Discussion
hearing aids and cognitive training, dementia, hearing, cognition, and mobility, hearing loss, cognitive and motor functioning
HEARING LOSS, CORTEX
In this multi-site single-blinded randomized controlled trial, we aim to establish the efficacy of an at-home cognitive training program aimed at improving cognitive and motor functioning under laboratory and simulated real-world conditions in normal-hearing middle aged and older adults and older hearing aid users. We hypothesize that executive function training will lead to greater improvements in dual-task performance compared to a wait-list control group. Moreover, we hypothesize that executive function training will lead to the largest dual-task improvements in older hearing aid users, followed by normal-hearing older adults, and then middle-aged adults. Lastly, we predict a differential pattern of neural plasticity as a function of age/hearing group following executive function training.Computerized executive function training has been shown to improve cognition and mobility in normal-hearing older adults [Our study aims to fill these gaps in knowledge and will be the first of its kind to examine the effect of an at-home executive function training program on complex auditory and motor performance in normal-hearing middle-aged and older adults and older hearing aid users. One advantage of our study protocol includes the targeted population given that hearing loss is associated with an increased risk for falls and dementia, which may be modified through hearing aids and cognitive training. We will also recruit normal-hearing middle-aged and older adults in order to examine differences in cognition and mobility that can occur with age and changes in hearing acuity.Another strength of the study protocol is the use of ecologically valid measurement techniques, including subjective and objective measures of hearing, cognition, and mobility, as well as an immersive, multisensory VR environment to assess realistic sensory-cognitive-motor challenges. Our previous research assessing dual-task performance in a simulated street crossing environment showed that older adults tended to prioritize posture over cognitive performance (e.g., reduced gait variability at the cost of word recognition accuracy) [A final strength of the protocol is the use of portable fNIRS to examine brain activity in the prefrontal cortex during dual-task walking before and after training. Currently, there are inconsistent findings with regard to the effect of dual-tasking on brain activity across younger and older adults, with some researchers showing a bilateral upregulation in the prefrontal cortex in older adults compared to younger adults [In conclusion, this research will help establish the efficacy of an at-home cognitive training program in improving cognitive and motor functioning in older adults with hearing loss. Given the association between hearing loss and dementia and falls risk, the results of this study may have direct implications for older adults, in terms of improving quality of life and level of autonomy, as well as potentially reducing healthcare costs. Indeed, dementia and falls cause $10.4 and $2 billion a year in healthcare costs, respectively [