Hearing Loss, Brain Structure, Cognition, and Dementia Risk in the Framingham Heart Study

1. In this cohort study, midlife hearing loss was linked with smaller brain volumes, faster decline in executive function, and a higher risk of developing dementia, particularly in those carrying the apolipoprotein E ε4 allele. 

Evidence Rating Level: 1 (Excellent) 

Age-related hearing loss has been linked by studies as a major risk factor for dementia, with several others noting the association between age-related hearing loss and poorer cognition. This study, using data from the Framingham Heart Study (FHS) Offspring Study, a 3-generational cohort study, examined the link between hearing loss with a multitude of brain outcomes, including those measured by MRI and neuropsychological ones. The presence of the apolipoprotein E (APOE) ε4 allele was used to evaluate the association and the value of hearing loss as a predictive risk factor for dementia. 1656 participants were studied and examined by certified audiologists for Pure Tone Averages (PTA), with patient histories obtained. A large spectrum of cognitive tests was run to link brain outcomes. The study found links between hearing loss and decline in brain function, with increasing PTA thresholds linearly associated with a greater increase in white matter hyperintensity volume (β [SE], 0.02 [0.01]; P = .048) and a greater decline in TMT-B minus TMT-A performance (β [SE], −0.02 [0.01]; P = .02). 12.7% of patients from a sample developed dementia, with a higher risk shown for those with any hearing loss (HR, 1.71; 95% CI, 1.01-2.90; P = .045). Those who did not use hearing aids showed a slightly elevated risk compared to those who did (HR, 1.72; 95% CI, 1.02-2.91; P = .04), with the primary risk being seen in APOE ε4 carriers (HR, 2.82; 95% CI, 1.11-7.16; P = .03). Overall, any more than a slight hearing loss showed 70% increase in dementia risk. The links between the two may be due to isolation or decreases in brain connectivity. Hearing loss can thus be seen to not just affect quality of life, but also brain health.

Click here to read this study in JAMA Network Open

Image: PD

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