Assessing Cognitive Abilities in High-Performing Cochlear Implant Users

Jake Hillyer,Alexandra Parbery-Clark,Stacey D Watson,Chantel Hazlewood,Elizabeth Elkins,Julie G Arenberg

doi:10.3389/fnins.2018.01056

Abstract

Despite being considered one of the most successful neural prostheses, cochlear implants (CIs) provide recipients with a wide range of speech perception performance. While some CI users can understand speech in the absence of visual cues, other recipients exhibit more limited speech perception. Cognitive skills have been documented as a contributor to complex auditory processing, such as language understanding; however, there are no normative data for existing standardized clinical tests assessing cognitive abilities in CI users. Here, we assess the impact of modality of presentation (i.e., auditory-visual versus visual) for the administration of working memory tests in high-performing CI users in addition to measuring processing speed, cognitive efficiency and intelligence quotient (IQ). Second, we relate performance on these cognitive measures to clinical CI speech perception outcomes.Methods: Twenty one post-lingually deafened, high-performing, adult CI users [age range: 52–88 years; 3 unilateral CI, 13 bimodal (i.e., CI with contralateral hearing aid), 5 bilateral CI] with clinical speech perception scores (i.e., AzBio sentences in quiet for the first-ear CI) of ≥60% were recruited. A cognitive test battery assessing auditory-visual working memory (AVWM), visual working memory (VWM), processing speed, cognitive efficiency and IQ was administered, in addition to clinical measures of speech perception in quiet (i.e., AzBio sentences in quiet). AzBio sentences were assessed in two conditions: first-ear CI only, and best-aided everyday wearing condition. Subjects also provided self-reported measures of performance and benefit from their CI using standardized materials, including the Glasgow Benefit Inventory (GBI) and the Nijmegen Cochlear Implant questionnaire (NCIQ).Results: High-performing CI users demonstrated greater VWM than AVWM recall. VWM was positively related to AzBio scores when measured in the first-ear CI only. AVWM, processing speed, cognitive efficiency, and IQ did not relate to either measure of speech perception (i.e., first-ear CI or best-aided conditions). Subjects’ self-reported benefit as measured by the GBI predicted best-aided CI speech perception performance.Conclusion: In high-performing CI recipients, visual presentation of working memory tests may improve our assessment of cognitive function.

Highlights

Cochlear implants (CIs) provide an effective treatment option for individuals with severe to profound hearing loss who no longer benefit from other assistive devices such as hearing aids (Dowell, 2012)
visual working memory (VWM) was positively related to AzBio scores when measured in the first-ear CI only
In high-performing CI users, working memory (WM) recall was impacted by modality of stimuli presentation, with a greater number of visually presented items correctly recalled than those presented in the auditory-visual modality (F1,20) = 26.748, p < 0.001; see Figure 1

Summary

Introduction

Cochlear implants (CIs) provide an effective treatment option for individuals with severe to profound hearing loss who no longer benefit from other assistive devices such as hearing aids (Dowell, 2012). Age at implantation and duration of hearing loss have shown to be negatively related to speech perception, and have been estimated to predict between 10 and 22% of the variance in speech perception scores (Blamey et al, 1996; Lazard et al, 2012b; Holden et al, 2013). While some evidence suggests an auditorycognitive link between working memory (WM) ability and speech perception in normal hearing (NH) middle-aged and older adults, as well as in hearing impaired (HI) individuals, especially in noise (van Rooij and Plomp, 1990; Akeroyd, 2008; Houtgast and Festen, 2008; Zekveld et al, 2011; Humes et al, 2013; Füllgrabe and Rosen, 2016), contributions of central cognitive factors (i.e., processes such as attention, memory, and problem solving used to complete complex tasks) to speech performance in adult cochlear implant recipients have only recently been explored (Moberly et al, 2017a; Pisoni et al, 2018)

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