Dementia and hearing-aid use: a two-way street

Abstract

Objectives Hearing-aid use may reduce risk of dementia, but cognitive impairment makes use more challenging. An observed association between reduced hearing-aid use and incident dementia could reflect either or both of these causal paths. The objective was to examine the effects of each path while minimising contamination between paths. Methods Health records data from 380,794 Veterans who obtained hearing aids from the US Veterans Affairs healthcare system were analysed. Analysis 1 (n = 72,180) used multivariable logistic regression to model the likelihood of incident dementia 3.5–5 years post hearing-aid fitting for patients free of dementia and mild cognitive impairment (MCI). Analysis 2 (n = 272,748) modelled the likelihood of being a persistent hearing-aid user at 3 years 2 months after fitting, contrasting subgroups by level of cognitive function at the time of fitting. Analysis time windows were optimized relative to dataset constraints. Models were controlled for available relevant predictors. Results The adjusted OR for incident dementia was 0.73 (95% CI 0.66–0.81) for persistent (versus non-persistent) hearing-aid users. The adjusted OR for hearing-aid use persistence was 0.46 (95% CI 0.43–0.48) in those with pre-existing dementia (versus those remaining free of MCI and dementia). Conclusion Substantial independent associations are observed in both directions, suggesting that hearing-aid use decreases risk of dementia and that better cognitive function predisposes towards persistent use. Research studying protective effects of hearing-aid use against dementia needs to account for cognitive status. Clinically, hearing devices and hearing care processes must be accessible and usable for all, regardless of their cognitive status.

Interactive effects of hearing aid use and cognitive function in patients with hearing loss

“…Clinically and ethically, hearing devices and hearing care processes must be accessible and usable for all, regardless of cognitive status. Naylor et al reported that patients over 60 years of age with a pre‐existing dementia diagnosis prior to HA fitting had 54% reduced odds of persistent HA use compared to those who remained free of MCI and dementia throughout the study time window 28 . The identification of MCI due to AD, and thus the preclinical stage of AD, is becoming increasingly important to clarify the direction of early intervention and prevention.…”

Patient perceptions of cognitive screening in adult audiology services: A qualitative exploration

“…It remains an open question as to whether earlier intervention for hearing loss could help to prevent or delay cognitive impairment. There are encouraging signs in the literature ( 63 ), but there is a lack of prospective research to demonstrate such benefits. In any case, in order to be able to undertake such studies requires early identification of hearing problems.…”

Demenzprävention

“…Bereits subklinische Hörstörungen führen zu einer Verschlechterung der Kognition. Zudem konnte auch gezeigt werden, dass kognitive Störungen zu einer reduzierten Inanspruchnahme von Hörhilfen führen [21].…”