Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study

Abstract

Background The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction. Objective The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV. Methods Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect. Results The group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group). Conclusions The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem.

Peripheral Auditory Function in Young HIV‐Positive Adults With Clinically Normal Hearing

“…While these effects were statistically reliable, their small magnitude means that they are unlikely to account for the higher incidence of hearing complaints among PLWH. Central auditory processing and aural cognition may contribute to these hearing difficulties, as shown in previous studies 2,8,9 . Still, this study indicates a subclinical difference in peripheral auditory function in young individuals living with HIV.…”

“…Central auditory processing and aural cognition may contribute to these hearing difficulties, as shown in previous studies. 2,8,9 Still, this study indicates a subclinical difference in peripheral auditory function in young individuals living with HIV. Future work aims to continue following these individuals to determine if the early signs of dysfunction augur subsequent clinical hearing loss.…”

The Relationship Between Central Auditory Tests and Neurocognitive Domains in Adults Living With HIV

“…Central auditory function, reflected in tests of speech perception in background noise, correlates with cognition (Watson, 1991;Hallgren et al, 2001;Anderson and Kraus, 2010;Hoover et al, 2017;Panza et al, 2018;Danielsson et al, 2019;Humes, 2020Humes, , 2021, including cognitive dysfunction due to mild cognitive impairment (MCI), Alzheimer's disease (Gates et al, 1996;Idrizbegovic et al, 2011), and HIV (Zhan et al, 2017b;Buckey et al, 2019;White-Schwoch et al, 2020;Niemczak et al, 2021). This suggests central auditory tests might be useful for tracking cognitive dysfunction in populations with disordered neuro-cognitive processing.…”

“…The correlation between central auditory function and cognition suggests that auditory information is not only processed by the cochlea and auditory pathway, but also by other associative cortical areas (Harris et al, 2012;Palmer and Musiek, 2014;Sardone et al, 2019;Song et al, 2020). Our previous work has shown a relationship between central auditory test performance and cognitive performance, which suggested that central auditory tests might be useful for tracking cognitive performance in people living with HIV (PLWH) (Maro et al, 2014;Zhan et al, 2018;Buckey et al, 2019;Niemczak et al, 2021). The goal of this study was to evaluate the relationship between central auditory tests and neurocognitive domains in adults living with HIV and HIV-negative (HIV-) controls.…”

“…Also, using fMRI we have shown activation in frontal areas during a challenging speech-in-noise task (Song et al, 2020) showing that challenging speech-in-noise tasks involve areas beyond the auditory cortex. In addition, a growing body of literature suggests central auditory processing deficits in PLWH on self-report, neurophysiological, and audiological measures (White-Schwoch et al, 2020;Niemczak et al, 2021). The relationship between measures of auditory processing and cognition likely relates to the similarities in specific neurocognitive domains used for advanced processes of auditory perception and higher-order cognition (Danielsson et al, 2019).…”