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The Response of the Central Auditory System to Sound in Normal Hearing Adults with and Without HIV/AIDS: an Fmri Study

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The Response of the Central Auditory System to Sound in Normal Hearing Adults with and Without HIV/AIDS: an Fmri Study The response of the central auditory system to sound in normal hearing adults with and without HIV/AIDS: An fMRI study CELESTÉ PRETORIUS U10457900 A thesis submitted in partial fulfillment of the requirements for the degree D. Phil. Communication Pathology in the Department of Speech-Language Pathology and Audiology at the UNIVERSITY OF PRETORIA FACULTY OF HUMANITIES PROMOTORS: Dr Maggi Soer Dr Lidia Pottas November 2017 No part of this work may be reproduced in any form or by any means, electronically, mechanically, by print or otherwise without prior written permission by the author. Celesté Pretorius Department of Speech-Language Pathology and Audiology University of Pretoria [email protected] i ACKNOWLEDGEMENTS My sincere appreciation and thanks to everyone mentioned below. • My supervisors, Dr Maggi Soer and Dr Lidia Pottas, thank you for the many hours of assistance, guidance, and advice, as well as for sharing your expertise with me. I really appreciated your continuous encouragement when I needed it most. You were such an inspiration. I will always remember the tactful manner in which you mentored me step by step through the whole thesis. Without your support, this thesis would never have become a reality. • Prof Francois Steffens, many thanks for your swift assistance with the statistical analyses and your patience. I appreciated your professional approach and expertise very much. • Elsie Naude, I truly appreciated your prompt help with the language editing as well as your expert advice. • Thank you to the members of the MRC/UCT Medical Imaging Research Unit, Department of Human Biology, University of Cape Town, who contributed to the progress that I made with my research studies. During the past few years Prof Meintjies and Keri Woods taught me several techniques and gave me very good advice. • Prof EM Meintjies, a special thank you for always being available to offer advice and comments on my research studies. I always benefited so much from the discussions with you. I really appreciated the arrangement that you made so that I could use the lab and BrainVoyager at UCT. • Keri Woods, my sincere thanks to you for all your advice and help with the BrainVoyager as well as all the examples of articles. • Thank you, Karen Fitzgerald, for all your advice regarding fMRI and for the use of your BrainVoyager in Pretoria. ii Last but not least, I want to thank those who are close to me. “Music imprints itself on the brain deeper than any other human experience. Music evokes emotion and emotion can bring with it memory. Music brings back the feeling of life when nothing else can” (Dr Oliver Sacks) • My parents Prof Mike van Heerden and Anne-Marie van Heerden “You raise me up, so I can stand on mountains. You raise me up, to walk on stormy seas. I am stronger when I am on your shoulders. You raise me up to be more than I can be” (Josh Groban) Dear Dad and Mom, thank you for always supporting me and believing in me. Thank you that you have always encouraged me to work harder and to complete my DPhil. I will always love you unconditionally and will follow the good examples that you have taught me, namely to work hard for the things that I aspire to achieve. Prof Mike van Heerden (Dad) thank you for always making time to help me with my studies when I needed it. I really appreciate it from the bottom of my heart. • Johan Pretorius, I truly thank my dear husband, for his continued and unfailing love, support and understanding during my career, internship and my preparation of my thesis. You have been a constant source of support and encouragement during the challenges of my internship, the writing of my thesis and our life with our son. Thank you for looking after him, while I was busy with my research studies. I am truly thankful for having you in my life. Thank you also for the little things you’ve done for me. Thank you for all your help with the editing and layout of my whole thesis, you have done a great job. • Ivan Pretorius, thank you my loving son for believing in mommy and constantly reminded me to work hard, and that you, someday, also want to study at the University. I appreciated all those nights you had to fall asleep with only your dad by your bedside, and for all those times you had to watch cartoons with your dad because I needed to do my research studies. You are the motivation for my heart to keep beating. I completed my research because you needed to see me do it, so that I can be your example. Lastly, no matter what happens, I will always love you. You are the best son I could ever have had, thank you for reminding me that you will look after me with your favourite song iii “Kan ek jou superman, batman, ironman, spiderman wees, ek sal jou oppas in die donker vir jou ‘n HERO wees” (Eden) • My Heavenly Father Lord, thank you for my talents, opportunities and grace. Without You I would be nothing in nowhere. I would like to thank you for making me a curious being who loves to explore His creation and for giving me the opportunity and talents to have written this thesis. Without You, I can do nothing. “Trust in the Lord with all your heart, and lean not on your own understanding, in all your ways acknowledge Him, and He shall direct your paths.” (Proverbs 3:5-6) - John A Logan iv ABSTRACT Titel: The response of the central auditory system to sound in normal hearing adults with and without HIV/AIDS: An fMRI study Name: Celesté Pretorius Supervisors: Dr Maggi Soer Dr Lidia Pottas Department: Department of Speech-Language Pathology and Audiology Degree: D. Phil. (Communication Pathology) Research applying fMRI to evaluate any activation in the central auditory nervous system (CANS) is currently limited, but has shown some promising potential. fMRI is likely to become the tool of choice for addressing many research questions concerning the auditory system, especially regarding the localization of the function of certain auditory areas and brain connectivity. The main aim was to determine the response of the central auditory nervous system (CANS) to sound in normal hearing adults with and without HIV/AIDS, using fMRI. A between-group comparative design was used to determine and compare the response of the CANS to auditory stimuli of a sample of 15 normal hearing participants without (HIV/AIDS) and 12 normal hearing participants with (HIV/AIDS). Structural and fMRI images were acquired using a 1.5T Siemens Magnetom Espree. Two different listening stimuli tasks namely nonsense syllables and warble tones were presented binaurally using earphones. These stimuli were presented with a block design with two conditions, silence (baseline) of twenty seconds and the stimuli task tone of twenty seconds. It was interleaved with duration of 20 seconds per block, with each block repeated four times. The task paradigm was done with blood oxygen level-dependent (BOLD) technique. v Images were analysed by statistical parametric mapping software. A priori regions of interest (ROIs) for the CANS were defined and separate participant analyses were performed on the average signal in each ROI using the general linear model. The beta values generated from this analysis reflected the mean percentage signal change within the ROI of the CANS for the two tasks for each participant. A whole brain analysis was also done to determine and compare the multiple areas of activation and responses to the two tasks in the whole brain. Both groups of participants showed activation in all the ROIs of the CANS, but the mean percentage signal change in BA41 and BA42 differed significantly between the 2 groups with a p-value of 0.03 both BA41 and BA42. The control group showed a significantly greater increase in neuronal activity caused by cerebral blood flow to BA41 and BA42 than the HIV/AIDS group. The influence of possible confounding factors such as gender, age, and education on the mean percentage signal change in BA41 and BA42 in the two groups was also determined. Age (p = 0.95) and education (p = 0.68) had no statistically significant effect on the mean percentage signal change in BA41 and BA42 for any of the two groups in this study. However, gender had a significant effect for the mean percentage signal change for BA41 (p = 0.042) and BA42 (p = 0.037). The influence of the CD4 count and years on ART on the neural response of the ROIs CANS to the auditory stimulation (nonsense syllables) was also determined. The results showed a negative linear regression analysis, thus indicating an inverse correlation between the years on ART and the activated BOLD signals in BA41 and BA42 areas during the nonsense syllables task. The use of ART could have reduced the CD4 count in this study. Although this trend was observed, it would require a bigger sample to shed more light on these findings. Results of the response of the ROIs to warble tones indicated no significant differences between all the ROIs of the two groups, however a borderline significant difference (0.07) of activation occurred, namely the inferior colliculus in the right hemisphere of the HIV/AIDS group. vi The results of the whole brain analysis showed that the two participant groups differ in brain activation and confirmatory voxel-by-voxel comparison results were noted. These noted differences could be related to the neurocognitive impairments related to HIV/AIDS, but were not explored in depth and should therefore be investigated and documented further.
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