By Rajesh Kumar, M.P.H.
As New Zealand entered Level 4 lockdown at the end of March, researchers around the country faced many questions: How do we progress ongoing research that requires face-to-face contact with human participants when there is no certainty about when we will be able to resume contact with others again? What if the protocols have been finalised and funding already awarded? And what if your participants are 65 years plus?
Technological solutions came to the rescue of researchers at the Eisdell Moore Centre (EMC) when faced with this very dilemma during the six-week Covid-19 lockdown in New Zealand.
A multi-disciplinary team of researchers from varied disciplines of psychology, audiology and dementia prevention was awarded funding earlier this year to explore the usefulness of a computer-based perceptual training protocol in preserving or improving cognitive performance.
Lead researcher Professor of Psychology Suzanne Purdy says several studies have already demonstrated a link between hearing loss and cognitive impairment, although causal mechanisms are still unknown. And each year lived with unaddressed impairment could potentially be causing deterioration in cognition due to the consequences of sensory deficits such as social isolation.
The focus of much research in this field so far has been on providing individuals experiencing hearing impairment with hearing aids following early diagnosis of cognitive difficulties. But the uptake of hearing aids is not optimal, due to reasons such as clients’ reluctance to wear them and costs associated with the devices.
Conversely, addressing poor hearing and auditory processing through perceptual training may prevent early cognitive decline and prevent or delay dementia. A positive effect of auditory perceptual training on cognition, the researchers believe, could strengthen evidence for sensory deficits having a negative impact on cognition.
Professor Purdy and her team want to see if online auditory perceptual training aimed at enhancing auditory processing can affect cognition in both young and old, so that cognitive decline associated with hearing impairment could be prevented. Currently, there is sparse evidence demonstrating efficacy of computer-based perceptual training in older adults with sensory impairment.
Researcher Dr Joan Leung says the original research planned to take an iPad preloaded with the SoundStorm app to the elderly and an equal number of younger healthy subjects to deliver the perceptual training on site. Prior to this, participants would be assessed at the University of Auckland clinics using a neuropsychological and hearing test battery. Training would ensue and then be followed up by testing to compare and take note of any changes to cognition scores, if any.
Auditory processing testing for speech-in-noise is to be done using the internet version of the University of Canterbury Digit Triplet Test developed by EMC member, Professor Gregory O’Beirne. This validated test has been described by the researchers as a robust hearing screening test that individuals can access from home, particularly those in rural areas where audiological services are sparse and for those who have mobility issues which restrict attendance at clinical appointments.
Since face-to-face contact was no longer feasible under the Covid-19 lockdown, the team began looking for alternatives for face to face testing and training research protocols. Acoustic Pioneer (by Matt Barker) involving online auditory training games developed originally for children with auditory processing disorder, was found to be a good online alternative. Just before the lockdown, the team applied in urgency to the EMC, and received approval, for a variance in the study protocol so that the study could be conducted remotely using this on young and elderly subjects.
Dr Leung says the first part of the study that’s funded by the EMC Grant-in-aid would likely generate qualitative information regarding the feasibility and acceptability of these online tools and the process of remote-testing. Detailed written instructions, and video-conferencing with participants should address any queries during the assessment and/or training stages of the study.
Evaluation of online neuro-cognitive and auditory processing assessments before and after training will determine whether this approach is reliable for future phases of the research.
“This grant will be used to refine the remote-testing and training battery, first with young and then with older (65 years +) healthy control participants” Dr Leung says, “We will take these findings to our colleagues at the Dementia Prevention Research Clinic to propose a collaborative application for larger grants to trial the method on subjects with cognitive impairment.”
When asked about the elderly participants’ access to technology and internet, Professor Purdy quotes anecdotal evidence suggesting that Covid-19 shutdown had motivated families and older individuals to improve access to technology to allow for online video calls and activities during social isolation.
Contrary to the view that older people struggle with technology, she says there is widespread access to digital technology and the internet amongst older New Zealanders [See: “Golden age no stranger to digital age”] and InternetNZ are endeavouring to grow this through their digital inclusion plan, “which is good news for this research.”
“We will provide any support necessary, such as online training on how to use the online tool, to a spouse or caregiver and help them through the process,” Dr Leung adds.
Meagan Barclay, EMC Research Operations Manager and a selection committee member, says when Covid-19 level 4 restrictions came into effect, the EMC management committee decided to take a flexible and pragmatic approach to all grants that had already been awarded. The flexibility included allowing researchers to request variations in protocols or potentially on aims of projects, if it would facilitate research outputs during lockdown.
“This project was a really good example of how researchers Suzanne Purdy and Joan Leung adapted quickly to the changed research environment and explained to us how their study could be entirely conducted online. The results of this project will be really interesting, not just in terms of their direct findings, but also their learnings of conducting research in this way,” says Dr Barclay.
Researchers say the study has also provided them with an opportunity to collaborate with a private company to perform the neuropsychological assessments online. CNS-VS (Computerized Neurocognitive Assessment – Vital Signs) offers customisable neuropsychological test batteries that have been shown to be sensitive and applicable to populations with mild cognitive impairment.
“From our point of view, it’s a win-win situation. By making their products more accessible online, private companies expand their reach, while researchers have opportunities to explore different ways of conducting research with human participants” says Dr Barclay. “Online research studies provide opportunities to access larger pools of participants as well as potentially improving the efficiency.”
(Rajesh Kumar is a former journalist and a part-time consultant at the EMC. He is currently preparing for his PhD in Public Health).