Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Auris Nasus Larynx. 2022 Jun;49(3):360-367. doi: 10.1016/j.anl.2021.09.006. Epub 2021 Oct 20.
It is shown that eliminating hearing loss in mid-life may reduce the risk for deterioration in cognitive function. Cochlear implantation (CI) is the only available therapy that can eliminate hearing loss in patients who suffer from profound sensorineural hearing loss. This suggests there may be positive effects of hearing level on cognition in older adults following CI. Therefore, the purpose of this study is to clarify whether cognitive function can be improved or maintained using cochlear implants in older adult patients with hearing impairments.
Data for patients that underwent CI surgery for profound bilateral sensorineural hearing loss were collected prospectively. Patients aged 65 years and older were recruited at our university hospital from 2013 to 2017. Twenty-one patients (age range: 65-80 years) were included in this study. The primary outcome measurement was the change in cognitive function three points assessed by Mini-Mental State Examination (MMSE): preoperatively, and at 1 and 2 years after surgery. The secondary outcome measurements were the followings; the Nijmegen Cochlear Implant Questionnaire (NCIQ), the Self-Rating Depression Scale (SDS), and hearing and speech recognition threshold assessment before CI, and 1 and 2 years after CI. Differences in MMSE scores were compared for statistical significance using the Friedman test. The Wilcoxon signed-rank test was used as a post hoc test. Possible correlations between MMSE scores and NCIQ subdomain scores 2 years after surgery were evaluated with Spearman's tests. Statistical significance was defined as a p-value <0.05.
CI recipients showed significant improvement in MMSE scores. This improvement peaked 1 year after CI surgery. The postoperative MMSE score was correlated with the NCIQ speech production score but not with the other five NCIQ subdomains. There was no correlation between MMSE score and speech recognition.
Speech production is important to improve cognitive function after CI, and this improvement peaked 1 year after CI. Although severe or profound hearing loss in older adults worsens the natural course of cognitive function decline, CI has positive impacts on cognitive function even if MMSE scores decrease 1 year after the peak (i.e., 2 years after CI). Talking with others based on hearing is crucial to improve cognitive function. We should encourage older adult patients to take many opportunities to talk with others after CI surgery.
研究表明，中年时期消除听力损失可能会降低认知功能恶化的风险。人工耳蜗植入（CI）是唯一可以消除患有重度感音神经性听力损失患者听力损失的治疗方法。这表明，在接受 CI 的老年患者中，听力水平可能对认知有积极影响。因此，本研究旨在阐明在听力受损的老年患者中使用人工耳蜗植入是否可以改善或维持认知功能。
前瞻性收集接受 CI 手术治疗双侧重度感音神经性听力损失患者的数据。2013 年至 2017 年，在我们的大学医院招募年龄在 65 岁及以上的患者。本研究纳入 21 例患者（年龄 65-80 岁）。主要结局测量是通过 Mini-Mental State Examination（MMSE）评估的认知功能变化：术前、术后 1 年和 2 年。次要结局测量包括以下内容：Nijmegen 人工耳蜗植入问卷（NCIQ）、自评抑郁量表（SDS）、CI 前和 CI 后 1 年和 2 年的听力和言语识别阈值评估。采用 Friedman 检验比较 MMSE 评分的差异是否有统计学意义。Wilcoxon 符号秩检验用于事后检验。采用 Spearman 检验评估术后 2 年 MMSE 评分与 NCIQ 子域评分之间的可能相关性。统计学意义定义为 p 值<0.05。
CI 接受者的 MMSE 评分显著提高。这种改善在 CI 手术后 1 年达到峰值。术后 MMSE 评分与 NCIQ 言语产生评分相关，但与其他五个 NCIQ 子域无关。MMSE 评分与言语识别无相关性。
言语产生对 CI 后认知功能的改善很重要，这种改善在 CI 后 1 年达到峰值。尽管老年人的严重或极重度听力损失会使认知功能下降的自然病程恶化，但即使在 MMSE 评分在峰值后 1 年（即 CI 后 2 年）下降，CI 对认知功能仍有积极影响。基于听力与他人交谈对于改善认知功能至关重要。我们应该鼓励老年患者在接受 CI 手术后有更多机会与他人交谈。
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