Laboratory of Behavioral Neuroscience, National Institute of Aging, Baltimore, Maryland.
Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.
J Gerontol A Biol Sci Med Sci. 2020 Feb 14;75(3):537-544. doi: 10.1093/gerona/glz173.
Hearing loss (HL) and menopausal hormone therapy (conjugated equine estrogens [CEE] and/or medroxyprogesterone acetate [MPA]) are separately associated with cognitive decline and increased risk of incident cognitive impairment. Joint effects of HL and HT could be associated with additive or synergistic decline in global cognition and risk of incident cognitive impairment among postmenopausal women.
Using the Women's Health Initiative (WHI) Memory Study, 7,220 postmenopausal women with measures of HL, global cognition (Modified Mini-Mental State Examination score), and cognitive impairment (centrally adjudicated diagnoses of mild cognitive impairment and dementia) from 1996 to 2009. Multivariable linear mixed-effects models were used to analyze rate of change in global cognition. Accelerated failure time models were used to evaluate time to incident cognitive impairment, stratified by HT.
Within the CEE-Alone trial, observed adverse effects of CEE-Alone on change in global cognition did not differ by HL, and estimated joint effects of HL and CEE-Alone were not associated with incident cognitive impairment. Within the CEE+MPA trial, while HL did not independently accelerate time to cognitive impairment, the adverse effect of CEE+MPA on global cognition was heightened in older women with HL. Older women on CEE+MPA either with HL (time ratio [TR] = 0.82, 95% confidence interval [CI]: 0.71, 0.94) or with normal hearing (TR = 0.86, 95% CI: 0.76, 0.97) had faster time to cognitive impairment than those with normal hearing and placebo.
HL may accentuate the adverse effect of CEE+MPA, not CEE-Alone, on global cognitive decline, not incident cognitive impairment, among postmenopausal women on HT.
听力损失（HL）和绝经激素治疗（结合马雌激素[CEE]和/或醋酸甲羟孕酮[MPA]）分别与认知能力下降和认知障碍发生率增加相关。HL 和 HT 的联合效应可能与绝经后妇女的整体认知能力下降和认知障碍发生率增加相关，这种下降可能具有累加或协同作用。
使用妇女健康倡议（WHI）记忆研究，对 1996 年至 2009 年间的 7220 名绝经后妇女进行了 HL、整体认知（改良的 Mini-Mental State 检查评分）和认知障碍（经中心裁定的轻度认知障碍和痴呆诊断）的评估。采用多变量线性混合效应模型分析整体认知的变化率。采用加速失效时间模型，按 HT 分层，评估认知障碍的发生时间。
在 CEE-单独试验中，观察到 CEE-单独治疗对整体认知变化的不良影响与 HL 无关，并且 HL 和 CEE-单独治疗的联合作用与认知障碍的发生无关。在 CEE+MPA 试验中，虽然 HL 本身不能加速认知障碍的发生时间，但 CEE+MPA 对 HL 老年女性的整体认知的不良影响加剧。接受 CEE+MPA 治疗的老年女性，无论是否有 HL（时间比[TR] = 0.82，95%置信区间[CI]：0.71，0.94）或听力正常（TR = 0.86，95% CI：0.76，0.97），其认知障碍发生时间均快于听力正常且接受安慰剂治疗的女性。
HL 可能会加剧 CEE+MPA 而不是 CEE-单独治疗对绝经后接受 HT 治疗的女性整体认知下降的不良影响，而不是认知障碍的发生。
