The Longitudinal Association of Subclinical Hearing Loss With Cognition in the Health, Aging and Body Composition Study.

Alexander Chern,Rahul K Sharma,Justin S Golub,Qixuan Chen,Alexandria L Irace,Yuan Zhang

doi:10.3389/fnagi.2021.789515

Abstract

ObjectivesTo examine the longitudinal association between subclinical hearing loss (SCHL) and neurocognitive performance.DesignLongitudinal analyses were conducted among 2,110 subjects who underwent audiometric testing in a US multi-centered epidemiologic cohort study. The primary exposure was better ear hearing (pure tone average). SCHL was defined as hearing ≤ 25 dB. The primary outcome was neurocognitive performance, measured by Digit Symbol Substitution Test (DSST), Modified Mini Mental State Examination (3MS), and CLOX1. Linear mixed models were performed to assess the longitudinal association between hearing and cognitive performance, adjusting for covariates. Models were fit among all individuals and among individuals with SCHL only.ResultsAmong 2,110 participants, mean (SD) age was 73.5 (2.9) years; 52.3% were women. Mean (SD) better ear pure tone average was 30.0 (13.1) dB. Mean follow-up was 9.1 years (range 3–16). Among all participants, worse hearing was associated with significantly steeper cognitive decline measured by the DSST [0.054-point/year steeper decrease per 10 dB worse hearing, 95% confidence interval (CI): 0.026–0.082] and 3MS (0.044-point/year steeper decrease per 10 dB worse hearing, CI: 0.026–0.062), but not CLOX1. Among those with SCHL, worse hearing was associated with significantly steeper cognitive performance decline as measured by DSST (0.121-point/year steeper decrease per 10 dB worse hearing, CI: 0.013–0.228), but not CLOX1 or 3MS.ConclusionAmong those with SCHL, worse hearing was associated with steeper cognitive performance declines over time as measured by DSST. The relationship between hearing loss and cognition may begin at earlier levels of hearing loss than previously recognized.

Highlights

Age-related hearing loss (ARHL) is highly prevalent and notably undertreated in the elderly
Two thirds of adults older than 70 years have hearing loss (HL) (Goman and Lin, 2016; Sharma et al, 2020), but fewer than 20% of adults affected by HL obtain treatment (Chien and Lin, 2012)
The objective of the present study is to examine the longitudinal association between SCHL and cognitive impairment using a large US multi-centered and multi-ethnic cohort study, where findings may better generalize to the US population

Summary

Introduction

Age-related hearing loss (ARHL) is highly prevalent and notably undertreated in the elderly. As the global population grows and ages, the number of people with HL is increasing rapidly. For individuals aged 12 years and older in the United States, nearly 1 in 8 has bilateral HL (30 million or 12.7% of Americans). This estimate increases to nearly 1 in 5 (48.1 million or 20.3%) when including individuals with unilateral HL (Lin et al, 2011b). There is a significant health burden that comes with untreated HL—an estimated annual global cost of US$750 billion (World Health Organization, 2021a)

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