针对年龄相关性听力损失老年人的基于网络的游戏化听觉-认知双任务训练：一项试点随机对照试验

摘要(中文译文)

日常聆听能力对个体的健康与福祉至关重要。年龄相关性听力损失（ARHL）与沟通参与度降低、社交孤立、孤独感、认知衰退及痴呆风险增加相关。同时针对听觉加工和认知功能的干预，尤其是在具有参与性和生态效度的情境中进行的干预，可能比单一模态干预带来更大的获益。然而，针对患有ARHL的老年人量身定制的、经文化适配的、基于网络的、游戏化的听觉-认知双任务训练（ACDT）仍未被充分探索。在撰写本文时，可用的中文听觉或听觉-认知训练项目寥寥无几，这给老年人造成了语言和文化障碍。本研究旨在（1）评估居家ACDT在中国患有ARHL的老年人中的可行性和可接受性，以及（2）考察其对整体认知、听力、社交参与和孤独感的初步效果。研究假设干预组在整体认知、听力和社交参与方面的改善程度将大于对照组。在一项单盲试点随机对照试验中，60名居住在社区、患有轻至中度ARHL的老年人按1：1随机分配至ACDT组或等待名单对照组。在基线、第6周和第12周收集人口学数据和结局指标。干预后进行访谈以评估ACDT的可行性和可接受性。共60名参与者被随机分组（平均年龄67.65岁，SD 4.78岁；45/60，75%为男性）。ACDT表现出较高的可行性和可接受性。ACDT组在聚焦注意力（平均变化=-0.15；P=.02；d=-0.46）和分配性注意力（平均变化=-0.21；P=.002；d=-0.63）方面显示出显著改善。干预组在香港-蒙特利尔认知评估量表（Hong Kong-Montreal Cognitive Assessment）中的命名（r=0.37；P=.05）和视觉认知（r=0.44；P=.02）方面表现出显著的认知改善，而对照组未发现显著改善。两组均报告情绪性听力障碍显著减轻，干预组（r=0.39；P=.03）的改善略大于对照组（r=0.37；P=.04）。线性混合模型分析显示，听觉词语学习测验（Auditory Verbal Learning Test）中5分钟延迟回忆存在小至中等程度的组间效应（Cohen d=0.38），固定效应解释了69%的变异（边际R²=0.69）。左耳阈值存在显著的时间×组别交互作用（P=.01）。定性分析确定了三个关键主题：（1）干预一致性及参与者对ACDT的情感态度；（2）从ACDT中感知到的认知、信息获取和自我意识方面的获益；（3）认为ACDT负担较轻且自我效能感增强。未来的迭代应纳入人工智能增强的个性化。需要涉及多样化样本和主动对照条件的大规模随机对照试验，以确认对听觉和认知健康、双任务聆听-认知能力及真实世界功能的持续效果。

Abstract

Everyday listening ability is essential for individual health and well-being. Age-related hearing loss (ARHL) is associated with reduced communication engagement, social isolation, loneliness, cognitive decline, and increased dementia risk. Interventions that simultaneously target auditory processing and cognitive function, particularly within engaging and ecologically valid contexts, may offer greater benefits than unimodal approaches. However, culturally adapted, web-based, gamified auditory-cognitive dual-task training (ACDT) tailored for older adults with ARHL remains underexplored. At the time of this writing, few auditory or auditory-cognitive training programs are available in Chinese languages, creating linguistic and cultural barriers for older adults. This study aimed to (1) assess the feasibility and acceptability of home-based ACDT among older Chinese adults with ARHL and (2) examine its preliminary effects on global cognition, hearing, social engagement, and loneliness. It was hypothesized that the intervention group would demonstrate greater improvements in global cognition, hearing, and social engagement than the control group. Sixty community-dwelling older adults with mild-to-moderate ARHL were randomized 1:1 to either the ACDT group or a waitlist control group in a single-blinded pilot randomized controlled trial. Demographic data and outcome measures were collected at baseline, week 6, and week 12. Postintervention interviews were conducted to assess the feasibility and acceptability of ACDT. A total of 60 participants were randomized (mean age 67.65, SD 4.78 years; 45/60, 75% male). ACDT demonstrated high feasibility and acceptability. The ACDT group showed significant improvements in focused attention (mean change=-0.15; P=.02; d=-0.46) and divided attention (mean change=-0.21; P=.002; d=-0.63). Significant cognitive improvements on the Hong Kong-Montreal Cognitive Assessment were identified in naming (r=0.37; P=.05) and visual cognition (r=0.44; P=.02) in the intervention group, while no significant improvements were found in the control group. Both groups reported significant decreases in emotional hearing handicap, with slightly greater improvement in the intervention group (r=0.39; P=.03) than in the control group (r=0.37; P=.04). Linear mixed model analysis revealed a small to moderate group effect (Cohen d=0.38) for 5-minute delayed recall on the Auditory Verbal Learning Test, with the fixed effects explaining 69% of the variance (marginal R²=0.69). A significant time×group interaction was observed for left-ear thresholds (P=.01). Qualitative analysis identified three key themes: (1) intervention coherence and participants' affective attitude toward ACDT; (2) perceived benefits in cognition, information acquisition, and self-awareness from ACDT; and (3) perceiving ACDT as less burdensome with enhanced self-efficacy. Future iterations should incorporate artificial intelligence-enhanced personalization. Large-scale randomized controlled trials involving diverse samples and active control conditions are needed to confirm sustained effects on auditory and cognitive health, dual-task listening-cognitive abilities, and real-world functioning.

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