Effects of hearing impairment and hearing aid use on the incidence of cognitive impairment among community-dwelling older adults: evidence from the Taiwan Longitudinal Study on Aging (TLSA)

Chi-Jung Tai; Tzyy-Guey Tseng; Yu-Han Hsiao; Tsu-Ann Kuo; Ching-Ya Huang; Yi-Hsin Yang; Meng-Chih Lee

doi:10.1186/s12877-021-02012-4

Effects of hearing impairment and hearing aid use on the incidence of cognitive impairment among community-dwelling older adults: evidence from the Taiwan Longitudinal Study on Aging (TLSA)

10.21203/rs.3.rs-42684/v1 ◽

2020 ◽

Author(s):

Chi-Jung Tai ◽

Tzyy-Guey Tseng ◽

Yu-Han Hsiao ◽

Tsu-Ann Kuo ◽

Ching-Ya Huang ◽

...

Keyword(s):

Cognitive Impairment ◽

Longitudinal Study ◽

Propensity Score ◽

Cognitive Decline ◽

Hearing Impairment ◽

Hearing Aid ◽

Community Dwelling ◽

Geriatric Syndromes ◽

Hearing Aid Use

Abstract Background: Previous studies have reported associations between hearing impairment (HI) and cognitive impairment, but the evidence is not conclusive while considering concurrent geriatric syndromes. Especially, evidence from previous studies rarely came from Asian studies. This study aimed to evaluate the independent effects of HI and hearing aid use on the incidence of cognitive impairment while considering most geriatric confounders.Methods: This population-based, propensity-score matched cohort study used cohort from Waves IV–VII (1999–2011) survey of the Taiwan Longitudinal Study on Aging (TLSA). Cognitive impairment was identified based on Short Portable Mental Status Questionnaire (SPMSQ) scores. The hazard ratio (HR) was calculated using the Cox proportional hazard regression adjusting for age, sex, comorbidities, socioeconomic status, Center for Epidemiologic Studies Depression (CES-D) scores, the instrumental activities of daily living scale, mobility condition and quality of life. In addition, social support and participation were also considered as confounders in the analysis. To assess the robustness of our findings, we conducted a sensitivity analysis designed to access unmeasured confounding factors by calculating E-values.Results: After 1:1 propensity-score matching, we included 709 participants in both the HI and non-HI groups with a mean age of 73.4 years and 39.4% of participants were female. The mean follow-up was 8.9±3.9 years. The HI group had a higher incidence of cognitive impairment than the non-HI group (74.5% vs. 69.1%, respectively), with an adjusted HR of 1.16 (95% confidence interval [CI], 1.03–1.32) based on a 12-year follow up. The E-value was 1.45 for the estimate, which provided evidence for this study’s robustness. Although, a subgroup analysis showed that hearing aid use was associated with lower incidences of cognitive impairment (66.3% vs. 75.6%) when compared to non-users in the HI group, the adjusted HR of 0.82 (95% CI, 0.61–1.09) revealed no significant differences.Conclusions: HI was an independent risk factor of incident cognitive impairment on top of concurrent geriatric syndromes. Early HI detection may thus be effective for preventing cognitive decline. Further studies are needed to evaluate the effect of hearing aid use on the prevention of cognitive decline.

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Effects of hearing impairment and hearing aid use on the incidence of cognitive impairment among community-dwelling older adults: evidence from the Taiwan Longitudinal Study on Aging (TLSA)

10.21203/rs.3.rs-42684/v2 ◽

2020 ◽

Author(s):

Chi-Jung Tai ◽

Tzyy-Guey Tseng ◽

Yu-Han Hsiao ◽

Tsu-Ann Kuo ◽

Ching-Ya Huang ◽

...

Keyword(s):

Cognitive Impairment ◽

Longitudinal Study ◽

Propensity Score ◽

Cognitive Decline ◽

Hearing Impairment ◽

Hearing Aid ◽

Community Dwelling ◽

Geriatric Syndromes ◽

Hearing Aid Use

Abstract Background: Previous studies have reported associations between hearing impairment (HI) and cognitive impairment, but the evidence is not conclusive while considering concurrent geriatric syndromes. Especially, evidence from previous studies rarely came from Asian studies. This study aimed to evaluate the independent effects of HI and hearing aid use on the incidence of cognitive impairment while considering most geriatric confounders.Methods: This population-based, propensity-score matched cohort study used cohort from Waves IV–VII (1999–2011) survey of the Taiwan Longitudinal Study on Aging (TLSA). Cognitive impairment was identified based on Short Portable Mental Status Questionnaire (SPMSQ) scores. The hazard ratio (HR) was calculated using the Cox proportional hazard regression adjusting for age, sex, comorbidities, socioeconomic status, Center for Epidemiologic Studies Depression (CES-D) scores, the instrumental activities of daily living scale, mobility condition and quality of life. In addition, social support and participation were also considered as confounders in the analysis. To assess the robustness of our findings, we conducted a sensitivity analysis designed to access unmeasured confounding factors by calculating E-values.Results: After 1:1 propensity-score matching, we included 709 participants in both the HI and non-HI groups with a mean age of 73.4 years and 39.4% of participants were female. The mean follow-up was 8.9±3.9 years. The HI group had a higher incidence of cognitive impairment than the non-HI group (74.5% vs. 69.1%, respectively), with an adjusted HR of 1.16 (95% confidence interval [CI], 1.03–1.32) based on a 12-year follow up. The E-value was 1.45 for the estimate, which provided evidence for this study’s robustness. Although, a subgroup analysis showed that hearing aid use was associated with lower incidences of cognitive impairment (66.3% vs. 75.6%) when compared to non-users in the HI group, the adjusted HR of 0.82 (95% CI, 0.61–1.09) revealed no significant differences.Conclusions: HI was an independent risk factor of incident cognitive impairment on top of concurrent geriatric syndromes. Early HI detection may thus be effective for preventing cognitive decline. Further studies are needed to evaluate the effect of hearing aid use on the prevention of cognitive decline.

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The impact of hearing impairment and hearing aid use on progression to mild cognitive impairment in cognitively healthy adults: a longitudinal study of 5721 participants

10.21203/rs.3.rs-153405/v1 ◽

2021 ◽

Author(s):

Magda Bucholc ◽

Sarah Bauermeister ◽

Daman Kaur ◽

Paula McClean ◽

Stephen Todd

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Decline ◽

Hearing Impairment ◽

Hearing Aids ◽

Hearing Aid ◽

Hearing Impaired ◽

Hearing Aid Use ◽

Increased Risk ◽

The Impact

Abstract The increasing prevalence of dementia in older adults warrants attention to the identification of practices that can delay or reduce likelihood of progression to early forms of cognitive impairment, in particular, to mild cognitive impairment (MCI) which is often considered a transitional stage between healthy aging and dementia. In this study, we investigated the effect of hearing impairment and hearing aid usage on cognitive decline and progression to MCI in cognitively healthy individuals. We used data from a large referral-based cohort obtained from the National Alzheimer’s Coordinating Center. The baseline sample included 5721 cognitively normal subjects aged ≥ 40. We found that hearing impairment was associated with increased risk of progression to MCI (hazard ratio [HR] = 1.40, 95%CI, 1.16-1.68, false discovery rate [FDR] P < 0.001) and an accelerated rate of cognitive decline (P < 0.001). Among hearing-impaired participants, hearing aid users were less likely to develop MCI (HR, 0.33; 95% CI, 0.23-0.47; FDR P < 0.001) and experienced slower cognitive decline (P = 0.004) when compared to those not using hearing aids. We found no statistically significant differences in risk of conversion to MCI between individuals with normal hearing and hearing-impaired adults using hearing aids (HR, 1.23; 95% CI, 0.99-1.50; FDR P = 0.08). Our findings highlight the need for a randomized clinical trial that will allow us to investigate whether there is a causal relationship between hearing loss, hearing aid use, and conversion to MCI. Such knowledge could provide new and novel insights into prevention of cognitive impairment and dementia.

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DIRECTIONALITY BETWEEN COGNITION AND DEPRESSIVE SYMPTOMS: A LONGITUDINAL CROSS-LAGGED PANEL ANALYSIS

Innovation in Aging ◽

10.1093/geroni/igz038.592 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S166-S166

Author(s):

Randolph Chan ◽

Jennifer Y M Tang ◽

Tianyin Liu ◽

Gloria H Y Wong

Keyword(s):

Cognitive Impairment ◽

Depressive Symptoms ◽

Older People ◽

Cognitive Decline ◽

Cognitive Functioning ◽

Community Dwelling ◽

Cognitive Complaints ◽

Subjective Cognitive Function ◽

Subjective Cognitive Complaints

Abstract Background and Objectives: The relationship between objective and subjective cognitive function and depressive symptoms is complex and potentially multidirectional. This longitudinal prospective study examined the directionality of their relationship among a community sample of older people with no known diagnosis or treatment for dementia or depression. Research Design and Methods: We examined the temporal relationship between objective cognitive functioning, subjective cognitive complaints, and depressive symptoms in 1,814 community-dwelling older people at baseline and one-year follow-up using regression and two-wave cross-lagged panel analyses, after controlling for demographic and health confounders. Results: Cross-lagged analysis showed that depressive symptoms at follow-up were directly predicted by baseline subjective cognitive complaints, but not baseline objective cognitive functioning. The effect differed across objective cognitive functioning levels. In people with clinically significant cognitive impairment at baseline, objective cognitive decline but not baseline subjective cognitive complaints predicted depressive symptoms. In people with mild objective cognitive impairment at baseline, baseline subjective complaints but not objective cognitive decline predicted depressive symptoms. Discussion and Implications: The effects of objective and subjective cognitive decline on depressive symptoms varied across older people with different levels of cognitive impairment. Awareness and insight of one’s cognitive status may contribute to the development/progression in depressive symptom in people with mild cognitive impairment. Mechanisms unrelated to appraisal may be involved in increased depressive symptoms among older persons with significant objective cognitive impairment.

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Serum Sodium and Cognition in Older Community-Dwelling Men

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.07400717 ◽

2018 ◽

Vol 13 (3) ◽

pp. 366-374 ◽

Cited By ~ 10

Author(s):

Kristen L. Nowak ◽

Kristine Yaffe ◽

Eric S. Orwoll ◽

Joachim H. Ix ◽

Zhiying You ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Cognitive Decline ◽

Serum Sodium ◽

Older Men ◽

Community Dwelling ◽

Common Finding ◽

Lower Serum ◽

The Mean

Background and objectivesMild hyponatremia is a common finding in older adults; however, the association of lower serum sodium with cognition in older adults is currently unknown. We determined whether lower normal serum sodium is associated with cognitive impairment and risk of cognitive decline in community-dwelling older men.Design, setting, participants, & measurementsFive thousand four hundred thirty-five community-dwelling men aged ≥65 years who participated in Osteoporotic Fractures in Men, a cohort study with a median follow-up for cognitive function of 4.6 years, were included in this analysis. Multivariable logistic regression was used to examine the association between baseline fasting serum sodium levels and the odds of prevalent cognitive impairment (cross-sectional analysis; modified Mini-Mental Status [3MS] score <1.5 SD [<84] below or Trail Making Test Part B time >1.5 SD above the mean [>223 seconds]) and cognitive decline (prospective analysis [n=3611]; decrease in follow-up 3MS score or increase in Trails B time >1.5 SD of the mean score/time change [>9 or >67 seconds]).ResultsParticipants were aged 74±6 years with a fasting mean serum sodium level of 141±3 mmol/L. Fifteen percent (n=274), 12% (n=225), and 13% (n=242) had prevalent cognitive impairment in tertiles 1, 2, and 3, respectively. After adjustment, lower serum sodium was associated with prevalent cognitive impairment (tertile 1 [126–140 mmol/L] versus tertile 2 [141–142 mmol/L], odds ratio [OR], 1.30; 95% confidence interval [95% CI], 1.06 to 1.61). Fourteen percent (n=159), 10% (n=125), and 13% (n=159) had cognitive decline in tertiles 1, 2, and 3, respectively. Lower serum sodium was also associated with cognitive decline (tertile 1 versus tertile 2, OR, 1.37; 95% CI, 1.06 to 1.77). Tertile 3 (143–153 mmol/L) was additionally associated with cognitive decline. Results were similar in sensitivity analyses according to clinical cut-offs and by quartiles.ConclusionsIn community-dwelling older men, serum sodium between 126–140, and 126–140 or 143–153 mmol/L, are independently associated with prevalent cognitive impairment and cognitive decline, respectively.

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CEREAL INTAKE INCREASES AND DAIRY PRODUCTS DECREASE RISK OF COGNITIVE DECLINE AMONG ELDERLY FEMALE JAPANESE

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2014.29 ◽

2014 ◽

pp. 1-7

Author(s):

R. Otsuka ◽

Y. Kato ◽

Y. Nishita ◽

C. Tange ◽

M. Nakamoto ◽

...

Keyword(s):

Longitudinal Study ◽

Cognitive Decline ◽

Mmse Score ◽

Smoking Status ◽

Statistical Significance ◽

Dairy Product ◽

Community Dwelling ◽

Dietary Record ◽

Second Wave

BACKGROUND: If cognitive decline can be prevented through changes in daily diet with no medical intervention, it will be highly significant for dementia prevention. OBJECTIVES: This longitudinal study examined the associations of different food intakes on cognitive decline among Japanese subjects. DESIGN: Prospective cohort study. SETTING: The National Institute for Longevity Sciences - Longitudinal Study of Aging, a community-based study. PARTICIPANTS: Participants included 298 males and 272 females aged 60 to 81 years at baseline who participated in the follow-up study (third to seventh wave) at least one time. MEASUREMENTS: Cognitive function was assessed with the Mini-Mental State Examination (MMSE) in all study waves. Nutritional intake was assessed using a 3-day dietary record in the second wave. Cumulative data among participants with an MMSE >27 in the second wave were analyzed using a generalized estimating equation. Multivariate adjusted odds ratios (OR) and 95% confidence intervals (CI) for an MMSE score ≤27 in each study wave according to a 1 standard deviation (SD) increase of each food intake at baseline were estimated, after adjusting for age, follow-up time, MMSE score at baseline, education, body mass index, annual household income, current smoking status, energy intake, and history of diseases. RESULTS: In men, after adjusting for age, and follow-up period, MMSE score at baseline, the adjusted OR for a decline in MMSE score was 1.20 (95% CI, 1.02-1.42; p=0.032) with a 1-SD increase in cereal intake. After adjusting for education and other confounding variables, the OR for a decrease in MMSE score did not reach statistical significance for this variable. In women, multivariate adjusted OR for MMSE decline was 1.43 (95% CI, 1.15-1.77; p=0.001) with a 1-SD increase in cereal intake and 0.80 (95% CI, 0.65-0.98; p=0.034) with a 1-SD increase in milk and dairy product intake. CONCLUSIONS: This study indicates that a 1-SD (108 g/day) decrease in cereal intake and a 1-SD (128 g/day) increase in milk and dairy product intake may have an influence of cognitive decline in community-dwelling Japanese women aged 60 years and older. Further studies are needed in order to explore the potential causal relationship.

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Effects of hearing aid on improving cognition and depressive symptoms in elderly

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20211186 ◽

2021 ◽

Vol 7 (4) ◽

pp. 639

Author(s):

K. J. Arun Kumar ◽

M. Vidyalakshmi

Keyword(s):

Depressive Symptoms ◽

Cognitive Decline ◽

Hearing Impairment ◽

Hearing Aids ◽

Negative Impact ◽

Hearing Aid ◽

Financial Burden ◽

Hearing Aid Use ◽

The Mean ◽

The Individual

Background: The prevalence of dementia among people aged over 60 years is between 5–7%, with the numbers of those affected globally predicted to double every 20 years between 2010 and 2050. While cognitive impairment and dementia have a negative impact on the individual, caregivers and society, the financial burden of cognitive decline and dementia are also a major source of concern. However, there is some cause for optimism in the form of potentially modifiable risk factors which can prevent or delay dementia. In this study we investigate the effect of hearing aid on improving cognition and depressive symptoms in elderly individuals with hearing impairment.Methods: Patients with hearing impairment were selected based on inclusion and exclusion criteria and prescribed with similar type of hearing aid. MMSE and GDS scores were obtained before fitting hearing aid and 3 months after fitting hearing aid.Results: A total number of 66 patients, 40 males (61%) and 26 females (39%) were included in the study. Before using hearing aids, the mean MMSE score was 18.98±5.37 (range 10–26), and it increased to 21.08±4.77 (range 12–27) after 3 months of hearing aid use (p<0.005). The GDS analysis revealed a mean score of 6.85±2.81 (range 3–11) before using hearing aid and it decreased to 5.44±1.82 (range 3–8 after using the hearing aid (p<0.005).Conclusions: Treating hearing loss with hearing aid may reduce burden associated with cognitive decline and depression.

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Association of the use of hearing aids with the conversion from mild cognitive impairment to dementia and progression of dementia: a longitudinal retrospective study

10.1101/2020.01.31.19015503 ◽

2020 ◽

Author(s):

Magda Bucholc ◽

Paula L. McClean ◽

Sarah Bauermeister ◽

Stephen Todd ◽

Xuemei Ding ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Hearing Impairment ◽

Hearing Aids ◽

Hearing Aid ◽

Hearing Impaired ◽

Sensitivity Analyses ◽

Risk Of Death ◽

Hearing Aid Use ◽

Incident Dementia

AbstractINTRODUCTIONHearing aid usage has been linked to improvements in cognition, communication, and socialization, but the extent to which it can affect the incidence and progression of dementia is unknown. Such research is vital given the high prevalence of dementia and hearing impairment in older adults, and the fact that both conditions often coexist. In this study, we examined for the first time the effect of the use of hearing aids on the conversion from mild cognitive impairment (MCI) to dementia and progression of dementia.METHODSWe used a large referral-based cohort of 2114 hearing-impaired patients obtained from the National Alzheimer’s Coordinating Center. Survival analyses using multivariable Cox proportional hazards regression model and weighted Cox regression model with censored data were performed to assess the effect of hearing aid use on the risk of conversion from MCI to dementia and risk of death in hearing-impaired participants. Disease progression was assessed with CDR® Dementia Staging Instrument Sum of Boxes (CDRSB) scores. Three types of sensitivity analyses were performed to validate the robustness of the results.RESULTSMCI participants that used hearing aids were at significantly lower risk of developing all-cause dementia compared to those not using hearing aids (hazard ratio [HR] 0.73, 95%CI, 0.61-0.89; false discovery rate [FDR] P=0.004). The mean annual rate of change (standard deviation) in CDRSB scores for hearing aid users with MCI was 1.3 (1.45) points and significantly lower than for individuals not wearing hearing aids with a 1.7 (1.95) point increase in CDRSB per year (P=0.02). No association between hearing aid use and risk of death was observed. Our findings were robust subject to sensitivity analyses.DISCUSSIONAmong hearing-impaired adults, hearing aid use was independently associated with reduced dementia risk. The causality between hearing aid use and incident dementia should be further tested.HighlightsHigh prevalence of dementia and hearing impairment in older adultsHearing aid (HA) use associated with a lower risk of incident dementiaSlower cognitive decline in users than non-users of HA with mild cognitive impairmentThe relationship between hearing impairment and dementia should be further tested

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Reading activity prevents long-term decline in cognitive function in older people: evidence from a 14-year longitudinal study

International Psychogeriatrics ◽

10.1017/s1041610220000812 ◽

2020 ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Yu-Hung Chang ◽

I-Chien Wu ◽

Chao A. Hsiung

Keyword(s):

Longitudinal Study ◽

Cognitive Function ◽

Older People ◽

Cognitive Decline ◽

Community Dwelling ◽

Education Levels ◽

Reading Activity ◽

Reduced Risk

ABSTRACT Objective: This study examined the effect of daily life reading activity on the risk of cognitive decline and whether the effect differs regarding education levels. Design: A longitudinal study with 6-, 10-, and 14-year follow-up. Setting: Face-to-face interviews with structured questionnaires at home. Participants: A representative sample of 1,962 Taiwanese community-dwelling older persons aged 64 and above, followed up in four waves of surveys over 14 years. Measurements: Baseline reading frequencies were measured based on a scale of leisure activity. The Short Portable Mental Status Questionnaire was used to measure cognitive performance. We performed logistic regression to assess associations between baseline reading and later cognitive decline. Interaction terms between reading and education were to compare the reading effects on cognitive decline at different education levels. Results: After adjusting for covariates, those with higher reading frequencies (≥1 time a week) were less likely to have cognitive decline at 6-year (adjusted odds ratio [AOR]: 0.54; 95% confidence interval [CI]: 0.34–0.86), 10-year (AOR: 0.58, 95% CI: 0.37–0.92), and 14-year (AOR: 0.54, 95% CI: 0.34–0.86); in a 14-year follow-up, a reduced risk of cognitive decline was observed among older people with higher reading frequencies versus lower ones at all educational levels. Conclusions: Reading was protective of cognitive function in later life. Frequent reading activities were associated with a reduced risk of cognitive decline for older adults at all levels of education in the long term.

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Predictors of Changes in Cognitive Function in Older Korean Adults: The 2006–2018 Korean Longitudinal Study of Aging

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18126345 ◽

2021 ◽

Vol 18 (12) ◽

pp. 6345

Author(s):

Minjeong Kang ◽

Inhwan Lee ◽

Haeryun Hong ◽

Jeonghyeon Kim ◽

Hyunsik Kang

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Longitudinal Study ◽

Cognitive Function ◽

Cognitive Decline ◽

Community Dwelling ◽

Severe Cognitive Impairment ◽

Korean Adults ◽

Age Related ◽

Normal Cognition

Cognitive decline with normal aging varies widely among individuals. This study aimed to investigate predictors of longitudinal changes in cognitive function in community-dwelling Korean adults aged 65 years and older. Data from 727 older adults who participated in the Korean Longitudinal Study of Aging (KLoSA) survey from 2006 (baseline) until 2018 (seventh wave) were used. Cognitive performance was assessed with the Korean Mini-Mental State Examination. The participants were retrospectively classified into normal cognition, mild cognitive impairment, and moderate/severe cognitive impairment. Education, income, religion, living area, alcohol intake, smoking, physical activity, handgrip strength, functional dependency, depression, comorbidity, medications, fall experience, and unintentional weight loss were included as covariates. A linear mixed regression analysis showed that a steeper decline in cognitive function over time was significantly associated with parameters of poor socio-economic status, health conditions, and unhealthy behaviors. Individuals with mild cognitive impairment or moderate/severe cognitive impairment were likely to have steeper cognitive declines compared with individuals with normal cognition. The current findings of the study showed that age-related cognitive decline was multifactorial in older Korean adults.

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