1 Department of Psychology, Concordia University, Montréal, Québec, Canada. Rachel.downey@mail.concordia.ca.
2 PERFORM Centre, Concordia University, Montréal, Québec, Canada. Rachel.downey@mail.concordia.ca.
3 Department of Psychology, Concordia University, Montréal, Québec, Canada.
4 Department of Psychology, University of Toronto, Toronto, ON, Canada.
5 KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
6 Département de Médecine, Université de Montréal, Montréal, Québec, Canada.
7 Centre de Recherche de L'Institut de Cardiologie de Montréal, Montréal, Québec, Canada.
8 Centre de Recherche de L'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
9 PERFORM Centre, Concordia University, Montréal, Québec, Canada.
10 École d'optométrie, Université de Montréal, Montréal, Québec, Canada.
11 Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada.
12 École d'orthophonie Et d'audiologie, Université de Montréal, Montréal, Québec, Canada.

Background: Hearing loss predicts cognitive decline and falls risk. It has been argued that degraded hearing makes listening effortful, causing competition for higher-level cognitive resources needed for secondary cognitive or motor tasks. Therefore, executive function training has the potential to improve cognitive performance, in turn improving mobility, especially when older adults with hearing loss are engaged in effortful listening. Moreover, research using mobile neuroimaging and ecologically valid measures of cognition and mobility in this population is limited. The objective of this research is to examine the effect of at-home cognitive training on dual-task performance using laboratory and simulated real-world conditions in normal-hearing adults and older hearing aid users. We hypothesize that executive function training will lead to greater improvements in cognitive-motor dual-task performance compared to a wait-list control group. We also hypothesize that executive function training will lead to the largest dual-task improvements in older hearing aid users, followed by normal-hearing older adults, and then middle-aged adults.

Methods: A multi-site (Concordia University and KITE-Toronto Rehabilitation Institute, University Health Network) single-blinded randomized controlled trial will be conducted whereby participants are randomized to either 12 weeks of at-home computerized executive function training or a wait-list control. Participants will consist of normal-hearing middle-aged adults (45-60 years old) and older adults (65-80 years old), as well as older hearing aid users (65-80 years old, = 6 months hearing aid experience). Separate samples will undergo the same training protocol and the same pre- and post-evaluations of cognition, hearing, and mobility across sites. The primary dual-task outcome measures will involve either static balance (KITE site) or treadmill walking (Concordia site) with a secondary auditory-cognitive task. Dual-task performance will be assessed in an immersive virtual reality environment in KITE's StreetLab and brain activity will be measured using functional near infrared spectroscopy at Concordia's PERFORM Centre.

Discussion: This research will establish the efficacy of an at-home cognitive training program on complex auditory and motor functioning under laboratory and simulated real-world conditions. This will contribute to rehabilitation strategies in order to mitigate or prevent physical and cognitive decline in older adults with hearing loss.

Trial registration: Identifier: NCT05418998. https://clinicaltrials.gov/ct2/show/NCT05418998.