Modifiable Risk Factors For Dementia Research Articles

Hearing Restorative Devices and Dementia


 This Horizon Scan summarizes the available information regarding hearing restorative devices for improving cognition or delaying disease progression for people living with dementia.
 Hearing loss is 1 of the largest modifiable risk factors for dementia.
 Evidence regarding the effectiveness of hearing devices to improve cognition in people living with dementia is still evolving. However, in individuals without dementia, managing hearing loss may prevent cognitive decline in the long term.
 Early evidence suggests that hearing aids may be a cost-effective intervention for preventing dementia in the long term.
 Barriers to access such as high out-of-pocket costs, equitable access to health care, and low utilization even in the general population are issues to consider. If managing hearing loss with hearing restorative devices indeed prevents cognitive decline, if they are accessible only to those with the financial means to pay high out-of-pocket costs, this could exacerbate systemic health inequities.

Dementia prevention and the GP's role: a qualitative interview study.

GPs play an increasingly important role in proactively preventing dementia. Dementia in 40% of patients could be prevented or delayed by targeting 12 modifiable risk factors throughout life. However, little is known about how GPs perceive their role in dementia prevention and the associated barriers. To explore the role of GPs in dementia prevention. Qualitative study among UK GPs. Semi-structured online interviews were conducted with 11 UK GPs exploring their views regarding their role in dementia prevention. Data were analysed using thematic analysis. GPs reported that they never explicitly discuss dementia risk with patients, even when patients are presenting with risk factors, but acknowledge that dementia prevention should be part of their role. They advocate for adopting a whole team approach to primary care preventive practice, using long-term condition/medication reviews or NHS health checks as a platform to enable dementia risk communication targeting already at-risk individuals. Barriers included a lack of time and an absence of knowledge and education about the modifiable dementia risk factors, as well as a reluctance to use 'dementia' as a term within the appointment for fear of causing health anxiety. 'Brain health' was perceived as offering a more encouraging discursive tool for primary care practitioners, supporting communication and behaviour change. There needs to be a whole-systems shift towards prioritising brain health and supporting primary care professionals in their preventive role. Education is key to underpinning this role in dementia prevention.

Knowledge and motivation to adopt recommended health behaviours to reduce dementia risk among the elderly in Norway: a qualitative study

ObjectivesDementia is a major healthcare challenge; however, there is evidence that modifiable risk factors may contribute to reduce dementia risk. The aim of the study was to explore the knowledge and motivation for adopting recommended health behaviours among older adults in Norway. Study designThe study has a qualitative, descriptive design. MethodsIndividual interviews were used for data collection. The study population comprised 15 participants, five men and 10 women, aged ≥73 years, recruited from a region in the centre of Norway. Interviews were analysed according to qualitative content analysis. ResultsThree categories were identified and presented as the main findings, as follows: (1) sufficient knowledge about risk reduction for dementia, including the media as the main source of information; (2) current prevention activities and motivation for risk reduction, including physical, social and cognitive activities and a healthy diet; and (3) motivation for prevention of dementia from a life-course perspective, including experience of health problems, desire to live independently and limited awareness of dementia risk factors in midlife. ConclusionsTo tailor information about the modifiable risk factors of dementia and develop preventive interventions, knowledge about motivating factors is essential. Promotion of healthy ageing is required in addition to addressing the fear of future illness and dependency.

Multidomain modifiable dementia risk factors are associated with poorer cognition in midlife.

Studies of modifiable dementia risk factors (MDRFs) generally consider MDRFs individually, despite strong evidence that they co-occur in adult populations. In a large sample of middle-aged adults, this study aimed to determine the frequency and co-occurrence of MDRFs, spanning five domains (mood symptomatology, risky lifestyle behaviors, cardiovascular conditions, cognitive/social engagement, sleep disorders/symptomatology). The relationship between number of domains in which MDRFs were reported with cognitive performance and subjective cognitive concerns was then determined. Middle-aged adults (n = 1,610) enrolled in the Healthy Brain Project and completed self-report surveys about their health and lifestyle. Participants also completed the Cogstate Brief Battery and the Cognitive Function Instrument, a measure of subjective ratings of cognition. Participants were classified according to number of domains (mood symptomatology, risky lifestyle behaviors, cardiovascular conditions, cognitive/social engagement, sleep disorders/symptomatology) in which they reported at least one MDRF (0-5). Age, sex, education, and ethnicity were adjusted for in analyses. Most individuals (66.5%) reported MDRFs in two or more domains. Compared with individuals displaying no MDRFs, individuals with MDRFs in 3-5 domains showed worse learning/working memory performance and greater subjective cognitive concerns, with the magnitude of these differences moderate-to-large (d = 0.30-0.93). Individuals displaying MDRFs in five domains also showed worse attention/psychomotor function (d = 0.58) compared to those displaying no MDRFs. These findings may suggest that multidomain MDRFs are highly frequent in middle-aged adults and are related to poorer cognition. This supports that modifiable dementia risk is multidimensional and raises the possibility that multidomain behavioral intervention trials in middle-aged adults may be useful to delay or prevent cognitive impairment or decline. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Functional social isolation mediates the association between depression and executive function in older women: findings from the Canadian Longitudinal Study on Aging Comprehensive cohort

ABSTRACT Depression and social isolation increase risk for executive function declines and are among the top five modifiable risk factors for dementia. However, the interrelationships between depression, social isolation and executive function are not well established. Further evidence is needed to inform strategies to promote executive function and independence in older age. We examined whether social isolation mediated the association between depression and executive function in community-dwelling middle-aged and older adults and whether this association was modified by age and sex. Adults aged 45 to 85 years from the Canadian Longitudinal Study on Aging (CLSA) Comprehensive cohort were followed over three years (complete case analysis, n = 14,133). Baseline depressive symptoms, a history of clinical depression, and functional social isolation (perceived lack of social support) were self-reported. Executive function at follow-up was a composite measure of five cognitive tests. Conditional process analysis assessed the mediating effects of functional social isolation across age group and sex, adjusted for sociodemographic and health covariates. Functional social isolation significantly mediated the association of depressive symptoms (proportion mediated [P M ] = 8.0%) or clinical depression (P M = 17.5%) with executive function only among women aged 75+ years. Functional social isolation explains a proportion of the total effect of depressive symptoms or clinical depression on executive function in women aged 75 and older. Although reverse causation cannot be ruled out, our findings suggest that interventions that reduce functional social isolation or depression in older women may promote executive function.

Gender differences in modifiable dementia risk factors in monolingual and bilingual Australian adults.

Gender and bilingualism are reported to influence the risk of dementia. This study examined the prevalence of self-reported modifiable dementia risk factors by gender in two samples: one that speaks at least one language other than English (LoE) and one that speaks only English. A descriptive cross-sectional study was conducted on a sample of Australian residents aged 50 years or over (n = 4339). Participant characteristics and dementia risk behaviours were inspected using descriptive statistics in data collected via online surveys between October 2020 and November 2021. In both samples, men had a higher rate than women of being overweight and were classified more frequently as being at risk of dementia due to alcohol consumption, lower cognitive activity, and non-adherence to the Mediterranean-style diet. Men reported better management of their cardiometabolic health than women across both groups. Non-significant trends showed men were more often smokers but more physically active than women in the LoE group, and less often smokers but less physically active than women in the English-only group. This study found men and women reported similar patterns of dementia risk behaviours regardless of LoE or English-only status. SO WHAT?: Gender differences in risk behaviours prevail regardless of language-speaking status. The results can be used to guide future research aiming to understand and reduce modifiable dementia risk in Australia and beyond.

Have We Been Underestimating Modifiable Dementia Risk? An Alternative Approach for Calculating the Combined Population Attributable Fraction for Modifiable Dementia Risk Factors.

Estimating the fraction of dementia cases in a population attributable to a risk factor or combination of risk factors (the population attributable fraction (PAF)) informs the design and choice of dementia risk-reduction activities. It is directly relevant to dementia prevention policy and practice. Current methods employed widely in the dementia literature to combine PAFs for multiple dementia risk factors assume a multiplicative relationship between factors and rely on subjective criteria to develop weightings for risk factors. In this paper we present an alternative approach to calculating the PAF based on sums of individual risk. It incorporates individual risk factor interrelationships and enables a range of assumptions about the way in which multiple risk factors will combine to affect dementia risk. Applying this method to global data demonstrates that the previous estimate of 40% is potentially too conservative an estimate of modifiable dementia risk and would necessitate subadditive interaction between risk factors. We calculate a plausible conservative estimate of 55.7% (95% confidence interval: 55.2, 56.1) based on additive risk factor interaction.

Retinal Functional and Structural Neural Indices: Potential Biomarkers for the Monitoring of Cerebral Neurodegeneration: The Maastricht Study.

If retinal indices of neurodegeneration are to be biomarkers for the monitoring of cerebral neurodegeneration, it is important to establish whether potentially modifiable risk factors for dementia are associated with retinal neurodegenerative changes. To study associations of dementia risk factors with retinal sensitivity, an index of retinal neural function, and retinal nerve fiber layer (RNFL) thickness, an index of retinal neural structure. We used cross-sectional data from The Maastricht Study (up to 5,666 participants, 50.5% men, mean age 59.7), and investigated associations with regression analyses (adjusted for potential confounders). Most risk factors under study (i.e., hyperglycemia, unhealthy diet, lower cardiorespiratory fitness, smoking, alcohol consumption, and hypertension) were significantly associated with lower retinal sensitivity and lower RNFL thickness. Findings of this population-based study support the concept that retinal neural indices may be biomarkers for the monitoring of therapeutic strategies that aim to prevent early-stage cerebral neurodegeneration and, ultimately, dementia.

Adult mice with noise-induced hearing loss exhibited temporal ordering memory deficits accompanied by microglia-associated neuroplastic changes in the medial prefrontal cortex

Acquired peripheral hearing loss in midlife is considered the primary modifiable risk factor for dementia, while the underlying pathological mechanism remains poorly understood. Excessive noise exposure is the most common cause of acquired peripheral hearing loss in modern society. This study was designed to investigate the impact of noise-induced hearing loss (NIHL) on cognition, with a focus on the medial prefrontal cortex (mPFC), a brain region that is involved in both auditory and cognitive processes and is highly affected in patients with cognitive impairment. Adult C57BL/6 J mice were randomly assigned to a control group and seven noise groups: 0HPN, 12HPN, 1DPN, 3DPN, 7DPN, 14DPN, and 28DPN, which were exposed to broadband noise at a 123 dB sound pressure level (SPL) for 2 h and sacrificed immediately (0 h), 12 h, or 1, 3, 7, 14, or 28 days post-noise exposure (HPN, DPN), respectively. Hearing assessment, behavioral tests, and neuromorphological studies in the mPFC were performed in control and 28DPN mice. All experimental animals were included in the time-course analysis of serum corticosterone (CORT) levels and mPFC microglial morphology. The results illustrated that noise exposure induced early-onset transient serum CORT elevation and permanent moderate-to-severe hearing loss in mice. 28DPN mice, in which permanent NIHL has been verified, exhibited impaired performance in temporal order object recognition tasks concomitant with reduced structural complexity of mPFC pyramidal neurons. The time-course immunohistochemical analysis in the mPFC revealed significantly higher morphological microglial activation at 14 and 28 DPN, preceded by a remarkably higher amount of microglial engulfed postsynaptic marker PSD95 at 7 DPN. Additionally, lipid accumulation in microglia was observed in 7DPN, 14DPN and 28DPN mice, suggesting a driving role of lipid handling deficits following excessive phagocytosis of synaptic elements in delayed and sustained microglial abnormalities. These findings provide fundamentally novel information concerning mPFC-related cognitive impairment in mice with NIHL and empirical evidence suggesting the involvement of microglial malfunction in the mPFC neurodegenerative consequences of NIHL.

PROTECT Norge: Online assessment of potentially modifiable risk factors for dementia on cognitive performance in a Norwegian ageing cohort

AbstractBackgroundPROTECT Norge, a fully digital platform, aims to help determine the role of defined genetic, lifestyle and environmental factors on cognition, health and wellbeing in people 50+. Annual questionnaires on demographics, medical conditions and medication use, mental health and lifestyle are completed online. The current study aims to assess whether potentially modifiable risk factors for dementia as presented by the Lancet Commission by Livingston and colleagues (2020) are related to cognitive performance in cognitively healthy people aged 50 and above.MethodA total of 2349 participants completed the PROTECT Cognitive Test System, an online cognitive battery containing six tasks which assess visual episodic memory, spatial and working memory, verbal reasoning, visual attention and task switching. The following risk factors were included in our analysis: physical activity, alcohol use, smoking, social isolation, age, BMI, education, depression, high blood pressure, head trauma and hearing loss. Multiple hierarchical regression analysis was performed. Separate analyses were conducted with the average performance across three sessions for each of the six cognitive measures as the dependent variable. Independent variables were included into the model in a hierarchy based on known risk factors for dementia.ResultResults show that age was associated with reduced cognitive performance for all tasks (p<0.001). In addition, for the digit span test, the risk factors were found to influence the test score were: smoking and previously diagnosed stroke. For the paired associate learning task, the only additional significant risk factor appeared to be gender, with male gender associated with poorer performance. For the grammatical reasoning task, the risk factors associated with lower scores were lower education, older age and smoking. For the switching Stroop test, the risk factors of lower scores were older age, smoking and previously diagnosed depression. For Trail‐making B test, the risk factors of lower scores were age, stroke and the history of heart disease.ConclusionThese preliminary results may improve our understanding of potentially modifiable risk factors for dementia and could inform the design and delivery of interventional trials as a mean to protect cognition in later life and to prevent or slow progression of cognitive decline.

Why should we discuss gender inequalities in Latin America and their effects in later life?

AbstractBackgroundHigh inequalities in Latin America (LA) affect social groups differently, with women being disadvantaged in many domains. Further, dementia prevalence is higher and with earlier onset in LA, especially among women, after accounting for women’s longer life expectancy. This narrative review discusses the modifiable risk factors of dementia established by previous studies and postulates further harmful, often hidden, factors experienced by women that might influence gender‐specific time of onset and general prevalence of dementia.MethodWe searched databases for qualitative and quantitative articles systematising dementia‐associated factors between genders/sexes in LA.ResultWe review hidden modifiable risk factors for late‐life cognitive impairment that should be integrated into future research. In doing this, we point out pervasive gender roles around education, labour market participation, but also the distribution of resources within families and across generations. Gender roles affect family structure living conditions during childhood and extend their influence over the life course. Other stressors strongly correlated with established modifiable risk factors or intrinsically relevant to dementia risk seem to be commonplace in women’s lives in LA, such as food insecurity, overweight/obesity, violence, and limited career opportunities.ConclusionBased on the evidence of gender inequalities in many domains to the disadvantage of women in LA, there is a need to consider unexplored risk factors since they could perpetuate burden of dementia among women disproportionately. Moreover, bringing hidden risk factors to open discussion can encourage and promote public policies to decrease gender inequalities and protect women’s health and well‐being.

Cognitive function and hearing loss: A longitudinal investigation of the effect of hearing aid use on cognitive performance in older adults

AbstractBackgroundHearing loss is highly prevalent in older adults and has been identified as the largest single potentially modifiable risk factor for dementia. Although hearing aids are a successful treatment for hearing loss, it is unknown whether their use can delay the onset of cognitive decline or improve cognitive function. Less than 20% of adults who would benefit from hearing aids actually using them. Results at 18‐ and 36‐months post‐hearing aid fitting in this prospective Australian longitudinal study will be presented.MethodParticipants were assessed before and every 18 months after hearing aid fitting. Results were compared with those of a control group of participants of a cohort study of aging in older adults (AIBL) and also with a large normative group using the cognitive assessment tool. Assessments included cognitive function (visually presented computerized assessment battery), hearing, speech perception, quality of life, activity, diet, loneliness and isolation, anxiety, depression, medical health, and genetic riskResultAfter 18 months of hearing aid use there was no significant cognitive decline for hearing aid participants, and group mean scores for executive function significantly improved, with stability or improvement for 92%. Comparative group results showed no improvement at 18 months. At 36‐month follow‐up, after almost 18 months of repeated COVID lockdowns, hearing aid use had decreased, and loneliness had increased. The previously observed improvement in executive function was no longer evident, but performance on 4/5 subtests remained stable.ConclusionThis is the first study to follow participants for this length of time. After 36 months of hearing aid use, most participants had remained stable, and a subset had improved cognitive function. These results suggest that hearing aid use may not only delay cognitive decline but could improve cognitive function. This study will continue to investigate whether cognitive function could continue to improve for some participants, and the longer‐term trajectory of effects of hearing aid use.

Does informing people about modifiable dementia risk factors lead to improved behavioral risk profiles?

AbstractBackgroundThe Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) is a large, online, prospective public health cohort study with nested interventions targeting modifiable dementia risk. The objective of ISLAND is to investigate the effectiveness of public health strategies aimed at increasing knowledge about behavioral and lifestyle factors associated with dementia, and to encourage behavior change to reduce future risk profiles at individual and population level.MethodCommencing October 2019, Tasmanian residents aged 50 and over were invited via a rolling media campaign to join ISLAND. Online surveys administered at baseline were repeated annually to enable tracking of changes in physical and mental health, social functioning, dementia risk knowledge, motivations and behaviors. After each survey wave, participants were provided a personal Dementia Risk Profile (DRP), a traffic‐light style report of their own risk level against nine domains, together with WHO recommendations for achieving ‘low risk’ status. For analyses, the DRP provides individual domain scores and a cumulative risk score, computed by summing domain scores (low = 0, medium = 0.5, high = 1). Newsletters and study information included prompts for participants to join the PD‐MOOC, a free, 4‐week online course about preventing dementia, which runs three times each year.ResultParticipants who provided full data at baseline and the October 2021 annual surveys (n = 2,935) reported a significant and moderate‐sized reduction in their cumulative DRP scores (βs = ‐.36 [95%CI ‐.40, ‐.31]. Within this sample, the participants who engaged with the PD‐MOOC (1,208, 42%) reported a small additional independent benefit (βs = ‐.08 [95%CI‐.11, ‐.05]). General knowledge about dementia risk reduction increased across all respondents (βs = .11 [95%CI .06, .15]) and amongst PD‐MOOC participants, the effect was stronger (βs = .61 [95%CI .53, .70]). The results of mediation models testing the role of knowledge and motivations in observed DRP changes will be presented.ConclusionThese preliminary findings support the core hypothesis of ISLAND, that increasing knowledge about modifiable dementia risk factors is associated with action‐taking to change key risk behaviors. Future work will link dementia‐risk knowledge and behavioral patterns over time with cognitive and blood‐based markers of neurodegeneration, to understand the long‐term effects of this online public health project.

Modifiable dementia risk factors are associated with greater subjective cognitive concerns but not perceived susceptibility to dementia in late middle‐aged adults: Baseline characteristics of the BetterBrains Trial

AbstractBackgroundA range of lifestyle factors in midlife can increase risk for developing dementia in late‐life.1 However, it remains unclear whether the presence of such risk factors (RFs) is associated with individuals’ insight into their risk of developing dementia. In a group of middle‐aged adults with a family history of dementia enrolled in a lifestyle prevention trial, we measured associations between modifiable RF prevalence, subjective cognitive concerns, and perceived susceptibility to dementia.MethodParticipants (n = 456) enrolled in BetterBrains (betterbrains.org.au)2 completed a comprehensive self‐report RF assessment at baseline. Modifiable dementia risk was determined across four domains (vascular health, social/cognitive engagement, mood, sleep) and trial eligibility required risk in at least one domain. Participants were grouped according to the number of domains in which they reported high‐risk (ranging from 1‐4). Participants completed the Cognitive Function Instrument, and a brief questionnaire to assess perceived susceptibility to dementia (Motivation to Change Lifestyle/Health Behaviours for Dementia Risk Reduction scale). Linear regressions examined associations between modifiable RF prevalence, subjective cognition, and perceived susceptibility to dementia, adjusting for age, sex, education, negative beliefs about ageing, and beliefs about protective health behaviours on dementia risk.ResultParticipants were mostly female (80%), with an average age of 59.4 years and 15.2 years of education. Of the sample, 29.6% reported risk in all domains (29.6%) and 16.9% in three domains. Risk in a higher number of RF domains was significantly associated with greater subjective cognitive concerns (β(SE) = 0.18(0.06), p = <.001), but not with greater perceived susceptibility to developing dementia (β(SE) = 0.62(0.35), p = .08). Increasingly negative beliefs about ageing and weaker beliefs in the protective effect of health behaviours were the only significant predictors of perceived susceptibility to dementia (both p’s <.05).ConclusionIn middle‐aged adults, dementia RFs are associated with greater subjective cognitive concerns, but not with an increased perception of susceptibility to dementia. Incongruence between participants’ self‐report of subjective cognitive concerns and susceptibility to dementia may be due in part to poor knowledge on modifiable dementia RFs.3 Perceptions of personal susceptibility to dementia may also be tied more closely to negative ageing stereotypes typically associated with older age and family history of disease.

Vision impairment in a life course model of potentially modifiable dementia risk factors

AbstractBackgroundThere is considerable evidence that vision impairment and blindness are a risk factor for accelerated cognitive decline and incident dementia. Additionally, up to 90% of vision impairment is preventable or has yet to be treated. Nonetheless, vision impairment has not been included in prevailing life‐course models of dementia risk factors used to shape public health policy and research priorities.MethodWe calculated the population attributable fraction (PAF) of dementia for vision impairment and other potentially modifiable dementia risk factors. The relative risk of dementia was derived from published meta‐analyses. Communalities and risk factor prevalence were calculated using cross‐sectional survey data from the 2018 Health and Retirement Study. Data on vision impairment were derived from the CDC’s Vision and Eye Health Surveillance System. All PAF values were weighted for communality (clustering of risk factors).ResultThe 12 risk factors in this model were associated with 59.8% of dementia cases in the U.S (Figure). Hypertension had the highest PAF (12.3%) among all risk factors. Vision impairment had a prevalence of 8.3% and a PAF of 1.8%, which suggests that >100,000 prevalent cases of dementia in the U.S. may have been prevented through healthy vision.ConclusionVision impairment contributes significantly to existing life‐course models of potentially modifiable dementia risk factors and has a magnitude similar to that of some other well accepted risk factors. A majority of vision impairment is modifiable, so this risk factor may represent an important target for future interventional research to prevent dementia.

A Closer Look at Hearing Loss, Dementia, and Stigma

A Closer Look at Hearing Loss, Dementia, and Stigma

Impact of the COVID-19 pandemic on some modifiable risk factors of dementia in an aging, rural Indian population.

The impact of the COVID-19 pandemic and associated lockdowns is likely to have caused adverse changes in lifestyle-related/cardiovascular risk factors and other such modifiable risk factors of dementia. We aimed to examine the pandemic's impact on some modifiable risk factors of dementia among rural Indians belonging to a large, prospective aging cohort-Srinivaspura Aging, NeuoSenescence, and COGnition (SANSCOG). This was a cross-sectional study among adults aged ≥ 45 years (n = 3,148; 1,492 males and 1,656 females) residing in the villages of Srinivaspura in Karnataka state, India. SANSCOG study data (clinical and biochemical assessments) of these participants were obtained from three distinct periods: (i) the "pre-COVID period"-before India's nationwide lockdown on 24 March 2020, (ii) the "COVID period"-during the first and second waves of the pandemic, wherein the social restrictions were prominent (25 March 2020 to 30 September 2021), and (iii) the "post-COVID period"-after easing of restrictions (from 1 October 2021 onward). Proportions of participants with diabetes, hypertension, obesity, dyslipidemia (diagnosed using standard criteria), and depression (diagnosed using the Geriatric Depression Scale) were compared between the above three periods. The odds of having obesity, abnormal triglycerides, and depression among individuals in the COVID period were 1.42 times, 1.38 times, and 2.65 times more than the odds in the pre-COVID period, respectively. The odds of having hypertension, obesity, abnormal total cholesterol, abnormal triglycerides, abnormal LDL, and depression among individuals in the post-COVID period were 1.27 times, 1.32 times, 1.58 times, 1.95, 1.23, and 3.05 times more than the odds in the pre-COVID period, respectively. The odds of diabetes did not differ between any of the three periods. We found significantly higher odds of some of the studied risk factors in the COVID and post-COVID periods compared to the pre-COVID period, suggesting that the pandemic adversely impacted the physical and psychological health of this marginalized, rural Indian population. We call for urgent public health measures, such as multimodal, lifestyle-based, and psychosocial interventions, to mitigate this negative impact and reduce the future risk of dementia.

Hearing Loss and Dementia: A Population-Based Cohort Study

Introduction: Hearing loss (HL) is considered a potentially modifiable risk factor for dementia. We aimed to examine the relationship between HL and incident dementia diagnosis in a province-wide population-based cohort study with matched controls. Methods: Administrative healthcare databases were linked to generate a cohort of patients who were aged ≥40 years at their first claimed hearing amplification devices (HAD) between April 2007 and March 2016 through the Assistive Devices Program (ADP) (257,285 with claims and 1,005,010 controls). The main outcome was incident dementia diagnosis, ascertained using validated algorithms. Dementia incidence was compared between cases and controls using Cox regression. Patient, disease, and other risk factors were examined. Results: Dementia incidence rates (per 1,000 person-years) were 19.51 (95% confidence interval [CI]: 19.26–19.77) and 14.15 (95% CI: 14.04–14.26) for the ADP claimants and matched controls, respectively. In adjusted analyses, risk of dementia was higher in ADP claimants compared with controls (hazard ratio [HR]: 1.10 [95% CI: 1.09–1.12, p < 0.001]). Subgroup analyses showed a dose-response gradient, with risk of dementia higher among patients with bilateral HADs (HR: 1.12 [95% CI: 1.10–1.14, p < 0.001]), and an exposure-response gradient, with increasing risk over time from April 2007-March 2010 (HR: 1.03 [95% CI: 1.01–1.06, p = 0.014]), April 2010-March 2013 (HR: 1.12 [95% CI: 1.09–1.15, p < 0.001]), and April 2013-March 2016 (HR: 1.19 [95% CI: 1.16–1.23, p < 0.001]). Conclusion: In this population-based study, adults with HL had an increased risk of being diagnosed with dementia. Given the implications of HL on dementia risk, understanding the effect of hearing interventions merits further investigation.

Managing comorbid cognitive impairment and hearing loss in older adults: a UK survey of audiology and memory services.

midlife hearing loss is a potentially modifiable risk factor for dementia. Addressing comorbid hearing loss and cognitive impairment in services for older adults may offer opportunities to reduce dementia risk. to explore current practice and views amongst UK professionals regarding hearing assessment and care in memory clinics and cognitive assessment and care in hearing aid clinics. national survey study. Between July 2021 and March 2022, we distributed the online survey link via email and via QR codes at conferences to professionals working in National Health Service (NHS) memory services and audiologists working in NHS and private adult audiology services. We present descriptive statistics. 135 professionals working in NHS memory services and 156 audiologists (68% NHS, 32% private sector) responded. Of those working in memory services, 79% estimate that >25% of their patients have significant hearing difficulties; 98% think it useful to ask about hearing difficulties and 91% do so; 56% think it useful to perform a hearing test in clinic but only 4% do so. Of audiologists, 36% estimate that >25% of their older adult patients have significant memory problems; 90% think it useful to perform cognitive assessments, but only 4% do so. Main barriers cited are lack of training, time and resources. although professionals working in memory and audiology services felt addressing this comorbidity would be useful, current practice varies and does not generally address it. These results inform future research into operational solutions to integrating memory and audiology services.

Cataract, Cataract Surgery, and Risk of Incident Dementia: A Prospective Cohort Study of 300,823 Participants

BackgroundVisual impairment and interventions to preserve vision may impact dementia risk. Thus, we aimed to explore the associations of cataract and cataract surgery with the risk of dementia. MethodsProspective data from 300,823 individuals in the UK Biobank were used. We used multivariate Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals for associations, with healthy control subjects as a reference. The same method was used to explore the effects of surgery on dementia outcomes of patients with cataract. One-way analysis of variance was performed to examine the associations between cataract and brain morphometric measures. ResultsAfter a mean follow-up of 8.4 years, 3226 individuals were diagnosed with dementia. The nonsurgical cataract group had increased risk of all-cause dementia (HR, 1.214; 95% CI, 1.012–1.456; p = .037) and Alzheimer’s disease (HR, 1.479; 95% CI, 1.105–1.981; p = .009). However, there was no difference in dementia risk between the cataract surgery group and the healthy control group. Cataract surgery was associated with decreased risk of all-cause dementia (HR, 0.632; 95% CI, 0.421–0.947; p = .026) and Alzheimer’s disease (HR, 0.399; 95% CI, 0.196–0.812; p = .011) compared with the nonsurgical group. Additionally, cataract was negatively associated with cortical volumes, aging-related subcortical volumes, and fractional anisotropy of white matter fibers. ConclusionsCataract patients who did not receive surgical treatment had an increased risk of dementia. However, cataract surgery could reverse the risk of dementia. Our findings on brain structures and pathways in patients with cataract also provided evidence for the mechanism. Reversible visual impairment, such as cataract, is a promising modifiable risk factor for dementia.