Hearing loss associated with aging – presbycusis – can have negative consequences in other ways, as poor hearing can contribute to older people becoming socially isolated and not participating in activities that help them stay active, leading to physical deterioration. , but, in addition, various studies have linked untreated deafness in older adults with a higher probability of developing mental disorders, and even dementia.
Now, a new study has found that three years of hearing aid use halved cognitive decline in a subgroup of older adults with hearing loss who were at increased risk of developing cognitive decline. This is the largest clinical trial conducted to date to determine whether treatment of hearing loss with hearing aids is useful in preventing cognitive decline.
The results of the ‘Aging and Cognitive Health Evaluation in Elders (ACHIEVE)’ study were announced at the Alzheimer’s Association® International Conference (AAIC®) 2023, in Amsterdam, The Netherlands and online, and were published in the scientific journal The Lancet. Although the results were negative in the total study population, the hearing intervention decreased cognitive decline in older adults with mild to moderate hearing loss by 48% in a pre-specified segment of the study population comprised of 238 individuals participating in a ongoing observational study of heart health.
“Hearing loss is highly treatable in old age, making it an important public health target to reduce the risk of cognitive decline and dementia”
The ACHIEVE study is a randomized trial involving people aged 70 to 84 years with untreated hearing loss without significant cognitive impairment, conducted at four sites in the US. Participants were selected from Two study populations at each site: one comprised of 977 older adults participating in a long-term observational study of cardiovascular health—the Atherosclerosis Risk in Communities (ARIC) study—and another comprised of 739 healthy volunteers from the community.
At the start of the trial all participants had mild to moderate hearing loss, which is very common in older adults, but no relevant cognitive impairment. These people were randomly assigned to either a hearing intervention (audiological counseling and provision of hearing aids) or a control health education intervention (individual sessions with a health educator covering topics on chronic disease prevention) and follow-up every six months.
The three-year intervention included the use of hearing aids, a hearing ‘toolkit’ to help with self-management, and ongoing instruction and counseling with an audiologist. The health education control group of the comparison group attended discussion sessions with a health educator on the prevention of chronic diseases. The total study population was analyzed, hearing intervention versus health education control; the ARIC and community subgroups were also analyzed in this way. The primary endpoint was the three-year change in a comprehensive battery of neurocognitive tests, which included procedures to help ensure that hearing loss did not affect the results.
Hearing loss as a risk factor for dementia
The results of the comparison of hearing intervention versus control in the total study population were negative, as were the comparison of the community population of hearing intervention versus control. The most interesting result was the comparison of the ARIC subgroup auditory intervention versus control, in which a 48% decrease in cognitive impairment was observed.
The researchers found that the group of ARIC study participants had more risk factors for cognitive decline, lower baseline cognitive scores, and a faster three-year rate of cognitive decline during the study than the others. “The positive results with auditory intervention in the ARIC subgroup analysis are encouraging and warrant further investigation,” said Maria C. Carrillo, Alzheimer’s Association Chief Scientific Officer. “Previous research has identified hearing loss as potentially the largest risk factor for dementia that can be addressed or modified with existing tools that remain underutilized,” she adds.
“The hearing intervention had a significant effect in reducing cognitive change within three years in the study population of older adults who are at increased risk of cognitive decline,” said Dr. Frank Lin, of the School of Johns Hopkins University of Medicine and Bloomberg School of Public Health, and co-principal investigator of the ACHIEVE study. “Hearing loss is highly treatable in old age, making it an important public health goal to reduce the risk of cognitive decline and dementia, along with other risk factors for dementia, such as less education in early childhood. life, high blood pressure, social isolation and physical inactivity.
ACHIEVE researchers have found that 65% of adults over the age of 60 have hearing loss, making it urgent to identify dementia prevention strategies that can be implemented globally. Findings from the ACHIEVE study suggest that older adults at increased risk of cognitive decline and dementia who also have hearing loss may benefit most from this hearing intervention within three years. According to ACHIEVE researchers, hearing intervention can slow the decline in thinking and memory by making listening easier on the brain or by helping people stay more socially and physically active.
“In both the ARIC group and the new group of community volunteers, we also found that the auditory intervention improved communication skills, social functioning, and loneliness,” Lin said. “Until we know more, we recommend for general health and well-being that older adults have their hearing checked regularly and that any hearing problems be addressed appropriately.”
