 Hello, my name is Zhang, a PhD student at the University of Hong Kong, Professor Ina Wang, my supervisor. It is a pleasure to give a talk in VCCA 2023. The title of my talk is Distinguishing difficulties in speech outstanding due to hearing loss or cognitive decline. Hearing loss and cognitive decline are highly prevalent in older adults. Over 42 percent of individuals with any degree of hearing loss aged about 60 years old. Mild cognitive impairment, MCI, is commonly observed in older adults, affecting at least 80 percent of individuals over 65 years old. Given a high prevalence, co-occurrence of these two-inch conditions is frequently encountered in older clinical practice. Early screening for both hearing and cognitive decline are crucial in order to facilitate prompt intervention and treatment. Oldologists or healthcare professionals are real positioned to detect cognitive decline in older adults with hearing loss and referral for diagnostic evaluation. But for some older adults with very poor understanding performance, differentiating whether speech outstanding difficulties are solely due to hearing loss or partially due to cognitive decline can be challenging without conducting a cognitive test. Otherwise, it can lead to doing repeated fine tuning of hearing devices without improvement of speech outstanding performance. And this can also affect the effectiveness of counselling and the setting of rehabilitation programs. And conducting standard cognitive screening tests could be time consuming. For example, the popular one, mocha, montreal cognitive assessment usually takes 10 to 15 minutes for these people with hearing loss or cognitive decline. Longer time will be needed. Another big issue of conducting cognitive tests is hearing loss. Hearing loss cannot only make verbal instruction difficult, but it can also impact the accuracy of test score if autoestimuli are used. Most of researchers are familiar with the digital triplets test. It's used through digital sequences as test stimuli and has been widely used for game screening. Due to its good test with test reliability, sensitivity and specificity, the triplet test primarily measures bottom up speech outstanding noise due to its smaller corpus, usually the first night to 10 digits lack of linguistic and contextual information. Recently, our lab has developed a new version of the digital ignore test recorded integrated digital ignore test IDing. It is using two to five, two to five digit sequences as test stimuli. And the participant can be asked to repeat the DGC here in forward or backward orders. The intervals of time between the digits can also be customized. In the forward IDing test with 200 millisecond interval time, test with test reliability was less than one dB within the business. Additionally, high correlations were found between the IDing test and the two membrane senders similar test. We also found five digits SRT was more correlated with working memory than two to four digits sequences in older adults. So we propose using IDing test to measure cognitive function and to distinguish difficulties in speech outstanding due to hearing loss or cognitive decline. Here's the idea of using IDing for cognitive screening. The two digits SRT is primarily determined by hearing loss with a small contribution from the cognitive function. As cognitive functions come more involved in the top-down speech perception, such as the two or three digits SRT with backwards response or the five digits SRT or the two or three digits SRT with short interval time between the digits. They are influenced by both hearing loss and the cognitive function. Therefore, the difference in SRT between complex conditions and the two digits conditions may serve as indicators for cognitive screening. The two digits SRT can serve as a baseline for automatic speech perception ability, while the difference between the complex condition and two digits conditions can remove the effect of hearing loss to some degree. And I just want to highlight that this test can be used not only in hearing centers, but also in like GP and any other department that the healthcare professionals will face old adults with potential hearing loss or potential cognitive decline in clinical practice. Then I would like to share a preliminary study that investigated the use of IDing for cognitive screening in old adults or hearing aid users. Here we only do a comparison between the five and two digits SRT. A total of 81 participants were recruited for this study. They had a moderate to severe hearing loss. Two cognitive tests were conducted, MOCA for general cognitive function assessment, and the DigiSpan test DST for measuring working memory and attention. Among participants, 21 failed to the MOCA MCS screening, and two were unable to complete the five digit IDing test, leaving a total of 79 participants for analysis. The participants were divided into two groups based on their MOCA screening results. The two groups had similar built-in averaging in the past year, however the group that passed the MOCA screening had a higher education level and a younger age. We compared the five and two DGC SRT differences among three groups, young adults, old adults who passed the MOCA and old adults who failed the MOCA. Our young adult data was from a preliminary study. Interestingly, we found no significant differences in digits five and two SRT differences between the young adults and old adults who passed the MOCA, suggesting little effect on age. However, significant differences were observed between the groups that failed the MOCA and the two other groups. Additionally, we found a high correlation between the five and two DGC SRT difference, and the results of two cognitive function tests. The correlation coefficients were 0.6 to 0.7, quite high. We also analyzed the data to identify a cutoff point that could suggest the possibility of cognitive decline for the forum. In the graph, the red dots indicate those who failed the MOCA and while the blue dots indicate who passed. We found the best cutoff point to distinguish whether passed the MOCA is 3.15 DPS and not with high sensitivity and specificity. Here is the conclusion of today's talk. Two DGC SRT could indicate bottom-up speed sectioning ability while comparison of five DGC and two DGC SRT may indicate issues with cognitive function. In the future research, we would like to explore the effects of more severe cognitive decline and the different degree and the types of hearing loss. Yes, we need more data. Additionally, I'm interested in using IDIN to measure different aspects of cognitive function, such as doing a comparison between the three DGC SRT with forward and backward responses, which may provide insight into cognitive processing effect. Okay, here. That's all for today's talk. Thank you.