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26-07-2023 | Dementia | Editor's Choice | News

Wearing hearing aids reduces risk of cognitive decline in at-risk populations

Author: Dr. Jonathan Smith


medwireNews: Equipping hearing-impaired older adults with hearing aids may reduce cognitive decline over a 3 year period, but only in people who are at increased risk for the condition, findings from the ACHIEVE study show.

“[O]ur findings suggest that hearing loss might be a particularly important global public health target for dementia prevention efforts,” comment the investigators in The Lancet.

“Hearing loss is highly prevalent in adults aged 70 years and older and is treatable with an established intervention (ie, hearing aids and related support services) that is underused and confers essentially no medical risk.”

The researchers assessed data on 977 participants aged 70–84 years from two cohorts: people taking part in the Atherosclerosis Risk in Communities (ARIC) study (n=238) and healthy de novo volunteers (n=739).

The participants had a mean age of 76.8 years and the vast majority (88%) were White. Just over half (54%) were women. None of the participants had cognitive impairment, but they all had untreated hearing loss, with a mean 4-frequency pure tone average of 39.4 dB and a hearing handicap score of 15.3. Their mean self-perceived communication impairment (HHI) score was 15.3, signaling mild-to-moderate impairments in communication.

The participants were randomly assigned to receive either a hearing intervention (n=490), including sessions of audiological counseling and hearing aids, or a control intervention (n=487), comprising health education centered on healthy aging. Their cognition was measured annually using a comprehensive neurocognitive battery.

According to the results, there was no significant difference in cognitive decline over 3 years between the two intervention groups.

However, a prespecified sensitivity analysis showed that the hearing intervention did significantly reduce cognitive decline by 48% (–0.211 SD units in the treatment group compared with –0.402 SD units in the control group) in the ARIC population, whereas there was no effect in the de novo population.

The authors, led by Frank Lin (Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, Maryland, USA), note that “[c]ompared with the de novo cohort of healthy volunteers, the ARIC cohort had more risk factors for cognitive decline and dementia.”

The ARIC population had significantly lower global cognition (–0.01 vs 0.96) and cognitive domain scores at baseline, and the rate of cognitive decline was 2.7 times faster over 3 years between the ARIC and de novo control groups.

Participants from the ARIC population were also more likely to be Black, female, older, less educated, and live alone, than the healthy volunteers, as well as have a lower income and underlying conditions such as diabetes and hypertension.

While both populations had similar audiometric measurements at the start of the trial, the de novo population had a higher HHI, indicating that they saw themselves better able to communicate than the ARIC population.

“Hearing intervention in adults aged 70 years and older who are at increased risk for cognitive decline and dementia might have an important effect on reducing cognitive change within 3 years,” say Lin and co-authors.

By contrast, the hearing intervention might not have appreciable effects on reducing cognitive change within 3 years in populations at decreased risk for cognitive decline.”

In an editorial related to the study, Gill Livingston and Sergi Costafreda, both from University College London in the UK, say that the ACHIEVE trial findings were “eagerly awaited,” but note that the 48% protective effect of hearing aids on cognition could be spurious.

“We await trials on the effects of hearing aids on secondary outcomes including mood, independence, social network, and physical activity to elucidate potential mechanisms of action,” they explain.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2023 Springer Healthcare Ltd, part of the Springer Nature Group

The Lancet 2023; doi:10.1016/S0140-6736(23)01406-X


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