Age-Related Hearing Loss, Late-Life Depression, and Risk for Incident Dementia in Older Adults

Abstract

Background Hearing loss (HL), late-life depression, and dementia are three prevalent and disabling conditions in older adults, but the inter-relationships between these disorders remain poorly understood. Methods N=8,529 participants ≥60 years who were free of cognitive impairment at baseline were analyzed from National Alzheimer’s Coordinating Center Uniform Data Set. Participants had either No HL, Untreated HL, or Treated HL. Primary outcomes included depression (15-item Geriatric Depression Scale ≥5) and conversion to dementia. A longitudinal logistic model was fit to examine the association between HL and changes in depressive symptoms across time. Two Cox proportional hazards models were used to examine HL and the development of dementia: Model A included only baseline variables and Model B included time-varying depression to evaluate for the direct effect of changes in depression on dementia over time. Results Treated HL (vs. no HL) had increased risk for depression (OR=1.26, 95% CI 1.04-1.54, p=0.02) and conversion to dementia (HR=1.29, 95% CI 1.03-1.62, p=0.03). Baseline depression was a strong independent predictor of conversion to dementia (HR=2.32, 95% CI 1.77-3.05, p<.0001). Development/persistence of depression over time was also associated with dementia (HR=1.89, 95% CI 1.47-2.42, p<.0001), but only accounted for 6% of the direct hearing-dementia relationship (Model A logHR=0.26 [SE 0.12] to Model B logHR=0.24 [SE 0.12]) suggesting no significant mediation effect of depression. Conclusions Both HL and depression are independent risk factors for eventual conversion to dementia. Further understanding the mechanisms linking these later-life disorders may identify targets for early interventions to alter the clinical trajectories of at-risk individuals.

Hearing Loss and Dementia: A Meta-Analysis of Prospective Cohort Studies

“…Among them, 1,628 studies were further excluded because they were not related to the purpose of the meta-analysis based on titles and abstracts. Then, for the remaining 53 studies evaluated by full-text reading, 39 were not included for the reasons presented in Figure 1 , which resulted in 14 prospective cohort studies finally analyzed in the meta-analysis (Gates et al, 1996 , 2002 , 2011 ; Lin et al, 2011 ; Gallacher et al, 2012 ; Gurgel et al, 2014 ; Deal et al, 2017 ; Golub et al, 2017 ; Amieva et al, 2018 ; Ford et al, 2018 ; Brenowitz et al, 2019 ; Osler et al, 2019 ; Vassilaki et al, 2019 ; Brewster et al, 2021 ).…”

“…Overall, 14 cohort studies including 726,900 participants were considered eligible for the meta-analysis (Gates et al, 1996 , 2002 , 2011 ; Lin et al, 2011 ; Gallacher et al, 2012 ; Gurgel et al, 2014 ; Deal et al, 2017 ; Golub et al, 2017 ; Amieva et al, 2018 ; Ford et al, 2018 ; Brenowitz et al, 2019 ; Osler et al, 2019 ; Vassilaki et al, 2019 ; Brewster et al, 2021 ), which were performed in the United States (Gates et al, 1996 , 2002 , 2011 ; Lin et al, 2011 ; Gurgel et al, 2014 ; Deal et al, 2017 ; Golub et al, 2017 ; Brenowitz et al, 2019 ; Vassilaki et al, 2019 ; Brewster et al, 2021 ), the United Kingdom (Gallacher et al, 2012 ), France (Amieva et al, 2018 ), Australia (Ford et al, 2018 ), and Denmark (Osler et al, 2019 ). All of the studies included a community-derived general population, and 11 of them included only an elderly population (Gates et al, 1996 , 2002 , 2011 ; Gurgel et al, 2014 ; Deal et al, 2017 ; Golub et al, 2017 ; Amieva et al, 2018 ; Ford et al, 2018 ; Brenowitz et al, 2019 ; Vassilaki et al, 2019 ; Brewster et al, 2021 ). Hearing loss was diagnosed via an audiometry test in 10 studies (Gates et al, 1996 , 2002 , 2011 ; Lin et al, 2011 ; Gallacher et al, 2012 ; Gurgel et al, 2014 ; Deal et al, 2017 ; Brenowitz et al, 2019 ; Osler et al, 2019 ; Brewster et al, 2021 ), but was also evidenced by self-reports (Golub et al, 2017 ; Amieva et al, 2018 ; Vassilaki et al, 2019 ) or International Classification...…”

“…All of the studies included a community-derived general population, and 11 of them included only an elderly population (Gates et al, 1996 , 2002 , 2011 ; Gurgel et al, 2014 ; Deal et al, 2017 ; Golub et al, 2017 ; Amieva et al, 2018 ; Ford et al, 2018 ; Brenowitz et al, 2019 ; Vassilaki et al, 2019 ; Brewster et al, 2021 ). Hearing loss was diagnosed via an audiometry test in 10 studies (Gates et al, 1996 , 2002 , 2011 ; Lin et al, 2011 ; Gallacher et al, 2012 ; Gurgel et al, 2014 ; Deal et al, 2017 ; Brenowitz et al, 2019 ; Osler et al, 2019 ; Brewster et al, 2021 ), but was also evidenced by self-reports (Golub et al, 2017 ; Amieva et al, 2018 ; Vassilaki et al, 2019 ) or International Classification of Diseases (ICD) codes (Ford et al, 2018 ). A total of 70,129 participants had hearing loss at baseline.…”

“…For example, some potential mechanisms are the concurrent dysfunction of common pathways that cause hearing loss and dementia, as well as decreased stimulation of cognitive processing that results from hearing loss (Recanzone, 2018 ; Jafari et al, 2019 ; Uchida et al, 2019 ; Di Stadio et al, 2021 ). Accordingly, some prospective cohort studies have been conducted to reveal the relationship between hearing loss and the subsequent incidence of dementia (Gates et al, 1996 , 2002 , 2011 ; Lin et al, 2011 ; Gallacher et al, 2012 ; Gurgel et al, 2014 ; Deal et al, 2017 ; Golub et al, 2017 ; Amieva et al, 2018 ; Ford et al, 2018 ; Brenowitz et al, 2019 ; Osler et al, 2019 ; Vassilaki et al, 2019 ; Brewster et al, 2021 ). However, results of these studies were not always consistent.…”

Hearing loss patterns throughout life: Insights from Japan

“…This condition typically first impairs perception of high-frequency sounds and eventually affects lower frequencies. Given that age-related hearing loss is associated with increased risk of incident dementia [1] , [2] , [3] and depressive symptoms [ 4 , 5 ], prompt diagnosis and intervention is important. In addition, the older population is rapidly growing [6] and better characterization of hearing loss in adults ≥80 years old is needed, as public datasets sometimes mask the upper extremes of age to protect anonymity [7] .…”