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Original Investigation
Feb 25, 2013

Hearing Loss and Cognitive Decline in Older Adults

Author Affiliations

Author Affiliations: Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins School of Medicine, and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (Dr Lin), and The Johns Hopkins Center on Aging and Health (Drs Lin and Xue and Ms Xia), Baltimore, and Laboratory of Epidemiology, Demography, and Biometry (Dr Harris) and Intramural Research Program (Drs Ferrucci and Simonsick), National Institute on Aging, Bethesda, Maryland; Departments of Psychiatry and Neurology (Dr Yaffe) and Epidemiology and Biostatistics (Drs Yaffe and Ayonayon), University of California, San Francisco; Department of Epidemiology and Biostatistics, State University of New York Downstate Medical Center, Brooklyn (Dr Purchase-Helzner); and Department of Preventive Medicine, University of Tennessee, Memphis (Dr Satterfield).

JAMA Intern Med. 2013;173(4):293-299. doi:10.1001/jamainternmed.2013.1868

Background Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown.

Methods We studied 1984 older adults (mean age, 77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, ≥80) who underwent audiometric testing in year 5. Participants were followed up for 6 years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and 11 and consisted of the 3MS (measuring global function) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was defined as a 3MS score of less than 80 or a decline in 3MS score of more than 5 points from baseline. Mixed-effects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors.

Results In total, 1162 individuals with baseline hearing loss (pure-tone average >25 dB) had annual rates of decline in 3MS and Digit Symbol Substitution test scores that were 41% and 32% greater, respectively, than those among individuals with normal hearing. On the 3MS, the annual score changes were −0.65 (95% CI, −0.73 to −0.56) vs −0.46 (95% CI, −0.55 to −0.36) points per year (P = .004). On the Digit Symbol Substitution test, the annual score changes were −0.83 (95% CI, −0.94 to −0.73) vs −0.63 (95% CI, −0.75 to −0.51) points per year (P = .02). Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual's baseline hearing loss.

Conclusions Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. Further studies are needed to investigate what the mechanistic basis of this association is and whether hearing rehabilitative interventions could affect cognitive decline.