Abstract
BackgroundPrevious studies identifying hearing loss as a promising modifiable risk factor for cognitive decline mostly adjusted for baseline age solely. As such a faster cognitive decline at a higher age, which is expected considering the non-linear relationship between cognition and age, may have been overlooked. Therefore it remains uncertain whether effects of hearing loss on cognitive decline extend beyond age-related declines of cognitive function.Methods3,590 non-demented participants were eligible for analysis at baseline, and a maximum of 837 participants were eligible for the longitudinal analysis. Hearing loss was defined at baseline. Cognitive function was measured at baseline and at follow-up (4.4 years [SD: 0.2]). Multivariable linear regression analysis was used for the cross-sectional analysis. Linear mixed models were used to assess the longitudinal association between hearing loss and cognitive decline over time while adjusting for confounders and the interaction of age and follow-up time.ResultsHearing loss was associated with lower cognitive function at baseline. Moreover, hearing loss was associated with accelerated cognitive decline over time on a memory test. After additionally adjusting for the interaction between age and follow-up time, we found that hearing loss did not accelerate cognitive decline anymore.ConclusionsHearing loss was associated with lower cognitive function at baseline and accelerated cognitive decline on a memory test. The association between hearing loss and accelerated cognitive decline was non-significant after additional adjustment for non-linear age effects. More evidence is needed to ensure the role of hearing loss as a modifiable risk factor for cognitive decline.
Highlights
Hearing loss has been put forward as a promising modifiable risk factor for cognitive decline and dementia [5, 28, 29, 32, 45]
Results did not differ between males and females or between midlife and latelife (Supplementary Tables 3 and 4). In this large population-based study in non-demented older adults at risk for cognitive decline and cognitive impairment, we found that hearing loss was associated with poorer global cognitive functioning, executive functioning, verbal fluency, attention, memory, and manual dexterity
After adjustment for the possible non-linear effects of age on cognitive change during follow-up, we did not find that hearing loss for either hearing thresholds or speech understanding in noise accelerates cognitive decline over time
Summary
Hearing loss has been put forward as a promising modifiable risk factor for cognitive decline and dementia [5, 28, 29, 32, 45]. Previous studies identifying hearing loss as a promising modifiable risk factor for cognitive decline mostly adjusted for baseline age solely. As such a faster cognitive decline at a higher age, which is expected considering the nonlinear relationship between cognition and age, may have been overlooked. Linear mixed models were used to assess the longitudinal association between hearing loss and cognitive decline over time while adjusting for confounders and the interaction of age and follow-up time. The association between hearing loss and accelerated cognitive decline was non-significant after additional adjustment for non-linear age effects. More evidence is needed to ensure the role of hearing loss as a modifiable risk factor for cognitive decline
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