Hearing aids could help fight dementia

Man holding a hearing aid

A study published in Lancet Public Health suggests that the use of hearing aids may protect against the higher risk of dementia associated with hearing loss. The study of 437,704 participants found that people with hearing loss but not using hearing aids had a 1.7% risk of dementia, compared with 1.2% in people without hearing loss or using hearing aids. The authors call for increased public awareness, reduced costs and more support for primary care workers to screen for hearing impairment and provide treatment, such as hearing aid fittings.

According to a new study published in Lancet Public Health log. However, using a hearing aid can reduce this risk to the same level as people without hearing loss.

Dementia and hearing loss are common conditions in older people. THE Lancet The Commission on Dementia Prevention, Intervention and Care, published in 2020, suggested that hearing loss may be linked to around 8% of dementia cases worldwide,(1) therefore, managing hearing loss could be a crucial way to reduce the global burden of dementia.

“Evidence is accumulating that hearing loss may be the single most important modifiable risk factor for dementia in mid-life, but the effectiveness of hearing aid use in reducing dementia risk worldwide remains uncertain. Our study provides the best evidence to date to suggest that hearing aids may be a minimally invasive and cost-effective treatment to mitigate the potential impact of hearing loss on dementia,” says corresponding author Professor Dongshan Zhu, Shandong University (China).

The researchers looked at data from 437,704 people in the UK Biobank database. Information on the presence of hearing loss and the use of hearing aids was collected via self-report questionnaires, and dementia diagnoses were determined using hospital records and death registry data. The average age of study participants at enrollment was 56 years and the average follow-up time was 12 years.

About three-quarters of the participants (325,882/437,704) had no hearing loss, and the remaining quarter (111,822) had some level of hearing loss. Among people with hearing loss, 11.7% (13,092 / 111,822) used hearing aids.

After controlling for other factors, the study suggests that compared to participants with normal hearing, people with hearing loss who did not use hearing aids had a 42% higher risk of dementia from all causes, whereas no increased risk was found in people with hearing loss who used hearing aids.

This equates to approximately a 1.7% risk of dementia in people with hearing loss who do not use hearing aids, compared to 1.2% in people without hearing loss or who have hearing loss but use hearing aids .

“Almost four-fifths of people with hearing loss do not use hearing aids in the UK.(2) Hearing loss can begin in your early 40s and there is evidence that progressive cognitive decline before a diagnosis of dementia can last 20-25 years. Our findings underscore the urgent need to rapidly introduce hearing aids when a person begins to experience hearing loss. A whole-of-society group effort is needed, including raising awareness of hearing loss and potential links to dementia, improving accessibility to hearing aids by reducing costs, and increased support for primary care workers to screen for hearing loss, raise awareness and provide treatment. such as fitting hearing aids,” says Dongshan Zhu.

The researchers also analyzed how other factors, including loneliness, social isolation and depressive symptoms, might impact the association between hearing loss and dementia. Analysis of the study suggests that less than 8% of the association between hearing aid use and reduced dementia risk could be reversed by improving psychosocial problems. The authors say this indicates that the association between hearing aid use and protection against increased dementia is likely primarily due to the direct effects of hearing aids rather than the indirect causes studied.

“The underlying pathways that may link hearing aid use and reduced risk of dementia are unclear. Further research is needed to establish a causal relationship and the presence of underlying pathways,” says the author of the study, Dr Fan Jiang, from Shandong University (China).

The authors acknowledge some limitations to the study, including that self-reporting carries a risk of bias and that, as this study is observational, the association between hearing loss and dementia could be due to reverse causation via neurodegeneration or other shared mechanisms. Additionally, while many co-factors were taken into account, there could be unmeasured factors, such as those who use hearing aids potentially taking better care of their health than those who do not. Finally, most UK Biobank participants are white and very few participants were born deaf or had hearing loss before acquiring spoken language, which may limit the generalizability of the results to other ethnicities and people. hearing impaired using sign language.

Writing in a linked comment, Professor Gill Livingston and Dr Sergi Costafreda, of University College London, who were not involved in this research, said: “With the addition of the work of Jiang and his colleagues, the evidence that hearing aids are a powerful tool for reducing the risk of dementia in people with hearing loss, is as good as it gets without randomized controlled trials, which might not be practically possible or ethical because people with hearing loss should not be prevented to use effective treatments. Dementia is not only a disease that affects the individual and their family, but it can also be costly. However, the use of hearing aids to prevent dementia has been shown to be cost effective and economical. In the United States, hearing aids are now available for purchase over-the-counter, making them more accessible. The evidence is compelling that treating hearing loss is a promising way to reduce the risk of dementia. Now is the time to increase awareness and detection of hearing loss, as well as the acceptability and ease of use of hearing aids. »

The references:

  1. “Dementia prevention, intervention and care: 2020 report from the Lancet Commission” by Professor Gill Livingston, MD; Jonathan Huntley, Ph.D.; Andrew Sommerlad, Ph.D.; Prof. David Ames, MD; Prof. Clive Ballard, MD; Prof. Sube Banerjee, MD; Prof. Carol Brayne, MD; Professor Alistair Burns, MD; Prof. Jiska Cohen-Mansfield, PhD; Prof. Claudia Cooper, PhD; Sergi G Costafreda, PhD; Amit Dias, MD; Prof. Nick Fox, MD; Prof Laura N Gitlin, PhD; Professor Robert Howard, MD; Prof. Helen C Kales, MD; Prof. Mika Kivimäki, FMedSci; Prof. Eric B Larson, MD; Prof. Adesola Ogunniyi, MBChB; Vasiliki Orgeta, PhD; Prof. Karen Ritchie, PhD; Prof. Kenneth Rockwood, MD; Prof. Elizabeth L Sampson, MD; Quincy Samus, PhD; Prof. Lon S Schneider, MD; Prof Geir Selbaek, MD; Prof Linda Teri, PhD and Naaheed Mukadam, PhD, July 30, 2020, The Lancet.
    DOI: 10.1016/S0140-6736(20)30367-6
  2. “Correlates of hearing aid use in UK adults: self-reported hearing difficulties, social participation, living situation, health and demographics” by Chelsea S Sawyer, Christopher J Armitage, Kevin J Munro, Gurjit Singh and Piers D Dawes, September/October 2019, ear and hearing.
    DOI: 10.1097/AUD.0000000000000695

Reference: “Association between hearing aid use and all-cause and specific dementia: a UK Biobank cohort analysis” by Fan Jiang, PhD; Shiva Raj Mishra, PhD; Nipun Shrestha, Ph.D.; Professor Akihiko Ozaki, PhD; Prof. Salim S Virani, PhD; Tess Bright, Ph.D.; Prof. Hannah Kuper, ScD; Prof Chengchao Zhou, PhD and Prof Dongshan Zhu, PhD, April 13, 2023, Lancet Public Health.
DOI: 10.1016/S2468-2667(23)00048-8

This study was funded by the National Natural Science Foundation of China and Shandong Province, Taishan Scholars Project, China Medical Board, and China Postdoctoral Science Foundation. See the article for a full list of author affiliations.

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