Hearing loss has been related to impaired cognition among older adults. The cost effectiveness of existing hearing support tools is controversial. Other potential modifying strategies that could effectively intervene in this prevalent and far-reaching association between hearing loss and cognitive decline remain unclear. This study aimed to narratively and quantitatively synthesize the mediators and moderators involved in the link between hearing loss and cognitive impairment from a psycho-social and physical point of view.
Method
We searched 6 databases for articles exploring mediating or moderating associations of hearing loss-cognition association from inception to March, 2024. Data were synthesized narratively and quantitatively by meta-analytic approaches.
Results
The search yielded 63 included studies. Social (social engagement, social support, age, sex, ethnicity, cognitive reserve)-psycho (depression, anxiety, loneliness, resilience)-physical (cardiovascular diseases and risk factors, perceived health, disability, APOE carrier, vision impairment, gait speed) variables mediated or moderated the relationship between hearing loss and cognitive impairment to varying degrees. Subgroup analyses identified susceptible populations at greater risk for cognitive decline, including women, younger elders with hearing loss, and older adults with dual sensory loss.
Conclusion
Combined interventions targeting these modifiable variables across psycho-social and physical dimensions may be more cost-effective for intervening in the ensemble of hearing loss-cognitive impairment in older adults.
BoothRGDasguptaMForchukCShariffSZ. Prevalence of dementia among people experiencing homelessness in Ontario, Canada: a population-based comparative analysis. Lancet Public Health. 2024;9(4):e240-e249. doi:10.1016/s2468-2667(24)00022-7
2.
BrookmeyerRJohnsonEZiegler-GrahamKArrighiHM. Forecasting the global burden of Alzheimer's disease. Alzheimers Dement. 2007;3(3):186-191. doi:10.1016/j.jalz.2007.04.381
LivingstonGSommerladAOrgetaV, et al.Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673-2734. doi:10.1016/s0140-6736(17)31363-6
6.
SardoneRSborgiaGNiroA, et al.Retinal vascular density on optical coherence tomography angiography and age-related central and peripheral hearing loss in a southern Italian older population. J Gerontol A Biol Sci Med Sci. 2021;76(12):2169-2177. doi:10.1093/gerona/glaa269
7.
StickelAMMendozaATarrafW, et al.Hearing loss and associated 7-year cognitive outcomes among hispanic and latino adults. JAMA Otolaryngol Head Neck Surg. 2024;150:385-392. doi:10.1001/jamaoto.2024.0184
8.
FuXEikelboomRHTianRLiuBWangSJayakodyDMP. The relationship of age-related hearing loss with cognitive decline and dementia in a sinitic language-speaking adult population: a systematic review and meta-analysis. Innov Aging. 2023;7(1):igac078. doi:10.1093/geroni/igac078
9.
LiangZLiAXuYQianXGaoX. Hearing loss and dementia: a meta-analysis of prospective cohort studies. Front Aging Neurosci. 2021;13:695117. doi:10.3389/fnagi.2021.695117
10.
LoughreyDGKellyMEKelleyGABrennanSLawlorBA. Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2018;144(2):115-126. doi:10.1001/jamaoto.2017.2513
11.
GomanAMLinFR. Prevalence of hearing loss by severity in the United States. Am J Public Health. 2016;106(10):1820-1822. doi:10.2105/ajph.2016.303299
12.
BisgaardNZimmerSLaureynsMGrothJ. A model for estimating hearing aid coverage world-wide using historical data on hearing aid sales. Int J Audiol. 2022;61(10):841-849. doi:10.1080/14992027.2021.1962551
13.
HooperEBrownLJECrossHDawesPLeroiIArmitageCJ. Systematic review of factors associated with hearing aid use in people living in the community with dementia and age-related hearing loss. J Am Med Dir Assoc. 2022;23(10):1669-1675.e16. doi:10.1016/j.jamda.2022.07.011
14.
Committee on, A, Affordable Hearing Health Care for, A, Board on Health Sciences, P, Health, Medicine, D, National Academies of Sciences, E, Medicine. The national academies collection: reports funded by national institutes of health. In: BlazerDGDomnitzSLivermanCT, eds. Hearing Health Care for Adults: Priorities for Improving Access and Affordability. Washington: National Academies Press (US) Copyright 2016 by the National Academy of Sciences. All rights reserved; 2016. doi:10.17226/23446
15.
LivingstonGCostafredaSG. Interventions to prevent dementia should target those at high risk. Lancet. 2023;402(10404):750-751. doi:10.1016/s0140-6736(23)01472-1
16.
FitzhughMCPaJ. Women with hearing loss show increased dementia risk and brain atrophy. Alzheimers Dement (Amst). 2023;15(4):e12499. doi:10.1002/dad2.12499
17.
CaoXLiuQLiuJYangBZhouJ. The impact of hearing loss on cognitive impairment: the mediating role of depressive symptoms and the moderating role of social relationships. Front Public Health. 2023;11:1149769. doi:10.3389/fpubh.2023.1149769
18.
MatthewsKDawesPElliotRMaharaniAPendletonNTampubolonG. What explains the link between hearing and vision impairment and cognitive function? Analysis of mediating effects in the USA, England and Ireland. Int J Geriatr Psychiatry. 2024;39(9):e6149. doi:10.1002/gps.6149
19.
JiangDHouJNanH, et al.Relationship between hearing impairment and dementia and cognitive function: a Mendelian randomization study. Alzheimers Res Ther. 2024;16(1):215. doi:10.1186/s13195-024-01586-6
20.
ShamseerLMoherDClarkeM, et al.Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350:g7647. doi:10.1136/bmj.g7647
21.
BookerSQMelilloKDBoltzMHorgasALHarrisMMcDermott-LevyR. Foresight and forecast: the future of gerontological nursing for the next 50 years. J Gerontol Nurs. 2024;50(12):31-40. doi:10.3928/00989134-20241118-04
22.
Wells GaSBO'ConnellDPetersonJWelchVTugwellP. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses In: 3rd Symposium on systematic reviews: beyond the basics, Oxford, UK, July 3-5, 2000.
23.
CheungMW. Synthesizing indirect effects in mediation models with meta-analytic methods. Alcohol Alcohol. 2022;57(1):5-15. doi:10.1093/alcalc/agab044
24.
CaoXYangBZhouJ. Hearing loss and subjective well-being among older adults: mediating effect of social activity and cognitive function. Clin Gerontol. 2023;47(4):1-12. doi:10.1080/07317115.2023.2240337
25.
ChenL. Leisure activities and psychological wellbeing reduce the risk of cognitive impairment among older adults with hearing difficulty: a longitudinal study in China. Maturitas. 2021;148:7-13. doi:10.1016/j.maturitas.2021.03.011
26.
DawesPEmsleyRCruickshanksKJ, et al.Hearing loss and cognition: the role of hearing AIDS, social isolation and depression. PLoS One. 2015;10(3):e0119616. doi:10.1371/journal.pone.0119616
27.
MaharaniAPendletonNLeroiI. Hearing impairment, loneliness, social isolation, and cognitive function: longitudinal analysis using English longitudinal study on ageing. Am J Geriatr Psychiatry. 2019;27(12):1348-1356. doi:10.1016/j.jagp.2019.07.010
28.
StevensonJSCliftonLKuźmaELittlejohnsTJ. Speech-in-noise hearing impairment is associated with an increased risk of incident dementia in 82,039 UK biobank participants. Alzheimers Dement. 2022;18(3):445-456. doi:10.1002/alz.12416
29.
WuFZhouC. Hearing impairment and cognitive function: mediating role of social isolation and depression. Am J Alzheimers Dis Other Demen. 2024;39:15333175241227318. doi:10.1177/15333175241227318
30.
YorgasonJBTannerCTRichardsonS, et al.The longitudinal association of late-life visual and hearing difficulty and cognitive function: the role of social isolation. J Aging Health. 2022;34(6-8):765-774. doi:10.1177/08982643211063338
31.
ZhaoIYParialLLMontayreJ, et al.Social engagement and depressive symptoms mediate the relationship between age-related hearing loss and cognitive status. Int J Geriatr Psychiatry. 2023;38(8):e5982. doi:10.1002/gps.5982
32.
BrewsterKKHuMCZilcha-ManoS, et al.Age-related hearing loss, late-life depression, and risk for incident dementia in older adults. J Gerontol A Biol Sci Med Sci. 2021;76(5):827-834. doi:10.1093/gerona/glaa242
33.
GeSPanWWuBPlassmanBLDongXMcConnellES. Sensory impairment and cognitive decline among older adults: an analysis of mediation and moderation effects of loneliness. Front Neurosci. 2022;16:1092297. doi:10.3389/fnins.2022.1092297
34.
LiuYXuYYangXMiaoGWuYYangS. Sensory impairment and cognitive function among older adults in China: the mediating roles of anxiety and depressive symptoms. Int J Geriatr Psychiatry. 2023;38(1):e5866. doi:10.1002/gps.5866
35.
BazarganMBakerRSBazarganSH. Sensory impairments and subjective well-being among aged African American persons. J Gerontol B Psychol Sci Soc Sci. 2001;56(5):P268-P278. doi:10.1093/geronb/56.5.p268
36.
FritzeTTeipelSÓváriAKilimannIWittGDoblhammerG. Hearing impairment affects dementia incidence. An analysis based on longitudinal health claims data in Germany. PLoS One. 2016;11(7):e0156876. doi:10.1371/journal.pone.0156876
37.
KolliAZhouYChungGWareEBLangaKMEhrlichJR. Interactions between the apolipoprotein E4 gene and modifiable risk factors for cognitive impairment: a nationally representative panel study. BMC Geriatr. 2022;22(1):938. doi:10.1186/s12877-022-03652-w
38.
OkelyJAAkeroydMAAllerhandMStarrJMDearyIJ. Longitudinal associations between hearing loss and general cognitive ability: the Lothian birth cohort 1936. Psychol Aging. 2019;34(6):766-779. doi:10.1037/pag0000385
39.
PhillipsNAIslerLKabirR, et al.Hearing and visual acuity predict cognitive function in adults aged 45-85 years: findings from the baseline wave of the Canadian longitudinal study on aging (CLSA). Psychol Aging. 2022;37(8):891-912. doi:10.1037/pag0000716
40.
StickelAMTarrafWBainbridgeKE, et al.Hearing sensitivity, cardiovascular risk, and neurocognitive function: the hispanic community health study/study of latinos (HCHS/SOL). JAMA Otolaryngol Head Neck Surg. 2021;147(4):377-387. doi:10.1001/jamaoto.2020.4835
41.
RayJPopliGFellG. Association of cognition and age-related hearing impairment in the English longitudinal study of ageing. JAMA Otolaryngol Head Neck Surg. 2018;144(10):876-882. doi:10.1001/jamaoto.2018.1656
42.
HämäläinenAPhillipsNWittichWPichora-FullerMKMickP. Sensory-cognitive associations are only weakly mediated or moderated by social factors in the Canadian longitudinal study on aging. Sci Rep. 2019;9(1):19660. doi:10.1038/s41598-019-55696-5
43.
ChenFChenYJiangX, et al.Impact of hearing loss on cognitive function in community-dwelling older adults: serial mediation of self-rated health and depressive anxiety symptoms. Front Aging Neurosci. 2023;15:1297622. doi:10.3389/fnagi.2023.1297622
44.
ChenL. Self-reported hearing difficulty increases 3-year risk of incident cognitive impairment: the role of leisure activities and psychological resilience. Int J Geriatr Psychiatry. 2021;36(8):1197-1203. doi:10.1002/gps.5511
45.
Al-YawerFPichora-FullerMKWittichW, et al.Sex-specific interactions between hearing and memory in older adults with mild cognitive impairment: findings from the COMPASS-ND study. Ear Hear. 2023;44(4):751-767. doi:10.1097/aud.0000000000001322
46.
LiuCMLeeCT. Association of hearing loss with dementia. JAMA Netw Open. 2019;2(7):e198112. doi:10.1001/jamanetworkopen.2019.8112
47.
ParadaHLaughlinGAYangMNedjat-HaiemFRMcEvoyLK. Dual impairments in visual and hearing acuity and age-related cognitive decline in older adults from the Rancho Bernardo study of healthy aging. Age Ageing. 2021;50(4):1268-1276. doi:10.1093/ageing/afaa285
48.
GolubJSBrickmanAMCiarleglioAJSchupfNLuchsingerJA. Audiometric age-related hearing loss and cognition in the hispanic community health study. J Gerontol A Biol Sci Med Sci. 2020;75(3):552-560. doi:10.1093/gerona/glz119
49.
ChenLLuB. Cognitive reserve regulates the association between hearing difficulties and incident cognitive impairment evidence from a longitudinal study in China. Int Psychogeriatr. 2020;32(5):635-643. doi:10.1017/s1041610219001662
50.
AlattarAABergstromJLaughlinGA, et al.Hearing impairment and cognitive decline in older, community-dwelling adults. J Gerontol A Biol Sci Med Sci. 2020;75(3):567-573. doi:10.1093/gerona/glz035
51.
SarantJZBusbyPASchembriAJFowlerCHarrisDC. ENHANCE: a comparative prospective longitudinal study of cognitive outcomes after 3 years of hearing aid use in older adults. Front Aging Neurosci. 2023;15:1302185. doi:10.3389/fnagi.2023.1302185
52.
HanTDTNakamuraKSeinoKDucVNHVoTV. Do communication patterns affect the association between cognitive impairment and hearing loss among older adults in Vietnam?Int J Environ Res Public Health. 2021;18(4):1603. doi:10.3390/ijerph18041603
53.
SunJLiHJinLLuoH. Does hearing impairment affect mental health among Chinese older adults? Evidence from the Chinese longitudinal healthy longevity survey. Risk Manag Healthc Policy. 2021;14:629-641. doi:10.2147/rmhp.S299180
54.
CheungESLZhangZ. Moderating role of neighborhood environment in the associations between hearing loss and cognitive challenges among older adults: evidence from US national study. Res Aging. 2024;46:400-413. doi:10.1177/01640275241234372
55.
PowellDSBrenowitzWDYaffeK, et al.Examining the combined estimated effects of hearing loss and depressive symptoms on risk of cognitive decline and incident dementia. J Gerontol B Psychol Sci Soc Sci. 2022;77(5):839-849. doi:10.1093/geronb/gbab194
56.
ScarinciNWaiteMNickbakhtM, et al.How do adults with hearing loss, family members, and hearing care professionals respond to the stigma of hearing loss and hearing aids?Int J Audiol. 2024;63:1-8. doi:10.1080/14992027.2024.2406885
57.
FieldhouseJLPvan EngelenMPEHandgraafD, et al.Trajectories of behavior and social cognition in behavioral variant frontotemporal dementia and primary psychiatric disorders: a call for better operationalization of socioemotional changes. Eur J Neurol. 2024;31(12):e16426. doi:10.1111/ene.16426
58.
ArjmandiMKNeils-StrunjasJNematiS, et al.Age-related hearing loss, cognitive decline, and social interaction: testing a framework. J Speech Lang Hear Res. 2024;67(8):2743-2760. doi:10.1044/2024_jslhr-23-00810
59.
Hay-McCutcheonMJHyamsAYangXPartonJ. Hearing loss and social support in urban and rural communities. Int J Audiol. 2018;57(8):610-617. doi:10.1080/14992027.2018.1461262
60.
MoserSLuxenbergerWFreidlW. The influence of social support and coping on quality of life among elderly with age-related hearing loss. Am J Audiol. 2017;26(2):170-179. doi:10.1044/2017_aja-16-0083
61.
DongNZhangYMaXYinKLiuY. Carrying ostracism overnight: the cognitive mechanism underlying the effect of daily workplace ostracism on next-day work engagement. Stress Health. 2024;40(6):e3500. doi:10.1002/smi.3500
62.
WilliamsonTTZhuXPinerosJDingBFrisinaRD. Understanding hormone and hormone therapies' impact on the auditory system. J Neurosci Res. 2020;98(9):1721-1730. doi:10.1002/jnr.24588
63.
ChengMSommetNJoppDSSpiniD. Income-related inequalities in physical and cognitive health domains over the later life course: longitudinal evidence from the U.S. (1992-2016). Res Aging. 2024;46(1):59-71. doi:10.1177/01640275231183438
64.
WayneRVJohnsrudeIS. A review of causal mechanisms underlying the link between age-related hearing loss and cognitive decline. Ageing Res Rev. 2015;23(Pt B):154-166. doi:10.1016/j.arr.2015.06.002
FancourtDAughtersonHFinnSWalkerESteptoeA. How leisure activities affect health: a narrative review and multi-level theoretical framework of mechanisms of action. Lancet Psychiatry. 2021;8(4):329-339. doi:10.1016/s2215-0366(20)30384-9
67.
RafnssonSBMaharaniATampubolonG. Social contact mode and 15-year episodic memory trajectories in older adults with and without hearing loss: findings from the English longitudinal study of ageing. J Gerontol B Psychol Sci Soc Sci. 2022;77(1):10-17. doi:10.1093/geronb/gbab029
68.
NewASFanJMurroughJW, et al.A functional magnetic resonance imaging study of deliberate emotion regulation in resilience and posttraumatic stress disorder. Biol Psychiatry. 2009;66(7):656-664. doi:10.1016/j.biopsych.2009.05.020
69.
HirtJVetschJWeissenfelsIHeinrichS. Nurse-led physical activity interventions for people with dementia in nursing homes: a systematic review on intervention characteristics and implementation facilitators/barriers. Int J Nurs Stud. 2024;154:104756. doi:10.1016/j.ijnurstu.2024.104756
70.
WeiJLiKKimY, et al.Initiation of hearing aids use and incident dementia among mid-to-late life adults: the health and retirement study 2010-2018. J Geriatr Psychiatry Neurol. 2024;38(3):8919887241302107. doi:10.1177/08919887241302107
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