Hearing loss (HL) of moderate or higher grades is common in older adults with increasing prevalence as people age, rising from 12% at the age of 60 years to over 58% at 90 years. HL in midlife is one of the main potentially modifiable risk factors for dementia. It is estimated that 7% of dementia cases globally could be avoided if this risk factor was eliminated. However, much of the research conducted has been in high-income countries even though low- and middle-income countries have the highest prevalence of dementia.
Objective
To study the association between HL and cognitive decline during eight years of follow-up in a Brazilian sample.
Methods
Participants from the São Paulo center of the Brazilian Longitudinal Study of Adult Health were evaluated in three study waves (2008–10, 2012–14, and 2017–19). HL was defined as pure-tone audiometry above 25 dB in the better ear. Cognitive performance was evaluated with six tests related to memory, verbal fluency, and trail-making tests. A global cognitive z-score was derived from these tests. The association between HL and cognitive decline was evaluated with linear mixed-effects models adjusted for sociodemographic, lifestyle, and clinical factors.
Results
Of 805 participants (mean age 51 ± 9 years, 52% women, 60% White), 62 had HL. During follow-up, HL was associated with faster global cognitive decline (β = −0.012, 95% CI = −0.023; 0.000, p = 0.039).
Conclusions
HL was significantly associated with a faster rate of global cognitive decline after a median follow-up of eight years in a sample of middle-income country.
United Nations, Department of Economic and Social Affairs, Population Division. World population ageing 2015. New York: United Nations, 2015.
2.
World Health Organization. World report on hearing. Geneva: World Health Organization, 2021.
3.
World Health Organization. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization, 2018.
4.
LivingstonGHuntleyJLiuKY, et al.Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet2024; 404: 572–628.
5.
SuemotoCKMukadamNBruckiSMD, et al.Risk factors for dementia in Brazil: differences by region and race. Alzheimers Dement2023; 19: 1849–1857.
6.
CrollPHVinkeEJArmstrongNM, et al.Hearing loss and cognitive decline in the general population: a prospective cohort study. J Neurol2021; 268: 860–871.
7.
AlattarAABergstromJLaughlinGA, et al.Hearing impairment and cognitive decline in older, community-dwelling adults. J Gerontol A Biol Sci Med Sci2020; 75: 567–573.
8.
IraceALArmstrongNMDealJA, et al.Longitudinal associations of subclinical hearing loss with cognitive decline. J Gerontol A Biol Sci Med Sci2022; 77: 623–631.
9.
ArmstrongNMAnYFerrucciL, et al.Temporal sequence of hearing impairment and cognition in the Baltimore Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci2020; 75: 574–580.
10.
LongSBenoistCWeidnerW. World Alzheimer report 2023. Reducing dementia risk: never too early, never too late. London, UK: Alzheimer’s Disease International, 2023.
11.
PrinceMWimoAGuerchetM, et al.World Alzheimer report 2015. The global impact of dementia: An analysis of prevalence, incidence, cost and trends. London, UK: Alzheimer’s Disease International, 2015.
12.
CalandriILLivingstonGParadelaR, et al.Sex and socioeconomic disparities in dementia risk: a population-attributable fraction analysis in Argentina. Neuroepidemiology2024; 58: 264–275.
13.
ParkHYPhillipsDWilkensJ, et al.Care need, caregiver availability, and care receipt: variations across countries and over time in three middle-income countries. J Gerontol A Biol Sci Med Sci2024; 79: S59–S67.
14.
NitriniRBarbosaMTBruckiSMD, et al.Current trends and challenges on dementia management and research in Latin America. J Glob Health2020; 10: 010362.
15.
LiangZLiAXuY, et al.Hearing loss and dementia: a meta-analysis of prospective cohort studies. Front Aging Neurosci2021; 13: 695117.
16.
LiljasAEMWaltersKde OliveiraC, et al.Self-reported sensory impairments and changes in cognitive performance: a longitudinal 6-year follow-up study of english community-dwelling adults aged ⩾50 years. J Aging Health2020; 32: 243–251.
17.
RayJPopliGFellG. Association of cognition and age-related hearing impairment in the English Longitudinal Study of Ageing. JAMA Otolaryngol Head Neck Surg2018; 144: 876–882.
18.
MichalowskyBHoffmannWKostevK. Association between hearing and vision impairment and risk of dementia: results of a case-control study based on secondary data. Front Aging Neurosci2019; 11: 363.
19.
KielyKMGopinathBMitchellP, et al.Evaluating a dichotomized measure of self-reported hearing loss against gold standard audiometry: prevalence estimates and age bias in a pooled national data set. J Aging Health2012; 24: 439–458.
20.
ChoiJSBetzJDealJ, et al.A comparison of self-report and audiometric measures of hearing and their associations with functional outcomes in older adults. J Aging Health2016; 28: 890–910.
21.
TsimpidaDKontopantelisEAshcroftD, et al.Comparison of self-reported measures of hearing with an objective audiometric measure in adults in the English longitudinal study of ageing. JAMA Netw Open2020; 3: e2015009.
22.
ChernAIraceALSharmaRK, et al.The longitudinal association of subclinical hearing loss with cognition in the health, aging and body composition study. Front Aging Neurosci2022; 13: 789515.
23.
AquinoEMBarretoSMBensenorIM, et al.Brazilian Longitudinal Study of Adult Health (ELSA-Brasil): objectives and design. Am J Epidemiol2012; 175: 315–324.
24.
SchmidtMIDuncanBBMillJG, et al.Cohort profile: Longitudinal Study of Adult Health (ELSA-Brasil). Int J Epidemiol2015; 44: 68–75.
25.
SamelliAGSantosISMoreiraRR, et al.Diabetes mellitus and sensorineural hearing loss: is there an association? Baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Clinics (São Paulo)2017; 72: 5–10.
26.
van BuurenSGroothuis-OudshoornK. Mice: multivariate imputation by chained equations in R. J Stat Softw2011; 45: 1–67.
27.
World Health Organization. Report of the informal consultation on the economic analysis of sensory disabilities.Geneva: World Health Organization, 2000.
28.
SamelliAGSantosISDealJA, et al.Hearing loss and cognitive function: baseline findings from the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil. Ear Hear2022; 43: 1416–1425.
29.
BertolucciPHFOkamotoIHNetoJT, et al.Performance of Brazilian population in neuropsychological battery of consortium to establish a registry for Alzheimer’s disease. Rev Psiquiatr Clin1998; 25: 80–83.
30.
StraussEShermanESpreenO. A compendium of neuropsychological tests: administration, norms, and commentary. 3rd ed. Oxford: University Press, 2006.
31.
BertolaLBenseñorIMGrossAL, et al.Longitudinal measurement invariance of neuropsychological tests in a diverse sample from the ELSA-Brasil study. Braz J Psychiatry2021; 43: 254–261.
32.
GreenliefCLMargolisRBErkerGJ. Application of the trail making test in differentiating neuropsychological impairment of elderly persons. Percept Mot Skills1985; 61: 1283–1289.
33.
NunesMAAlvesMG de MChorD, et al.Adaptação transcultural do CIS-R (clinical interview schedule- revised version) para o português no Estudo Longitudinal De Saúde Do Adulto (ELSA). Rev HCPA2012; 31: 487–490.
34.
SjostromMAinsworthBaumanA, et al.Guidelines for data processing and analysis of the International physical activity questionnaire (IPAQ) - short and long forms. 2005.
35.
HernánMARobinsJM. Estimating causal effects from epidemiological data. J Epidemiol Community Health2006; 60: 578–586.
36.
DealJABetzJYaffeK, et al.Hearing impairment and incident dementia and cognitive decline in older adults: the health ABC study. J Gerontol A Biol Sci Med Sci2017; 72: 703–709.
37.
LinFRThorpeRGordon-SalantS, et al.Hearing loss prevalence and risk factors among older adults in the United States. J Gerontol A Biol Sci Med Sci2011; 66: 582–590.
38.
CruickshanksKJTweedTSWileyTL, et al.The 5-year incidence and progression of hearing loss: the epidemiology of hearing loss study. Arch Otolaryngol Head Neck Surg2003; 129: 1041–1046.
39.
WeiJHuYZhangL, et al.Hearing impairment, mild cognitive impairment, and dementia: a meta-analysis of cohort studies. Dement Geriatr Cogn Dis Extra2017; 7: 440–452.
40.
YuRCProctorDSoniJ, et al.Adult-onset hearing loss and incident cognitive impairment and dementia - A systematic review and meta-analysis of cohort studies. Ageing Res Rev2024; 98: 102346.
41.
CuocoSCappielloAScarpaA, et al.Neuropsychological profile of hearing-impaired patients and the effect of hearing aid on cognitive functions: an exploratory study. Sci Rep2021; 11: 9384.
42.
TranYTangDLoC, et al.Co-occurring hearing loss and cognitive decline in older adults: a dual group-based trajectory modeling approach. Front Aging Neurosci2021; 13: 794787.
43.
BucksRSDunlopPDTaljaardDS, et al.Hearing loss and cognition in the Busselton Baby Boomer cohort: an epidemiological study. Laryngoscope2016; 126: 2367–2375.
44.
VölterCGötzeLFalkensteinM, et al.Application of a computer-based neurocognitive assessment battery in the elderly with and without hearing loss. Clin Interv Aging2017; 12: 1681–1690.
45.
CampbellJSharmaA. Compensatory changes in cortical resource allocation in adults with hearing loss. Front Syst Neurosci2013; 7: 71.
46.
YeoBSYSongHJJMDTohEMS, et al.Association of hearing aids and cochlear implants with cognitive decline and dementia: a systematic review and meta-analysis. JAMA Neurol2023; 80: 134–141.
47.
AnSJoEJunSB, et al.Effects of cochlear implantation on cognitive decline in older adults: a systematic review and meta-analysis. Heliyon2023; 9: e19703.
48.
LinFRPikeJRAlbertMS, et al.Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet2023; 402: 786–797.
49.
GolubJSBrickmanAMCiarleglioAJ, et al.Association of subclinical hearing loss with cognitive performance. JAMA Otolaryngol Head Neck Surg2020; 146: 57–67.
50.
de OliveiraTLOliveiraRVGriepRH, et al.Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participant’s profile regarding self-rated health: a multiple correspondence analysis. BMC Public Health2021; 21: 1761.
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