Association of hearing impairment with brain volume changes in older adults

Preoperative MRI, audiovisual speech perception, and mood are associated with cochlear implant outcomes in adults with postlingual deafness

Acquired severe to profound hearing loss is an increasingly challenging problem of our aging population. Cochlear implantation (CI) is the gold standard treatment for this advanced form of sensory deprivation. Despite the overall satisfactory results of CI, a substantial number of patients show unsatisfactory outcomes. This study aims to improve current predictive models of CI outcome by integrating preoperative MRI with behavioral data. We acquired a 3D T1 MRI to measure cortical thickness (CT) and volume using surface-based analysis and parcellation from the Brainnetome atlas. CI success at 6 months post-implant, as measured by audiovisual speech perception, was correlated with preoperative speech and audiovisual perception with hearing aids, and residual hearing, especially at the side of the non-implanted ear. In addition, CI outcome correlated positively with CT of the left superior temporal gyrus and sulcus, left inferior frontal region, and bilateral superior frontal regions. The volume of the left middle frontal gyrus and regions of the parietal lobe, especially at the left side, also correlated with CI outcome. Linear regression models revealed that CI outcome was best predicted by the combination of preoperative measures of audiovisual speech perception, residual hearing, depression and CT. Our results highlight the importance of preserved brain areas implicated in hearing, language, audiovisual integration, and cognitive functions for CI success. Furthermore, brain MRI in conjunction with other predictors can help to identify patients who may need more time to adjust to the CI, allowing a more tailored rehabilitation, and potentially greater efficacy.

Hearing loss and its relation to cognition in Indian cohort: A behavioral and neuroimaging study

INTRODUCTION

Hearing loss (HL) is an unexplored modifiable risk factor that impacts 41% of the Indian population. This study aimed to determine the prevalence of HL, investigate the association between HL and cognitive impairment in older adults, and assess neuronal structures involved in HL and cognitive impairment using behavioral and magnetic resonance imaging (MRI).

METHODS

This study assessed 589 individuals aged 45 and above using HearCheck handheld audiometry, cognitive testing, and MRI.

RESULTS

Participants with HL are 1.69 times more likely to experience cognitive impairment compared to those without HL. Neuroimaging revealed significantly less gray matter in various temporal and hippocampal regions in individuals with HL and cognitive impairment as compared with normal hearing and normal cognition.

DISCUSSION

These findings underscore the importance of exploring the link between sensory impairments, specifically HL, and cognitive impairment, emphasizing the need for preventive strategies in diverse populations.

Highlights

A large urban cohort provides insights into hearing and cognitive function.Hearing loss (HL) is associated with a 69% higher likelihood of cognitive impairment.Magnetic resonance imaging (MRI) reveals reduced gray matter (GM) loss in individuals with HL.Comprehensive cognitive and hearing evaluations strengthen findings.Findings align with sensory deprivation and shared risk factor hypotheses.

Exploring the bioactive ingredients of three traditional Chinese medicine formulas against age-related hearing loss through network pharmacology and experimental validation

Traditional Chinese medicine (TCM) formulas, including the Er-Long-Zuo-Ci pill, Tong-Qiao-Er-Long pill, and Er-Long pill, have long been utilized in China for managing age-related hearing loss (ARHL). However, the specific bioactive compounds, pharmacological targets, and underlying mechanisms remain elusive. This study aims to find the shared bioactive ingredients among these three formulas, uncover the molecular pathways they regulate, and identify potential therapeutic targets for ARHL. Furthermore, it seeks to validate the efficacy of these major components through both in vivo and in vitro experiments. Common bioactive ingredients were extracted from the TCMSP database, and their putative target proteins were predicted using the Swiss Target Prediction database. ARHL-related target proteins were collected from GeneCards and OMIM databases. Our approach involved constructing drug-target networks and drug-disease-specific protein-protein interaction networks and conducting clustering, topological property analyses, and functional annotation through GO and KEGG enrichment analysis. Molecular docking analysis was utilized to delineate interaction mechanisms between major bioactive ingredients and key target proteins. Finally, in vivo and in vitro experiments involving ABR recording, immunofluorescent staining, HE staining, and quantitative PCR were conducted to validate the treatment effects of flavonoids on the declining auditory function in DBA/2 J mice. We identified 11 common chemical compounds across the three formulas and their associated 276 putative targets. Additionally, 3350 ARHL-related targets were compiled. As an intersection of the putative targets of the common compounds and ARHL-related proteins, 145 shared targets were determined. Functional enrichment analysis indicated that these compounds may modulate various biological processes, including cell proliferation, apoptosis, inflammatory response, and synaptic connections. Notably, potential targets such as TNFα, MAPK1, SRC, AKT, EGFR, ESR1, and AR were implicated. Flavonoids emerged as major bioactive components against ARHL based on target numbers, with molecular docking demonstrating diverse interaction models between these flavonoids and protein targets. Furthermore, baicalin could mitigate the age-related cochlear damage and hearing loss of DBA/2 J mice through its multi-target and multi-pathway mechanism, involving anti-inflammation, modulation of sex hormone-related pathways, and activation of potassium channels. This study offers an integrated network pharmacology approach, validated by in vivo and in vitro experiments, shedding light on the potential mechanisms, major active components, and therapeutic targets of TCM formulas for treating ARHL.

Hearing Loss and Falls: A Systematic Review and Meta-Analysis

Importance

Falls constitute a significant public health concern worldwide and have been associated with increased morbidity and mortality across all ages. Identifying potentially modifiable risk factors for falls is a key public health priority. Literature surrounding the association between hearing loss (HL) and falls remains inconclusive.

Objective

To conduct a systematic review and meta-analysis to comprehensively synthesize evidence surrounding the impact of HL on falls.

Data Sources

PubMed, Embase, and Cochrane Library from database inception through April 9, 2024.

Study Selection

Observational studies investigating the association between HL and falls were selected. Only studies reporting covariate-adjusted estimates were included to minimize confounding.

Data Extraction and Synthesis

Two independent reviewers evaluated studies for eligibility, extracted data, and assessed the risk of bias of included studies. Using a random-effects model, adjusted estimates were pooled in meta-analyses. Heterogeneity was evaluated using subgroup and sensitivity analyses, and publication bias was assessed.

Main Outcomes and Measures

The cross-sectional odds and longitudinal risk of falls among patients with HL compared with those without HL.

Results

A total of 5 071 935 participants were included from 27 studies; approximately 49.2% of participants were female, and 14 studies were conducted in Asia, 7 in North America, 3 in Europe, and 3 in Oceania, represented by Australia. Patients with HL exhibited an increased cross-sectional odds of falls (odds ratio, 1.51; 95% CI, 1.37-1.67; I2 = 64%) and longitudinal risk of falls (risk ratio, 1.17; 95% CI, 1.06-1.29; I2 = 69%) than those without HL. Further stratification by self-reported or validated hearing assessments, fall reporting duration, continent, community-dwelling adults, and studies adjusting for other sensory deficits identified as fall risk factors by the World Falls Guideline did not change significance. These results remained robust to sensitivity analyses, and publication bias was absent.

Conclusions and Relevance

This systematic review and meta-analysis found that overall, HL may be a risk factor for falls. With a rapidly aging global population, it is crucial to acknowledge the public health concerns surrounding falls and consider if HL could be a potentially modifiable risk factor. Nonetheless, further randomized clinical trials are needed to elucidate any benefit of treating HL on fall prevention.

Prevalence and related factors of physical function and cognitive impairment among older adults: a population-based regional cross-sectional study

Background and aims

As the country with the largest and fastest-aging older population worldwide, China has hosted an increasing number of regional investigations into disability among older adults. However, the prevalence of disabilities related to physical function and cognition in southern China remains unknown. This study aimed to assess the prevalence of and associated factors for cognitive and physical function impairment in individuals aged 60 years and older.

Methods

For this population-based cross-sectional study, a total of 5,603 participants were recruited between June 2021 and December 2022 using a multistage, stratified, cluster sampling procedure. Instruments, including a general questionnaire, basic and instrumental activities of daily living, the Chinese version of the Mini-Mental State Examination (MMSE), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7), were used to collect data through a WeChat mini program. Binary and multivariate logistic regression analyses were applied to explore the influencing factors.

Results

The prevalence of physical function and cognitive impairment among older adults was 37.3 and 31.0%, respectively. Multivariate regression analyses revealed that age, family income, education level, place of residence, medication type, annual physical examinations, weekly social activities, support from family or friends, hearing disorders, walking disorders, and depression were all associated with both physical function and cognitive impairment. Moreover, an increased risk of physical function impairment correlated with BMI, region, income source, smoking, and weekly exercise, while cognitive impairment was associated with the number of children, insurance type, coronary heart disease, and anxiety. Physical function (OR: 1.79, 95% CI: 1.49-2.16) and cognitive impairment (OR: 1.83, 95% CI: 1.51-2.21) were mutually influential in our study.

Conclusion

This study showed a high prevalence of various factors related to physical function and cognitive impairment. The results revealed that comprehensive and systematic prevention and control programs for disabilities should be developed to improve the quality of life for older adults.

The Associations of Sensory Impairment With 10-Year Risk of Dementia and Alzheimer's Disease: The Health and Retirement Study, 2010-2020

BACKGROUND

Studies have examined the association between dual sensory impairment and late-life cognitive outcomes in the U.S with inconsistent findings.

OBJECTIVE

To examine the associations between sensory impairment and 10-year risk of dementia or Alzheimer's disease among U.S. adults aged ≥ 50.

METHODS

A prospective cohort study based on the Health and Retirement Study from 2010 to 2020. Individuals aged ≥ 50 years without self-reported dementia and Alzheimer's disease in 2010 were included in the analysis. Self-reported visual and hearing impairments were measures in 2010. Main failure events included self-reported incident dementia and Alzheimer's disease over a 10-year follow-up period. Participants were categorized as having no visual or hearing impairment, visual impairment only, hearing impairment only, and dual sensory impairment. Fine-Gray competing risk regression model was applied to estimate the associations of sensory impairment with incident dementia and Alzheimer's disease, adjusted for demographic characteristics, health behaviors, and health conditions at baseline.

RESULTS

Of 20,248 identified individuals, 14.6% had visual impairment only, 11.2% had hearing impairment only, and 9.1% had dual impairment at baseline. After adjusting for all covariates, dual sensory impairment was associated with higher risk of dementia (HR = 1.46, 95% CI: 1.23-1.73) and Alzheimer's disease (HR = 1.35, 95% CI: 1.03-1.76). Visual impairment only was also associated with incident dementia and Alzheimer's disease among individuals <65 years.

CONCLUSION

Older adults in the U.S. with visual and hearing impairments simultaneously had a particularly greater risk of dementia and Alzheimer's disease, indicating the needs of targeted screening for timely treatment and further prevention of dementia and Alzheimer's disease.

Hearing loss and the risk of dementia: A longitudinal analysis of the Korean National Health Insurance Service Senior Cohort

BackgroundHearing loss is a potentially modifiable risk factor implicated in dementia, with recent research suggesting an association between age-related hearing degradation and dementia.ObjectiveThis study aims to elucidate the relationship between hearing decline and dementia risk.MethodsWe analyzed data from 511,953 subjects from the Korean National Health Insurance Service-Senior Cohort (2002-2008). After excluding those diagnosed with dementia in 2002, 511,935 subjects were included. Subjects with hearing loss between 2002 and 2008 were selected and matched with a control group without hearing impairment based on age and gender. Statistical analyses, including Pearson's chi-squared test and the Cox proportional hazards model, were conducted, controlling for confounding variables such as household income and residential area. Subgroup analysis was also performed for Alzheimer's disease and vascular dementia.ResultsSubjects with hearing loss had a 1.245 times higher risk of all-cause dementia compared to those without hearing loss (adjusted hazard ratio over 3 years, 95% CI = 1.201-1.290), adjusting for gender, age, residence, and income. The adjusted hazard ratios for Alzheimer's disease over 3, 5, 7, and 10 years from the index date were 1.259 (95% CI = 1.211-1.308), 1.258 (95% CI = 1.208-1.310), 1.269 (95% CI = 1.215-1.325), and 1.235 (95% CI = 1.170-1.304), respectively. No significant association was found for vascular dementia, except for 3 years.ConclusionsHearing loss consistently increased the risk of all-cause dementia and Alzheimer's disease across timespans, suggesting a complex link between hearing loss and neurodegenerative diseases. These findings highlight the importance of early intervention and cognitive monitoring for individuals with hearing loss.

Correlation of Neuroanatomical Structures Related to Speech in Cerebral Palsy Patients Aged 0-17: A Retrospective MRI Study

Background/Objectives: Cerebral Palsy (CP) is a non-progressive clinical condition characterized by secondary issues, including speech impairments. Our study aims to evaluate the volumes of brain areas related to speech in patients diagnosed with CP between the ages of 0-17. Methods: this study includes the images of 84 children: 42 in the control group who applied to the hospital between the specified dates and were reported as healthy by MRI from the patient records, and 42 patients with CP. Results: in the CP group, white and gray matter, cerebrum, cerebellum, thalamus, lobus frontalis, lobus temporalis, lobus parietalis, lobus insularis, gyrus cinguli, and nuclei basales volumes were observed to decrease statistically significantly compared to the control group (p ˂ 0.001). Conclusions: we found a significant decrease in the volumes of speech-related brain areas in CP patients, indicating that CP can significantly impact the brain's speech-related regions.

The association between dual sensory impairment and dementia: A systematic review and meta-analysis

BACKGROUND

Sensory impairments have been linked to dementia. However, the impact of dual sensory impairment (DSI), combining both vision impairment and hearing impairment, on dementia has shown inconsistent results.

OBJECTIVE

To systematically review the evidence on the association DSI and dementia.

METHODS

A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library databases. Included studies were prospective or retrospective cohort studies and a case-control study. The primary outcome was the onset of dementia or its various subtypes, including Alzheimer's disease (AD) and vascular dementia (VaD). Effect sizes, including hazard ratios (HRs), were pooled through a random-effects model.

RESULTS

A total of 11 observational studies with 346,659 participants were included. DSI was significantly associated with the incidence of dementia compared to no sensory impairment (9 studies; HR: 1.46; 95% confidence interval [CI]: 1.29-1.65). Among subtypes of dementia, DSI was associated with AD onset (4 studies; HR: 2.07; 95% CI: 1.45-2.94); however, this association was not found in VaD (2 studies; HR: 1.65; 95% CI: 0.96-2.85).

CONCLUSIONS

These findings suggest that DSI is significantly associated with an increased risk of dementia. Further research is required to identify preventive strategies to decrease the incidence of dementia in individuals with sensory impairment.

Association between adult-onset hearing loss and dementia biomarkers: A systematic review

BACKGROUND AND OBJECTIVE

People with adult-onset hearing loss (AoHL) are at increased dementia risk. In this study, we explore potential aetiological mechanisms by synthesising the evidence on the association between AoHL and neuropathological, cerebrospinal fluid (CSF), blood and imaging biomarkers of dementia.

METHODS

We systematically searched electronic databases from inception to 30 April 2024 for cross-sectional and longitudinal studies, including quantitative data on the association between AoHL and dementia biomarkers. Study quality was assessed with the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Sixty-six studies reporting 63 cross-sectional and 10 longitudinal analyses were included. Twenty-one studies met all MMAT quality criteria. We report a narrative synthesis due to the heterogeneity of the included studies. In CSF-based or blood-based assays or imaging, five out of six cross-sectional analyses found that AoHL was associated with elevated in vivo tau levels, whilst four out of 17 reported a link with elevated in vivo β-amyloid measures. One longitudinal analysis identified an association between AoHL and a steeper increase of CSF tau, but not Aβ42, levels over time. Twenty-five out of 44 cross-sectional and six out of nine longitudinal analyses identified associations between AoHL and grey matter atrophy of the temporal regions, particularly the medial temporal lobe. Studies using other biomarkers had inconsistent findings.

CONCLUSIONS

AoHL was usually associated with more temporal regions grey matter atrophy both cross-sectionally and longitudinally, and elevated in vivo tau but not β-amyloid. Increasing atrophy and higher tau, leading to decreased cognitive reserve may be how hearing loss increases dementia risk.

Neural correlates of age-related hearing loss: An MRI and FDG-PET study

AIM

Age-related hearing loss (ARHL) is a common problem among older adults and contributes to adverse health outcomes such as cognitive impairment. However, the neural mechanisms underlying ARHL remain unclear. We aimed to reveal the structural and metabolic (i.e., neural activity) correlates of ARHL using magnetic resonance imaging (MRI) and positron emission tomography with 18F-fluorodeoxyglucose (FDG-PET).

METHODS

A total of 162 community-dwelling older adults without cerebral disorders or cognitive impairment (Mini-Mental State Examination score < 24) were included in this study. Auditory acuity was measured using a pure-tone average (PTA) of hearing thresholds for the better-hearing ear for 0.5-4-kHz tones. ARHL was defined as a PTA of >40 dB (i.e., greater than moderate hearing loss). The participants then underwent MRI and FDG-PET at rest to assess changes in brain structure and activity associated with ARHL.

RESULTS

Among the 162 participants, 27 (16.6%) had ARHL. A region-of-interest analysis focusing on the bilateral superior temporal gyrus showed significantly lower glucose metabolism in this region, including in the auditory cortex (BA 41 and 42), in participants with ARHL than in those without ARHL. In contrast, no significant structural differences were observed between the groups.

CONCLUSIONS

These findings suggest that, prior to structural changes, the effects of ARHL may manifest in neural activity, which is strongly reflected in the regions involved in auditory processing. It is possible that ARHL first alters neural activity in auditory-related regions owing to reduced auditory stimulation. Geriatr Gerontol Int 2025; 25: 300-306.

Blood Neurofilament Light Chain and Phospho-Tau 181 in Subjects with Mild Cognitive Impairment Due to Age-Related Hearing Loss

Background: Mild cognitive impairment is increasingly recognized as a precursor to more severe neurodegenerative conditions, particularly in the context of aging. Recent studies have highlighted the intersection of hearing loss and cognitive decline, suggesting that auditory deficits may exacerbate cognitive impairments in older adults, proposing the use of hearing aids to mitigate cognitive decline, and indicating that early intervention in hearing loss could be crucial for preserving cognitive function. The underlying mechanisms of the relationship between hearing and cognitive impairment may involve neuroinflammatory processes and neurodegeneration. Recent studies have evidenced the role of tau proteins and neurofilaments as biomarkers in the onset and progression of neurodegenerative diseases. Methods: We selected 30 subjects with age-related hearing loss, and we evaluated their cognitive status through the administration of screening tests, which also measured neurofilament light chain and phospho-tau 181 serum levels as biomarkers of neurodegeneration. The subjects were re-evaluated six months after the hearing aid fitting. Results: Patients with hearing impairment presented slightly altered results on cognitive tests, typical of a mild cognitive impairment. At the same time, serum levels of neurofilament light chain and phospho-tau 181 were significantly increased compared to the matched control group. After the hearing aids fitting, auditory, cognitive, and serum values results improved. Conclusions: The results of the study highlight the cognitive involvement in patients with hearing impairment and identify neurofilament light chain and phospho-tau 181 as serum biomarkers of neurodegeneration useful in monitoring the pathology.

Association of cumulative average sensory impairments with cognitive function and depressive symptoms: Two prospective cohort studies

BACKGROUND

Globally, over 2.2 billion people have a vision impairment and over 1.5 billion live with hearing impairment, which are significant public health concerns given the meaningful impacts on individual and society. We aimed to investigate whether long-term average visual, hearing, and dual sensory impairment was independently associated with cognitive impairment, incident dementia, and incident depressive symptoms.

METHODS

We used data from the Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS), two nationally representative and prospective cohorts of community middle aged and older adults. Average sensory impairment was calculated using the area under the curve divided by follow-up time from wave 3 (1996) to wave 15 (2020) in HRS and wave 1 (2011) to wave 4 (2018) in CHARLS. Cox regression models adjusted for multiple covariates were used to estimate adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CIs).

RESULTS

For each one standard deviation (SD) increment in average visual impairment, the risk of developing cognitive impairment, incident dementia, and incident depressive symptoms increased by 12 %, 34 %, and 39 % in CHARLS and 11 %, 14 % and 10 % in HRS. Similar results were found for each SD increment in average hearing impairment and dual sensory impairment. Nonlinear dose-response relationships were identified between visual impairment and dementia, as well as dual sensory impairment and dementia in both cohorts.

LIMITATIONS

The diagnosis of cognitive impairment, dementia, and depression were based on subjective assessment.

CONCLUSION

Multi-level approaches aimed at improving access to sensory care are needed to improve middle-aged and older adults' visual and auditory functions.

Hearing Loss and Alzheimer Disease

Several studies have been done to investigate the role of hearing loss (HL) in cognitive decline. A co-existence of these two conditions has been identified. Recently, thanks to the use of functional MRI and EEG it has been shown that untreated HL can expose patients with cognitive decline to a higher risk of developing Alzheimer Disease (AD). This chapter will discuss the difference between central and peripheral HL, the link between HL and cognition and the relationship between HL and AD. At the end of the chapter the available technologies to treat HL will be discussed as well as their impact on memory and cognition.

Hearing loss and its relation to longitudinal changes in white matter microstructure in older adults: The Rotterdam Study

Hearing loss is considered a potentially modifiable risk factor for dementia. The sensory deprivation theory postulates that hearing loss adversely affects cognition in older adults through structural brain changes, but longitudinal studies are scarce. To find evidence for a possible detrimental effect of hearing loss on white matter microstructure, we carried out a longitudinal study in the population-based Rotterdam Study. A total of 1877 participants with a median age at baseline of 56.4 years (IQR: [52.2-60.0]) underwent audiometry and had longitudinal diffusion imaging data available with a mean follow-up of 4.0 years. A lower level of hearing acuity was associated with worse white matter microstructure in the left uncinate fasciculus and superior longitudinal fasciculus at baseline. Poorer hearing acuity was also associated with faster microstructural deterioration over time in the left superior longitudinal fasciculus. The strongest effects were observed for low-frequency hearing thresholds, while the high-frequency thresholds showed the weakest associations. These results suggest that hearing loss may contribute to the age-related decline in brain structure, consistent with the sensory deprivation theory.

Functional Near-Infrared Spectroscopy Analysis of the Cognitive Functions of Elderly Patients With Hearing Loss

BACKGROUND AND OBJECTIVES

Age-related hearing loss is a modifiable risk factor for mild cognitive impairment (MCI); however, the potential mechanisms linking these conditions remain unclear. Therefore, in this study, we analyzed the cognitive function profiles of elderly patients with hearing loss via functional near-infrared spectroscopy (fNIRS) to determine the cortical activity differences between patients at risk of MCI and those with normal cognition. Materials and.

METHODS

Sixty-three elderly patients with bilateral, moderate, or severe hearing loss were prospectively recruited for this study. Their demographic information was obtained, and audiological evaluations and cognitive function tests were performed. Various instruments were used to assess the cognitive and depression domains. Additionally, fNIRS was used to image the brains of the normal group and group at risk of MCI.

RESULTS

fNIRS analysis of individual cognitive task data revealed that the normal group exhibited significantly higher oxygenated hemoglobin (HbO2) levels in all cognitive function tasks, except the Stroop color and word test, than the group at risk of MCI. Detailed comparisons of the Brodmann areas revealed that, compared to the group at risk of MCI, normal group exhibited significantly higher HbO2 levels in the right and left dorsolateral prefrontal cortices, ventrolateral prefrontal cortex, frontopolar cortex, and orbitofrontal cortex in the J1 task, right ventrolateral prefrontal cortex in the J2 task, and right orbitofrontal cortex in the J6 task.

CONCLUSIONS

Measurement of fNIRS signals in the frontal lobes revealed different HbO2 signals between the normal group and group at risk of MCI during minimal hearing loss. Future studies should explore the causal link between hearing loss and cognitive impairment by analyzing the changes in cognitive function after auditory rehabilitation.

Auditory brainstem responses as a biomarker for cognition

A non-invasive, accessible and effective biomarker is critical to the diagnosis, monitoring and treatment of age-related cognitive decline. Recent work has suggested a strong association between auditory brainstem responses (ABR) and cognitive function in aging macaques. Here we show in 118 human participants (66 females; age range=18-92 years; hearing loss = -5 to 70 dB HL) that cognition is associated with both age and hearing level, but this triad relationship is mainly driven by the age factor. After adjusting for age, cognition is still significantly associated with both the ABR wave V amplitude (B, 0.110, 95% CI, 0.018- 0.202; p = 0.020) and latency (B, -0.101, 95% CI, -0.186- -0.016; p = 0.021). Importantly, this age-adjusted ABR-cognition association is primarily driven by older individuals and language-dependent cognitive functions. We also perform the area under the curve (AUC) of the receiver-operating-characteristic analysis and find that the ABR wave V amplitude is best for detecting good cognitive performers (AUC = 0.96) whereas the wave V latency is best for detecting poor ones (AUC = 0.86). The present result not only confirms the previous animal work in humans but also shows the clinical potential of using auditory brainstem responses to improve diagnosis and treatment of age-related cognitive decline.

COCHLEA: Longitudinal Cognitive Performance of Older Adults with Hearing Loss and Cochlear Implants at 4.5-Year Follow-Up

OBJECTIVES

Hearing loss is highly prevalent in older adults and is independently associated with accelerated cognitive decline. Cochlear implants are usually the only effective treatment for people with severe-profound hearing loss, who have the highest risk of cognitive decline and dementia, however, very few receive them. Current evidence of the effects of cochlear implant use on cognitive decline/dementia outcomes is limited and unclear. This study aimed to investigate the effect of cochlear implant use on longitudinal cognitive performance, as this intervention may be an effective method of modifying cognitive outcomes for older adults with significant hearing loss.

METHODS

This prospective longitudinal observational study investigated cognitive performance in a convenience sample of older adults (mean age 74 years) with cochlear implants over 4.5 years post-implantation, comparing this with that of community-living adults with untreated hearing loss/normal hearing over 3 years (Australian Imaging, Biomarker and Lifestyle Flagship Study of Ageing; AIBL). All participants were assessed at 18-month intervals from baseline using the same measures. Panel regression was used to compare cognitive trajectories.

RESULTS

Cochlear implant users demonstrated significantly improved performance in executive function and working memory, as well as stability in attention, psychomotor function, and visual learning at 4.5-year follow-up. Comparatively, AIBL participants showed significantly greater worsening performance per year in attention and psychomotor function, and stability in working memory and visual learning at 3-year follow-up.

CONCLUSIONS

Cochlear implant use may delay cognitive decline and/or improve cognitive performance in older adults with severe-profound hearing loss, providing proof-of-concept evidence of the positive effects of hearing intervention on cognitive performance in older adults with hearing loss.

Executive Function Associations With Audibility-Adjusted Speech Perception in Noise

PURPOSE

Speech recognition in noise is challenging for listeners and appears to require support from executive functions to focus attention on rapidly unfolding target speech, track misunderstanding, and sustain attention. The current study was designed to test the hypothesis that lower executive function abilities explain poorer speech recognition in noise, including among older participants with hearing loss who often exhibit diminished speech recognition in noise and cognitive abilities.

METHOD

A cross-sectional sample of 400 younger-to-older adult participants (19 to < 90 years of age) from the community-based Medical University of South CarolinaLongitudinal Cohort Study of Age-related Hearing Loss were administered tasks with executive control demands to assess individual variability in a card-sorting measure of set-shifting/performance monitoring, a dichotic listening measure of selective attention/working memory, sustained attention, and processing speed. Key word recognition in the high- and low-context speech perception-in-noise (SPIN) tests provided measures of speech recognition in noise. The SPIN scores were adjusted for audibility using the Articulation Index to characterize the impact of varied hearing sensitivity unrelated to reduced audibility on cognitive and speech recognition associations.

RESULTS

Set-shifting, dichotic listening, and processing speed each explained unique and significant variance in audibility-adjusted, low-context SPIN scores (ps < .001), including after controlling for age, pure-tone threshold average (PTA), sex, and education level. The dichotic listening and processing speed effect sizes were significantly diminished when controlling for PTA, indicating that participants with poorer hearing sensitivity were also likely to have lower executive function and lower audibility-adjusted speech recognition.

CONCLUSIONS

Poor set-shifting/performance monitoring, slow processing speed, and poor selective attention/working memory appeared to partially explain difficulties with speech recognition in noise after accounting for audibility. These results are consistent with the premise that distinct executive functions support speech recognition in noise.

Alzheimer's Disease-Related Analytes Amyloid-β and Tau in Perilymph: Correlation With Patient Age and Cognitive Score

OBJECTIVE

To describe the collection methods for perilymph fluid biopsy during cochlear implantation, detect levels of amyloid β 42 and 40 (Aβ42 and Aβ40), and total tau (tTau) analytes with a high-precision assay, to compare these levels with patient age and Montreal Cognitive Assessment (MoCA) scores, and explore potential mechanisms and relationships with otic pathology.

STUDY DESIGN

Prospective study.

SETTING

Tertiary referral center.

METHODS

Perilymph was collected from 25 patients using polyimide tubing to avoid amyloid adherence to glass, and analyzed with a single-molecule array advanced digital enzyme-linked immunosorbent assay platform for Aβ40, Aβ42, and tTau. Cognition was assessed by MoCA.

RESULTS

Perilymph volumes ranged from ∼1 to 13 µL, with analyte concentrations spanning 2.67 to 1088.26 pg/mL. All samples had detectable levels of tTau, Aβ40, and Aβ42, with a significant positive correlation between Aβ42 and Aβ40 levels. Levels of Aβ42, Aβ40, and tTau were positively correlated with age, while MoCA scores were inversely correlated with age. tTau and Aβ42/Aβ40-ratios were significantly correlated with MoCA scores.

CONCLUSION

Alzheimer's disease-associated peptides Aβ42, Aβ40, and tau analytes are detectable in human perilymph at levels approximately 10-fold lower than those found in cerebrospinal fluid (CSF). These species increase with age and correlate with cognitive impairment indicators, suggesting their potential utility as biomarkers for cognitive impairment in patients undergoing cochlear implantation. Future research should investigate the origin of these analytes in the perilymph and their potential links to inner ear pathologies and hearing loss, as well as their relationships to CSF and plasma levels in individuals.

Visual and Auditory Sensory Impairments Differentially Relate with Alzheimer's Pathology

Objective

We intended to investigate the relationships between visual sensory impairment (VSI) or auditory sensory impairment (ASI) and brain pathological changes associated with cognitive decline in older adults.

Methods

We primarily tried to examine whether each sensory impairment is related to Alzheimer's disease (AD) pathology, specifically beta-amyloid (Aβ) deposition, through both cross-sectional and longitudinal approaches in cognitively unimpaired older adults. Self-report questionnaires on vision and hearing status were administered at the baseline. Neuroimaging scans including brain [11C] Pittsburgh Compound B PET and MRI, as well as clinical assessments, were performed at baseline and 2-year follow-up.

Results

Cross-sectional analyses showed that the VSI-positive group had significantly higher Aβ deposition than the VSI-negative group, whereas there was no significant association between ASI positivity and Aβ deposition. Longitudinal analyses revealed that VSI positivity at baseline was significantly associated with increased Aβ deposition over 2 years (β = 0.153, p = 0.025), although ASI positivity was not (β = 0.045, p = 0.518). VSI positivity at baseline was also significantly associated with greater atrophic changes in AD-related brain regions over the 2-year follow-up period (β = -0.207, p = 0.005), whereas ASI positivity was not (β = 0.024, p = 0.753). Neither VSI nor ASI positivity was related to cerebrovascular injury, as measured based on the white matter hyperintensity volume.

Conclusion

The findings suggest that VSI is probably related to AD-specific pathological changes, which possibly mediate the reported relationship between VSI and cognitive decline. In contrast, ASI appears not associated with AD pathologies but may contribute to cognitive decline via other mechanisms.

Pure-tone audiometry and dichotic listening in primary progressive aphasia and Alzheimer's disease

Hearing is multifaceted, and the relative contributions of peripheral and central hearing loss are rarely considered together in the context of dementia. Here, we assessed peripheral (as measured with pure-tone audiometry) and central (as measured with dichotic listening) hearing in 19 patients with typical amnestic Alzheimer's disease (tAD), 10 patients with logopenic variant primary progressive aphasia (lvPPA), 11 patients with nonfluent/agrammatic variant PPA (nfvPPA), 15 patients with semantic variant PPA (svPPA), and 28 healthy age-matched individuals. Participants also underwent neuropsychological assessment and magnetic resonance image scanning, allowing us to use voxel-based morphometry to assess associations between hearing scores and grey matter volume. Dichotic listening was impaired in all patient groups relative to healthy controls. In the combined patient (but not healthy control) cohort, dichotic listening scores were significantly correlated with measures of global cognitive functioning and speech-based neuropsychological tasks. Pure-tone audiometry scores were not significantly elevated in any patient group relative to the healthy control group, and no significant correlations were observed between peripheral hearing and neuropsychological task performance in either the combined patient or healthy control cohorts. Neuroanatomically, dichotic listening performance was associated with grey matter volume in a bilateral fronto-temporoparietal network over the combined patient cohort, but no correlates were identified for pure-tone audiometry. Our findings highlight the importance of speech parsing mechanisms beyond elementary sound detection in driving cognitive test performance, underline the importance of assessing central hearing alongside peripheral hearing in people with dementia, and further delineate the complex auditory profiles of neurodegenerative dementias.

A comprehensive evaluation on the associations between hearing and vision impairments and risk of all-cause and cause-specific dementia: results from cohort study, meta-analysis and Mendelian randomization study

BACKGROUND

Epidemiological studies show inconsistent links between hearing/vision impairment and dementia risk. Using multisource data, we investigated how single or combined sensory impairments relate to risks of all-cause and specific types of dementia.

METHODS

We employed a triangulation approach combining three methodologies. We analyzed 90,893 UK Biobank (UKB) adults to explore single and joint effects of hearing and vision impairments on all-cause and Alzheimer's disease (AD), vascular dementia (VD) and non-AD non-VD (NAVD). A meta-analysis of prospective studies involving 937,908 participants provided stronger evidence. Finally, we conducted Mendelian randomization (MR) analysis using genome-wide association studies from UKB (361,194 participants) and FinnGen (412,181 participants) to validate relationships between sensory impairments and dementia occurrence.

RESULTS

In the UKB cohort study, compared to participants with normal hearing, those in the mild and severe hearing impairment groups had progressively and significantly higher risk of all-cause dementia (mild: HR1.52, 95%CI 1.31-1.77; severe: HR1.80, 95%CI 1.36-2.38), AD (mild: HR1.63, 95%CI 1.30-2.04; severe: HR2.18, 95%CI 1.45-3.27), VD (mild: HR1.68, 95%CI 1.19-2.37; severe: HR1.47, 95%CI 1.22-1.78), and NAVD (mild: HR1.47, 95%CI 1.22-1.78; severe: HR1.98, 95%CI 1.43-2.75). Besides, vision impairment was associated with an increased risk of all-cause dementia (HR1.55, 95%CI 1.18-2.04) and NAVD (HR1.51, 95%CI 1.07-2.13). Furthermore, dual sensory impairment was associated with stepwise increased risks of all-cause and cause-specific dementia than single hearing or vision impairment. In the meta-analysis of 31 prospective cohort studies, risks of all-cause dementia and AD were elevated in participants with single hearing impairment (all-cause dementia: HR1.30, 95%CI 1.21-1.40; AD: HR1.30, 95%CI 1.21-1.40) and dual sensory impairment (all-cause dementia: HR1.63, 95%CI1.14-2.12; AD: HR 2.55, 95%CI 1.19-3.91), while single vision impairment only associated with higher risk of all-cause dementia (HR1.43, 95%CI 1.16-1.71) but not AD. Finally, the MR analysis revealed a significant association between hearing impairment and all-cause dementia (OR1.74, 95%CI 1.01-2.99), AD (OR1.56, 95%CI 1.09-2.23), and NAVD (OR1.14, 1.02-1.26), as well as vision impairment and NAVD (OR1.62, 95%CI 1.13-2.33).

CONCLUSIONS

Our findings showed significant associations between hearing and vision impairments and increased risks of all-cause and cause-specific dementia. Standardized hearing and vision assessment and intervention should be emphasized in dementia prevention strategies.

The impact of noise-induced hearing loss on individual job performance: exploring the role of aggression and work-related quality of life

BACKGROUND

Noise-Induced Hearing Loss (NIHL) may have a significant effect on individual job performance (IJP). These effects may exert through aggression and work-related quality of life (WRQoL). Hence, the present study was conducted to investigate the modeling of the impact of NIHL on IJP by exploring the role of aggression and WRQoL.

METHODS

In 2022, a comprehensive study was carried out on 335 industrial workers in Kaveh Industrial Town, Saveh, Iran. The study encompassed a range of assessments, including a questionnaire-based survey that included the IJP questionnaire, WRQoL questionnaire, and Aggression questionnaire, as well as a pure tone audiometry test. The data gathered from these assessments were analyzed using structural equation modeling, providing a robust framework for understanding the complex relationships between variables.

RESULTS

Based on Spearman correlation test there is a negative correlation between NIHLtotal and WRQoL and IJP, with coefficients of -0.459 (P-value < 0.01) and - 0.575 (P-value < 0.01), respectively. Additionally, there is a positive correlation between NIHLtotal and aggression, with a coefficient of 0.374 (P-value < 0.05). The direct effect coefficients for the impact of NIHLtotal on WRQoL, aggression, and IJP were - 0.412, 0.453, and - 0.128, respectively. Moreover, the indirect effect coefficients of NIHLtotal on the IJP through aggression, through WRQoL, and through both aggression and WRQoL were - 0.057, -0.275, and - 0.078, respectively.

CONCLUSION

Overall, the results indicate that NIHL had a negative and positive association with WRQoL and aggression among workers, respectively. Furthermore, IJP was found to be directly and indirectly influenced by NIHL, through reduced WRQoL and aggressive behavior as negative consequences of NIHL.

Risk factors for mild cognitive impairment in patients with age-related hearing loss: a meta-analysis

OBJECTIVES

One of the most common sensory impairments in the elderly is age-related hearing loss, and individuals with this condition have a higher risk of mild cognitive impairment than the overall aged population. The purpose of this study was to conduct a systematic review of the literature in order to evaluate the evidence supporting the hypothesis that mild cognitive impairment may be developed in patients with age-related hearing loss.

METHODS

The PRISMA principles were followed when searching the databases of the China Knowledge Network, Wanfang, China Biomedical Literature Database, Pub Med, Cochrane Library, Embase, and Web of Science. Two investigators independently carried out the quality assessment, data extraction, and literature review of the eligible studies. Stata 17.0 was used to finish the statistical analysis and descriptive results.

RESULTS

A total of 13 articles containing 2,222,036 individuals who were evaluated for demographic traits, factors associated with age-related hearing loss, vascular neurologic factors, and psychological factors were included after 2166 search records were found in the database. In patients with age-related hearing loss, eleven factors were found to be risk factors for the development of mild cognitive impairment: age (OR = 1.63; 95% CI 1.09-2.43), male (OR = 1.29; 95% CI 1.14-1.47), degree of hearing loss (OR = 1.35; 95% CI 1.03-1.75), not wearing hearing aids (OR = 1.56; 95% CI 1.37-1.79), cerebrovascular disease (OR = 1.41; 95% CI 1.17-1.69), cardiovascular disease (OR = 1.29; 95% CI 1.07-1.55), diabetes mellitus (OR = 1.28; 95% CI 1.20-1.35), head injury (OR = 1.22; 95% CI 1.13-1.33), alcohol consumption (OR = 1.28; 95% CI 1.14-1.43), and tobacco use (OR = 1.19; 95% CI 1.14-1.25), and depression (OR = 1.63; 95% CI 1.47-1.81).

CONCLUSION

Caregivers can customize care strategies to decrease the occurrence of mild cognitive impairment in elderly deaf patients by considering demographic traits, factors associated with age-related hearing loss, vascular-neurologic factors, and psychological factors.

The Role of Hearing Aids in Improving Dual-Task Gait Performance in Older Adults With Presbycusis: A Cognitive and Motor Analysis

BACKGROUND

Cognitive decline is a common challenge faced by older individuals with presbycusis; their performance on dual-task (DT) activities is generally lower compared to those without hearing loss. However, the influence of hearing aids on nonauditory cognitive decline in this population remains unclear. This study aims to investigate the effect of hearing aids on nonauditory DT performance in older adults with presbycusis.

MATERIAL AND METHODS

This study included older people with presbycusis who used hearing aids (P&HA group), those with presbycusis who did not use hearing aids (PoHA group), and a control group of healthy adults. Forward and backward digit span tests and timed up and go test (TUG) were administered to all individuals. TUG and motor and cognitive (forward and backward digit span) tasks were applied simultaneously to evaluate the participants' DT performance.

RESULTS

The study comprised 60 individuals with presbycusis (19 females, 41 males; mean age: 73.23 ± 6.49 years) and 30 healthy adults (15 females, 15 males; mean age: 35.93 ± 8.57 years). Healthy adults performed better than the P&HA and PoHA groups in all the administered tests (p < 0.05). There was a moderate negative relationship between the severity of hearing loss and the forward and backward digit span test performances (p < 0.05). The P&HA group performed better than the PoHA group on the DT cognitive forward and backward digit span tests.

CONCLUSION

The use of hearing aids and their proper fitting are important not only for improving communication skills and reducing listening effort but also for supporting nonauditory cognitive functions, minimizing the risk of falls during DT activities, and enhancing the overall quality of life.

Chronic tinnitus is associated with aging but not dementia

AIM

Aging is related to deterioration of bodily and neural functions, leading to various disorders and symptoms, including the development of dementia, hearing loss, or tinnitus. Understanding how these phenomena are intertwined and how aging affects those is crucial for prevention and the future development of interventions.

METHODS

We utilized the UK Biobank which includes a total of 502,382 participants between 40 and 70 years old. We used logistic regression models and cox proportional hazard models and compared hazard ratios.

RESULTS

The odds of reporting tinnitus in the older age group (i.e., older than 58 years) were increased by 53.6 % and a one decibel increase in the speech-reception thresholds enhanced the odds for tinnitus by 13.0 %. For our second analysis regarding hearing loss, the risk of dementia increased by 14.0 % with an increase by one decibel in the speech-reception threshold score. In terms of aging, each additional year increased the risk by 17.3 %. Tinnitus alone showed a significant influence with a hazard ratio of 52.1 %, however, when adding hearing loss, age and various covariates, the effect vanished.

CONCLUSION

Findings confirm that tinnitus is indeed related to aging, but presumably independent of the aging processes accompanying the development of dementia. This highlights the urge to further investigate the impact of aging on neural processes that are relevant for alterations in the auditory systems (e.g., leading to the development of tinnitus or hearing loss) as well as for increased vulnerability in terms of neurodegenerative diseases.

Hearing Function Moderates Age-Related Differences in Brain Morphometry in the HCP Aging Cohort

There are well-established relationships between aging and neurodegenerative changes, and between aging and hearing loss. The goal of this study was to determine how structural brain aging is influenced by hearing loss. Human Connectome Project Aging data were analyzed, including T1-weighted Magnetic Resonance Imaging (MRI) and Words in noise (WIN) thresholds (n = 623). Freesurfer extracted gray and white matter volume, and cortical thickness, area, and curvature. Linear regression models targeted (1) interactions between age and WIN threshold and (2) correlations with WIN threshold adjusted for age, both corrected for false discovery rate (pFDR < 0.05). WIN threshold moderated age-related increase in volume in bilateral inferior lateral ventricles, with a higher threshold associated with increased age-related ventricle expansion. Age-related differences in the occipital cortex also increased with higher WIN thresholds. When controlling for age, high WIN threshold was correlated with reduced cortical thickness in Heschl's gyrus, calcarine sulcus, and other sensory regions, and reduced temporal lobe white matter. Older volunteers with poorer hearing and cognitive scores had the lowest volume in left parahippocampal white matter. These results suggest that better hearing is associated with reduced age-related differences in medial temporal lobe, while better hearing at any age is associated with greater cortical tissue in auditory and other sensory regions. Future longitudinal studies are needed to assess the causal nature of these relationships, but these results indicate interventions that preserve or protect hearing function may combat some neurodegenerative changes in aging.

Relationship between hearing impairment and dementia and cognitive function: a Mendelian randomization study

BACKGROUND

There is a substantial body of observational research indicating an association between hearing impairment and dementia, yet the causal relationship and underlying mechanisms remain uncertain. This study aims to investigate the causal relationship between hearing impairment and its subtypes with dementia and cognitive function using two-sample Mendelian randomization (MR) analysis.

METHODS

We performed two-sample MR analysis to examine the causal effects of hearing impairment and its subtypes, including conductive and sensorineural hearing loss (CSHL), conductive hearing loss (CHL), sensorineural hearing loss (SHL), and sudden sensorineural hearing loss (SIHL), on six dementia phenotypes (overall dementia, Alzheimer's disease [AD], Lewy body dementia [DLB], frontotemporal dementia [FTD], Parkinson's disease dementia, and vascular dementia) and four cognitive functions. Additionally, multivariable MR (MVMR) analysis was employed to investigate potential mediating mechanisms.

RESULTS

Genetically determined CSHL was associated with an elevated risk of DLB (odds ratio [OR] 1.69; 95% CI 1.08 to 2.63; P = 0.021) and FTD (OR 1.66; 1.04 to 2.67; P = 0.035), but not AD (P = 0.958). Genetic predisposition to CHL was found to link with increased risks of AD (OR 1.07; 1.01 to 1.14; P = 0.031). Genetically determined SHL was causally associated with an elevated risk of semantic dementia (OR 3.81; 1.09 to 13.37; P = 0.037). Genetically predicted CHL and SIHL were both causally associated with lower general cognitive performance (β -0.015 and - 0.043; P = 0.007 and 0.013) and fluid intelligence score (β -0.045 and - 0.095; P = 0.037 and 0.040). In MVMR analysis, the causal relationship between hearing impairment and dementia was mediated by loneliness, depressed mood, and brain cortical volume, particularly the medial temporal lobe, but not by aging or ischemic stroke.

CONCLUSION

Overall, the study provides evidence supporting a causal relationship between hearing impairment and increased risks of different types of dementia (including AD, FTD, and DLB), as well as poorer general cognitive function. These findings underscore the importance of addressing hearing impairment as a modifiable risk factor for dementia.

Sensory impairments associated with cognitive impairment among older adults in China: A community-based, 10-year prospective cohort study

Background

To address an existing gap in knowledge due to limited and inconclusive evidence, we aimed to investigate the association between sensory impairments and cognitive decline among older Chinese individuals.

Methods

We retrieved data on 6862 adults aged ≥65 years that were collected through the Chinese Longitudinal Healthy Longevity Study (CLHLS), a nationwide, prospective, community-based elderly cohort study. Visual or hearing impairment in the CLHLS were identified through self-reported questionnaire. Sensory impairments were categorised as no sensory impairment, hearing impairment only, visual impairment only, and dual sensory impairment according to hearing and vision function. Cognitive impairment was defined as having a score <18 on the Chinese version of the Mini Mental State Examination. We used a Cox proportional hazard model to evaluate the relationship between sensory and cognitive impairments.

Results

Among 6862 participants, 5.7% had dual sensory impairment, 7.4% had hearing impairment only, and had 17.2% visual impairment only. Compared with participants with no sensory impairment, those with hearing impairment only (adjusted hazard ratio (aHR) = 1.65; 95% confidence interval (CI) = 1.41, 1.92), visual impairment only (aHR = 1.25; 95% CI = 1.11, 1.41), and dual sensory impairment (aHR = 1.47; 95% CI = 1.25, 1.74) were significantly associated with higher risk of cognitive impairment in the fully adjusted model.

Conclusions

Our results show that having hearing impairment only, visual impairment only, and dual sensory impairment was significantly associated with a higher risk of cognitive impairment among Chinese older adults aged ≥65 years. This suggest a need for the timely identification and management of sensory impairments for the elderly to reduce dementia risk.

Sex differences in the pleiotropy of hearing difficulty with imaging-derived phenotypes: a brain-wide investigation

Hearing difficulty (HD) is a major health burden in older adults. While ageing-related changes in the peripheral auditory system play an important role, genetic variation associated with brain structure and function could also be involved in HD predisposition. We analysed a large-scale HD genome-wide association study (GWAS; ntotal = 501 825, 56% females) and GWAS data related to 3935 brain imaging-derived phenotypes (IDPs) assessed in up to 33 224 individuals (52% females) using multiple MRI modalities. To investigate HD pleiotropy with brain structure and function, we conducted genetic correlation, latent causal variable, Mendelian randomization and multivariable generalized linear regression analyses. Additionally, we performed local genetic correlation and multi-trait co-localization analyses to identify genomic regions and loci implicated in the pleiotropic mechanisms shared between HD and brain IDPs. We observed a widespread genetic correlation of HD with 120 IDPs in females, 89 in males and 171 in the sex-combined analysis. The latent causal variable analysis showed that some of these genetic correlations could be due to cause-effect relationships. For seven of them, the causal effects were also confirmed by the Mendelian randomization approach: vessel volume→HD in the sex-combined analysis; hippocampus volume→HD, cerebellum grey matter volume→HD, primary visual cortex volume→HD and HD→fluctuation amplitudes of node 46 in resting-state functional MRI dimensionality 100 in females; global mean thickness→HD and HD→mean orientation dispersion index in superior corona radiata in males. The local genetic correlation analysis identified 13 pleiotropic regions between HD and these seven IDPs. We also observed a co-localization signal for the rs13026575 variant between HD, primary visual cortex volume and SPTBN1 transcriptomic regulation in females. Brain structure and function may have a role in the sex differences in HD predisposition via possible cause-effect relationships and shared regulatory mechanisms.

Hearing Loss, Hearing Aids, and Cognition

Importance

Most observational studies examining the association between hearing loss (HL) and cognitive impairment used subjective measures of hearing and addressed only one dimension of cognition, and very few investigated the potential benefit of hearing aids (HAs).

Objective

To evaluate objectively measured HL and several dimensions of cognition and estimate the association with HA use.

Design, Setting, and Participants

A cross-sectional analysis of the CONSTANCES cohort study, which recruited participants from January 1, 2012, to December 31, 2020, was conducted. Participants were a representative sample of adults (age, 45-69 years) with audiometric data and cognitive evaluation from 21 preventive health centers in France. Data analysis was conducted from April 1 to September 15, 2023.

Exposure

The main exposure was HL, which was defined by a pure-tone average in the best ear higher than 20 dB hearing level for mild loss and 35 dB hearing level for disabling loss. Secondary exposure was self-reported HA use.

Main Outcomes and Measures

Cognition was evaluated at study inclusion by a standardized battery of 5 cognitive tests conducted by trained neuropsychologists. A global cognitive score was computed from principal component analysis and global cognitive impairment was defined as having a score less than or equal to the 25th percentile of the distribution.

Results

The study population included 62 072 participants with audiometric data (mean [SD] age, 57.4 [7] years; 52% women). Overall, 38% (n = 23 768) had mild HL, 10% (n = 6012) had disabling HL, and 3% (n = 1668) were HA users. In multivariable analyses, mild HL (odds ratio [OR], 1.10; 95% CI, 1.05-1.15) and disabling HL (OR, 1.24; 95% CI, 1.16-1.33) were associated with greater global cognitive impairment. The odds of cognitive impairment did not differ significantly between all participants with HA use and participants with disabling HL without HAs (OR, 0.94; 95% CI, 0.83-1.07), except among participants with depression (OR, 0.62; 95% CI, 0.44-0.88).

Conclusions and Relevance

In this cohort study, an association between the severity of HL and global cognitive impairment was found. The use of HAs was not associated with significantly lower odds of cognitive impairment. The findings suggest that it may be useful to monitor cognitive function in middle-aged individuals with HL.

Investigating the impact of hearing loss on attentional networks among older individuals: an event-related potential study

Attention is a core cognitive domain crucial in facilitating day-to-day life. Using an attention network test (ANT) along with event-related potentials (ERPs) in older individuals with hearing loss would provide excellent information about the impact of hearing loss on attentional processes. Thus, the current study aims to understand the attentional deficits and its cortical dynamics in older individuals with and without hearing loss. The study recruited 40 participants, 20 older individuals with hearing loss and 20 age and education-matched controls with normal hearing. All the participants underwent cognitive assessment using ANT with simultaneous 32-channel EEG recording. Results revealed significant impairment in executive attention and subtle alterations in alerting and orienting attention among older individuals with hearing loss compared to their normal-hearing counterparts. These findings suggest the negative impact of hearing loss on attentional networks. In addition, ANT and ERPs provide insight into the underlying neural mechanisms in specific attention network deficits associated with hearing loss.

Conductive Hearing Loss Associates With Dementia, and Middle Ear Reconstruction Mitigates This Association: A Multinational Database Study

OBJECTIVE

To test the hypothesis that conductive hearing loss (CHL) is associated with dementia, and that middle ear reconstruction (MER) associates with improved outcomes for these measures in a multinational electronic health records database.

STUDY DESIGN

Retrospective cohort study with propensity-score matching (PSM).

SETTING

TriNetX is a research database representing about 110 million patients from the United States, Taiwan, Brazil, and India.

PATIENTS

Subjects older than 50 years with no HL and any CHL (ICD-10: H90.0-2). Subjects of any age with and without any MER (CPT: 1010174).

MAIN OUTCOME MEASURES

Odds ratios (ORs) and hazard ratios with 95% confidence intervals (95% CIs) for incident dementia (ICD-10: F01, F03, G30).

RESULTS

Of 103,609 patients older than 50 years experiencing any CHL, 2.74% developed dementia compared with 1.22% of 38,216,019 patients with no HL (OR, 95% CI: 2.29, 2.20-2.37). Of patients experiencing CHL, there were 39,850 who received MER. The average age was 31.3 years, with 51% female patients. A total of 343,876 control patients with CHL were identified; 39,900 patients remained in each cohort after 1:1 PSM for HL- and dementia-related risk factors. Matched risk for developing dementia among MER recipients was 0.33% compared with 0.58% in controls (OR: 0.58, 0.46-0.72).

CONCLUSIONS

CHL increases the odds for dementia, and MER improves the odds for incident dementia. This study represents the first population study on the topic of CHL, MER, and dementia.

Cross-Sectional Associations of Peripheral Hearing, Brain Imaging, and Cognitive Performance With Speech-in-Noise Performance: The Aging and Cognitive Health Evaluation in Elders Brain Magnetic Resonance Imaging Ancillary Study

PURPOSE

Population-based evidence in the interrelationships among hearing, brain structure, and cognition is limited. This study aims to investigate the cross-sectional associations of peripheral hearing, brain imaging measures, and cognitive function with speech-in-noise performance among older adults.

METHOD

We studied 602 participants in the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) brain magnetic resonance imaging (MRI) ancillary study, including 427 ACHIEVE baseline (2018-2020) participants with hearing loss and 175 Atherosclerosis Risk in Communities Neurocognitive Study Visit 6/7 (2016-2017/2018-2019) participants with normal hearing. Speech-in-noise performance, as outcome of interest, was assessed by the Quick Speech-in-Noise (QuickSIN) test (range: 0-30; higher = better). Predictors of interest included (a) peripheral hearing assessed by pure-tone audiometry; (b) brain imaging measures: structural MRI measures, white matter hyperintensities, and diffusion tensor imaging measures; and (c) cognitive performance assessed by a battery of 10 cognitive tests. All predictors were standardized to z scores. We estimated the differences in QuickSIN associated with every standard deviation (SD) worse in each predictor (peripheral hearing, brain imaging, and cognition) using multivariable-adjusted linear regression, adjusting for demographic variables, lifestyle, and disease factors (Model 1), and, additionally, for other predictors to assess independent associations (Model 2).

RESULTS

Participants were aged 70-84 years, 56% female, and 17% Black. Every SD worse in better-ear 4-frequency pure-tone average was associated with worse QuickSIN (-4.89, 95% confidence interval, CI [-5.57, -4.21]) when participants had peripheral hearing loss, independent of other predictors. Smaller temporal lobe volume was associated with worse QuickSIN, but the association was not independent of other predictors (-0.30, 95% CI [-0.86, 0.26]). Every SD worse in global cognitive performance was independently associated with worse QuickSIN (-0.90, 95% CI [-1.30, -0.50]).

CONCLUSIONS

Peripheral hearing and cognitive performance are independently associated with speech-in-noise performance among dementia-free older adults. The ongoing ACHIEVE trial will elucidate the effect of a hearing intervention that includes amplification and auditory rehabilitation on speech-in-noise understanding in older adults.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25733679.

Stochastic resonance in the sensory systems and its applications in neural prosthetics

Noise is generally considered to be detrimental. In the right conditions, however, noise can improve signal detection or information transmission. This counterintuitive phenomenon is called stochastic resonance (SR). SR has generated significant interdisciplinary interest, particularly in physics, engineering, and medical and environmental sciences. In this review, we discuss a growing empirical literature that suggests that noise at the right intensity may improve the detection and processing of auditory, sensorimotor, and visual stimuli. We focus particularly on applications of SR in sensory biology and investigate whether SR-based technologies present a pathway to improve outcomes for individuals living with sensory impairments. We conclude that there is considerable evidence supporting the application of SR in developing sensory prosthetics. However, the progression of SR-based technologies is variable across the sensory modalities. We suggest opportunities for further advancements in each modality, considering the best approaches to maximise benefits and capitalise on progress already made. Overall, SR can offer opportunities to improve existing technologies or to motivate innovations.

What Explains the Link Between Hearing and Vision Impairment and Cognitive Function? Analysis of Mediating Effects in the USA, England and Ireland

OBJECTIVES

Hearing and vision impairments are associated with cognitive decline and dementia risk. Explanations for this include age-related processes impacting on sensory and cognitive function (common cause), or sensory impairments having a direct or indirect impact on cognition via social engagement, depression and physical activity (cascade). We tested whether associations between hearing, vision and episodic memory were mediated by allostatic load, social engagement, depression and physical activity.

METHODS

We used structural equation modelling with cross-sectional data from the USA (n = 4746, aged 50-101), England (n = 4907, aged 50-89) and Ireland (4292, aged 50-80) to model factors related to the common cause (indexed by allostatic load) and the cascade hypothesis with respect to cognitive ability (episodic memory).

RESULTS

Poorer hearing/vision was associated with lower social engagement, depression and sedentary lifestyle. Poor vision was not related to allostatic load, and poor hearing was associated with allostatic load in only one data set, contributing to a common-cause hypothesis. Lower social engagement, depression and a sedentary lifestyle were associated with poorer episodic memory, contributing to the cascade hypothesis. Using effect estimates to calculate the proportion of the total effects mediated by the combined mediator variables, up to two fifths of the relationship between hearing and vision with episodic memory can be explained by the mediators.

CONCLUSIONS

The association between hearing, vision and episodic memory is mediated by allostatic load, social engagement, depression, and physical activity. The finding that social engagement, depression, and physical activity mediate the association between sensory abilities and cognitive function supported the cascade hypotheses. Interventions to improve healthy lifestyle, reduce depression and foster social engagement of older people with sensory impairments are likely to be beneficial in preventing cognitive decline and dementia.

Visual selective attention in individuals with age-related hearing loss

Evidence from epidemiological studies suggests that hearing loss is associated with an accelerated decline in cognitive function, but the underlying pathophysiological mechanism remains poorly understood. Studies using auditory tasks have suggested that degraded auditory input increases the cognitive load for auditory perceptual processing and thereby reduces the resources available for other cognitive tasks. Attention-related networks are among the systems overrecruited to support degraded auditory perception, but it is unclear how they function when no excessive recruitment of cognitive resources for auditory processing is needed. Here, we implemented an EEG study using a nonauditory visual attentional selection task in 30 individuals with age-related hearing loss (ARHLs, 60-73 years) and compared them with aged (N = 30, 60-70 years) and young (N = 35, 22-29 years) normal-hearing controls. Compared with their normal-hearing peers, ARHLs demonstrated a significant amplitude reduction for the posterior contralateral N2 component, which is a well-validated index of the allocation of selective visual attention, despite the comparable behavioral performance. Furthermore, the amplitudes were observed to correlate significantly with hearing acuities (pure tone audiometry thresholds) and higher-order hearing abilities (speech-in-noise thresholds) in aged individuals. The target-elicited alpha lateralization, another mechanism of visuospatial attention, demonstrated in control groups was not observed in ARHLs. Although behavioral performance is comparable, the significant decrease in N2pc amplitude in ARHLs provides neurophysiologic evidence that may suggest a visual attentional deficit in ARHLs even without extra-recruitment of cognitive resources by auditory processing. It supports the hypothesis that constant degraded auditory input in ARHLs has an adverse impact on the function of cognitive control systems, which is a possible mechanism mediating the relationship between hearing loss and cognitive decline.

Research trends and hotspot analysis of age-related hearing loss: A bibliometric analysis from 2019 to 2023

BACKGROUND

Age-related hearing loss (ARHL) - also termed presbycusis - is prevalent among older adults, leading to a range of issues. Although considerable progress in the understanding of ARHL over the decades, available reports lack data from recent years and do not comprehensively reflect the latest advancements and trends. Therefore, our study sought to assess research hotspots and trends in ARHL over the past 5 years to provide the basis for future research.

MATERIALS AND METHODS

The Web of Science Core Collection database was searched and screened from January 1, 2019 to October 21, 2023, according to the inclusion criteria. CiteSpace (5.8.R3), VOSviewer (1.6.19), and Microsoft Excel 2019 were employed for bibliometric analysis and visualization.

RESULTS

3084 articles from 92 countries led by the United States and China were included. There has been a steady upward trend in the number of publications from 2019 to 2023. The most productive institutions, authors, and journals are Johns Hopkins University (n = 113), Lin FR (n = 66), and Ear and Hearing (n = 135), respectively. Trend topic analyses revealed that "cochlear synaptopathy" and "dementia" were the predominant foci. Keywords, including "individuals" and "national health", began to appear.

CONCLUSION

Over the past 5 years, the annual number of publications has increased significantly and will continue to do so. Research on the mechanism of ARHL, represented by "oxidative stress", is a continuing focus. Emerging topics such as "individual differences" and "national health" may be potential future hotspots in this field.

Review and research gap identification in genetics causes of syndromic and nonsyndromic hearing loss in Saudi Arabia

Congenital hearing loss is one of the most common sensory disabilities worldwide. The genetic causes of hearing loss account for 50% of hearing loss. Genetic causes of hearing loss can be classified as nonsyndromic hearing loss (NSHL) or syndromic hearing loss (SHL). NSHL is defined as a partial or complete hearing loss without additional phenotypes; however, SHL, known as hearing loss, is associated with other phenotypes. Both types follow a simple Mendelian inheritance fashion. Several studies have been conducted to uncover the genetic factors contributing to NSHL and SHL in Saudi patients. However, these studies have encountered certain limitations. This review assesses and discusses the genetic factors underpinning NSHL and SHL globally, with a specific emphasis on the Saudi Arabian context. It also explores the prevalence of the most observed genetic causes of NSHL and SHL in Saudi Arabia. It also sheds light on areas where further research is needed to fully understand the genetic foundations of hearing loss in the Saudi population. This review identifies several gaps in research in NSHL and SHL and provides insights into potential research to be conducted.

Underlying dimensions of real-time word recognition in cochlear implant users

Word recognition is a gateway to language, linking sound to meaning. Prior work has characterized its cognitive mechanisms as a form of competition between similar-sounding words. However, it has not identified dimensions along which this competition varies across people. We sought to identify these dimensions in a population of cochlear implant users with heterogenous backgrounds and audiological profiles, and in a lifespan sample of people without hearing loss. Our study characterizes the process of lexical competition using the Visual World Paradigm. A principal component analysis reveals that people's ability to resolve lexical competition varies along three dimensions that mirror prior small-scale studies. These dimensions capture the degree to which lexical access is delayed ("Wait-and-See"), the degree to which competition fully resolves ("Sustained-Activation"), and the overall rate of activation. Each dimension is predicted by a different auditory skills and demographic factors (onset of deafness, age, cochlear implant experience). Moreover, each dimension predicts outcomes (speech perception in quiet and noise, subjective listening success) over and above auditory fidelity. Higher degrees of Wait-and-See and Sustained-Activation predict poorer outcomes. These results suggest the mechanisms of word recognition vary along a few underlying dimensions which help explain variable performance among listeners encountering auditory challenge.

Peripheral hearing loss at age 70 predicts brain atrophy and associated cognitive change

BACKGROUND

Hearing loss has been proposed as a modifiable risk factor for dementia. However, the relationship between hearing, neurodegeneration, and cognitive change, and the extent to which pathological processes such as Alzheimer's disease and cerebrovascular disease influence these relationships, is unclear.

METHODS

Data from 287 adults born in the same week of 1946 who underwent baseline pure tone audiometry (mean age=70.6 years) and two time point cognitive assessment/multimodal brain imaging (mean interval 2.4 years) were analysed. Hearing impairment at baseline was defined as a pure tone average of greater than 25 decibels in the best hearing ear. Rates of change for whole brain, hippocampal and ventricle volume were estimated from structural MRI using the Boundary Shift Integral. Cognition was assessed using the Pre-clinical Alzheimer's Cognitive Composite. Regression models were performed to evaluate how baseline hearing impairment associated with subsequent brain atrophy and cognitive decline after adjustment for a range of confounders including baseline β-amyloid deposition and white matter hyperintensity volume.

RESULTS

111 out of 287 participants had hearing impairment. Compared with those with preserved hearing, hearing impaired individuals had faster rates of whole brain atrophy, and worse hearing (higher pure tone average) predicted faster rates of hippocampal atrophy. In participants with hearing impairment, faster rates of whole brain atrophy predicted greater cognitive change. All observed relationships were independent of β-amyloid deposition and white matter hyperintensity volume.

CONCLUSIONS

Hearing loss may influence dementia risk via pathways distinct from those typically implicated in Alzheimer's and cerebrovascular disease in cognitively unimpaired older adults.

Moderating Role of Neighborhood Environment in the Associations Between Hearing Loss and Cognitive Challenges Among Older Adults: Evidence From US National Study

This study examined the associations between hearing loss and cognitive challenges among community-dwelling older adults and whether neighborhood characteristics (physical disorder and low social cohesion) moderated the associations. Cross-sectional national data from Round 11 of the National Health and Aging Trends Study were adopted (N = 2,515). Multinomial logistic regressions were used to examine associations among variables and interactive analyses were conducted to examine moderating effects. Results indicated significant relationships between the experience of hearing loss and possible dementia and between severe or profound hearing loss and probable dementia. Interactive models suggested that residing in neighborhoods with physical disorder and low social cohesion were negatively associated with possible dementia among older adults with moderate and severe or profound hearing loss, respectively, compared to those without hearing loss. Findings underscore the necessity of environmental and social interventions to enhance cognitive health among older adults with varying degrees of hearing challenges.

Cortical volumetric changes after cochlear implantation in postlingually deaf adults: correlation with speech perception abilities

This study aims to analyse the volumetric changes in brain MRI after cochlear implantation (CI), focusing on the speech perception in postlingually deaf adults. We conducted a prospective cohort study with 16 patients who had bilateral hearing loss and received unilateral CI. Based on the surgical side, patients were categorized into left and right CI groups. Volumetric T1-weighted brain MRI were obtained before and one year after the surgery. To overcome the artifact caused by the internal device in post-CI scan, image reconstruction method was newly devised and applied using the contralateral hemisphere of the pre-CI MRI data, to run FreeSurfer. We conducted within-subject template estimation for unbiased longitudinal image analysis, based on the linear mixed effect models. When analyzing the contralateral cerebral hemisphere before and after CI, a substantial increase in superior frontal gyrus and superior temporal gyrus (STG) volumes was observed in the left CI group. A positive correlation was observed in the STG and post-CI word recognition score in both groups. As far as we know, this is the first study attempting longitudinal brain volumetry based on post-CI MRI scans. We demonstrate that better auditory performance after CI is associated with structural restoration in central auditory structures.

Alpha and theta oscillations on a visual strategic processing task in age-related hearing loss

Introduction

Emerging evidence suggests changes in several cognitive control processes in individuals with age-related hearing loss (ARHL). However, value-directed strategic processing, which involves selectively processing salient information based on high value, has been relatively unexplored in ARHL. Our previous work has shown behavioral changes in strategic processing in individuals with ARHL. The current study examined event-related alpha and theta oscillations linked to a visual, value-directed strategic processing task in 19 individuals with mild untreated ARHL and 17 normal hearing controls of comparable age and education.

Methods

Five unique word lists were presented where words were assigned high- or low-value based on the letter case, and electroencephalography (EEG) data was recorded during task performance.

Results

The main effect of the group was observed in early time periods. Specifically, greater theta synchronization was seen in the ARHL group relative to the control group. Interaction between group and value was observed at later time points, with greater theta synchronization for high- versus low-value information in those with ARHL.

Discussion

Our findings provide evidence for oscillatory changes tied to a visual task of value-directed strategic processing in individuals with mild untreated ARHL. This points towards modality-independent neurophysiological changes in cognitive control in individuals with mild degrees of ARHL and adds to the rapidly growing literature on the cognitive consequences of ARHL.

The effect of hearing loss on age-related differences in neural distinctiveness

Age differences in cognitive performance have been shown to be overestimated if age-related hearing loss is not taken into account. Here, we investigated the role of age-related hearing loss on age differences in functional brain organization by assessing its impact on previously reported age differences in neural differentiation. To this end, we analyzed the data of 36 younger adults, 21 older adults with clinically normal hearing, and 21 older adults with mild-to-moderate hearing loss who had taken part in a functional localizer task comprising visual (i.e., faces, scenes) and auditory stimuli (i.e., voices, music) while undergoing functional magnetic resonance imaging. Evidence for reduced neural distinctiveness in the auditory cortex was observed only in older adults with hearing loss relative to younger adults, whereas evidence for reduced neural distinctiveness in the visual cortex was observed both in older adults with normal hearing and in older adults with hearing loss relative to younger adults. These results indicate that age-related dedifferentiation in the auditory cortex is exacerbated by age-related hearing loss.

A Comparison of Montreal Cognitive Assessment Scores among Individuals with Normal Hearing and Cochlear Implants

OBJECTIVES

The Montreal Cognitive Assessment (MoCA) is a cognitive screening tool that has 4 of 10 test items heavily dependent on auditory input, potentially leaving hearing-impaired (HI) individuals at a disadvantage. Previous work found that HI individuals scored lower than normal-hearing (NH) individuals on the MoCA, potentially attributed to the degraded auditory signals negatively impacting the ability to commit auditory information to memory. However, there is no research comparing how cochlear implant (CI) recipients perform on the MoCA relative to NH and HI individuals. This study aimed to (1) examine the effect of implementing three different hearing-adjusted scoring methods for a group of age-matched CI recipients and NH individuals, (2) determine if there is a difference between the two groups in overall scores and hearing-adjusted scores, and (3) compare scores across our CI and NH data to the published HI data for all scoring methods. We hypothesized that (1) scores for CI recipients would improve with implementation of the hearing-adjusted scoring methods over the original method, (2) CI recipients would score lower than NH participants for both original and adjusted scoring methods, and (3) the difference in scores between NH and CI listeners for both adjusted and unadjusted scores would be greater than that reported in the literature between NH and HI individuals due to the greater severity of hearing loss and relatively poor spectral resolution of CIs.

DESIGN

A total of 94 adults with CIs and 105 adults with NH were initially enrolled. After age-matching the two groups and excluding those who self-identified as NH but failed a hearing screening, a total of 75 CI participants (mean age 61.2 y) and 74 NH participants (mean age 58.8 y) were administered the MoCA. Scores were compared between the NH and CI groups, as well as to published HI data, using the original MoCA scoring method and three alternative scoring methods that excluded various auditory-dependent test items.

RESULTS

MoCA scores improved for all groups when two of the three alternative scoring methods were used, with no significant interaction between scoring method and group. Scores for CI recipients were significantly poorer than those for age-matched NH participants for all scoring methods. CI recipients scored better than the published data for HI individuals; however, the HI group was not age matched to the CI and NH groups.

CONCLUSIONS

MoCA scores are only partly affected by the potentially greater cognitive processing required to interpret degraded auditory signals. Even with the removal of the auditory-dependent items, CI recipients still did not perform as well as the age-matched NH group. Importantly, removing auditory-dependent items significantly and fundamentally alters the test, thereby reducing its sensitivity. This has important limitations for administration and interpretation of the MoCA for people with hearing loss.

Hearing difficulties and memory problems: the mediating role of physical health and psychosocial wellbeing

OBJECTIVE

To investigate whether the association between hearing difficulties and self-reported memory problems is mediated by physical health and psychosocial wellbeing.

DESIGN

A cross-sectional study. Path analyses were used to test potential theoretical models (psychosocial-cascade, common cause) of the association between hearing difficulties and memory problems, adjusting for age.

STUDY SAMPLE

A sample of 479 adults (18-87 years) completed self-reported outcome measures.

RESULTS

Half the participants reported clinically significant hearing difficulties and 30% self-reported memory problems. In the direct model, reporting hearing difficulties was associated with a greater likelihood of reporting memory problems (β = 0.17, p = 0.007, 95% Confidence Intervals [CI] = 0.00, 0.01). Hearing difficulties were also associated with poorer physical health, but this did not mediate the association with memory. Psychosocial factors, however, fully mediated the relationship between hearing difficulties and memory problems (β = 0.03, p = 0.019, 95% CI = 0.00, 0.01).

CONCLUSIONS

Adults with hearing difficulties may be more likely to self-report memory problems, irrespective of age. This study supports the psychosocial-cascade model, as the association between self-reported hearing and memory problems was explained entirely by psychosocial factors. Future studies should investigate these associations using behavioural measures, as well as explore whether interventions can reduce the risk of developing memory problems in this population.

Design and Methods of the Early Age-Related Hearing Loss Investigation Randomized Controlled Trial

OBJECTIVE

Hearing loss has been identified as a major modifiable risk factor for cognitive decline. The Early Age-Related Hearing Loss Investigation (EARHLI) study will assess the mechanisms linking early age-related hearing loss (ARHL) and cognitive impairment.

STUDY DESIGN

Randomized, controlled, single-site, early phase II, superiority trial.

SETTING

Tertiary academic medical center.

PARTICIPANTS

One hundred fifty participants aged 55 to 75 years with early ARHL (severity defined as borderline to moderate) and amnestic mild cognitive impairment will be included.

INTERVENTIONS

Participants will be randomized 1:1 to a best practice hearing intervention or a health education control.

MAIN OUTCOME MEASURES

The primary study outcome is cognition measured by the Alzheimer Disease Cooperative Study-Preclinical Alzheimer Cognitive Composite. Secondary outcomes include additional measures of cognition, social engagement, and brain organization/connectivity.

RESULTS

Trial enrollment will begin in early 2024.

CONCLUSIONS

After its completion in 2028, the EARHLI trial should offer evidence on the effect of hearing treatment versus a health education control on cognitive performance, social engagement, and brain organization/connectivity in 55- to 75-year-old community-dwelling adults with early ARHL and amnestic mild cognitive impairment.

Hearing Loss and Cognitive Decline in the Aging Population: Emerging Perspectives in Audiology

In this perspective article, the author explores the connections between hearing loss, central auditory processing, and cognitive decline, offering insights into the complex dynamics at play. Drawing upon a range of studies, the relationship between age-related central auditory processing disorders and Alzheimer's disease is discussed, with the aim of enhancing our understanding of these interconnected conditions. Highlighting the evolving significance of audiologists in the dual management of cognitive health and hearing impairments, the author focuses on their role in identifying early signs of cognitive impairment and evaluates various cognitive screening tools used in this context. The discussion extends to adaptations of hearing assessments for older adults, especially those diagnosed with dementia, and highlights the significance of objective auditory electrophysiological tests. These tests are presented as vital in assessing the influence of aging and Alzheimer's disease on auditory processing capabilities and to signal cognitive dysfunction. The article underscores the critical role of audiologists in addressing the challenges faced by the aging population. The perspective calls for further research to improve diagnostic and therapeutic strategies in audiology, and emphasizes the need for a multidisciplinary approach in tackling the nexus of hearing loss, auditory processing, and cognitive decline.