Tinnitus and Neuropsychological Dysfunction in the Elderly: A Systematic Review on Possible Links

Abstract

Introduction: Tinnitus is a common and disabling symptom often associated with hearing loss. While clinical practice frequently shows that a certain degree of psychological discomfort often characterizes tinnitus suffers, it has been recently suggested in adults as a determining factor for cognitive decline affecting attention and memory domains. The aim of our systematic review was to provide evidence for a link between tinnitus, psychological distress, and cognitive dysfunction in older patients and to focus on putative mechanisms of this relationship. Methods: We performed a systematic review, finally including 192 articles that were screened. This resulted in 12 manuscripts of which the full texts were included in a qualitative analysis. Results: The association between tinnitus and psychological distress, mainly depression, has been demonstrated in older patients, although only few studies addressed the aged population. Limited studies on cognitive dysfunction in aged patients affected by chronic tinnitus are hardly comparable, as they use different methods to validate cognitive impairment. Actual evidence does not allow us with certainty to establish if tinnitus matters as an independent risk factor for cognitive impairment or evolution to dementia. Conclusion: Tinnitus, which is usually associated with age-related hearing loss, might negatively affect emotional wellbeing and cognitive capacities in older people, but further studies are required to improve the evidence.

Tinnitus-associated cognitive and psychological impairments: a comprehensive review meta-analysis

“…The findings indicated that individuals with tinnitus often faced concurrent conditions such as depression, poor sleep, and anxiety (Clarke et al, 2018 ). A recently published study has unveiled that elderly tinnitus patients face a considerably higher risk of dementia, and they also exhibit associations with other cognitive impairments, including anxiety, depression, and sleep difficulties (Malesci et al, 2021 ). However, contrary to expectations, an investigational study conducted in 2021 revealed a positive association between tinnitus and enhanced cognitive performance in non-Hispanic elderly individuals with hearing loss.…”

Vascular Factors in Patients with Midlife Sensorineural Hearing Loss and the Progression to Mild Cognitive Impairment

“…Previous studies assert an increased risk of psychiatric comorbidities among patients with tinnitus [ 48 ], but they also report mild psychiatric symptoms and a worsening of quality of life [ 49 , 50 ]. Recent literature argues there is a complex association among tinnitus perception, emotional disorders, and cognitive dysfunction, however the causal link is still not fully understood [ 51 , 52 ].…”

“…Although it is largely demonstrated that psychiatric discomfort is present in a large number of tinnitus suffers [ 23 , 48 ], actual evidence does not allow us to establish, with certainty, if tinnitus matters as an independent risk factor for cognitive impairment or the evolution to dementia [ 49 ]. Nevertheless, a previous evaluation of glucose metabolic connectivity through FDG-PET has already shown a lower metabolism in the right superior temporal pole and in the fusiform gyrus among subjects with MCI and tinnitus, unlike those with only a cognitive impairment [ 54 ].…”

“…In addition, a lower grey matter volume in the right insula was detected among patients with a worse THI score, suggesting a correlation between the alteration of the brain and the emotional reaction to tinnitus. Therefore, the pathophysiology of tinnitus and the central neural changes that it determines might explain the relationship between the impact of tinnitus and the development of cognitive decline [ 49 ]. It has been previously demonstrated that the long-term hearing deprivation of auditory inputs can impact cognitive performance by decreasing the quality of communication, leading to social isolation and depression and facilitating dementia [ 3 , 4 , 5 ].…”

Cognitive Screening and Hearing Assessment in Patients With Chronic Tinnitus

“…Several cross-sectional studies have consistently demonstrated an association between cognitive decline and HL across different populations [ 9 ]. Indeed, HL appears to exacerbate cognitive deficits in the elderly and may serve as a prognostic factor for mild cognitive impairment (MCI) [ 10 ]. Moreover, prospective cohort studies have suggested that the use of hearing aids in patients with HL can reduce cognitive decline in older adults [ 9 ].…”