The relationship between subjective hearing impairment and mild behavioral impairment – A study of older adults without dementia in the COMPASS‐ND Study

Abstract

AbstractBackgroundHearing loss and mild behavioral impairment (MBI) are both early warning signs of cognitive decline and dementia in older adults and have been recommended for use as non‐cognitive markers of dementia. To date, few studies have directly investigated the relationship between these two markers.MethodBaseline data from 219 non‐demented participants (10 cognitively normal; CN, 48 subjective cognitive decline; SCD, 161 mild cognitive impairment; MCI) in the COMPASS‐ND study (February 2020 release) were analyzed. Hearing impairment was measured in three ways: with a 10‐item self‐report measure using the Hearing Handicap Inventory for the Elderly – Screening Version (HHIE‐S), with a speech and noise test using the Canadian Digit Triplet Test (CDTT), and with screening audiometry using 2 discrete input levels at 2000 Hz to generate 6 hearing loss categories. Global and domain‐specific MBI burden was approximated using the Neuropsychiatric Inventory Questionnaire (NPI‐Q) with a published algorithm. Multivariable linear regressions were conducted to examine the association between the three hearing impairment measures and global MBI burden, adjusting for sex, age, education, hearing aid use, and Montreal Cognitive Assessment (MoCA) score or diagnosis. Multivariable logistic regressions were used to investigate whether the hearing variables could predict MBI domains.ResultHalf of all participants showed MBI symptoms (Figure 1). Greater self‐reported hearing impairment measured by the HHIE‐S was significantly associated with greater global MBI burden and the presence of apathy and affective dysregulation when controlling for global cognition or diagnosis (Table 1). These associations remained significant in analyses restricted to MCI alone. Performance on CDTT and screening audiometry, were not associated with global or domain‐specific MBI burden.ConclusionThe HHIE‐S, which was designed to capture the emotional and social aspects of hearing loss, was positively related to global MBI burden and more specifically to apathy and affect. Unlike audiometry and speech and noise measures, self‐reported measures of hearing impairment can be influenced by age, sex, other comorbidities, and social factors. Our findings underscore that value of self‐report measures of hearing impairment as distinct from audiometry and speech and noise measures in their association with behavioral impairment and as non‐cognitive markers of dementia.