The longitudinal relationship between hearing loss and cognitive decline in tonal language-speaking older adults in China

A cross-sectional study of how high-frequency hearing loss impacts cognitive functions in middle-aged-to-older adults

Purpose

Research on the association between hearing loss and cognition has primarily focused on speech-range hearing frequencies (i.e., 0.5-4 kHz), as these frequencies are most relevant to everyday functioning. However, age-related hearing loss (ARHL) tends to impact higher-frequency hearing first, and more severely. Despite this, limited research has investigated the relationship between high-frequency (i.e., >4 kHz) hearing loss and cognitive impairment. In the current study, we aimed to assess whether high-frequency hearing loss predicts non-verbal cognitive functions (i.e., visuospatial executive function, learning, and memory tasks) above and beyond speech-frequency hearing loss.

Materials and methods

Participants were 241 English-speaking adults, aged 40-88 years, with hearing loss. Audiometrically assessed better-ear, speech-frequency (0.5, 1, 2 & 4 kHz; BE4PTA) and high-frequency (6 & 8 kHz; BE2PTA) hearing loss were compared to cognitive functions measured using non-verbal tests from the Cambridge Neuropsychological Test Automated Battery; covariates included hearing-loss asymmetry, age, sex, premorbid IQ, and mental health measured with the short-form Depression Anxiety Stress Scales.

Results

While correlation analyses demonstrated that all measured cognitive faculties were associated with both BE4PTA and BE2PTA, hierarchical linear regression analyses demonstrated that only BE4PTA predicted cognitive flexibility and working-memory ability after controlling for covariates; age primarily accounted for BE2PTA's cognitive effects.

Conclusion

While both speech and higher-frequency hearing loss were associated with poorer cognition, only the former demonstrated effects beyond those of ageing. However, the present study only investigated two frequencies in the higher range, encouraging broader investigation of higher-frequency hearing's cognitive effects in the future.

Validation of a smartphone-based digits-in-noise hearing test in Mandarin Chinese

OBJECTIVE

This study aimed to provide normative ranges of Chinese smartphone-based digits-in-noise (DIN) test results, to explore the association between speech reception threshold (SRT) and pure-tone average (PTA) threshold, and to verify the effectiveness and feasibility of the Chinese DIN.

DESIGN

Chinese-speaking adult subjects with varying types, symmetry and degrees of hearing loss, were recruited. All participants completed a pure-tone audiometric hearing test and DIN test with dichotic and antiphasic stimulus presentation.

STUDY SAMPLE

The overall sample consisted of 191 subjects, 24 with normal hearing and 167 with hearing loss.

RESULTS

There was a positive correlation between antiphasic DIN SRTs and PTA thresholds. Receiver operating characteristic curves (ROC) were calculated based on the classification of poorer ears. When SRT was ≥ -15.8 dB, it suggested the possible presence of mild or more severe hearing loss; when SRT was ≥ -14.2 dB, it suggested the possible presence of moderate or more severe hearing loss.

CONCLUSION

The Chinese DIN SRT showed a highly positive correlation with PTA and exhibited high sensitivity and specificity in detecting hearing loss. Poorer ear PTA was the primary predictor of the antiphasic DIN SRT. The present results verify the validity of the Chinese DIN in its purpose of hearing screening.

Hearing and cognitive scores measured with the Montreal Cognitive Assessment Scale in The HUNT Study, Norway

INTRODUCTION

Hearing impairment is associated with dementia. We aimed to clarify the association between hearing impairment and future cognitive test performance measured by the Montreal Cognitive Assessment Scale (MoCA), adjusted for confounders, avoiding reverse causation through long follow-up.

METHODS

We used the Norwegian population-based longitudinal cohort study, The Trøndelag Health Study (HUNT). At baseline, we invited all residents 20+ for an audiometric hearing assessment, and at 20+ years follow-up, we cognitively assessed all persons 70+ including MoCA adjusted for hearing impairment. We analyzed the association using linear regression.

RESULTS

We included 6879 persons (mean 56.1 years, standard deviation 6.2). At follow-up, the MoCA score was -0.25 (95% confidence interval [CI] -0.35, -0.14), per 10 dB increase in hearing threshold and for persons < 85 years, -0.31 (95% CI -0.42, -0.20).

DISCUSSION

This study finds a long-term association between hearing impairment and dose related reduced cognitive performance, particularly in those aged < 85.

CLINICAL TRIAL REGISTRATION

ID NCT04284384, hearing impairment as a risk factor for dementia in older adults.

HIGHLIGHTS

Hearing loss predicts long-term cognitive decline measured by MoCA over 20+ years. Long follow-up is crucial to avoid reverse causation in the hearing-cognition relationship. A 10 dB hearing threshold increase is linked to a 0.25-point reduction in MoCA score. Strongest cognitive decline associations are seen in people aged below 85 years. The association remained after excluding hearing-dependent tasks in the MoCA.

Cognitive Disorders In Acquired Sensorineural Hearing Loss, At The Ent Department Of The "Village Bondeko" Center, In Kinshasa

Context

Several data from the literature have focused on the relationship between congenital sensorineural hearing loss, as well as acquired hearing loss, and their impact on cognition and the risk of dementia. However, few studies have been conducted on this subject in countries where access to hearing rehabilitation measures is limited. Thus, the objective of the present study was to investigate the relationship between sensorineural hearing loss and cognitive disorders in a correlational approach.

Methods

This is a cross-sectional and analytical study conducted in the ENT department of the Center for the Disabled (visual, auditory, and mental) "Village Bondeko", from June to September 2023, involving 150 adults (≥20 years) with acquired sensorineural hearing loss; without a history of neuropsychic disorders. Sensorineural hearing loss was confirmed by tonal threshold audiometry and characterized according to WHO criteria; cognitive disorders were defined according to the MoCA scale.

Results

In total, 150 adults, including 78 men and 72 women, were collected in the present study. The average age was 54.11 ± 20 years, with extremes ranging from 20 to 87 years. In univariate analysis, there was a significant association (p<0.0001) between the degree of hearing loss and cognitive disorders. The analysis of variance (ANOVA) comparing the means demonstrated a very significant correlation (p ˂ 0.0001) between the decline in cognitive functions and the severity of hearing impairment. The low level of education, marital status, and cardiovascular risk factors were associated with cognitive disorders; however, no association was demonstrated between advancing age, gender, socioeconomic status, and cognitive disorders in the study population.

Conclusion

The present study has demonstrated the existence of an association between sensorineural hearing loss and cognitive disorders, involving a multidisciplinary and early management of sensorineural hearing loss.

Hearing loss, hearing aid use, and performance on the Montreal cognitive assessment (MoCA): findings from the HUNT study in Norway

Purpose

To evaluate the associations between hearing status and hearing aid use and performance on the Montreal Cognitive Assessment (MoCA) in older adults in a cross-sectional study in Norway.

Methods

This study utilized data from the fourth wave of the Trøndelag Health Study (HUNT4, 2017-2019). Hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz (or PTA4) in the better hearing ear were used to determine participants' hearing status [normal hearing (PTA4 hearing threshold, ≤ 15 dB), or slight (PTA4, 16-25 dB), mild (PTA4, 26-40 dB), moderate (PTA4, 41-55 dB), or severe (PTA4, ≥ 56 dB) hearing loss]. Both standard scoring and alternate MoCA scoring for people with hearing loss (deleting MoCA items that rely on auditory function) were used in data analysis. The analysis was adjusted for the confounders age, sex, education, and health covariates.

Results

The pattern of results for the alternate scoring was similar to that for standard scoring. Compared with the normal-hearing group, only individuals with moderate or severe hearing loss performed worse in the MoCA. In addition, people with slight hearing loss performed better in the MoCA than those with moderate or severe hearing loss. Within the hearing loss group, hearing aid use was associated with better performance in the MoCA. No interaction was observed between hearing aid use and participants' hearing status with performance on the MoCA test.

Conclusion

While hearing loss was associated with poorer performance in the MoCA, hearing aid use was found to be associated with better performance in the MoCA. Future randomized control trials are needed to further examine the efficacy of hearing aid use on the MoCA performance. When compared with standard scoring, the alternate MoCA scoring had no effect on the pattern of results.

Bidirectional associations between hearing difficulty and cognitive function in Chinese adults: a longitudinal study

Background

Middle-aged and older adults frequently experience hearing loss and a decline in cognitive function. Although an association between hearing difficulty and cognitive function has been demonstrated, its temporal sequence remains unclear. Therefore, we investigated whether there are bidirectional relationships between hearing difficulty and cognitive function and explored the mediating role of depressive symptoms in this relationship.

Method

We used the cross-lagged panel model and the random-intercept cross-lagged panel model to look for any possible two-way link between self-reported hearing difficulty and cognitive function. To investigate depressive symptoms' role in this association, a mediation analysis was conducted. The sample was made up of 4,363 adults aged 45 and above from the China Health and Retirement Longitudinal Study (CHARLS; 2011-2018; 44.83% were women; mean age was 56.16 years). One question was used to determine whether someone had a hearing impairment. The tests of cognitive function included episodic memory and intelligence. The Center for Epidemiologic Studies Depression Scale, which consists of 10 items, was used to measure depressive symptoms.

Results

A bidirectional association between hearing and cognition was observed, with cognition predominating (Wald χ2 (1) = 7.241, p < 0.01). At the between-person level, after controlling for potential confounders, worse hearing in 2011 predicted worse cognitive function in 2013 (β = -0.039, p < 0.01) and vice versa (β = -0.041, p < 0.01) at the between-person level. Additionally, there was no corresponding cross-lagged effect of cognitive function on hearing difficulty; rather, the more hearing difficulty, the greater the cognitive decline at the within-person level. According to the cross-lagged mediation model, depressive symptoms partially mediates the impact of cognitive function on subsequent hearing difficulty (indirect effect: -0.003, bootstrap 95% confidence interval: -0.005, -0.001, p < 0.05), but not the other way around.

Conclusion

These results showed that within-person relationships between hearing impairment and cognitive function were unidirectional, while between-person relationships were reciprocal. Setting mental health first may be able to break the vicious cycle that relates hearing loss to cognitive decline. Comprehensive long-term care requires services that address depressive symptoms and cognitive decline to be integrated with the hearing management.