Association of Hearing Loss With Dementia | Dementia and Cognitive Impairment | JAMA Network Open | JAMA Network
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Christensen  K, Doblhammer  G, Rau  R, Vaupel  JW.  Ageing populations: the challenges ahead.  Lancet. 2009;374(9696):1196-1208. doi:10.1016/S0140-6736(09)61460-4PubMedGoogle ScholarCrossref
Lin  FR, Metter  EJ, O’Brien  RJ, Resnick  SM, Zonderman  AB, Ferrucci  L.  Hearing loss and incident dementia.  Arch Neurol. 2011;68(2):214-220. doi:10.1001/archneurol.2010.362PubMedGoogle ScholarCrossref
Lin  FR, Ferrucci  L, Metter  EJ, An  Y, Zonderman  AB, Resnick  SM.  Hearing loss and cognition in the Baltimore Longitudinal Study of Aging.  Neuropsychology. 2011;25(6):763-770. doi:10.1037/a0024238PubMedGoogle ScholarCrossref
Deal  JA, Betz  J, Yaffe  K,  et al; Health ABC Study Group.  Hearing impairment and incident dementia and cognitive decline in older adults: the Health ABC Study.  J Gerontol A Biol Sci Med Sci. 2017;72(5):703-709. doi:10.1093/gerona/glw069PubMedGoogle Scholar
Gates  GA, Anderson  ML, McCurry  SM, Feeney  MP, Larson  EB.  Central auditory dysfunction as a harbinger of Alzheimer dementia.  Arch Otolaryngol Head Neck Surg. 2011;137(4):390-395. doi:10.1001/archoto.2011.28PubMedGoogle ScholarCrossref
Gates  GA, Beiser  A, Rees  TS, D’Agostino  RB, Wolf  PA.  Central auditory dysfunction may precede the onset of clinical dementia in people with probable Alzheimer’s disease.  J Am Geriatr Soc. 2002;50(3):482-488. doi:10.1046/j.1532-5415.2002.50114.xPubMedGoogle ScholarCrossref
Zheng  Y, Fan  S, Liao  W, Fang  W, Xiao  S, Liu  J.  Hearing impairment and risk of Alzheimer’s disease: a meta-analysis of prospective cohort studies.  Neurol Sci. 2017;38(2):233-239. doi:10.1007/s10072-016-2779-3PubMedGoogle ScholarCrossref
Thomson  RS, Auduong  P, Miller  AT, Gurgel  RK.  Hearing loss as a risk factor for dementia: a systematic review.  Laryngoscope Investig Otolaryngol. 2017;2(2):69-79. doi:10.1002/lio2.65PubMedGoogle ScholarCrossref
Su  P, Hsu  CC, Lin  HC,  et al.  Age-related hearing loss and dementia: a 10-year national population-based study.  Eur Arch Otorhinolaryngol. 2017;274(5):2327-2334. doi:10.1007/s00405-017-4471-5PubMedGoogle ScholarCrossref
Amieva  H, Ouvrard  C, Meillon  C, Rullier  L, Dartigues  JF.  Death, depression, disability, and dementia associated with self-reported hearing problems: a 25-year study.  J Gerontol A Biol Sci Med Sci. 2018;73(10):1383-1389. doi:10.1093/gerona/glx250PubMedGoogle ScholarCrossref
Loughrey  DG, Kelly  ME, Kelley  GA, Brennan  S, Lawlor  BA.  Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis.  JAMA Otolaryngol Head Neck Surg. 2018;144(2):115-126. doi:10.1001/jamaoto.2017.2513PubMedGoogle ScholarCrossref
Livingston  G, Sommerlad  A, Orgeta  V,  et al.  Dementia prevention, intervention, and care.  Lancet. 2017;390(10113):2673-2734. doi:10.1016/S0140-6736(17)31363-6PubMedGoogle ScholarCrossref
National Health Research Institutes. National Health Insurance Research Database. Accessed June 4, 2019.
Austin  PC.  An introduction to propensity score methods for reducing the effects of confounding in observational studies.  Multivariate Behav Res. 2011;46(3):399-424. doi:10.1080/00273171.2011.568786PubMedGoogle ScholarCrossref
Ford  AH, Hankey  GJ, Yeap  BB, Golledge  J, Flicker  L, Almeida  OP.  Hearing loss and the risk of dementia in later life.  Maturitas. 2018;112:1-11. doi:10.1016/j.maturitas.2018.03.004PubMedGoogle ScholarCrossref
Osler  M, Christensen  GT, Mortensen  EL, Christensen  K, Garde  E, Rozing  MP.  Hearing loss, cognitive ability, and dementia in men age 19-78 years.  Eur J Epidemiol. 2019;34(2):125-130. doi:10.1007/s10654-018-0452-2PubMedGoogle ScholarCrossref
Martini  A, Castiglione  A, Bovo  R, Vallesi  A, Gabelli  C.  Aging, cognitive load, dementia and hearing loss.  Audiol Neurootol. 2014;19(suppl 1):2-5. doi:10.1159/000371593PubMedGoogle ScholarCrossref
Campbell  J, Sharma  A.  Compensatory changes in cortical resource allocation in adults with hearing loss.  Front Syst Neurosci. 2013;7:71. doi:10.3389/fnsys.2013.00071PubMedGoogle ScholarCrossref
Rönnberg  J, Rudner  M, Lunner  T, Zekveld  AA.  When cognition kicks in: working memory and speech understanding in noise.  Noise Health. 2010;12(49):263-269. doi:10.4103/1463-1741.70505PubMedGoogle ScholarCrossref
Boyle  PA, Wilson  RS, Schneider  JA, Bienias  JL, Bennett  DA.  Processing resources reduce the effect of Alzheimer pathology on other cognitive systems.  Neurology. 2008;70(17):1534-1542. doi:10.1212/01.wnl.0000304345.14212.38PubMedGoogle ScholarCrossref
Lin  FR, Yaffe  K, Xia  J,  et al; Health ABC Study Group.  Hearing loss and cognitive decline in older adults.  JAMA Intern Med. 2013;173(4):293-299. doi:10.1001/jamainternmed.2013.1868PubMedGoogle ScholarCrossref
Puschmann  S, Thiel  CM.  Changed crossmodal functional connectivity in older adults with hearing loss.  Cortex. 2017;86:109-122. doi:10.1016/j.cortex.2016.10.014PubMedGoogle ScholarCrossref
Lin  FR, Ferrucci  L, An  Y,  et al.  Association of hearing impairment with brain volume changes in older adults.  Neuroimage. 2014;90:84-92. doi:10.1016/j.neuroimage.2013.12.059PubMedGoogle ScholarCrossref
Rosemann  S, Thiel  CM.  Audio-visual speech processing in age-related hearing loss: stronger integration and increased frontal lobe recruitment.  Neuroimage. 2018;175:425-437. doi:10.1016/j.neuroimage.2018.04.023PubMedGoogle ScholarCrossref
Guthrie  DM, Davidson  JGS, Williams  N,  et al.  Combined impairments in vision, hearing and cognition are associated with greater levels of functional and communication difficulties than cognitive impairment alone: analysis of interRAI data for home care and long-term care recipients in Ontario.  PLoS One. 2018;13(2):e0192971. doi:10.1371/journal.pone.0192971PubMedGoogle ScholarCrossref
Hughes  SE, Hutchings  HA, Rapport  FL, McMahon  CM, Boisvert  I.  Social connectedness and perceived listening effort in adult cochlear implant users: a grounded theory to establish content validity for a new patient-reported outcome measure.  Ear Hear. 2018;39(5):922-934. doi:10.1097/AUD.0000000000000553PubMedGoogle ScholarCrossref
Dawes  P, Emsley  R, Cruickshanks  KJ,  et al.  Hearing loss and cognition: the role of hearing aids, social isolation and depression.  PLoS One. 2015;10(3):e0119616. doi:10.1371/journal.pone.0119616PubMedGoogle ScholarCrossref
Hsiao  YH, Chang  CH, Gean  PW.  Impact of social relationships on Alzheimer’s memory impairment: mechanistic studies.  J Biomed Sci. 2018;25(1):3. doi:10.1186/s12929-018-0404-xPubMedGoogle ScholarCrossref
Panza  F, Solfrizzi  V, Logroscino  G.  Age-related hearing impairment: a risk factor and frailty marker for dementia and AD.  Nat Rev Neurol. 2015;11(3):166-175. doi:10.1038/nrneurol.2015.12PubMedGoogle ScholarCrossref
Maharani  A, Dawes  P, Nazroo  J, Tampubolon  G, Pendleton  N; SENSE-Cog WP1 Group.  Longitudinal relationship between hearing aid use and cognitive function in older Americans.  J Am Geriatr Soc. 2018;66(6):1130-1136. doi:10.1111/jgs.15363PubMedGoogle ScholarCrossref
Stern  D, Hilly  O.  The relationship between hearing loss and cognitive decline in the elderly and the efficiency of hearing rehabilitation in preventing cognitive decline.  Harefuah. 2018;157(6):374-377.PubMedGoogle Scholar
Lundgaard  I, Wang  W, Eberhardt  A,  et al.  Beneficial effects of low alcohol exposure, but adverse effects of high alcohol intake on glymphatic function.  Sci Rep. 2018;8(1):2246. doi:10.1038/s41598-018-20424-yPubMedGoogle ScholarCrossref
Pfefferbaum  A, Lim  KO, Zipursky  RB,  et al.  Brain gray and white matter volume loss accelerates with aging in chronic alcoholics: a quantitative MRI study.  Alcohol Clin Exp Res. 1992;16(6):1078-1089. doi:10.1111/j.1530-0277.1992.tb00702.xPubMedGoogle ScholarCrossref
Schwarzinger  M, Thiébaut  SP, Baillot  S, Mallet  V, Rehm  J.  Alcohol use disorders and associated chronic disease: a national retrospective cohort study from France.  BMC Public Health. 2017;18(1):43. doi:10.1186/s12889-017-4587-yPubMedGoogle ScholarCrossref
Langballe  EM, Ask  H, Holmen  J,  et al.  Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: the HUNT study, Norway.  Eur J Epidemiol. 2015;30(9):1049-1056. doi:10.1007/s10654-015-0029-2PubMedGoogle ScholarCrossref
Ilomaki  J, Jokanovic  N, Tan  EC, Lonnroos  E.  Alcohol consumption, dementia and cognitive decline: an overview of systematic reviews.  Curr Clin Pharmacol. 2015;10(3):204-212. doi:10.2174/157488471003150820145539PubMedGoogle ScholarCrossref
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    2 Comments for this article
    Test for reversal of cognitive loss by using hearing aids?
    Ron Horgan, Diploma Applied Chemistry | Retired Research Chemist
    References 17-23 show that hearing loss by declining ear function is followed by loss of synaptic connections required to process the frequency signals. When a hearing aid tuned to selectively amplify the deficient frequencies is used, over time the lost connections are reestablished. Thus the unaided hearing improves substantially. It is possible that this reduction in cognitive load will result in improved memory and executive function, i.e. a reversal of dementia? This possible therapy may warrant development.
    RE: Association of hearing loss with dementia
    Tomoyuki Kawada, MD | Nippon Medical School
    I have read the article by Liu and Lee (1) with great interest. The authors conducted a prospective study to investigate the association between hearing loss and incident dementia in the general population with special reference to aging. Adjusted hazard ratio (HR) (95% confidence interval [CI]) of inhabitants with hearing loss for incident dementia was 1.17 (1.07-1.29). In addition, adjusted HR was highest in the middle age group (45-64 years) as compared to those aged 65-74 and above 74 years, respectively. Furthermore, adjusted HR (95% CI) of inhabitants aged 45 to 64 years and the same generations with hearing loss for incident dementia was 2.21 (1.57-3.12) and 1.40 (1.12-1.75), respectively. I have some concerns about their study.

    First, the hearing loss in inhabitants aged 45 to 64 years contributed to the risk reduction of dementia. I suppose that there is a need of specifying an interaction between aging and hearing loss for subsequent incident dementia. On this point, Osler et al. conducted a prospective study in 942,567 men, aged 19-38 years at baseline, to examine the effect of hearing loss on subsequent risk of dementia until age 58-78 years. They handled hearing loss as a time-varying variable for survival analysis. Adjusted HR (95% CI) of midlife hearing for incident dementia diagnosed before age 60 and at a later age were 1.90 (1.59-2.76) and 1.15 (1.06-1.25), respectively. In contrast, there was no effect of age in diagnosis of hearing loss for dementia, when stratified analysis was conducted before and after the age of 50 years. There is a need of further study to specify the mechanism for effect of hearing loss in inhabitants aged 45 to 64 years on subsequent dementia.

    Second, Ford et al. conducted a prospective study and a meta-analysis to investigate the association between hearing loss and dementia (3). Adjusted HR (95% CI) of men with hearing loss for incident dementia was 1.69 ( 1.54-1.85). In addition, pooled HR of hearing impairment for incident dementia was 1.49 (1.30-1.67), which was calculated from 14 prospective studies. Although significant relationship was observed, caution should be paid to difference in confounding variables in each study. I suspect that one of the plausible mechanisms might be the independent effects of aging on hearing loss and cognitive impairment (4,5). Anyway, continuous prospective studies are needed for stable risk estimation by a meta-analysis.

    Finally, Zheng et al. conducted a meta-analysis of prospective cohort studies to assess the association between hearing impairment and incident Alzheimer's disease (6). Although pooled HR (95% CI) of people with hearing impairment for incident Alzheimer's disease was 4.87 (0.90-26.35), pooled HR (95% CI) of people with hearing impairment for incident cognitive disorders was 2.82 (1.47-5.42), when 3 studies of Alzheimer's disease and one study of mild cognitive impairment were compiled. By classifying the type of dementia, sub-analysis for the relationship between hearing loss and subsequent dementia should be evaluated.

    1. Liu CM & Lee CT. JAMA Netw Open. 2019;2(7):e198112.
    2. Osler M, et al. Eur J Epidemiol. 2019;34(2):125-130.
    3. Ford AH, et al. Maturitas. 2018;112:1-11.
    4. Xu W, et al. Aging (Albany NY). 2019;11(10):3156-3169.
    5. Loughrey DG, et al. JAMA Otolaryngol Head Neck Surg. 2018;144(2):115-126.
    6. Zheng Y, et al. Neurol Sci. 2017;38(2):233-239.
    Original Investigation
    July 31, 2019

    Association of Hearing Loss With Dementia

    Author Affiliations
    • 1Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
    • 2Taiwan Centers for Disease Control, Taipei, Taiwan
    JAMA Netw Open. 2019;2(7):e198112. doi:10.1001/jamanetworkopen.2019.8112
    Key Points español 中文 (chinese)

    Question  What is the association of hearing loss with future incident dementia in the general population of Taiwan?

    Findings  In this population-based matched cohort study of 16 270 participants, hearing loss was positively associated with incident dementia, especially in patients aged 45 to 64 years.

    Meaning  Hearing loss is associated with a higher risk of dementia, and findings suggest that hearing protection, screening, and treatment may be used as strategies to mitigate this potential risk factor.


    Importance  Hearing loss (HL) may be a modifiable risk factor for dementia, and longitudinal studies are needed to examine the association of HL and dementia.

    Objective  To investigate the association of HL with incident dementia in Taiwanese adults in the general population.

    Design, Setting, and Participants  This population-based cohort study collected data from the National Health Insurance Research Database of Taiwan. Patients newly diagnosed with HL from January 1, 2000, through December 31, 2011 (n = 8135), constituted the exposed (HL) group. The HL group patients were matched by sex, age, residence, and insurance premium to individuals without HL (non-HL group) (n = 8135). Data were analyzed from January 1, 2000, to December 31, 2013.

    Exposure  Hearing loss defined according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

    Main Outcomes and Measures  Dementia classified according to ICD-9-CM codes.

    Results  Of a total of 16 270 participants (9286 [57.1%] men; mean [SD] age, 65.2 [11.1] years), 1868 developed dementia. The dementia incidence rate in the HL group was higher than that in the non-HL group (19.38 [95% CI, 18.25-20.57] per 1000 person-years vs 13.98 [95% CI, 13.01-15.00] per 1000 person-years) during the follow-up period. In the fully adjusted multivariate Cox proportional hazards regression model applied for risk analysis, patients with HL had a significant risk of dementia (hazard ratio [HR], 1.17; 95% CI, 1.07-1.29; false discovery rate [FDR] P = .003). Subgroup analysis revealed that, among 3 age groups (45-64, 65-74, and ≥75 years), the group aged 45 to 64 years was associated with a risk of dementia (HR, 2.21 [95% CI, 1.57-3.12]; FDR P < .001). In sensitivity analysis, the presence of HL among those aged 45 to 64 years (HR, 1.40; 95% CI, 1.12-1.75; FDR P = .01) was associated with a risk of dementia.

    Conclusions and Relevance  In this study, hearing loss was positively associated with a risk of dementia, especially in patients aged 45 to 64 years. Hearing protection, screening, and treatment may be used as strategies for mitigating this potential risk factor.