Late Middle-aged Persons Research Articles

AGE-RELATED HEARING LOSS AS A RISK FACTOR FOR LATE LIFE DEPRESSION AND COGNITIVE DECLINE: Session 408

Age-related hearing loss (ARHL) is the third most common health condition affecting older adults after heart disease and arthritis and is the fifth leading cause of years lived with disability worldwide. The prevalence of ARHL rises steeply with age, from 3% among adults 20-29 to 49% of adults ages 60-69 and over 80% in individuals 85 years of age and older. Many hearing-impaired older adults avoid or withdraw from social contexts in which background noise will make it difficult to communicate, resulting in social isolation and reduced communication with family and friends. Social isolation and loneliness have been linked to numerous adverse physical and mental health outcomes, including dementia, depression, and mortality, and they may also lead to declining physical activity and the development of the syndrome of frailty. Neuroimaging studies of ARHL have begun to elucidate the brain changes associated with degraded auditory input that provide plausible pathways by which chronic hearing loss may cause cognitive dysfunction and affective dysregulation. Specifically, compensatory activation increases in the cognitive control network (CCN) to support effortful listening may reduce the resources available for higher level tasks, while chronic deafferentiation leads to atrophy of primary auditory regions and impaired downstream cognitive and affective processing of speech. The overall goal of this symposium is to review data linking ARHL to depression and cognitive decline in an effort to make geriatric psychiatrists more aware of the implications of this ubiquitous aging process for their patients. Dr. Bret Rutherford, who is Associate Professor of Clinical Psychiatry at Columbia University and Director of the Neurobiology and Therapeutics of Aging Division at Columbia, will Chair the symposium. Specifically, he will open the symposium with a brief introductory presentation and then proceed to introduce the speakers and discussant. Dr. Rutherford is well-positioned to serve this role, as he has recently authored an American Journal of Psychiatry review article on hearing loss and late life neuropsychiatry and is principal investigator of an NIA-funded R21 research project focuses on treating ARHL in order to improve depressive symptoms. The first speaker will be Dr. Justin Golub, who is Assistant Professor of Otolaryngology—Head and Neck Surgery at Columbia. Dr. Golub has received a K23 Award from the NIA for a project titled "Mechanisms Linking Hearing Loss and Alzheimer's Disease and Related Dementias" that examines the associations of objectively measured ARHL with imaging markers of ADRD and cognitive performance in late middle aged persons. Dr. Golub will discuss his longitudinal studies linking audiometrically assessed ARHL to AD neuropathology (brain amyloid β with 18F-Florbetaben positron emission tomography [PET] and tau in inferior and medial temporal lobes using18F-THK5351 PET), cerebrovascular disease (CVD) on MRI, as well as comprehensively assessed cognition. Next, Dr. Katherine Brewster, who is a PGY IV psychiatry resident working in Dr. Rutherford's laboratory at Columbia, will present original data focusing on ARHL and depression. She will review a recent first-authored AJGP publication in which she analyzed Health Aging and Body Composition Survey data to show that ARHL increased risk for incident depressive symptoms in these otherwise healthy older adults over 10-year follow up. Dr. Brewster will go on to present data from a pilot randomized controlled trial in which older adults with comorbid hearing loss and Late-life Depression were prospectively treated under double-blind conditions with hearing aids or sham hearing aids. She will review the strengths of the study methodology, which include the first known effort to blind depressed subjects to hearing aid vs. sham treatment, and discuss implications of the initial study results. Finally, Dr. Anu Sharma, Professor of Speech, Language, and Hearing Sciences at the University of Colorado at Boulder, will present work from her research program on the neural consequences of auditory deprivation in older adults. This presentation will provide a neural mechanism for the clinical/epidemiologic links between hearing loss and depression/dementia discussed in the first two talks using electrophysiologic and neuroimaging data from Dr. Sharma's studies. The discussant will be Dr. Frank Lin, who is Associate Professor of Otolaryngology and Medicine (Geriatrics) in the Johns Hopkins School of Medicine and of Epidemiology and Mental Health at the Bloomberg School of Public Health. Dr. Lin is the ideal discussant for this topic, and his public health research focuses on understanding how hearing loss affects the health and functioning of older adults and the strategies and policies needed to mitigate these effects. From 2014-2016, Dr. Lin helped lead initiatives with the National Academies, White House and Congress focused on hearing loss, aging and public health which resulted in passage of the Over-the-Counter Hearing Aid Act of 2017 that overturned 40 years of established regulatory precedent in the U.S. As the director of the Cochlear Center at Johns Hopkins, Dr. Lin oversees nearly $30 million in committed NIH and philanthropic funding dedicated to advancing the mission areas of the Center.

Urban Neighborhoods and Depressive Symptoms in Late Middle Age

This study examines associations between multiple urban neighborhood characteristics (socioeconomic disadvantage, affluence, and racial/ethnic composition) and depressive symptoms among late middle aged persons and compares findings to those previously obtained for persons age 70 years and older. Survey data are from the Health and Retirement Study (HRS), a U.S. national probability sample of noninstitutionalized persons aged 51 to 61 years in 1992. Neighborhoods are 1990 U.S. census tracts. Hierarchical linear regression is used to estimate multilevel models. Depressive symptoms vary significantly across urban neighborhoods among late middle age persons. Neighborhood socioeconomic disadvantage is significantly associated with depressive symptoms, net of both individual-level sociodemographic and health variables. However, this association is contingent upon individual-level wealth in that persons with low wealth in the most disadvantaged neighborhoods report the most depressive symptoms. Unlike findings for older adults for whom neighborhood effects appear to be entirely compositional in nature, neighborhood context matters to subgroups of late middle age adults.

Degos' Acanthoma (Acanthome a Cellules Claires)

This report gives clinical and histological details of nine new examples of Degos' acanthoma (acanthome a cellules claires). This recently described lesion has not been reported previously in the English literature. Most commonly the acanthoma presents as a small, very slow-growing, firm, solitary nodule on the lower limb in late middle-aged persons. All of our patients showed the characteristic histopathology with abrupt epidermal thickening by pale edematous malpighian cells. In addition our ninth patient showed hyperplasia of sweat ducts beneath the acanthoma. In three cases we were able to make certain histochemical observations on unfixed frozen sections. Our findings tend to support the view that this tumor is of epidermal rather than adnexal origin.