Subclinical Hearing Loss is Associated With Depressive Symptoms.

OBJECTIVE: To assess whether the relationship between hearing and depressive symptoms is present among older adults classified as normal hearing (≤25 dB). DESIGN: Cross-sectional epidemiologic study (Hispanic Community Health Study). SETTING: US multicentered. PARTICIPANTS: Adults ≥50 years old (n = 5,499) with normal hearing or hearing loss (HL). MEASUREMENTS: The primary exposure was hearing, defined continuously by the 4-frequency pure-tone average threshold (dB) on audiometry. Hearing was additionally categorized into normal hearing (≤25 dB) and HL (>25 dB). The main outcome was depressive symptoms, measured with the Center for Epidemiologic Studies Depression Scale-10 (CESD-10). Depressive symptoms were defined both continuously and binarily (where CESD-10 ≥10 was categorized as clinically significant depressive symptoms). Multivariable linear, logistic, and generalized additive modeling (GAM) regressions were performed. RESULTS: Among those with normal hearing, the CESD-10 score increased by 1.04 points (95% confidence interval [CI]: 0.70, 1.37) for every 10 dB decrease in hearing, adjusting for age, gender, education, cardiovascular disease, and hearing aid use. Among those with HL, the CESD-10 score increased by 0.62 points (95% CI: 0.23, 1.01) for every 10 dB decrease in hearing, adjusting for the same confounders. Similar findings were noted when the outcome was clinically significant depressive symptoms (adjusted odds ratio: 1.28 [1.14, 1.44] in normal hearing versus 1.26 [1.11, 1.44] in HL). In certain sensitivity analyses, the relationship between hearing and depressive symptoms was significantly stronger among those with normal hearing than in those with HL. CONCLUSION: The relationship between hearing and clinically significant depressive symptoms is present among older adults with normal hearing (<25 dB). We introduce the term subclinical HL as imperfect hearing that is classically defined as normal (1-25 dB). The relationship between hearing and late life depressive symptoms may be more sensitive than previously recognized.

The Relationship between Age-Related Hearing Loss and Cognitive Disorder.

BACKGROUND: Although the rates of occurrence of age-related diseases, including presbycusis and cognitive disorders, have increased with an increase in the geriatric population, the relationship between these two conditions remains unclear. OBJECTIVE: To investigate the association between presbycusis and cognitive disorder. SUBJECTS AND METHODS: A retrospective review of patient medical records was conducted at a single tertiary university hospital. This study enrolled 399 patients aged ≥65 years who were prescribed hearing aids for the chief complaint of hearing loss. For main outcomes and measures we used audiograms, the Korean Mini-Mental State Examination, and the Global Deterioration Scale (GDS). RESULTS: Of the 399 patients who were prescribed hearing aids for presbycusis, 45 (11.3%) had dementia and 354 (88.7%) did not have dementia. When the cognitive disorder group was divided into mild (1-4) and severe (5-7) subgroups based on the GDS scores, the threshold of hearing loss was significantly higher in the severe group than in the mild group (p < 0.05). The prevalence of dementia was significantly higher in patients with hearing loss for ≥10 years than in patients with hearing loss for <10 years (p < 0.05). CONCLUSION: Presbycusis and cognitive disorder are correlated. More severe and prolonged hearing loss is associated with a higher prevalence of cognitive disorder.

[Hearing loss in adults in older age groups.]

There has been a steady increase in the prevalence of hearing loss among people in many countries around the world. One of the main reasons for this negative trend is an increase in life expectancy and an increase in the proportion of the elderly people, which means an increase in the number of people with age-related changes in the auditory system (presbycusis). Aging is accompanied primarily by damage to the structures of the inner ear, but it can also affect the central parts of the auditory analyzer, causing frustration at all levels of the auditory neural pathway. Presbycusis is accompanied by impaired hearing and speech intelligibility. Along with speech hearing, spatial hearing suffers. Just as in other countries of the world, in Russia the prevalence of age-related hearing loss is increasing year by year. The data on the prevalence of hearing impairment in the Russian Federation vary, due to the lack of uniform approaches to the registration of persons with hearing impairment. Creation of a surdologic register is necessary for information support of complex medical and social rehabilitation of surdological patients. Since hearing loss has a significant negative impact on the quality of life of patients, knowledge of the prevalence of hearing disorders among the population will allow to plan properly the need for technical means of hearing and speech rehabilitation at the state level, to promote social rehabilitation and active longevity of citizens of older age groups.

[Speech intelligibility in noise at presbycusis]. / Rozumení reci v sumu u presbyakuze.

Evaluation of speech recognition is possible by presenting testing material in sentence form with presence of competitive noise. We developed new test of sentence intelligibility in noise in the Czech language. This article demonstrates results of the influence of the babble noise on sentence intelligibility in hearing impaired listeners with presbycusis. The time characteristics of babble noise are similar to human voice. That is the reason why this noise masking is more enhanced at the central hearing level than any other noise masking. A group of 423 persons was divided into younger group (age from 40 to 65 years, N = 191, mean age 55.8 years.) and older group (age from 66 to 85 years, N = 232, mean age 75.4 years). For these two age groups, we compared the test performance in the subgroups stratified by the speech audiometry in silence. We demonstrate a statistically significant worse understanding of sentences in the older group against the younger group listening to sentences at level 65 dB SPL in competitive noise at level 65 dB SPL (p = 0.05). The development of the sentence intelligibility in noise test increased the possibilities of audiological examination by another test, which was up to now missing in the Czech language.

[Presbycusis - Age Related Hearing Loss]. / Presbyakusis - Altersschwerhörigkeit.

Presbycusis or age related hearing loss can be defined as a progressive, bilateral and symmetrical sensorineural hearing loss due to age related degeneration of inner ear structures. It can be considered a multifactorial complex disorder with environmental and genetic factors. The molecular, electrophysiological and histological damage at different levels of the inner ear cause a progressive hearing loss, which usually affects the high frequencies of hearing. The resulting poor speech recognition has a negative impact on cognitive, emotional and social function in older adults. Recent investigations revealed an association between hearing impairment and social isolation, anxiety, depression and cognitive decline in elderly. These findings emphasize the importance of diagnosis and treating hearing loss in the elderly population. Hearing aids are the most commonly used devices for treating presbycusis. The technical progress of implantable hearing devices allows an effective hearing rehabilitation even in elderly with severe hearing loss. However, most people with hearing impairments are not treated adequately.

The characteristics of hearing loss in outpatients with tinnitus over the age of 60: a 11-year cross-sectional study.

BACKGROUND: Presbycusis with tinnitus has a significant impact on the quality of life of elderly patients, becoming a serious socioeconomic problem. OBJECTIVES: We conducted an 11-year cross-sectional analysis of the audiometry results of elderly patients with tinnitus from 2011 to 2021. METHODS: 9642 patients aged 60 and over were divided into three groups: young-old (YO) (60-74), old-old (OO) (75-89), and longevous (LON) (90 and over). Pure-tone audiometry results of all patients were analyzed. RESULTS: Among 9642 patients, the cases of female with tinnitus were more than male in all years. The hearing curve showed a typical age-related decline. Hearing level of air conduction in female declined significantly at low frequencies while that of male was worse at high frequencies in YO and OO groups. Compared with right, left hearing level of air conduction was significantly decreased at all frequencies except 0.125 kHz. CONCLUSIONS: When the chief complaint was tinnitus, women were likely to experience more distress than men. However, men suffered from more hearing loss than women, at least in high frequencies. The influence weight of presbycusis and tinnitus on the auditory cortices might be a possible reason for the lateral distinction of hearing loss at different ages.

Hearing Loss in Exfoliation Syndrome: Systematic Review and Meta-Analysis.

OBJECTIVE: To determine if exfoliation syndrome (XFS) is associated with hearing loss (HL) or vestibular dysfunction. DATA SOURCES: PubMed, Scopus, CINAHL, and Cochrane Library through April 1, 2022. REVIEW METHODS: Two reviewers independently screened abstracts, selected articles for inclusion, and extracted data. Studies included for qualitative analysis conducted audiometric, tympanometric, or vestibular evaluations on all subjects. RESULTS: Twenty-one publications (1148 patients with XFS and 1212 controls) were included in the systematic review, and 16 publications (968 patients with XFS and 1147 controls) in the meta-analysis. Greater severity of HL was seen for patients with XFS compared to controls across all frequencies (odds ratio [OR] 8.8 [7.3-10.2]). Patients with XFS were more likely to have moderate to profound sensorineural HL (OR 1.8 [1.3-2.5]), and less likely to have none to mild HL (OR 0.34 [0.17-0.67]) or no HL (OR 0.37 [0.28-0.50]). Three studies found patients with XFS had lower tympanometric peaks. Two studies found that abnormal vestibular testing results could be more common for patients with XFS. CONCLUSIONS: HL is associated with XFS. A sensorineural component to HL is confirmed, and mixed HL is possible. Given the high prevalence and infrequent diagnosis of XFS, the authors hypothesize that the current understandings of presbycusis might be improved by further investigation in XFS. Laryngoscope, 133:1025-1035, 2023.

Impact of Hearing Aids on Progression of Cognitive Decline, Depression, and Quality of Life Among People with Cognitive Impairment and Dementia.

BACKGROUND: Hearing loss is common in people with dementia (PwD) and a modifiable risk factor for cognitive decline. Recent studies revealed that hearing loss could cause social isolation and depression, which is associated with health-related quality of life (HRQoL). However, there is a lack of knowledge about the impact of the utilization of hearing aids on these outcomes. OBJECTIVE: To assess whether hearing aids use might be positively associated with the progression of cognitive function, depression, and HRQoL among PwD. METHODS: We analyzed two-year follow-up data from 258 PwD (≥70 years, living at home). Cognitive decline was measured with Mini-Mental Status Examination (MMSE), depression using Geriatric Depression Scale (GDS), and HRQoL with Quality of Life in Alzheimer's Disease Scale (QoL-AD). The impact of hearing aid utilization on the progression of outcomes was assessed using multivariate regression models. RESULTS: 123 patients had hearing loss (47.7%), from which n = 54 (43.9%) used hearing aids. Patients with hearing loss were older and had a lower HRQoL than those without hearing loss. Use of hearing aids in patients with hearing loss was associated with a lower increase in depressive symptoms (b = -0.74, CI95 -1.48 --0.01, p = 0.047) over time as compared to those not using hearing aids. There was no effect on PwD's cognition, and the association with higher HRQoL was significant after one, but not consistently over two years. CONCLUSION: Early detection and intervention of presbycusis using hearing aids might improve mental health and HRQoL in dementia.

Presbycusis, part 1: can you hear the music of life?

We used a novel approach allowing participants in this study to self-monitor their hearing sensitivity to familiar sounds in the environment. The objective of this approach was to establish whether participants in the 80-89 and 90-99 age groups would recognize the degree of their hearing impairment. It was our hope that participants would value audiology treatment and that it would improve their quality of life over a short period. The pilot study took place in a clinical environment where participants answered survey questions before and after audiology treatment, which pertained to their hearing impairment, morale, social support, and life satisfaction. Caregivers were included in the research to rate and record participants' problem behaviors (e.g., shouting, anger, agitation, repetitive speech dialog, and depression) before, during, and after treatment. This research validates other scientists' findings that annoying problem behaviors may actually be the result of hearing loss because of a person's inability to recognize speech. The pilot study shows that participants with mild dementia adapted well to speech and sounds in the natural environment without agitation as well as to management of hearing aids within a 30-day period. The participants with moderate dementia were slower to adapt. All participants with dementia required the cooperation of their caregivers to maintain hygiene of ear canals and hearing aids and insertion. This study suggests that the sooner people receive treatment for hearing loss, the quicker they are to recognize speech and to master hearing aid technology.

The effect of presentation level on memory performance.

OBJECTIVES: A loss of speech intelligibility at high presentation levels is called rollover. It is a phenomenon that increases in prevalence as people age. Whether the adverse effect of high presentation levels extends to processes subsequent to speech intelligibility, such as memory, is unknown. The present study examined this question on the basis of the previous finding that older but not younger adults showed memory impairment when acoustically distorted words were presented at 50 dB SL compared with an undistorted baseline presented at 65 dB SPL. One question investigated in the present study was whether a presentation level of 50 dB SL put older listeners at the cusp of rollover and whether this subsequently impaired memory. Moreover, we wanted to know whether and at what level it was possible to induce a similar impairment in younger listeners. DESIGN: We used a paired-associate memory paradigm in which five word pairs per list were presented at a rate of 4 secs per word pair. After each list, the first word of one of the pairs was presented again and the listener was asked to recall the second word. Over the course of the experiment, all list positions were tested an equal number of times. The word pairs, which were acoustically distorted using a jittering algorithm, were presented at 40 dB SL to all younger and older participants and just below an uncomfortably loud level for younger listeners only. Intelligibility of the distorted words was equated across age groups for each presentation level. The effect of presentation level on memory performance was investigated and compared with data of a previous study that used the same design but presented the distorted and undistorted words at 50 dB SL to both age groups. A total of 58 younger and 24 older adults were tested in two experiments. RESULTS: The results showed that for older adults, memory performance for distorted words was decreased in all list positions at a presentation level of 50 dB SL compared with 40 dB SL and an undistorted 65 dB SPL baseline. This effect did not occur for younger listeners. However, when younger adults were tested at a very high presentation level, they showed the same memory decrease compared with the baseline as older adults showed for 50 dB SL. CONCLUSIONS: A high presentation level of distorted words can adversely affect memory even after intelligibility is equated for. Moreover, older listeners are affected at lower presentation levels. Hence, the choice of sound level, particularly for older listeners, is important and may affect their level of cognitive performance beyond its effects on intelligibility. Higher presentation levels may not always lead to better performance when the task involves recall of words previously heard.

Evaluation of the vestibular system in individuals with presbycusis using video head impulse test and videonystagmography.

BACKGROUND: Vestibulo-ocular reflex (VOR) function is expected to be normal in patients with presbycusis during sudden head rotations. AIM: This study aimed to determine whether presbycusis was accompanied by vestibular system pathologies. In addition, it was examined whether there was a difference existed between the patients with and without presbycusis in terms of normative data. MATERIALS AND METHODS: A total of 40 individuals were included in the study: 20 in the presbycusis group and 20 in the control group. The vestibular systems of both groups were evaluated using the video head impulse test and videonystagmography. RESULTS: The right and left lateral VOR gain values were decreased in the group with presbycusis compared to the control group. The difference between the two groups in the mean VOR gains in the right lateral canal and left lateral canal were statistically significant (p = .040 and p = .050, respectively). The air caloric tests of all individuals were found to be normal. CONCLUSIONS: This result suggests that the loss of vestibular hair cells and vestibular nerve degeneration in the lateral semicircular canal may be more severe in presbycusis than in the same age group with normal hearing.

Association of Age-Related Hearing Impairment With Physical Functioning Among Community-Dwelling Older Adults in the US.

Importance: Hearing impairment, a common treatable condition, may contribute to poorer physical function with aging. Objective: To assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function. Design, Setting, and Participants: In this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US. Exposures: Hearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment. Main Outcomes and Measures: Physical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time. Results: Of the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (ß, -0.82; 95% CI, -0.34 to -1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, -0.34 [-0.52 to -0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of -2.81 m (95% CI, -5.45 to -0.17 m) and -5.31 m (95% CI, -10.20 to -0.36 m) than those with normal hearing, respectively, during the 2-minute walk test. Conclusions and Relevance: In this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.

Diabetes reduces auditory sensitivity in middle-aged listeners more than in elderly listeners: a population- based study of age-related hearing loss.

BACKGROUND: Diabetes mellitus (DM) and hearing impairment are both highly prevalent in older adult populations, but how the impact of diabetes on hearing varies by age is not well-studied. MATERIAL/METHODS: The subjects were 2306 adults aged 40 to 86 years who participated in a population-based study of aging, and were divided into 2 age groups, 40-64 years and 65-86 years, for cross-sectional analysis. Air-conduction pure-tone thresholds at octave intervals from 125 to 8000 Hz were obtained. Outcomes were categorized in relation to presence or absence of DM. Hearing levels at 7 frequencies were set in the general linear model as objective variables with adjustment for confounders. Explanatory variables were age (<65 years vs. > or =65 years), DM (absence vs. presence), and interaction between age and DM. RESULTS: A statistically-significant adverse effect of DM on hearing was observed. This effect varied by age at the higher frequencies. The DM-age interaction was not synergistic at any test frequencies. No significant effects of the DM-age interaction were observed below 4000 Hz. In contrast, significant reciprocal effects of the DM-by-age interaction were found at 4000 Hz and 8000 Hz. Diabetes may accordingly affect higher-frequency hearing more strongly in the younger age-bracket. CONCLUSIONS: This study demonstrated that diabetes detrimentally affected hearing in community-dwelling middle-aged and elderly people, and that the effect of diabetes on higher-frequency hearing might be stronger in middle age. Screening for hearing impairment in diabetic patients may provide benefits for intervention or prevention of early presbycusis, particularly in this age group.

Non-verbal visual reinforcement affects speech audiometry in the elderly.

The purpose of this study was to investigate how non-verbal visual reinforcement provided by the audiologist during speech testing influences performance in the elderly. Thirty-two volunteers with age-related hearing loss with or without dual sensory-impairment (DSI), were administered a speech audiometry test in which they repeated lists of ten disyllabic words in two different conditions, namely with and without visual reinforcement. In the conditions of "with visual reinforcement", the tester provided non-verbal cues to acknowledge the response of each participant. The "visual reinforcement" condition did not apparently provide any significant variation in the results. However, when we considered the group of patients without DSI, the non-verbal "visual reinforcement" resulted in better scores (p < 0.001). Non-verbal visual reinforcement may influence speech audiometry results in the elderly. During speech testing of elderly people with age-related hearing loss, audiologists should always remember to administer visual reinforcement to the patients in order to remove a possible confounding factor from audiological evaluation.

Noise-induced hearing loss evolution: influence of age and exposure to noise.

The aims of this study were to evaluate the influence of age and exposure to noise in determining the evolution of hearing loss after noise-induced hearing loss has been already established and to define the further evolution of presbycusis. This is a cross-sectional study based on the evaluation of pure-tone audiometry threshold on 568 subjects affected by noise-induced hearing loss and exposed to noise for at least 10 years; noise exposure at testing was 85-90 dB Leqd(A). The further evolution of hearing loss was found to be more related to age than to noise exposure and was significantly less than expected for presbycusis. In conclusion our data support the hypothesis that once NIHL has manifested, it tends to worsen slightly with continued noise exposure and that progressive hearing loss is chiefly due to aging. However, in individuals with NIHL, age-related hearing loss is significantly less at frequencies damaged by noise than in non-noise-exposed individuals.

Osteoporosis and hearing loss: findings from the Korea National Health and Nutrition Examination Survey 2009-2011.

INTRODUCTION: Age-related hearing impairment is the most common sensory dysfunction in older adults. In osteoporosis, the mass of the ossicles will be decreased, affecting the bone density of the cochlea, and interfering with the sound transmission to the cochlea. Age related hearing loss might be closely related to osteoporosis. OBJECTIVE: To determine the relationship between age-related hearing impairment and osteoporosis by investigating the relationship between hearing loss and cortical bone density evaluated from femur neck bone mineral density. METHODS: We used data from the Korea National Health and Nutrition Examination Survey to examine the associations between osteoporosis and age-related hearing impairment from 2009 to 2011. Total number of participants was 4861 including 2273 men and 2588 women aged 50 years or older. Osteoporosis was defined as a bone mineral density 2.5 standard deviations below according to the World Health Organization diagnostic classification. Age-related hearing impairment was defined as the pure-tone averages of test frequencies 0.5, 1, 2, and 4kHz at a threshold of 40dB or higher on the more impaired hearing side. RESULTS: Total femur T-score (p<0.001), lumbar-spine T-score (p<0.001) and, femur neck T-score (p<0.001) were significantly lower in the osteoporosis group compared to the normal group. Thresholds of pure-tone averages were significantly different in normal compared to osteopenia, and osteoporosis groups. In addition, there were significantly higher pure-tone averages thresholds in the osteoporosis group compared to other groups (p<0.001). After adjusting for all covariates, the odds ratio for hearing loss was significantly increased by 1.7 fold with reduced femur neck bone mineral density (p<0.01). However, lumbar spine bone mineral density was not statistically associated with hearing loss (p=0.22). CONCLUSION: Our results suggest that osteoporosis is significantly associated with a risk of hearing loss. In addition, femur neck bone mineral density was significantly correlated with hearing loss, but lumbar spine bone mineral density was not.

Relationship of Type 2 diabetes to the prevalence, incidence and progression of age-related hearing loss.

AIMS: Type 2 diabetes and associated microvascular abnormalities are postulated to affect hearing. Our study reports on the relationship between Type 2 diabetes and the prevalence, 5-year incidence and progression of hearing impairment in a representative, older, Australian population. METHODS: The Blue Mountains Hearing Study is a population-based survey of age-related hearing loss conducted in a defined suburban area, west of Sydney. Hearing loss was defined as the pure-tone average of frequencies 0.5, 1.0, 2.0 and 4.0 kHz > 25 decibels hearing level (dB HL) in the better ear (bilateral hearing loss). Type 2 diabetes was defined from reported physician-diagnosed diabetes or fasting blood glucose > or = 7.0 mmol/l. RESULTS: Age-related hearing loss was present in 50.0% of diabetic participants (n = 210) compared with 38.2% of non-diabetic participants (n = 1648), odds ratio (OR) 1.55 [95% confidence interval (CI) 1.11-2.17], after adjusting for multiple risk factors. A relationship of diabetes duration with hearing loss was also demonstrated. After 5 years, incident hearing loss occurred in 18.7% of participants with, and 18.0% of those without diabetes, adjusted OR 1.01 (CI 0.54-1.91). Progression of existing hearing loss (> 5 dB HL), however, was significantly greater in participants with newly diagnosed diabetes (69.6%) than in those without diabetes (47.8%) over this period, adjusted OR 2.71 (CI 1.07-6.86). CONCLUSIONS: Type 2 diabetes was associated with prevalent, but not incident hearing loss in this older population. Accelerated hearing loss progression over 5 years was more than doubled in persons newly diagnosed with diabetes. These data explore further reported links between Type 2 diabetes and age-related hearing loss.

[Study on the relationship between age-related hearing loss and cognitive impairment].

Objective: To investigate the correlation between age-related hearing loss and cognitive impairment. Methods: 201 elderly patients, who were admitted to the Department of Otorhinolaryngology of Peking University People's Hospital from March 1, 2017 to March 31, 2017, were evaluated with hearing screening and the Montreal Cognitive Assessment Scale. Among them, 101 were female and 100 were male, aged 60-90 years old. Taking the cognitive level as the dependent variable, and taking the age, sex, education, occupation, marital status, residence, and average hearing loss (average hearing threshold of 500, 1 000, 2 000, and 4 000 Hz), as well as the length of conscious hearing loss as the independent variables, the single factor analysis and multivariate linear regression analysis were used to screen the main factors affecting the cognitive level of the elderly. Results: Of the 201 elderly patients, 39 had normal hearing, 65 had mild hearing loss, 80 had moderate hearing loss, 16 had severe hearing loss, and 1 had profound hearing loss. The average degree of hearing loss was the influencing factor of cognitive impairment, and it mainly affected the directional force and abstract ability in the cognitive domains (P<0.05); The age, self-reported hearing loss, years of education, marital status, past ear diseases, and hypertension were relatively independent factors that affected the cognitive level(P<0.05). Conclusions: Age-related hearing loss is the risk factor for the cognitive impairment, especially for abstraction and orientation, in the elderly. The self-reported hearing loss is an independent risk factor for cognitive impairment.

Age-related Hearing Loss Is Strongly Associated With Cognitive Decline Regardless of the APOE4 Polymorphism.

OBJECTIVE: To examine the association between hearing impairment and cognitive decline and to identify possible risk factors for presbycusis. STUDY DESIGN: Cross-sectional survey in prospective cohort study. SETTING: University hospital. PATIENTS: A total of 322 participants aged >60 years, for whom all the below data were available, were enrolled in the study. There were 168 females and 154 males with a median age of 71 years (range: 60-89 yrs). INTERVENTIONS: PROST (Project in Sado for Total Health), a medical database in Sado island Japan, was analyzed. MAIN OUTCOME MEASURES: Data on pure-tone audiometry, mini-mental state examination (MMSE), polymorphism of apolipoprotein E4 (ApoE4), diabetes mellitus, hypertension, smoking, and alcohol consumption were extracted. Hearing impairment was defined as an average frequency between 0.25 and 8 kHz that exceeded 30 dB. Multivariate analysis was used to identify which of the above factors could predict the hearing impairment. Hearing threshold of each Hz was compared between the ApoE4 (+/+), (+/-), and (-/-) groups. RESULTS: Among various factors, only low MMSE scores (<24) showed significant association with hearing impairment. There were no differences in the hearing threshold of all frequencies between ApoE status groups. CONCLUSIONS: Hearing impairment was associated with low MMSE sores, regardless of the ApoE4 status. If ApoE4 status would be a common upstream predictor for both the hearing and cognitive impairment, hearing threshold would be related to ApoE4 status. However, these results may suggest that hearing impairment may be causally related to the cognitive dysfunction, perhaps via the cognitive load mechanisms.