Sensation and Psychiatry: Linking Age-Related Hearing Loss to Late-Life Depression and Cognitive Decline

Abstract

Recent research has linked age-related hearing loss to impaired performance across cognitive domains and increased risk for dementia diagnosis. The data linking hearing impairment to incident late-life depression are more mixed but suggest that diminished hearing does increase risk for depression. Behavioral mechanisms may explain these associations, such as the withdrawal of older adults from situations in which they may have difficulty hearing and communicating, which may contribute to the development of social isolation, loneliness, and consequent cognitive decline and depression. At a neural level, chronic hearing loss leads to reduced activation in central auditory pathways, resulting in compensatory increased activation in the cognitive control network, dysfunctional auditory–limbic connectivity, and deafferentation-induced atrophy in frontal brain regions. These pathologic changes decrease cognitive performance and increase depression risk by reducing cognitive reserve, increasing executive dysfunction, and disrupting normative emotion reactivity and regulation. Based on the available data and informed by this model, evidence-based suggestions are proposed for clinicians treating older adults, and a research agenda is advanced to facilitate the development of rationally designed and age-appropriate psychiatric treatments for older adults with age-related hearing loss. First and foremost, treating hearing loss should be investigated as a means of improving cognitive and depressive outcomes in well-designed studies incorporating comprehensive psychiatric assessments, randomization, objective documentation of compliance, and analyses of treatment mediators that will facilitate further therapeutic development. Multimodal neuroimaging studies integrating audiometric, neuropsychological, and clinical assessments also are needed to further evaluate the model proposed.

Genome-wide association study identifies 44 independent genomic loci for self-reported adult hearing difficulty in the UK Biobank cohort

“…ARHI is characterised by a non-syndromic bilateral, sensorineural hearing loss that progresses with increasing age and is an established risk factor for depression [6][7][8] and dementia [9][10][11][12] . Hearing loss was ranked fourth in the latest study into the Global Burden of Diseases 13 , yet hearing amplification devices are the only treatment option currently available for ARHI.…”

Sensorineural hearing loss and cognitive impairments: Contributions of thalamus using multiparametric MRI

“…SENSORINEURAL HEARING LOSS (SNHL) accounts for 90% of reported hearing loss (HL), which leads to difficulties in understanding speech and other voices directly. Cross‐section and longitudinal evidence suggested that auditory system dysfunction, including deafness and acoustic trauma, contribute to cognitive impairments, which is a result of neural plasticity. However, the underlying mechanism of reduced audibility‐induced negative plasticity need to be further explored.…”

Biological insights from multi-omic analysis of 31 genomic risk loci for adult hearing difficulty

“…Finally, we detected a negative genetic correlation between hearing difficulty and the age at first childbirth, a proxy for educational attainment and cognition. Genetic correlations typically arise from diverse direct and indirect relationships, yet, remarkably, many of these correlations reflect known comorbidities and risk factors for hearing loss 12,13 .…”