Middle-age hearing loss linked to higher odds of cognitive decline and dementia

By Carolyn Crist

Hearing loss in middle age is associated with higher odds of cognitive decline and dementia in later years, suggests a large study in Taiwan. 

Researchers tracked more than 16,000 men and women and found that a new diagnosis of hearing loss between ages 45 and 65 more than doubled the odds of a dementia diagnosis in the next dozen years. 

Even mild levels of hearing loss could be a risk factor, so hearing protection, screening and hearing aids may be important means of reducing cognitive risk as well, the study team writes in JAMA Network Open. 

“Hearing loss is a potential reversible risk factor for dementia, including Alzheimer’s disease,” said senior study author Charles Tzu-Chi Lee of National Taiwan Normal University in Taipei. 

Past research suggests that about two thirds of the risk for dementia is hereditary or genetic, which means about one third of the risk is from things that are modifiable, Lee noted. Among modifiable risk factors, hearing loss accounts for about 9 per cent of dementia risk, a greater proportion than factors like hypertension, obesity, depression, diabetes and smoking. 

“The early identification of hearing loss... and successful hearing rehabilitation can mitigate the negative effects of hearing loss,” Lee told Reuters Health by e-mail. “However, the ideal time to perform hearing loss screening to reduce the risk of dementia remains unclear.” 

Lee and colleague Chin-Mei Liu of the Taiwan Centres for Disease Control analysed data on people aged 45 and older from the National Health Insurance Research Database of Taiwan. They matched 8,135 patients newly diagnosed with hearing loss between 2000 and 2011 to 8,135 similar individuals without hearing loss and followed them all through 2013. 

All were free of dementia at the start, but over time, 1,868 people developed dementia — and 59 per cent of them came from the hearing loss group. 

Among people with hearing loss, new dementia cases were identified at a rate of 19 per 10,000 people, compared with 14 per 10,000 without hearing loss. Overall, hearing loss was associated with a 17 per cent risk increase for dementia, the researchers calculated. 

But when they looked at subsets of people, almost all the increased risk was concentrated in the youngest age group. Among those 45-65, dementia risk was 2.21-fold higher with hearing loss. 

“The present study suggests that screening for hearing loss should be performed when people are middle aged,” Lee said. 

The results factored in variables such as sex, age and insurance type, as well as other known risks for cognitive decline and dementia. Among these, six other conditions were associated with an increased risk of dementia: cerebrovascular disease, diabetes, anxiety, depression, alcohol-related illnesses and head injury. 

The study was not designed to determine how hearing loss might contribute to dementia, or if the two conditions share the same cause. One limitation of insurance data, the researchers note, is lack of precision in the dementia diagnoses. 

“In an aging population, dementia will present one of the greatest challenges to society in this century,” said David Loughrey of the Trinity College Institute of Neuroscience in Dublin, who wasn’t involved in the study. 

“There are now more people over the age of 65 than under the age of five for the first time in human history,” he told Reuters Health by e-mail. “Pharmacological treatments for the most common cause of dementia, Alzheimer’s disease, only offer symptom-modifying effects. This has led to suggestions that a change in approach to prevention rather than treatment after diagnosis may be more beneficial.” 

Future studies will investigate whether treating hearing loss can decrease the risk of dementia, the study team writes. 

“Hearing health is critically important to the human experience,” said Dr Richard Gurgel of the University of Utah in Salt Lake City, who wasn’t involved in the study. 

 “There is more to hearing loss than just hearing. Hearing loss affects the way we fundamentally communicate and connect with one another,” he said in an email. “Hearing loss impacts the overall health of older adults, including their emotional well-being and social isolation, as well as cognition.”