Hearing loss, brain aging, and speech-in-noise performance in the ACHIEVE study

听力、大脑结构和功能（认知）以及沟通能力之间的相互关系 和理解噪声中的语音仍然知之甚少。表征这些途径对于 了解助听器等干预措施如何影响衰老的大脑，认知功能，以及我们的生活。 在噪音中沟通的能力。本提案的目的是了解这些相互关系的性质 通过在老年人衰老和认知健康评估中进行脑部MRI辅助研究， （ACHIEVE）随机对照试验（RCT）。ACHIEVE试验（R 01 AG 055426）是一项首个同类RCT， 将于2018年开始招募70-84岁的轻度-中度听力损失和正常认知的成年人， 调查听力干预（助听器、咨询、其他辅助设备）与 成功的老龄化教育控制干预降低了认知能力下降的速度。大约一半的n = 850名参与者将从社区神经认知研究中的动脉粥样硬化风险（ARIC- NCS），这是一个由15，792名成年人组成的纵向双种族队列，这些成年人已被随访超过30年。对于这一提议， 将在基线和3年后对ACHIEVE受试者的一个子集（n = 400）进行MRI脑部扫描 以及听力正常的ARIC参与者的额外子集（n = 200）。通过利用随机 通过ACHIEVE研究，我们将有机会了解大脑结构特征如何影响 听力、认知和助听器使用的方式预测噪声中的语音性能。同时，我们将 研究助听器的干预如何影响大脑结构，从而提供见解 未来减缓大脑衰老的潜在策略。目前，随着ACHIEVE RCT的开始， 2018年的积极招募提供了一个将脑成像纳入随机试验的独特机会， 为了了解助听器和大脑结构是如何 特征与听觉、认知和噪声中的语音性能相互作用。我们提议下列 目的：目的1研究听力（基于纯音测听）、脑功能（包括听力损失）和听力损失之间的横断面关系。 MRI结构特征和认知功能与ACHIEVE和 正常听力ARIC参与者在基线（N = 600）。目的2探讨助听器与听力损失的关系 3年随访期间，从无辅助到有辅助的噪声中语音性能得到改善， 哪些基线因素可预测随机分配至ACHIEVE组的受试者的改善程度？ 听力干预（N = 200）。目的3确定基线听力和开始使用助听器是否 与从基线到3年随访的脑结构变化相关（N = 600）。

The interrelationships between hearing, brain structure and function (cognition), and the ability to communicate and understand speech-in-noise remain poorly understood. Characterizing these pathways is important for understanding how interventions such as hearing aids could affect the aging brain, cognitive function, and our ability to communicate in noise. The goal of this proposal is to understand the nature of these interrelationships through conducting a brain MRI ancillary study in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized controlled trial (RCT). The ACHIEVE trial (R01AG055426) is a first-in-kind RCT that will begin recruitment in 2018 of 70-84 year-old adults with mild-moderate hearing loss and normal cognition to investigate whether a hearing intervention (hearing aids, counselling, other assistive devices) versus a successful aging education control intervention reduces rates of cognitive decline. Approximately half of the n = 850 participants will be recruited from the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC- NCS), a longitudinal bi-racial cohort of 15,792 adults who have been followed for >30 years. For this proposal, MRI brain scans will be conducted at baseline and 3 years later in a subset (n = 400) of ACHIEVE participants and in an additional subset (n = 200) of ARIC participants with normal hearing. By leveraging the randomized ACHIEVE study, we will have the opportunity to understand how brain structural characteristics may affect the way hearing, cognition, and hearing aid use predict speech-in-noise performance. In parallel, we will investigate how intervention with hearing aids may causally affect brain structure, thereby providing insights into potential future strategies to mitigate brain aging. The present juncture with the ACHIEVE RCT beginning active recruitment in 2018 offers a singular opportunity to incorporate brain imaging into a randomized trial that may never be repeated again on this scale in order to understand how hearing aids and brain structural characteristics interact with hearing, cognition, and speech-in-noise performance. We propose the following Aims: Aim 1 To investigate the cross-sectional associations of hearing (based on pure tone audiometry), brain MRI structural characteristics, and cognitive function with speech-in-noise performance in ACHIEVE and normal hearing ARIC participants at baseline (N = 600). Aim 2 To investigate the association of hearing aid use with improvement from unaided to aided speech-in-noise performance over 3 year follow-up and to identify which baseline factors predict the magnitude of improvement in ACHIEVE participants randomized to the hearing intervention (N = 200). Aim 3 To determine whether baseline hearing and initiation of hearing aid use are associated with changes in brain structure from baseline to 3 year follow-up (N = 600).