Report from the Academy Task Force on Central Presbycusis
Description
This report summarizes the work of the task force on central presbycusis and presents its findings. The task force’s charge was to review the body of evidence surrounding the existence of age-related declines in central-auditory processes and the consequences of any such declines for everyday communication and function. If the evidence warranted, the task force was also to review approaches to the identification and treatment of such age-related declines in central-auditory processes and to make recommendations in that regard.
Key Points
The task force chose to define central presbycusis narrowly as age-related changes in the auditory portions of the central nervous system beyond the auditory periphery. As such, it was important to distinguish difficulties in auditory perception or speech communication attributable to peripheral or cognitive factors from those attributable to age-related changes in the auditory portions of the central nervous system. The task force found it difficult to find evidence for central presbycusis as an independent entity in the absence of hearing loss, cognitive deficits, or both. Nevertheless, the sensitivity of some measures of auditory processing to deficits in cognitive function might enable the early identification of cognitive decline with such measures, though much more research is needed to corroborate this potential use of auditory-processing tests.
Such early identification is consistent with the functional form of “central presbycusis” including the decline of any processing beyond the auditory periphery in older adults that may negatively impact auditory perception and speech communication. Moreover, the task force’s review of the literature lends credibility to the likely existence of this more broadly defined form of “central presbycusis.” In addition, from an ecological standpoint, perhaps using reliable measures that incorporate broad-band speech stimuli in speech competition is a desirable approach precisely because these measures are subject to peripheral, central-auditory, and cognitive influences on performance.
Given the current inability to reliably and validly differentiate among the various hypothesized mechanisms underlying the speech-communication problems for a given patient, the intervention pursued will also be undifferentiated. Those individuals of a certain age, having a specified amount of hearing loss and, perhaps, a specified level of cognitive function, who perform “worse than expected” would likely receive the same intervention whether the factors underlying the poor performance were peripheral, central-auditory, or cognitive in nature. Such interventions might include more intensive counseling, auditory training, or aural rehabilitation. The interventions would be designed to encourage maintenance of social interactions to counteract a potential slide into social isolation, further worsening cognitive declines that might exist.
For those manifesting a peripheral hearing loss and using hearing aids, the intervention would most likely include ways to improve the speech-to-noise ratio beyond that experienced by other similar individuals, perhaps through the use of supplemental assistive technologies. Improving the speech-to-noise ratio is always warranted, regardless of the underlying cause of the individual’s speech-understanding difficulties.
Further, those older adults with relatively good hearing and who are not wearing hearing aids, for whom the underlying cause of exaggerated speech-understanding difficulties is central-auditory or cognitive in nature, most likely would also benefit from an improved speech-to-noise ratio, but it would need to be delivered via a device or technology other than a hearing aid.
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