Hearing loss and cognitive decline in older adults

Frank R. Lin, Kristine Yaffe, Jin Xia, Qian Li Xue, Tamara B. Harris, Elizabeth Purchase-Helzner, Suzanne Satterfield, Hilsa N. Ayonayon, Luigi Ferrucci, Eleanor M. Simonsick

Research output: Contribution to journalArticlepeer-review


Background: Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown. Methods: We studied 1984 older adults (mean age, 77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, ≥ 80) who underwent audiometric testing in year 5. Participants were followed up for 6 years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and 11 and consisted of the 3MS (measuring global function) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was defined as a 3MS score of less than 80 or a decline in 3MS score of more than 5 points from baseline. Mixedeffects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors. Results: In total, 1162 individuals with baseline hearing loss (pure-tone average ≲γτ∀ 25 dB) had annual rates of decline in 3MS and Digit Symbol Substitution test scores that were 41% and 32% greater, respectively, than those among individuals with normal hearing. On the 3MS, the annual score changes were -0.65 (95% CI, -0.73 to -0.56) vs -0.46 (95% CI,-0.55 to-0.36) points per year (P=.004). On the Digit Symbol Substitution test, the annual score changes were-0.83 (95% CI,-0.94 to-0.73) vs-0.63 (95% CI,-0.75 to-0.51) points per year (P=.02). Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual's baseline hearing loss. Conclusions: Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. Further studies are needed to investigate what the mechanistic basis of this association is and whether hearing rehabilitative interventions could affect cognitive decline..

Original languageEnglish (US)
Pages (from-to)293-299
Number of pages7
JournalJAMA internal medicine
Issue number4
StatePublished - Feb 25 2013

ASJC Scopus subject areas

  • Internal Medicine


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