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 对噪声中语音的理解仍然知之甚少。确定这些途径的特征对于 了解助听器等干预措施如何影响老化的大脑、认知功能和我们的 能够在嘈杂环境中进行交流。这项建议的目标是了解这些相互关系的性质 脑MRI辅助研究在老年人老龄化和认知健康评估中的应用 (实现)随机对照试验(RCT)。实现试验(R01AG055426)是第一个同类RCT， 将于2018年开始招募70-84岁轻中度听力损失且认知正常的成年人 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可降低认知功能减退率。大约一半的n =850名参与者将从社区动脉硬化风险神经认知研究(ARIC- NCS)，这是一个由15,792名成年人组成的纵向混血队列，他们已经被跟踪了30年。对于这项提议， 磁共振脑扫描将在基线时进行，三年后在ACENTH参与者的子组(n=400)中进行 听力正常的ARIC参与者的另一个子组(n=200)。通过利用随机的 完成研究，我们将有机会了解大脑结构特征可能如何影响 听力、认知和助听器的使用方式可以预测噪声中的语音表现。同时，我们将 研究助听器的干预如何对大脑结构产生影响，从而提供见解 转变为未来缓解大脑老化的潜在策略。目前与实现区域合作伙伴关系的开始 2018年的积极招募提供了一个将脑成像纳入随机试验的难得机会，该试验 可能再也不会以这种规模重复，以了解助听器和大脑结构 特征与听力、认知和噪声中的语音表现相互作用。我们提出以下建议 目的：目的1研究听力(基于纯音测听)、脑的横断面关联 REACH和AND的MRI结构特征、认知功能和噪声中的言语表现 听力正常的ARIC受试者基线(N=600)。目的2研究助听器的关联性。 在3年的跟踪和识别中，从无辅助到辅助噪声中语音性能的改进使用 哪些基线因素可以预测被随机分配到 听力干预(N=200)。目的3确定基线听力和开始使用助听器 与从基线到3年随访(N=600)的脑结构变化有关。

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).