By Kevin Burke, Special to University Communications and Marketing
Associate Professor of Communication Sciences and Disorders Michelle Arnold is concerned about the deleterious effects experienced by people who have trouble processing language. It is not because those individuals are unable to speak, read or write a different language; it's because they can't hear it.
Michelle Arnold
The consequences can be devastating, particularly for older adults, with hearing loss now identified as one of the leading risk factors for dementia. Fortunately, Arnold's latest project — the largest randomized, controlled clinical test of the efficacy of hearing aids for reducing long-term cognitive decline in older adults — provides compelling evidence that strong hearing intervention efforts can significantly forestall the loss of thinking and memory abilities in those at increased risk.
Called the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study and conducted in collaboration with the Johns Hopkins Bloomberg School of Public Health, results of the three-year, multisite survey were published on July 18 in The Lancet, the world's oldest and most respected medical journal. They indicate that in older adults at heightened vulnerability for cognitive decline — in this case, due to advanced atherosclerosis— strong hearing intervention efforts including use of hearing aids, a hearing “toolkit” to assist with self-management and ongoing instruction and counseling with an audiologist, slowed the deterioration of mental awareness and acuity 48 percent by "making listening easier for the brain." In turn, people are able to remain more socially and physically active, which contributes to mental and emotional wellbeing while helping to mitigate other negative aspects of ageing such as inactivity, isolation, anxiety and depression.
According to the U.S. Centers for Disease Control and Prevention (CDC), more than 40 million Americans over 18 already have some trouble hearing. Alzheimer's Disease International, meanwhile, projects the number of people worldwide living with dementia (currently 50 million) will reach 82 million in 2030 and 152 million by 2050. The ACHIEVE study findings therefore suggest that hearing loss should be a particularly important global public health focus for dementia prevention efforts, say Arnold and her co-authors on the study. Two of them are fellow USF faculty members Theresa H. Chisolm, professor of communication sciences and disorders and vice provost for strategic planning, performance and accountability; and Victoria Sanchez, research assistant professor in the Department of Otolaryngology in the USF Health Morsani College of Medicine.
September is World Alzheimer's Month, which Alzheimer's Disease International uses to raise awareness and challenge stigma surrounding Alzheimer's and dementia. Sept. 21 is World Alzheimer's Day.
In addition to designing the hearing intervention component of the study — a patient-centered, step-by-step process for comprehensive audiological assessment, goal setting and treatment through the use of hearing aids and other hearing assistive technologies, counseling and education — the trio of USF researchers trained the research audiologists engaged with the study's nearly 1,000 participants at four community-based field sites in North Carolina, Mississippi, Minnesota and Maryland.
"We have an awesome team of research audiologists that work really, really hard on all of our studies," says Arnold, also an investigator in the Auditory Rehabilitation and Clinical Trials laboratory (ARCT) on the Tampa campus. "And, you know, we hope to be able to continue funding them indefinitely, if possible."
Arnold has applied for a nearly $4 million grant from the National Institutes of Health (NIH) for joint research with USF's Center for Advanced Medical Learning and Simulation (CAMLS) into how to collect data that inform AI models on best training and practices for future hearing care providers. Machine learning or artificial intelligence is increasingly part of assistive hearing technology and treatment, Arnold says, from the self-adjusting microelectronics in hearing devices themselves to analysis of patient reactions to audiologist attitude and behavior during clinical encounters.
"The ability to predict human behavior is only as good as the data that's provided to the model," observes Arnold, with a shout out to her colleague, Shannon Bailey, a human factors scientist and senior scientific director at CAMLS. She goes on to explain that her newest research proposal would "collect data on hundreds of people from all different socio-demographic backgrounds regarding their perceptions of hearing care" and the factors impacting their adoption of/adherence to a course of hearing intervention, including greater use of hearing aids. (On average, reports the NIH, only about a quarter of American adults that could benefit from a hearing aid actually use one.)
"They'll be watching vignettes (prepared by CAMLS) and providing tons of feedback that we can use to inform potential models to train future providers using AI," says Arnold, who acknowledges the competitiveness of the grant process, but believes the reality of a rapidly aging population in most industrialized regions of the world is leading to "more and more favorable legislation and funding to support studies like these.
"We're lucky in that, in such a divided world that we live in these days, hearing loss is pretty universal," she says. "Everybody can agree that being able to talk to people and hear what they say and understand them is a really important issue."