Indeed, there is converging evidence that older people with age-related sensorineural hearing loss (HL) score significantly lower than age-matched normal-hearing (NH) controls on a variety of cognitive tasks ( McCoy et al., 2005 Dupuis et al., 2015). It also has been acknowledged that, in the older population, cognitive performance may be detrimentally affected by the interaction between age-related changes in peripheral sensory functions and the presentation format of the cognitive assessment ( Schaie, 2004 Wingfield et al., 2005 Ben-David et al., 2018). However, the generalized use of cognitive tests is not viewed uncritically due to potential intrinsic biases, such as cultural, socioeconomic, and educational factors ( Parker and Philp, 2004 Crane et al., 2008 Reynolds and Suzuki, 2012). It is also being debated whether to expand the scope of practice of the HHC professional to include routine cognitive screening of older adults, with the aim of detecting cognitive impairment, providing counselling, and, if indicated by the results, referring to a mental-healthcare professional for diagnostic evaluation ( Armero et al., 2017 American Speech-Language-Hearing Association, 2018 Beck et al., 2018). In addition, cognitive profiling can further the understanding of individual variability in (un)aided speech identification ( Humes et al., 2013 Füllgrabe et al., 2015 Nuesse et al., 2018), and help predict benefits associated with different hearing-aid processing features ( Lunner et al., 2009 Neher, 2014 Ohlenforst et al., 2016) as part of a more individualized auditory rehabilitation ( Kiessling et al., 2003 Kricos, 2006 Pichora-Fuller and Singh, 2006). For example, cognitive screening allows the enforcement of cognitive inclusion or exclusion criteria for and the adjustment of hearing and speech-identification assessments on the basis of the cognitive status of the participants ( Füllgrabe et al., 2018 Bott et al., 2019 British Society of Audiology, 2021). Conducting cognitive tests fulfills various purposes for the hearing scientist and the HHC professional. In recent years, cognitive abilities have also been assessed with increasing frequency in research in speech and hearing sciences and as part of the clinical practice in hearing health care (HHC Pichora-Fuller and Singh, 2006 Valente et al., 2006 Füllgrabe and Rosen, 2016). Traditionally, cognitive assessments are employed in the study of normal and pathological cognitive development and aging ( Ford et al., 2012 Weintraub et al., 2013 Salthouse, 2019) and for the screening of neurological and behavioral functions and clinical diagnosis ( Brandt, 1991 Nasreddine et al., 2005 Larner, 2017). In conclusion, simulated (and, by extrapolation, actual) age-related HL negatively affects cognitive-test performance and may change the composition of the cognitive processes associated with the completion of a cognitive task. In the listening condition simulating moderate HL (as experienced by the average 85-year-old person), BDS performance only correlated with performance on working-memory tests. In the normal-hearing condition, BDS performance correlated positively with both performance on tests of short-term memory and performance on tests of working memory. The results indicated that BDS performance was impaired by a simulated HL representing that of persons aged 75 years and above. Participants completed the BDS task in several listening conditions, as well as several commonly used visual tests of short-term and working memory. In the present study, an impairment-simulation approach, mimicking mild-to-moderate age-related HLs typical for persons aged 65, 75, and 85 years, was used in 19 young normal-hearing participants to evaluate the impact of HL on cognitive performance and the cognitive processes probed by the BDS task. If uncorrected, HL can have immediate assessment-format-related effects on cognitive-test performance and can result, in the long term, in neuroplastic changes impacting cognitive functioning. However, especially in aging research and audiology, persons who are administered the BDS task are often affected by hearing loss (HL). The recall of auditorily presented sequences of digits in reverse order (also known as the Backward Digit Span, BDS) is considered to reflect a person’s information storage and processing abilities which have been linked to speech-in-noise intelligibility. 2School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.1Ear Institute, University College London, London, United Kingdom.Christian Füllgrabe 1* and Ozan Cem Öztürk 2
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