BackgroundMultiple sclerosis (MS) is a chronic disease with an unpredictable clinical course, presenting both recurrent relapses and progressive worsening over time. People living with MS (pwMS) are impacted physically, psychologically, and socially. Illness perception refers to a person's cognitive and emotional representations of their disease, which can impact their psychophysical well-being and treatment adherence.ObjectiveTo assess the illness perception of pwMS and determine how it is impacted by cognitive dysfunction and fatigue.MethodsIn this cross-sectional pilot survey study, the Brief Illness Perception Questionnaire (B-IPQ), Montreal Cognitive Assessment (MoCA-BR), Modified Fatigue Impact Scale (MFIS-BR), and Multiple Sclerosis Quality of Life Questionnaire (MSQOL-54) were used. Demographic and clinical data, as well as the Expanded Disability Status Scale (EDSS), were collected.ResultsA total of 30 RRMS patients (66.7% of female subjects, with a mean age of 36.8 ± 1.8 years) were enrolled. The mean score on the B-IPQ scale was of 30.2 ± 8.9 points, with 40% presenting a threat perception of the disease. No significant correlation was observed between cognitive performance and illness perception (r = −0.058;p = 0.761). However, significant correlations were found between illness perception and all fatigue domains (total: r = 0.578;p = 0.001; physical: r = 0.594;p = 0.001; psychosocial: r = 0.672;p < 0.001), except the cognitive domain (r = 0.360;p = 0.051). The EDSS and MSQOL-54 scores also demonstrate significant correlations with illness perception (EDSS = 2.30;p = 0.034; MSQOL-54 physical: r = −0.776;p < 0.001; MSQOL-54 mental: r = −0.704;p < 0.001).ConclusionIllness perception in MS is influenced by patients' fatigue, quality of life, and disability levels, but it does not appear to be affected by cognition.

The benefits of digital signal-processing features, such as noise reduction (NR) and frequency compression (FC), differ among individuals. This study aimed to explore the impact of deactivating NR and FC on hearing aid (HA) benefit, acknowledging the complexity of interindividual variability. Thirty-two first-time HA users were assigned to three groups: a control group with no feature changes (n = 10, mean age [MA] = 68.40 years), an NR-off group (n = 11, MA = 65.82 years), and an FC-off group (n = 11, MA = 66.82 years). Two test sessions were separated by about 4 weeks of acclimatization. Session 1 included baseline assessments (cognition, speech understanding, subjective measures) using initial HA settings, followed by immediate speech understanding reassessment after group allocation. In Session 2, speech understanding and subjective outcomes were reassessed. Wilcoxon signed-ranks and Kruskal-Wallis tests examined within-group and between-groups differences. No significant effects of NR or FC on speech understanding or subjective measures were observed, but small trends emerged. Subjective improvements were most consistent in the control group. Tentative minor trends in subjective ratings suggested FC deactivation may be associated with declines in auditory-visual and psychosocial functioning and improvements in cognitive functioning, listening effort, and fatigue. Exploratory patterns suggest FC may impact subjective outcomes differently, despite no significant effects being found. The findings further critically reflect the complexity of evaluating cognition-related HA benefit and emphasize the need for multidimensional research to guide individualized HA fitting. https://doi.org/10.23641/asha.31141591.

Background: Liver cirrhosis is a chronic and progressive disease, and it affects liver parenchymal cells. Although it is known that during the course of this disease, cognitive function, balance, and physical activity levels decrease, and fatigue severity increases, the relationship between these variables remains unclear. This study is the first to examine the relationship between cognitive function level and balance, fatigue, and physical activity levels in patients with liver cirrhosis and was conducted to provide a new perspective on treatment. Aim: This study aims to investigate the relationship between cognitive function and balance, physical activity, and fatigue in patients with liver cirrhosis. Method: A total of 132 patients were included in the study. Cognitive function levels of the patients were measured with the Montreal Cognitive Assessment Scale, balance performance using the One-Legged Stance Test and timed up and go tests, physical activity levels with the International Physical Activity Scale-Short Form, and fatigue levels with the Fatigue Severity Scale. Results: Correlation analyses showed that cognitive function (MoCA) was significantly associated with static balance (r = 0.232, p = 0.007) and fatigue severity (r = -0.297, p = 0.001), whereas no statistically significant relationships were observed with dynamic balance (r = -0.068, p = 0.441) or physical activity (r = -0.011, p = 0.903). Multivariable regression analyses indicated that disease duration (β = 0.02, p = 0.009) and exercise habits (β = 0.65, p = 0.031) were independently associated with cognitive function (MoCA), while disease duration was also independently associated with static balance performance (β = 0.08, p = 0.002). Conclusions: These findings indicate statistically significant associations between cognitive function, static balance, and fatigue severity, whereas no significant associations were observed with dynamic balance or physical activity. These relationships should be interpreted as associative rather than causal and suggest that cognitive status may be clinically relevant when evaluating balance performance and fatigue burden in patients with cirrhosis.

Aim: Multiple sclerosis (MS) is a neurodegenerative disorder involving central nervous system inflammation and myelin damage, often leading to cognitive deficits, especially in information processing speed. This study aimed to examine the relationship between cognitive function and functional performance, fatigue, kinesiophobia, and physical activity level in individuals with MS.Material and Methods: A total of 40 individuals with MS and 40 healthy participants were recruited for the study. Cognitive performance was evaluated through the Montreal Cognitive Assessment (MoCA) and the Trail Making Test parts A and B (TMT A-B). Functional performance was assessed using the 6-Minute Walk Test (6MWT), the 30-Second Sit-to-Stand Test (30-sSTST), and the Timed Up and Go (TUG) test. Fatigue, kinesiophobia, and physical activity level were evaluated using the Fatigue Severity Scale (FSS), Tampa Kinesiophobia Scale (TSK), and International Physical Activity Questionnaire Short Form (IPAQ-SF), respectively.Results: Significant differences were found between MS and control groups in cognitive scores (MoCA, TMT A-B), functional performance (6MWT, 30-s STST, TUG), fatigue, kinesiophobia, and physical activity levels (p

Fatigue affects between 36.5% and 78% of people with multiple sclerosis (pwMS) and significantly impairs daily life. The neurobiological mechanisms underlying fatigue remain poorly understood and information about the time-varying communication between brain regions and the networks they form may offer new insights into the complex pathology of MS-related fatigue. Brain regions continuously reconfigure how they communicate within distinct networks (i.e., time-varying reconfigurations) and aberrant time-varying reconfigurations may contribute to the perception of fatigue in pwMS. This study aimed to explore if and how time-varying reconfigurations are associated with fatigue in pwMS. In this cross-sectional study, 155 pwMS (62% female; age = 39 ± 10 years; disease duration = 10 ± 8 years; median EDSS = 1.0 ± 2.0) and 48 healthy controls (HC) (71% female; age = 33 ± 10 years) underwent clinical, neuropsychological, and (resting-state functional) MRI assessments. Fatigue was evaluated with the "Fatigue Scale for Motor and Cognitive Function", comprising total, motor, and cognitive fatigue scores. Time-varying connectivity was derived using a sliding-window approach, with data-driven assignment of brain regions to one of eight resting-state networks for each window. Promiscuity (dispersion of reconfigurations), flexibility (frequency of reconfigurations), cohesion (joint reconfigurations), and disjointedness (independent reconfigurations) described the time-varying reconfigurations of the whole brain and its networks. Among pwMS, 57% reported experiencing at least mild total fatigue (motor: 60%, cognitive: 57%). Higher total fatigue was correlated with greater global promiscuity (r = 0.21, p = 0.032) and disjointedness (r = 0.24, p = 0.008). Similarly, higher motor fatigue was associated with greater global promiscuity (r = 0.25, p = 0.008), flexibility (r = 0.21, p = 0.032), and disjointedness (r = 0.28, p < 0.001). The associations with disjointedness remained significant even after controlling for demographics, clinical measures, and structural brain damage, such as lesion load and atrophy (total fatigue: adj.R2 = 0.23, β = 0.17, p = 0.033; motor fatigue: adj.R2 = 0.38, β = 0.16, p = 0.026). Network-level analyses in pwMS revealed that higher total (r = 0.25, p = 0.016) and motor (r = 0.25, p = 0.016) fatigue were associated with greater limbic network promiscuity. No significant correlations were found for cognitive fatigue in pwMS, or for total, motor, and cognitive fatigue in HC (all p > 0.05). Elevated levels of fatigue, particularly motor fatigue, in pwMS were linked to more unstable network reconfigurations, particularly of regions in the limbic network, possibly reflecting dysfunctional reward processing. More frequent dispersion requires more energy and may therefore contribute to increased fatigue. TRIAL REGISTRATION: This project was pre-registered at ClinicalTrials.gov (registration number: NCT04892134).

Machine learning in stroke and its sequelae: a narrative review of clinical applications and emerging trends.

Neurological sequela of COVID-19 in adults with multiple sclerosis.

Abstract - In today’s competitive academic environment, students often experience stress, distraction, and lack of concentration during study sessions. Poor time management and continuous mental pressure reduce productivity and learning efficiency. To address this issue, a desktop-based application called Stress-Free Study Clock has been developed. The system provides a structured timer-based study mechanism combined with gamification features to enhance user engagement. The application includes study plan selection, countdown timer control (Start, Pause, Reset), motivational alert messages, a digital sticker reward system, and short stress-relief mini games. Stickers are awarded after successful completion of study sessions to encourage consistency and positive reinforcement. Mini games are provided to reduce cognitive fatigue and refresh the user’s mind during breaks. The system is developed using Python and operates as a standalone desktop application without any database, backend server, or internet dependency. The primary objective of the system is to create a simple, engaging, and stress-reducing study environment that promotes disciplined learning habits. .Key Words - Time Management, Study Timer, Focus Enhancement, Stress Reduction, Desktop Application, Productivity Tool, Python Programming, Motivation System, Countdown Timer, Student Productivity

Modern lifestyles and rapidly urbanizing environments have significantly reduced daily contact with nature, despite humans having evolved in continuous interaction with natural surroundings. This separation has been linked to heightened stress, reduced emotional balance, and cognitive fatigue. Biophilic design, which incorporates natural elements and patterns into interior and architectural spaces, offers a pathway to restoring this connection. This review synthesizes existing research on biophilic design and its psychological outcomes, interpreted through the lens of Prakriti, the natural state of balance in human functioning. A narrative review with thematic analysis was conducted using ResearchGate, Google Scholar, ScienceDirect, and PubMed. Studies were included if they examined biophilic or nature-based design and reported psychological, emotional, cognitive, or behavioral outcomes. Eligible studies were screened, reviewed, and thematically organized. Across settings such as workplaces, classrooms, healthcare spaces, and residential environments, biophilic elements consistently reduced stress and anxiety, improved mood, enhanced attention and cognitive restoration, and supported psychological well-being. Some studies also reported better social interaction and physiological stress recovery. Interpreted through Prakriti, these findings suggest that biophilic environments help re-align human functioning with natural needs. Overall, biophilic design emerges as a meaningful contributor to mental health and restorative living.

Night shifts in intensive care units (ICUs) are associated with significant physical and cognitive fatigue among nurses, which may affect staff well-being and patient safety. Although short naps have been shown to reduce fatigue, their implementation in ICUs remains limited and poorly understood. This study explored ICU nurses' and nurse managers' perceptions of planned napping. A qualitative descriptive design was used, involving nine focus group interviews (n = 20) across three Finnish ICUs. Data were analysed using inductive content analysis. Participants described severe fatigue during night shifts and acknowledged the benefits of planned napping, including improved alertness, reduced errors, and enhanced well-being. Informal napping was common, but formal structures were lacking. Barriers included unclear policies, cultural resistance, and logistical challenges; whereas facilitators involved organisational culture, environment, scheduling, and managerial support. Emphasis was placed on fairness, flexibility, and clear protocols. Planned napping was perceived as a valuable strategy for managing fatigue, but successful implementation requires institutional support and context-sensitive planning. This study provides practical insights into implementing planned napping in high-acuity environments and supports the development of structured, evidence-informed protocols to promote staff well-being, patient safety and sustainable nursing practices.

Paediatric kidney transplantation, while life-saving, presents significant academic challenges for children. Frequent hospitalisations, medical treatments and the psychosocial impact of chronic illness can severely disrupt educational trajectories. This study aimed to explore the post-transplant academic experiences of children from the perspective of their parents. A qualitative phenomenological study. Data were collected through in-depth, semistructured interviews and analysed using inductive thematic analysis. The study was conducted in Lahore, Pakistan, with participants recruited from the registry of the Punjab Human Organ Transplantation Authority (PHOTA). Thirteen parents of children who had undergone a kidney transplant and were enrolled in a formal school. Five major themes emerged from the analysis: (1) academic disruption and coping, detailing declines in performance and motivation alongside efforts to maintain engagement; (2) cognitive fatigue and emotional strain, encompassing reduced focus, memory difficulties and psychological distress; (3) school attendance, participation and support, highlighting frequent absenteeism, limited engagement in activities, and the critical role of institutional flexibility; (4) social identity and peer exclusion, revealing fears of stigma, self-isolation and misunderstanding from peers and (5) navigating the future, reflecting parental anxieties about long-term educational and career prospects alongside adaptive hope. The findings underscore that formal support systems in schools and healthcare settings are currently underdeveloped to meet these children's complex needs. This study illuminates the profound and multifaceted academic challenges faced by children after kidney transplantation. The results emphasise that a transplant is not merely a medical event but a life-altering experience with significant educational consequences. There is a critical need for integrated, targeted interventions that provide robust psychological support, flexible educational policies and comprehensive school reintegration programmes to ensure these children can achieve their full academic and personal potential.

ABSTRACT Encephalitis can cause acquired brain injury due to inflammation, leading to cognitive issues and fatigue, exacerbating daily stress. Knowledge of real-time stress coping mechanisms among people post-encephalitis and how this relates to depression is limited. Ecological momentary assessment (EMA) may address limitations in standardized cross-sectional self-report assessments. This study evaluates the feasibility and acceptability of collecting EMA data on mood and coping. Twenty adults post-encephalitis (12 women, age range 26:67) completed daily and self-initiated EMA for mood and coping over 4 months, and post-study interviews explored acceptability using framework analysis. Average daily compliance rate was 79.3% (range 37.3-97.5%), showing EMA's feasibility, though low self-initiated EMA usage indicated challenges. Linear mixed-effects model revealed significant relationships between coping style and depression levels within individuals and over time. Framework analysis categorized two themes: “Encephalitis experience and its relationship to stress response” and “Experience of EMA: barriers and facilitators’. Qualitative analysis indicated acceptability for the m-Path app and measuring daily mood. Results suggest long-term daily EMA is feasible for collecting mood and coping in adults with encephalitis. However, patient and public involvement should be utilized to establish suitability. Following adaptations, EMA may serve as a psychological intervention targeting stress coping in daily life.

Advances in cancer therapy have markedly improved survival rates; however, long-term neurological sequelae represent a significant clinical challenge. Cancer treatment-related cognitive impairment (CRCI), commonly referred to as "chemobrain", affects a substantial proportion of cancer survivors and encompasses a broad spectrum of neuropsychiatric and cognitive symptoms, including anxiety, depression, fatigue, balance disturbances, and deficits in attention, memory, processing speed, and executive function. Increasing evidence suggests that these manifestations reflect accelerated biological aging of the brain, rather than merely transient toxic effects. This review synthesizes current clinical, molecular, and neuroimaging evidence supporting the concept of accelerated brain aging associated with multimodal cancer therapy. We summarize key molecular and cellular mechanisms including oxidative stress, neuroinflammation, blood-brain barrier dysfunction, mitochondrial impairment, cellular senescence with a senescence-associated secretory phenotype, and epigenetic remodeling that overlap with physiological brain aging hallmarks. Particular attention is given to circulating molecular biomarkers of accelerated aging, such as inflammatory mediators, senescence markers, endothelial and neuronal injury indicators, and epigenetic age acceleration, and their potential translational relevance. We discuss clinical and neuropsychological data alongside structural and functional magnetic resonance imaging findings demonstrating cortical thinning, altered gyrification, white matter microstructural changes, disrupted functional connectivity, and increased brain age estimates following cancer therapy. Framing CRCI within an accelerated brain aging paradigm may improve risk stratification, guide biomarker development, and inform personalized survivorship care.

Purpose As Generative Artificial Intelligence (GenAI) and Large Language Models (LLMs) increasingly shape personalization practices, scholarly attention to their emotional, relational and systemic implications has grown in the hospitality sector. To synthesize and integrate recent advances, this study constructs a conceptual framework that links not only antecedents and outcomes of GenAI personalization in hospitality activities, but also mediators and moderators of the relationships that drive these outcomes. Based on the gaps identified through this framework, this research develops directions for future research and theory development. Design/methodology/approach This research adopts a critical review approach, synthesizing literature published between 2020 and 2025 across human-centric AI, emotional computing and service research. A PRISMA-guided screening process and the Theory-Context-Characteristics-Methodology (TCCM) framework were used to identify dominant theories, methodological patterns and conceptual gaps. Insights from this synthesis informed the identification of aggregate themes and the development of an integrative conceptual framework, supported by causal loop modeling of key personalization dynamics. Findings GenAI capabilities, LLM-driven emotional adaptability, conversational naturalness and algorithmic transparency shape personalization fit and co-creation quality, which, in turn, activate both emotional engagement and personalization fatigue. These processes span five aggregate dimensions, namely, cultural, digital, economic, experiential and emotional-cognitive and are contingent on trust propensity, privacy concern and cultural orientation. While emotionally intelligent GenAI enhances perceived experience quality, satisfaction and brand loyalty, excessive or poorly calibrated personalization intensifies cognitive overload and fatigue. These portray personalization as a dynamic system in which reinforcing and balancing mechanisms jointly govern value creation, risk escalation and long-term relational outcomes. Research limitations/implications This research opens avenues for comparative, cross-cultural and longitudinal research designs that can deepen understanding of GenAI-driven personalization over time. It also highlights that GenAI personalization should be conceptualized not as a static technological feature but as an adaptive socio-technical system, requiring a shift beyond efficiency-centric perspectives toward frameworks that incorporate emotional resonance, cultural intelligence and relational sustainability in human–AI interactions. Originality/value This research advances GenAI personalization research by conceptualizing GenAI and LLMs as emotionally adaptive systems rather than purely functional technologies. It offers a novel conceptual framework that provides a foundation for future empirical testing and guides the responsible design of human-centered Gen AI personalization systems.

The massive growth of technology has transformed the learning environment for young generations. This (new) learning environment offers both benefits and challenges, such as brain rot phenomenon. Brain rot refers to cognitive decline, resulting from excessive screen time and overconsumption of short-duration content. Thus, this study examines whether brain rot affects speaking learning strategies among junior high school students, who are part of Gen Alpha and born as digital natives. A mixed-methods approach was applied, involving 64 students who completed questionnaires, followed by interviews with six participants. The findings indicate that students’ brain rot levels are generally low to moderate, while their speaking learning strategies are at moderate levels, with higher use of metacognitive and socio-affective strategies compared to cognitive strategies. Linear Regression analysis shows that brain rot has a significant and negative effect on speaking learning strategies, explaining 19.6% of the variance. The interviews confirm that excessive screen time leads to cognitive fatigue and cognitive load. These results highlight the need for teachers and parents to monitor students’ digital media use.

Objective: To address the heavy burden of ego depletion and decision conflict in patients with advanced cancer, this study employed network analysis to explore their interaction mechanisms and identify key intervention targets, overcoming the limitations of traditional linear studies. Methods: A total of 200 patients with advanced cancer were assessed using the Self-Regulatory Fatigue Scale (SRFS), Decisional Conflict Scale (DCS), and Functional Assessment of Cancer Therapy-General (FACT-G). A Gaussian Graphical Model (GGM) was constructed to identify key nodes. Results: Network analysis revealed a tight interactive network among ego depletion, decision conflict, and quality of life. Emotional Function (F3) and Emotional Fatigue (SF2) formed a core emotional cluster, while Uncertainty (D1) was the key cognitive hub. The core nodes F3, D1, and Social/Family Function (F2) were identified as crucial regulators connecting different modules. The core node with the highest Expected Influence was F4 (Functional Status, EI = 0.523), and the key bridge node connecting different modules was F2 (Social/Family Function, bridge strength = 1.114). D3 (Effective Decision-Making, EI = -0.469) was identified as a negative key node associated with adverse network effects. Quantitatively, the core nodes of the network were F4 (Functional Status, EI = 0.523), SF3 (Behavioral Fatigue, EI = 0.353), and SF1 (Cognitive Fatigue, EI = 0.326); the bridge nodes were F2 (Social/Family Function, bridge strength = 1.114), SF2 (Emotional Fatigue, bridge strength = 0.966), and D1 (Uncertainty, bridge strength = 0.858); and D3 (Effective Decision-Making, EI = -0.469) was the negative key node. Conclusions: This study challenges the traditional "symptom-specific treatment" model and proposes a new paradigm of "node-targeted intervention." Qualitatively, this study clarifies the multidimensional interactive mechanism of ego depletion, decision conflict, and quality of life in advanced cancer patients, and identifies key intervention nodes with different functional attributes (core nodes, bridge nodes, negative nodes). It provides empirical evidence for developing targeted palliative care strategies, which may offer new insights for optimizing symptom management in this population. Clinical Relevance: This study highlights the importance of exploring the multidimensional interaction mechanisms between self-regulatory fatigue, decision conflict, and quality of life in advanced cancer patients, emphasizing the guiding role of core nodes (Functional Status, Behavioral Fatigue, Cognitive Fatigue), bridge nodes (Social/Family Function, Emotional Fatigue, Uncertainty), and the negative node (Effective Decision-Making) in precise intervention. The findings support the integration of node-targeted hierarchical interventions into routine palliative care for advanced cancer patients to break the symptom vicious cycle and enhance their quality of life.

Comparison of treatment schedules on cognitive effects of rTMS in the 3xTg-AD model of Alzheimer's disease.

Examination periods are associated with significant psychological and physiological stress among students, often manifesting as anxiety, fear, impaired concentration, sleep disturbances, and stress-induced fever. Conventional management frequently relies on reassurance or pharmacological interventions, which may not always be suitable for adolescents. Homeopathy, as a holistic system of medicine, offers gentle, individualized, and non-sedative support for students during examination preparation. This paper explores the potential role of homeopathic medicines in managing examination-related fear, stress-triggered febrile responses, and cognitive exhaustion, along with general non-pharmacological measures for students and parents. The study emphasizes an integrative, ethical, and preventive approach aimed at improving mental equilibrium and academic performance.

Gulf War Illness (GWI) is a chronic, multi-system condition affecting a substantial proportion of veterans deployed during the 1990-1991 Gulf War. Neurological complications, including cognitive impairment, musculoskeletal pain, fatigue, depression, and migraine, represent a major clinical burden. Evidence implicates neuroinflammation, oxidative stress, mitochondrial dysfunction, and epigenetic dysregulation as central mechanisms, with emerging data suggesting early tauopathy and sex-specific immune responses. Neuroimaging studies reveal hippocampal atrophy, white matter disruptions, and increased translocator protein (TSPO) binding, while biomarker analyses identify elevated C-reactive protein (CRP), leptin, and matrix metalloproteinases. Genetic factors, such as HLA alleles, may modulate susceptibility. Animal models corroborate these findings, demonstrating hippocampal dysfunction, neurotransmitter imbalance, and neuroimmune activation following exposure to Gulf War-related chemicals. Therapeutic evidence supports cognitive behavioral therapy (CBT), exercise, and mindfulness-based interventions, with ongoing trials exploring vagus nerve stimulation, anti-inflammatory agents, and mitochondrial-targeted therapies. This review synthesizes current knowledge on GWI-related neurological dysfunction, highlights diagnostic and therapeutic advances, and underscores the need for biomarker-driven, sex-specific, and personalized approaches to improve outcomes for affected veterans.

Background/Objectives: Older adults with hearing loss frequently report increased listening effort and fatigue, particularly in complex auditory environments. These subjective experiences may reflect increased cognitive resource allocation during both auditory and visual tasks, yet the impact of hearing aids on task-related effort and fatigue remains unclear. This study examined subjective effort and fatigue in experienced older adult hearing aid users while completing cognitively demanding auditory and visual tasks in quiet and background noise, with and without hearing aids. Methods: Thirty-one adults aged 60-87 years completed a cognitive battery assessing inhibition, attention, executive function, and auditory and visual working memory across four listening conditions: aided-quiet, unaided-quiet, aided-noise, and unaided-noise. Subjective effort was measured using the NASA Task Load Index, and task-related fatigue was assessed using a situational fatigue scale. Linear mixed-effects models controlled for age and pure-tone average hearing thresholds. Results: Participants reported significantly lower effort and fatigue in quiet compared to background noise, regardless of hearing aid use. The aided-quiet condition was rated as the least effortful and fatiguing, whereas the unaided-noise condition was rated as the most demanding. Subjective effort and fatigue were moderately to strongly correlated across conditions, particularly in noise. Auditory working memory performance was significantly associated with subjective fatigue across listening conditions, while visual working memory was not associated with effort or fatigue. Hearing aid use did not produce significant reductions in effort or fatigue across conditions. Conclusions: Background noise substantially increases perceived task-related effort and fatigue during cognitively demanding auditory and visual tasks in older adults with hearing loss. While hearing aids did not significantly reduce effort or fatigue across conditions, optimal listening environments were associated with the lowest subjective reports. Auditory working memory emerged as a key factor related to fatigue, highlighting the interplay between hearing, cognition, and subjective listening experiences in older adulthood.