Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins School of Medicine, and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
JAMA Intern Med. 2013 Feb 25;173(4):293-9. doi: 10.1001/jamainternmed.2013.1868.
BACKGROUND Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown. METHODS We studied 1984 older adults (mean age, 77.4 years) enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998. Our baseline cohort consisted of participants without prevalent cognitive impairment (Modified Mini-Mental State Examination [3MS] score, ≥80) who underwent audiometric testing in year 5. Participants were followed up for 6 years. Hearing was defined at baseline using a pure-tone average of thresholds at 0.5 to 4 kHz in the better-hearing ear. Cognitive testing was performed in years 5, 8, 10, and 11 and consisted of the 3MS (measuring global function) and the Digit Symbol Substitution test (measuring executive function). Incident cognitive impairment was defined as a 3MS score of less than 80 or a decline in 3MS score of more than 5 points from baseline. Mixed-effects regression and Cox proportional hazards regression models were adjusted for demographic and cardiovascular risk factors. RESULTS In total, 1162 individuals with baseline hearing loss (pure-tone average >25 dB) had annual rates of decline in 3MS and Digit Symbol Substitution test scores that were 41% and 32% greater, respectively, than those among individuals with normal hearing. On the 3MS, the annual score changes were -0.65 (95% CI, -0.73 to -0.56) vs -0.46 (95% CI, -0.55 to -0.36) points per year (P = .004). On the Digit Symbol Substitution test, the annual score changes were -0.83 (95% CI, -0.94 to -0.73) vs -0.63 (95% CI, -0.75 to -0.51) points per year (P = .02). Compared to those with normal hearing, individuals with hearing loss at baseline had a 24% (hazard ratio, 1.24; 95% CI, 1.05-1.48) increased risk for incident cognitive impairment. Rates of cognitive decline and the risk for incident cognitive impairment were linearly associated with the severity of an individual's baseline hearing loss. CONCLUSIONS Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults. Further studies are needed to investigate what the mechanistic basis of this association is and whether hearing rehabilitative interventions could affect cognitive decline.
听力损失是否与老年人认知能力加速下降独立相关尚不清楚。
我们研究了 1984 名年龄在 77.4 岁的老年人（平均年龄），他们参加了健康 ABC 研究，这是一项始于 1997-1998 年的前瞻性观察性研究。我们的基线队列由无认知障碍（改良简易精神状态检查[3MS]评分≥80）的参与者组成，他们在第 5 年接受了听力测试。参与者随访 6 年。听力在基线时使用较好耳 0.5 至 4 kHz 频率的纯音平均阈值来定义。认知测试在第 5、8、10 和 11 年进行，包括 3MS（测量整体功能）和数字符号替代测试（测量执行功能）。新发认知障碍定义为 3MS 评分低于 80 或 3MS 评分较基线下降 5 分以上。混合效应回归和 Cox 比例风险回归模型调整了人口统计学和心血管危险因素。
共有 1162 名基线听力损失（纯音平均听力>25 dB）的患者，3MS 和数字符号替代测试的年评分下降率分别高出 41%和 32%，而听力正常者的年评分下降率分别高出 41%和 32%。在 3MS 上，每年的评分变化为-0.65（95%CI，-0.73 至-0.56）与-0.46（95%CI，-0.55 至-0.36）分/年（P=0.004）。在数字符号替代测试中，每年的评分变化为-0.83（95%CI，-0.94 至-0.73）与-0.63（95%CI，-0.75 至-0.51）分/年（P=0.02）。与听力正常者相比，基线时听力损失者新发认知障碍的风险增加 24%（风险比，1.24；95%CI，1.05-1.48）。认知下降率和新发认知障碍的风险与个体基线听力损失的严重程度呈线性相关。
听力损失与社区居住的老年人认知能力加速下降和新发认知障碍独立相关。需要进一步研究以探讨这种关联的机制基础以及听力康复干预是否会影响认知下降。
