA评分对SRT结果有独立贡献（总模型r(2) = 0.30, F = 38.8, p < 0.001）。来自爱雅的主观听力投诉支持了HINT的结果。爱雅与MoCA得分也有相关性（r(2) = 0.05, F = 8.5, p = 0.004），且MoCA得分越低的人爱雅问题越多。当将队列分为MoCA表现正常和异常组时，MoCA表现异常组的平均技能显著高于正常组（p < 0.001）。结论：在噪音中理解言语，无论是客观地用HINT还是主观地用AIAH测量，都与认知能力呈负相关，尽管听力学测定的听力正常。虽然年龄也是影响语音感知的重要独立因素，但本研究中语音发现中的年龄关系可能不仅仅代表了语音在噪音理解方面与年龄相关的下降。虽然没有关于疾病持续时间的可靠数据，但这一队列中的老年成员可能比年轻成员感染艾滋病毒的时间更长，并且在出现时可能有更严重的症状，因为上海的艾滋病毒早期检测和治疗随着时间的推移有所改善。因此，年龄关系可能还包括疾病持续时间和严重程度的因素。言语感知，特别是在困难的听力条件下，涉及皮层和皮层下中枢，是一项要求很高的神经系统任务。噪音HIV+个体的言语解释问题可能反映了HIV相关或HIV治疗相关的中枢神经损伤，这表明HIV+个体的中枢神经系统并发症可能通过中枢听觉测试被诊断和监测。
Objectives: Human immunodeficiency virus positive (HIV+) individuals report hearing difficulties, but standard audiological tests show no, or small, changes in peripheral hearing ability. The hearing complaints may reflect central nervous system (CNS) auditory processing deficits, rather than middle or inner ear problems, and may result from CNS damage due to HIV infection or treatment. If central auditory task performance and cognitive deficits in HIV+ individuals are shown to be related, then central auditory tests might serve as a "window" into CNS function in these patients.Design: We measured cognitive performance (Mandarin Montreal Cognitive Assessment [MoCA]) and speech in noise perception (Mandarin hearing-in-noise test [HINT]) in 166 normal-hearing HIV+ individuals (158 men, 8 women, average age 36 years) at the Shanghai Public Health Clinical Center in Shanghai, China. Data collection included audiometry, tympanometry, and the Amsterdam Inventory of Auditory Handicap (AIAH), which assesses the subjective ability to understand speech and localize sound.Results: Subjects had no middle ear disease and met criteria for normal-hearing sensitivity (all thresholds 20 dB HL or less). A significant negative relationship between speech reception thresholds (SRT) and MoCA scores (r(2) = 0.15, F = 28.2, p < 0.001) existed. Stepwise linear regression showed that when the factors of age, MoCA scores, hearing thresholds, and education level were considered, only age and MoCA scores contributed independently to the SRT results (overall model r(2) = 0.30, F = 38.8, p < 0.001). Subjective hearing complaints from the AIAH supported the HINT results. AIAH and MoCA scores were also related (r(2) = 0.05, F = 8.5, p = 0.004), with those with worse MoCA scores having more problems on the AIAH. When the cohort was divided into those with normal and abnormal performance on the MoCA, those with abnormal performance on the MoCA had significantly higher average Sills (p < 0.001).Conclusions: Understanding speech in noise measured both objectively with the HINT and subjectively with the AIAH was inversely related to cognitive abilities despite a normal ability to hear soft sounds determined by audiometry. Although age was also an important independent factor affecting speech perception, the age relationship within the speech findings in this study may represent more than just age-related declines in speech in noise understanding. Although reliable data on disease duration are not available, the older members of this cohort likely had HIV longer and probably had more severe symptoms at presentation than the younger members because early detection and treatment of HIV in Shanghai has improved over time. Therefore, the age relationship may also include elements of disease duration and severity. Speech perception, especially in challenging listening conditions, involves cortical and subcortical centers and is a demanding neurological task. The problems interpreting speech in noise HIV+ individuals have may reflect HIV-related or HIV treatment-related, central nervous damage, suggesting that CNS complications in HIV+ individuals could potentially be diagnosed and monitored using central auditory tests.