Abstract
IntroductionHearing aid usage has been linked to improvements in cognition, communication, and socialization, but the extent to which it can affect the incidence and progression of dementia is unknown. Such research is vital given the high prevalence of dementia and hearing impairment in older adults, and the fact that both conditions often coexist. In this study, we examined for the first time the effect of the use of hearing aids on the conversion from mild cognitive impairment (MCI) to dementia and progression of dementia.MethodsWe used a large referral‐based cohort of 2114 hearing‐impaired patients obtained from the National Alzheimer's Coordinating Center. Survival analyses using multivariable Cox proportional hazards regression model and weighted Cox regression model with censored data were performed to assess the effect of hearing aid use on the risk of conversion from MCI to dementia and risk of death in hearing‐impaired participants. Disease progression was assessed with Clinical Dementia Rating Sum of Boxes (CDR‐SB) scores. Three types of sensitivity analyses were performed to validate the robustness of the results.ResultsMCI participants that used hearing aids were at significantly lower risk of developing all‐cause dementia compared to those not using hearing aids (hazard ratio [HR] 0.73, 95% confidence interval [CI], 0.61 to 0.89; false discovery rate [FDR] P = 0.004). The mean annual rate of change (standard deviation) in CDR‐SB scores for hearing aid users with MCI was 1.3 (1.45) points and significantly lower than for individuals not wearing hearing aids with a 1.7 (1.95) point increase in CDR‐SB per year (P = 0.02). No association between hearing aid use and risk of death was observed. Our findings were robust subject to sensitivity analyses.DiscussionAmong hearing‐impaired adults, hearing aid use was independently associated with reduced dementia risk. The causality between hearing aid use and incident dementia should be further tested.
Highlights
Hearing aid usage has been linked to improvements in cognition, communication, and socialization, but the extent to which it can affect the incidence and progression of dementia is unknown
Slower conversion from mild cognitive impairment (MCI) to dementia in individuals using hearing aids suggests that effective identification and treatment of hearing loss may reduce the cumulative incidence of dementia
The competing risk of all-cause mortality and dementia among those with MCI should be examined in future work
Summary
Hearing aid usage has been linked to improvements in cognition, communication, and socialization, but the extent to which it can affect the incidence and progression of dementia is unknown. Survival analyses using multivariable Cox proportional hazards regression model and weighted Cox regression model with censored data were performed to assess the effect of hearing aid use on the risk of conversion from MCI to dementia and risk of death in hearing-impaired participants. The escalating costs and devastating psychological and emotional impact of dementia on affected individuals, their families, and caregivers makes the prevention, diagnosis, and treatment of dementia a national public health priority worldwide.[1] While the process of drug development to delay the onset of dementia has been slower than initially hoped, there is evidence that behavioral and lifestyle interventions might reduce dementia risk.[2,3,4] Numerous studies have investigated the effects of physical exercise; healthy diet; and management of medical conditions, such as diabetes and heart disease, on cognitive decline and risk of developing dementia.[2,5] there is a paucity of research on hearing impairment and dementia. Approximately 23 million adults with hearing loss in the United States do not use hearing aids even though the negative impact of untreated hearing loss has been widely documented.[7,8,9] The low level of hearing aid adoption is associated with stigma and affordability of hearing aids.[8,15] Adults with impaired hearing, who do not wear hearing aids, demonstrate significantly higher rates of depression, anxiety, and other psychosocial disorders.[9,10] Hearing loss has been associated with increased risk of incident dementia.[11,12,13,14]
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