Can Cochlear Implantation in Older Adults Reverse Cognitive Decline Due to Hearing Loss?

Abstract

Introduction: Older adults with late-onset hearing loss are at risk for cognitive decline. Our study addresses the question of whether cochlear implantation (CI) can counteract this potential influence. We investigated whether cognitive performance in older adults with severe and profound hearing loss improves 12 months after CI to a level comparable to controls with normal hearing, matched for age, sex, and education level.Design: This cohort study was performed at two tertiary referral centers. The study included 29 patients, of age between 60 and 80 years, with adult-onset, severe to profound bilateral sensorineural hearing loss and indication for CI (study group), as well as 29 volunteers with age-adjusted hearing abilities, according to the norm curves of ISO-702 9:2000-01, (control group). Before CI and 12 months after CI, participants completed a neurocognitive test battery including tests of global cognition, verbal and figural episodic memory, and executive functions (attentional control, inhibition, and cognitive flexibility).Results: Twelve months after CI, the performance of the study group improved significantly in global cognition, compared to the situation before CI. Differences in verbal episodic memory, figural episodic memory, and executive function were not significant. Moreover, the improvement of the study group was significantly larger only in global cognition compared to the control group. Noninferiority tests on the cognitive performances of the study group after CI revealed that comparable levels to normal hearing controls were reached only in global cognition, figural episodic memory (immediate recall), and attentional control. The improvement in global cognition was significantly associated with speech recognition 3 months after CI, but not with speech recognition 12 months after CI. Conclusion:One year after CI, cognitive deficits in older individuals with adult-onset hearing loss, compared to normal-hearing peers, could only improve some cognitive skills.

Cognition and Cognitive Reserve in Cochlear Implant Recipients

“…Zhan et al found only a correlation of sentence recognition in quiet after 6 months with the incompatible Stroop and the Symbol Span test, but not for the Digits or Object Span test ( Zhan et al, 2020 ). Huber et al reported a correlation of an improvement in the Clock Drawing test with monosyllabic and sentence recognition in quiet 3 months post-implantation, but not after 12 months ( Huber et al, 2021 ). Mosnier et al found no association between speech perception in quiet or in noise and in cognitive measures ( Mosnier et al, 2018 ).…”

“…But even in this high-quality study, the sample size was small and inhomogeneous and bias cannot be ruled out ( Mertens et al, 2021 ). Another approach was applied by Huber et al (2021) . Twenty-nine adult subjects aged 60–80 years scheduled for cochlear implantation and an age- and education-matched control group of normal-hearing subjects were enrolled in this study.…”

Cochlear Implantation in Hearing-Impaired Elderly: Clinical Challenges and Opportunities to Optimize Outcome

“…CI use could also contribute to working against the psychological and social deficits of these elderly people. Huber et al (2021) also describe that the group with hearing loss shows significantly more depressive problems but not more anxiety than their normal hearing peers in the control group. Population studies ( Gopinath et al, 2009 ; Li et al, 2014 ; Hsu et al, 2016 ) show that hearing loss in adulthood increases the likelihood of developing depressive problems and disorders.…”

“… Huber et al (2021) have studied the central question of whether cognitive changes following CI fitting are large enough to completely reverse cognitive decline due to hearing impairment, back to the levels comparable to normal-hearing participants. To do this, they compared data from participants in an age-matched normal-hearing control group of over 12 months in addition to the patient group with hearing loss.…”

“…In recent years, several prospective studies addressed the effects of CI fitting on cognitive function in elderly persons with hearing impairment (e.g., Mosnier et al, 2015;Castiglione et al, 2016;Cosetti et al, 2016;Ambert-Dahan et al, 2017;Jayakody et al, 2017;Sonnet et al, 2017;Claes et al, 2018;Völter et al, 2018;Sarant et al, 2019). The main findings in this regard are listed in the study of Huber et al (2021). Almost all studies, with the exception of the study by Sonnet et al (2017), report cognitive improvements after CI fitting.…”