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. 2022 May 5;77(5):839-849.
doi: 10.1093/geronb/gbab194.

Examining the Combined Estimated Effects of Hearing Loss and Depressive Symptoms on Risk of Cognitive Decline and Incident Dementia

Danielle S Powell  1   2 , Willa D Brenowitz  3   4 , Kristine Yaffe  3   4   5 , Nicole M Armstrong  6 , Nicholas S Reed  2   7 , Frank R Lin  2   8 , Alden L Gross  1   7 , Jennifer A Deal  2   7
Affiliations

Examining the Combined Estimated Effects of Hearing Loss and Depressive Symptoms on Risk of Cognitive Decline and Incident Dementia

Danielle S Powell et al. J Gerontol B Psychol Sci Soc Sci. .

Abstract

Objectives: Late-life depression is a comorbidity that may co-occur in older adults with hearing loss-each has prevalent and independent modifiable risk factors for dementia.

Methods: Using data from 1,820 Health, Aging and Body Composition study participants (74 ± 2.8 years, 38% Black race), we compared the hearing loss-dementia/cognitive decline relationship between those with normal hearing/mild hearing loss and those with moderate or greater hearing loss. Using linear mixed-effects and Cox proportional hazard models, we investigated if the associations between hearing loss and cognitive decline or dementia (Modified Mini-Mental State [3MS] Examination and Digit Symbol Substitution Test [DSST]) differed by the presence or absence of depressive symptoms. Depressive symptoms were defined as Center for Epidemiologic Study-Depression scale 10 ≥10 at one or more visits from Years 1-5. Algorithmic incident dementia was defined using medication use, hospitalizations, and cognitive test scores. Audiometric hearing loss was measured at Year 5 and categorized as normal/mild versus moderate or greater hearing loss.

Results: Having both hearing loss and depressive symptoms (vs. having neither) was associated with faster rates of decline in 3MS Examination (β = -0.30; 95% confidence interval [CI]: -0.78, -0.19) and DSST (β = -0.35; 95% CI: -0.67, -0.03) over 10 years of follow-up. Having both hearing loss and depressive symptoms (vs. neither) was associated with increased risk (hazard ratio [HR]: 2.91; 95% CI: 1.59, 5.33 vs. HR: 1.54; 95% CI: 1.10, 2.15 hearing loss only and HR: 2.35; 95% CI: 1.56, 3.53 depressive symptoms only) of incident dementia in multivariable-adjusted Cox proportional hazards models.

Discussion: Comorbid conditions among hearing-impaired older adults should be considered and may aid in dementia prevention and management strategies.

Keywords: Cognition; Depression; Hearing loss; Mental health.

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Figures

Figure 1.
Figure 1.
Estimated mean scores on cognitive test by exposure and measure of depressive symptom in the Health ABC Study over 11 years of follow-up (N = 2,061). (A) Estimated mean 3MS score over follow-up by hearing loss and baseline depressive symptoms status. (B) Estimated mean 3MS score over follow-up by hearing loss and repeated depressive symptoms status. (C) Estimated mean DSST score over follow-up by hearing loss and baseline depressive symptoms status. (D) Estimated mean DSST score over follow-up by hearing loss and repeated depressive symptoms status. Notes: BL depressive symptoms = CES-D 10 score ≥10 at baseline of Visit 1; Rep Depressive Symptoms = repeated depressive symptoms, CES-D 10 ≥10 at more than one visit between Visits 1–5; HL = moderate or greater hearing loss; Referent = normal or mild hearing loss and no depressive symptoms (CES-D 10 score <10); 3MS = Modified Mini-Mental State Examination; DSST = Digit Symbol Substitution Test.
Figure 2.
Figure 2.
Stratified hazard ratio of incident dementia for heterogeneity of effect between hearing loss and measure of depressive symptom. A: Hazard ratio of incident dementia among strata of hearing loss. B: Hazard of incident dementia among strata of depressive symptoms. Note: Depressive symptoms = CES-D 10 score ≥10 at baseline of Visit 1; Repeated Depressive Symptoms = CES-D; Hearing loss = moderate or greater hearing loss. CES-D = Center for Epidemiologic Study—Depression.
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