SMarTTER HeAR: Synergising Markers, Tests and Technologies to Enable Real-world Hearing in Alzheimer's and Related dementias

Scope: Hearing impairment is a potent association of dementia and a promising treatment target.

To realise this promise, we need to define how auditory brain dysfunction interacts with peripheral hearing, how heterogeneous neurodegenerative pathologies impact hearing and how hearing impairment relates to daily-life disability, disease course and brain degeneration.

Further, we need to use this information to innovate dynamic technologies and interventions that enhance real-world listening and communication.

Aims: We will: i) compare peripheral and central hearing functions, including novel, clinically-relevant measures in early Alzheimer’s disease and primary progressive aphasia; ii) establish neuroanatomical substrates of auditory phenotypes; iii) evaluate hearing and auditory plasticity measures in predicting diagnosis, disease course, disability, caregiver burden and brain damage; and we will synergise this information to iv) develop new ‘smart’ assistive signal-processing algorithms.

Methods: Hearing will be assessed systematically and longitudinally using a customised psychoacoustic and auditory cognition test battery, in well-characterised Alzheimer's, progressive aphasia and healthy age-matched cohorts. Neuroanatomical correlates will be assessed using structural and resting-state fMRI.

Novel hearing measures will be compared to standard audiometry as predictors of diagnosis and impact.

We will develop and evaluate signal-processing algorithms and virtual acoustic environments to enhance daily-life speech perception in the target diseases.

Outcomes: This work will generate new auditory measures that predict disease evolution, disability and burden, candidate central hearing biomarkers and algorithms for personalised, assistive hearing fittings in dementia.

These outputs will inform future clinical trials, guidelines and commercial applications for optimising hearing devices and listening environments for people with dementia. This project is jointly funded with Alzheimer’s Research UK.