[Understanding the Relationship Between Hearing and Cognition to Improve Neuropsychological Assessment in Adults Aged...

Age-related cognitive changes occur alongside sensory changes, including presbycusis, which notably affects speech understanding in noisy environments. Although typically diagnosed after the age of 60, hearing difficulties may begin insidiously as early as midlife. Given the well-established association between sensorineural hearing loss and cognitive functioning, we aimed to investigate 1) the associations between hearing abilities and cognitive performance in adults aged 45 years and older from the general population; and 2) the cognitive profile of middle-aged adults (45-65 years) with impaired speech intelligibility in noise. We used two complementary measures of hearing ability: pure-tone audiometry and a rapid speech-in-noise audiometry test (VRB). A total of 280 participants underwent audiometric testing and neuropsychological assessment as part of a preventive health screening programme. Multiple regression analyses were performed to examine neuropsychological performance in the overall sample, with pure-tone hearing loss and the speech-in-noise intelligibility threshold (SIB 50) included as predictors. Pure-tone hearing loss was not associated with cognitive performance. In contrast, the speech-in-noise intelligibility threshold was associated with global cognitive performance and verbal episodic memory. Among middle-aged participants, poorer speech intelligibility in noise was associated with lower global cognitive performance and poorer spontaneous cognitive flexibility. This retrospective population-based study highlights associations between speech intelligibility in noise and specific cognitive abilities from midlife onwards.