Comprehension of acoustically degraded speech in Alzheimer’s disease and primary progressive aphasia
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Abstract
Successful communication in daily life depends on accurate decoding of speech signals that are acoustically degraded by challenging listening conditions. This process presents the brain with a demanding computational task that is vulnerable to neurodegenerative pathologies. However, despite recent intense interest in the link between hearing impairment and dementia, comprehension of acoustically degraded speech in these diseases has been little studied. Here we addressed this issue in a cohort of 19 patients with typical Alzheimer's disease and 30 patients representing the three canonical syndromes of primary progressive aphasia (non-fluent/agrammatic variant primary progressive aphasia; semantic variant primary progressive aphasia; logopenic variant primary progressive aphasia), compared to 25 healthy age-matched controls. As a paradigm for the acoustically degraded speech signals of daily life, we used noise-vocoding: synthetic division of the speech signal into frequency channels constituted from amplitude-modulated white noise, such that fewer channels convey less spectrotemporal detail thereby reducing intelligibility. We investigated the impact of noise-vocoding on recognition of spoken three-digit numbers and used psychometric modelling to ascertain the threshold number of noise-vocoding channels required for 50% intelligibility by each participant. Associations of noise-vocoded speech intelligibility threshold with general demographic, clinical and neuropsychological characteristics and regional grey matter volume (defined by voxel-based morphometry of patients' brain images) were also assessed. Mean noise-vocoded speech intelligibility threshold was significantly higher in all patient groups than healthy controls, and significantly higher in Alzheimer's disease and logopenic variant primary progressive aphasia than semantic variant primary progressive aphasia (all P < 0.05). In a receiver operating characteristic analysis, vocoded intelligibility threshold discriminated Alzheimer's disease, non-fluent variant and logopenic variant primary progressive aphasia patients very well from healthy controls. Further, this central hearing measure correlated with overall disease severity but not with peripheral hearing or clear speech perception. Neuroanatomically, after correcting for multiple voxel-wise comparisons in predefined regions of interest, impaired noise-vocoded speech comprehension across syndromes was significantly associated (P < 0.05) with atrophy of left planum temporale, angular gyrus and anterior cingulate gyrus: a cortical network that has previously been widely implicated in processing degraded speech signals. Our findings suggest that the comprehension of acoustically altered speech captures an auditory brain process relevant to daily hearing and communication in major dementia syndromes, with novel diagnostic and therapeutic implications.
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Novel speech perception paradigms capture syndrome-differential deficits by manipulating temporal and spectral properties of recorded speech.
“Promising avenues for cross-linguistic research also come from novel speech perception paradigms, which capture syndrome-differential deficits by manipu lating temporal and spectral properties of recorded speech. 126-128”
From Speech and language markers of neurodegeneration: a call for global equity (2023) · cites this paper as [128]
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Burda, A. N., Hageman, C. F., Brousard, K. T., & Miller, A. (2004) · Perceptual and Motor Skills · doi:10.2466/pms.98.3c.1359-1362 · Cited by 10 · see citing works
Stalpaert, J., Miatton, M., Sieben, A., Langenhove, T. V., van Mierlo, P., & Letter, M. D. (2021) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2021.618549 · Cited by 6 · see citing works
A chimpanzee recognizes varied acoustical versions of sine-wave and noise-vocoded speech
Heimbauer, L. A., Beran, M. J., & Owren, M. J. (2021) · Animal Cognition · doi:10.1007/s10071-021-01478-4 · Cited by 5 · see citing works
Degraded and computer-generated speech processing in a bonobo
Lahiff, N. J., Slocombe, K. E., Taglialatela, J. P., Dellwo, V., & Townsend, S. W. (2022) · Animal Cognition · doi:10.1007/s10071-022-01621-9 · Cited by 5 · see citing works
Tarawneh, H. Y., Mulders, W. H. A. M., Sohrabi, H. R., Martins, R. N., & Jayakody, D. M. P. (2021) · Alzheimer s & Dementia · doi:10.1002/alz.058497 · Cited by 1 · see citing works
Flagged first, then by citations
2 of the 92 references couldn’t be matched to a known paper.
Research works printed but not linked: 3
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Cited by
Sorted by citations
Speech and language markers of neurodegeneration: a call for global equity
García, A. M., de Leon, J., Tee, B. L., Blasi, D. E., & Gorno-Tempini, M. L. (2023) · Brain · doi:10.1093/brain/awad253 · Cited by 102 · see citing works
Primary progressive aphasia: six questions in search of an answer
Belder, C. R. S., Marshall, C. R., Jiang, J., Mazzeo, S., Chokesuwattanaskul, A., Rohrer, J. D., Volkmer, A., Hardy, C. J. D., & Warren, J. D. (2023) · Journal of Neurology · doi:10.1007/s00415-023-12030-4 · Cited by 47 · see citing works
Jiang, D., Hou, J., Nan, H., Yue, A., Chu, M. K., Wang, Y., Wang, Y., & Wu, L. (2024) · Alzheimer s Research & Therapy · doi:10.1186/s13195-024-01586-6 · Cited by 30 · see citing works
Hearing impairment and dementia: cause, catalyst or consequence?
Levett, B. A., Chandra, A., Jiang, J., Koohi, N., Sharrad, D. F., Core, L. B., Johnson, J. C. S., Tutton, M., Green, T., Jayakody, D. M. P., et al. (2025) · Journal of Neurology · doi:10.1007/s00415-025-13140-x · Cited by 18 · see citing works
Gauch, M., Spelter, B., Geschke, K., Köb, A., Tüscher, O., Heinrich, I., & Corsten, S. (2025) · International Journal of Language & Communication Disorders · doi:10.1111/1460-6984.70129 · Cited by 7 · see citing works
Pure-tone audiometry and dichotic listening in primary progressive aphasia and Alzheimer’s disease
Jiang, J., Johnson, J., Levett, B. A., Core, L. B., Volkmer, A., Koohi, N., Bamiou, D., Marshall, C. R., Warren, J. D., & Hardy, C. J. D. (2024) · Quarterly Journal of Experimental Psychology · doi:10.1177/17470218241287349 · Cited by 8 · see citing works
Acoustically Altered Speech Perception in Frontotemporal Dementia Syndromes
Johnson, J. C. S., Jiang, J., Requena‐Komuro, M., Benhamou, E., Sivasathiaseelan, H., Nelson, A., Bamiou, D., Hardy, C. J. D., & Warren, J. D. (2025) · Neurology · doi:10.1212/wnl.0000000000214022 · Cited by 5 · see citing works
Fan, M., Song, X., Lu, L., He, J., Shen, Y., Zhang, C., Wang, F., & Xie, Y. (2024) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2024.116786 · Cited by 5 · see citing works
Jiang, J., Johnson, J. C. S., Requena‐Komuro, M., Benhamou, E., Sivasathiaseelan, H., Chokesuwattanaskul, A., Nelson, A., Nortley, R., Weil, R. S., Volkmer, A., et al. (2024) · Scientific Reports · doi:10.1038/s41598-024-82694-z · Cited by 4 · see citing works
Talbot, R., Farrington-Douglas, C., Mummery, C. J., Warren, J. D., & Volkmer, A. (2025) · Aphasiology · doi:10.1080/02687038.2025.2495618 · Cited by 2 · see citing works
Disentangling phonology from phonological short-term memory in Alzheimer’s disease phenotypes
Henderson, S. K., Halai, A. D., Tsvetanov, K. A., Cope, T., Patterson, K. E., Rowe, J. B., & Ralph, M. A. L. (2025) · Alzheimer s Research & Therapy · doi:10.1186/s13195-025-01856-x · Cited by 3 · see citing works
Subjective time perception in dementia: a behavioural and neuroanatomical analysis
Requena‐Komuro, M., Jiang, J., Benhamou, E., Sivasathiaseelan, H., Johnson, J. C. S., Chokesuwattanaskul, A., Nelson, A., Hardy, C. J. D., & Warren, J. D. (2025) · Brain Communications · doi:10.1093/braincomms/fcaf496 · Cited by 2 · see citing works
Speech perception and language comprehension in primary progressive aphasia
Dial, H. R., Tessmer, R., & Henry, M. L. (2024) · Cortex · doi:10.1016/j.cortex.2024.10.010 · Cited by 1 · see citing works
Atrophy of the auditory cortex in Alzheimer’s disease
Menezes, A. S., Coelho, A., Morais‐Ribeiro, R., & Oliveira, T. G. (2025) · Hearing Research · doi:10.1016/j.heares.2025.109430 · Cited by 1 · see citing works
Gauch, M., Feldmann, J., Jochmann, J., Geschke, K., Köb, A.-L., Tüscher, O., Heinrich, I., & Corsten, S. (2025) · Aphasiology · doi:10.1080/02687038.2025.2592632 · Cited by 1 · see citing works
Gauch, M., Ablinger, I., Corsten, S., Dörr, F., Flöel, A., Grewe, T., Foede, J., Heinrich, I., Knels, C., Köb, A., et al. (2026) · Dementia · doi:10.1177/14713012261473983 · Cited by 1 · see citing works
Disentangling phonology from phonological short-term memory in Alzheimer’s disease phenotypesPreprint
Henderson, S. K., Halai, A. D., Tsvetanov, K. A., Cope, T., Patterson, K. E., Rowe, J. B., & Ralph, M. A. L. (2025) · medRxiv · doi:10.1101/2025.01.07.25320125 · Cited by 1 · see citing works
Al-Sallami, D., Aameri, R. F. H. A., Tischkau, S., Rybak, L. P., & Ramkumar, V. (2025) · Research Square · doi:10.21203/rs.3.rs-6431143/v1
Popli, T. A. (2025) · Neurology · doi:10.1212/wnl.0000000000214128
Identifying ROCK2 as an intervention target for bilirubin encephalopathy
Ke, B., Mao, L., Hu, M., Cui, Y., Chen, M., Wu, C., Guan, R., Yin, S., & Li, C. (2025) · Fundamental Research · doi:10.1016/j.fmre.2025.09.006
A neurological perspective on hearing impairment in dementia
Froud, S. A., Levett, B. A., Core, L. B., Jiang, J., Hardy, C. J. D., & Warren, J. D. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-29198-2.00012-6
Li, Z., Liu, Y. M., Zhang, X., Kou, N., Zhao, X. L., Jia, X., Engel, A. K., Zhang, D., & Wang, S. (2026) · European Journal of Neuroscience · doi:10.1111/ejn.70392
Chaves, M., Lambert, M. A., Kelly, L., Diaz-Carr, I., Neal, V., Hillis, A. E., & Stockbridge, M. D. (2026) · Brain Sciences · doi:10.3390/brainsci16020149
Transitional cognitive syndrome: Reconsidered classification of cognitive disorders
Levin, O. S., Vasenina, E. E., Gankina, O. A., А.Б., Б., Morozova, I. O., Savilov, V., Kurmyshev, M. V., Andryushchenko, A. V., & Kostyuk, G. P. (2026) · S S Korsakov Journal of Neurology and Psychiatry · doi:10.17116/jnevro202612604247
Non‐verbal dichotic listening: A new cognitive hearing test for dementia
Hardy, C. J. D., Levett, B. A., Jiang, J., Core, L. B., Froud, S. A., Bishop, L., Lim, D., Durrani, F. G., Volkmer, A., Koohi, N., et al. (2026) · Alzheimer s & Dementia · doi:10.1002/alz.71358
Speech‐In‐Noise Perception in Alzheimer's Disease and Primary Progressive Aphasia
Froud, S. A., Levett, B. A., Jiang, J., Core, L. B., Koohi, N., Tutton, M., Green, T., Bamiou, D., Marshall, C. R., Hardy, C. J. D., et al. (2026) · European Journal of Neurology · doi:10.1111/ene.70701
Transitional Cognitive Syndrome: Reconsidered Classification of Cognitive Disorders
Levin, O. S., Vasenina, E. E., Gankina, O. A., А.Б., Б., Morozova, I. O., Savilov, V., Kurmyshev, M. V., Andryushchenko, A. V., & Kostyuk, G. P. (2026) · Neuroscience and Behavioral Physiology · doi:10.1007/s11055-026-02066-0
Mairesse, S., Briganti, G., & Lechien, J. R. (2026) · Journal of Voice · doi:10.1016/j.jvoice.2026.08.038
- Authors
- Jiang, J., Johnson, J. C. S., Requena-Komuro, M.-C., Benhamou, E., Sivasathiaseelan, H., Chokesuwattanaskul, A., Nelson, A., Nortley, R., Weil, R. S., Volkmer, A., Marshall, C. R., Bamiou, D.-E., Warren, J. D., & Hardy, C. J. D.
- Affiliations
- UCL Queen Square Institute of Neurology (GB)
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London , London WC1N 3AR , UK
- Thai Red Cross Society (TH)
- Wexham Park Hospital (GB)
- University College London (GB)
- Queen Mary University of London (GB)
- UCL Biomedical Research Centre (GB)
- Corresponding author
- Hardy, Chris J D
- ORCID
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2023-05-15
- Volume
- 146
- Issue
- 10
- Pages
- 4065-4076
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC10545509
- OpenAlex
- W4376618147
- Cited by
- 28
- References
- 92
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 5 · 2023: 2
- FWCI
- 5.68
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Brain (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
- Funders
- The Dementia Research Centre
- Alzheimer’s Research UK
- Brain Research Trust
- The Wolfson Foundation
- Alzheimer’s Society (AS-PG-16-007)
- the Royal National Institute for Deaf People, Alzheimer’s Research UK
- National Institute for Health Research University College London Hospitals Biomedical Research Centre
- the Wellcome Trust (102129/B/13/Z)
- UK Research and Innovation
- Creative Commons Attribution
- Frontotemporal Dementia Research Studentship in Memory of David Blechner
- The National Brain Appeal
- Association of British Neurologists Clinical Research Training Fellowship
- Wellcome Trust PhD studentship (102129/B/13/Z)
- Brain Research UK PhD Studentship
- Clinical Research Fellowship
- Leonard Wolfson Experimental Neurology Centre
- NIHR Advanced Fellowship (NIHR302240)
- Bart’s Charity and the National Institute for Health Research (NIHR204280)
- Wellcome Clinical Research Career Development Fellowship (205167/Z/16/Z)
- Royal National Institute for Deaf People
- RNID-Dunhill Medical Trust Pauline Ashley Fellowship (PA23_Hardy)
- Wellcome Institutional Strategic Support Fund Award (204841/Z/16/Z)
- National Institute for Health Research (NIHR204280)
- NIHR [Invention for Innovation (NIHR204280)
- NIHR
- Department of Health and Social Care
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Hearing Loss and Rehabilitation
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
- Keywords
- speech understanding, Alzheimer's disease, primary progressive aphasia, noise-vocoded speech, dementia, logopenic variant primary progressive aphasia, semantic dementia, planum temporale, angular gyrus, anterior cingulate cortex, gray matter atrophy, auditory cortex, hearing loss
- MeSH terms
- Alzheimer Disease, Aphasia, Brain, Humans, Neuropsychological Tests, Speech, Aphasia, Primary Progressive, Comprehension
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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