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Hearing Loss and Cognitive Decline in Older Adults
Frank R. Lin, Kristine Yaffe, Jin Xia, Qian-Li Xue, Tamara B. Harris, Elizabeth Purchase-Helzner, Suzanne Satterfield, Hilsa N. Ayonayon et al.. JAMA Internal Medicine, 2013-01-21
Topic: Risk, prevention and care in population studies
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.
Key findings
- BACKGROUND Whether hearing loss is independently associated with accelerated cognitive decline in older adults is unknown.
- 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.
- 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.
Why it matters
This prospective study found that older adults with hearing loss had faster rates of cognitive decline and a higher risk of incident cognitive impairment than those with normal hearing. It does not show that treating hearing loss prevents Alzheimer's disease.
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Study details
- Participants1,984
- Evidence strengthModerate
How this study scored 57/100
Published in a leading specialty journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited and senior author's track record, so those were left out: it earned 39 of the 68 points we could judge it on, which is 57 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (JAMA Internal Medicine) |
| Journal's citation record | 3 / 4 | JAMA Internal Medicine: journal h-index 258 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2013 — within 20 year(s) of the newest study here |
| Sample size | 3 / 4 | 1,984 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | Citation count not trusted: 25 of 166 library studies citing it were published more than a year before it - a sign OpenAlex merged several works under this DOI — left out of this score |
| Citations per year | — / 5 | Citation count not trusted (see above) — left out of this score |
| Impact for its field and year | — / 6 | Citation count not trusted (see above) — left out of this score |
| Cited by studies here | — / 6 | Library citations not trusted (see above) — left out of this score |
| Still being cited | — / 4 | Citation count not trusted (see above) — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 23337978) |
| Free to read | 2 / 2 | Free to read |
| Points | 39 / 68 | Scored on 14 of 20 parts. We have no data for the rest, so they are left out: 39 of the 68 points we could judge it on is 57 out of 100. |
| Total | 57 / 100 | — |
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Read the original
- DOI: 10.1001/jamainternmed.2013.1868
- PubMed: 23337978
- Original source →
- Free full text: PubMed Central →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Lin, F. R., Yaffe, K., Xia, J., Xue, Q.-L., Harris, T. B., Purchase-Helzner, E., et al. (2013). Hearing Loss and Cognitive Decline in Older Adults. JAMA Internal Medicine. https://doi.org/10.1001/jamainternmed.2013.1868
Vancouver
Lin FR, Yaffe K, Xia J, Xue Q.-L, Harris TB, Purchase-Helzner E, et al. Hearing Loss and Cognitive Decline in Older Adults. JAMA Internal Medicine. 2013. doi:10.1001/jamainternmed.2013.1868. PMID: 23337978.
BibTeX
@article{lin2013-23337978,
author = {Lin, Frank R. and Yaffe, Kristine and Xia, Jin and Xue, Qian-Li and Harris, Tamara B. and Purchase-Helzner, Elizabeth and Satterfield, Suzanne and Ayonayon, Hilsa N. and others},
title = {{Hearing Loss and Cognitive Decline in Older Adults}},
journal = {JAMA Internal Medicine},
year = {2013},
doi = {10.1001/jamainternmed.2013.1868},
pmid = {23337978},
url = {https://doi.org/10.1001/jamainternmed.2013.1868}
}
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