Hearing loss and incident dementia

Abstract

Objective: To determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease (AD).

Design: Prospective study of 639 individuals who underwent audiometric testing and were dementia free in 1990 to 1994. Hearing loss was defined by a pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear (normal, <25 dB [n = 455]; mild loss, 25-40 dB [n = 125]; moderate loss, 41-70 dB [n = 53]; and severe loss, >70 dB [n = 6]). Diagnosis of incident dementia was made by consensus diagnostic conference. Cox proportional hazards models were used to model time to incident dementia according to severity of hearing loss and were adjusted for age, sex, race, education, diabetes mellitus, smoking, and hypertension.

Setting: Baltimore Longitudinal Study of Aging.

Participants: Six hundred thirty-nine individuals aged 36 to 90 years.

Main outcome measure: Incident cases of all-cause dementia and AD until May 31, 2008.

Results: During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed, of which 37 cases were AD. The risk of incident all-cause dementia increased log linearly with the severity of baseline hearing loss (1.27 per 10-dB loss; 95% confidence interval, 1.06-1.50). Compared with normal hearing, the hazard ratio (95% confidence interval) for incident all-cause dementia was 1.89 (1.00-3.58) for mild hearing loss, 3.00 (1.43-6.30) for moderate hearing loss, and 4.94 (1.09-22.40) for severe hearing loss. The risk of incident AD also increased with baseline hearing loss (1.20 per 10 dB of hearing loss) but with a wider confidence interval (0.94-1.53).

Conclusions: Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.

Figure 1

Selection of subjects for study inclusion

Figure 2

Risk of incident all-cause dementia by baseline hearing loss after adjustment for age, sex, race, education, diabetes, smoking, and hypertension. Hearing loss is defined by the pure tone average (PTA) of 0.5, 1, 2, and 4 kHz tones presented by air-conduction in the better hearing ear. Upper and lower dashed lines correspond to the 95% confidence interval.