Abstract
Hearing loss is a modifiable risk factor for dementia and cognitive decline. However, the association between cognition and hearing acuity at different frequencies is unknown. We aimed to assess the relationships between hearing acuity at different frequencies with global cognitive function and five domains of cognition among a low-income elderly population in northern rural China. A population-based cross-sectional study was conducted to collect basic information from elderly residents aged 60 years and older in rural areas of Tianjin, China from April 2012 to November 2013. Pure tone averages (PTAs) at different frequencies in the ear with better hearing and Mini-Mental State Examination (MMSE) scores were measured, and the relationships between these variables were assessed. A total of 737 residents aged 60 years or more were enrolled in this study, and the prevalence of hearing impairment was 60.7%. After adjusting for sex, age, education, income, smoking, drinking, systolic blood pressure (SBP), total cholesterol (TC), and low-density lipoprotein cholesterol level (LDL-C), MMSE score and immediate recall score were negatively associated with overall PTA (OPTA) at four frequencies (0.5, 1, 2, and 4 kHz), PTA at low frequencies (LPTA; 0.5, 1, and 2 kHz), and PTA at high frequencies (HPTA; 3, 4, and 8 kHz) in the ear with better hearing. Moreover, orientation score was negatively associated with OPTA and LPTA, and the attention and calculation scores were negatively associated with OPTA and HPTA. Each 10-dB increase in OPTA was associated with a MMSE score decrease of 0.464. Each 10-dB increase in LPTA or HPTA was associated with a MMSE score decrease of 0.441 (95% CI: −0.795, −0.086) and 0.351 (95% CI: −0.592, −0.110), respectively. The present study demonstrated significant but weak relationships between OPTA, LPTA, and HPTA with global cognitive function, as defined using MMSE scores; these relationships were independent of age, education, lifestyle factors, and laboratory test values. These results indicated that hearing was associated with cognitive decline among older individuals, who should be screened routinely to identify risk for cognitive decline.
Highlights
Cognitive impairment is the leading cause of disability and a global public health priority for aging populations (Wortmann, 2012; GBD 2017 DALYs and HALE Collaborators, 2018)
Most people with dementia live in developing countries, and the number of people living with dementia in China accounts for approximately 25% of total dementia population worldwide, posing a substantial economic and social burden (GBD 2016 Neurology Collaborators, 2019)
Factors Associated With Mini-Mental State Examination (MMSE) Score in the Univariate Analysis
Summary
Cognitive impairment is the leading cause of disability and a global public health priority for aging populations (Wortmann, 2012; GBD 2017 DALYs and HALE Collaborators, 2018). According to the Global Burden of Disease study, there were 1.4 billion people living with hearing impairment in 2017, and approximately 90% of people with moderate to severe hearing impairment reside in developing countries (GBD 2017 Disease and Injury Incidence and Prevalence Collaborators, 2018). Numerous epidemiological studies have demonstrated hearing impairment at older age was associated with cognitive decline (Lin et al, 2013; Gurgel et al, 2014; Deal et al, 2017; Pabst et al, 2021; Saji et al, 2021). Only one cross-sectional study enrolling 307 elderly demonstrated PTA at low frequencies, but not high frequencies, was related to cognitive performance among older individuals (Mukari et al, 2017). The association between PTA at different frequencies and cognitive function is not as well established
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