Objectives
To investigate the association between hearing loss, hearing aid use, and cognitive decline.
Design
Prospective population‐based study.
Setting
Data gathered from the Personnes Agées QUID ...study, a cohort study begun in 1989–90.
Participants
Individuals aged 65 and older (N = 3,670).
Measurements
At baseline, hearing loss was determined using a questionnaire assessing self‐perceived hearing loss; 137 subjects reported major hearing loss, 1,139 reported moderate problems (difficulty following the conversation when several persons talk at the same time or in a noisy background), and 2,394 reported no hearing trouble. Cognitive decline was measured using the Mini‐Mental State Examination (MMSE), administered at follow‐up visits over 25 years.
Results
Self‐reported hearing loss was significantly associated with lower baseline MMSE score (β = −0.69, P < .001) and greater decline during the 25‐year follow‐up period (β = −0.04, P = .01) independent of age, sex, and education. A difference in the rate of change in MMSE score over the 25‐year follow‐up was observed between participants with hearing loss not using hearing aids and controls (β = −0.06, P < .001). In contrast, subjects with hearing loss using a hearing aid had no difference in cognitive decline (β = 0.07, P = .08) from controls.
Conclusion
Self‐reported hearing loss is associated with accelerated cognitive decline in older adults; hearing aid use attenuates such decline.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Hearing loss is the third most prevalent health condition in older age. In recent years, research has consistently reported an association between hearing loss and mental health outcomes, including ...poorer cognitive performances. Whether treating hearing loss in elders improves cognition has been directly or indirectly addressed by several studies. This review aims at providing a synthesis of those results. Regarding the literature on hearing aids' use and cognition, although the lack of interventional studies has to be underlined, observational data suggest that hearing aids positively impact long-term cognition, even though more research is necessary to ascertain this statement and provide information on the length or frequency of use required in order to observe benefits. Regarding cochlear implants in elders experiencing more severe auditory deprivation, the literature is scarcer. The available studies have many limitations and do not allow the drawing of clear conclusions. Taken together, the results are encouraging. Nevertheless, because hearing loss is suspected to account for 9% of dementia cases, and also because hearing loss is one of the few potentially modifiable factors from a dementia prevention perspective, the need to stimulate research to have clearer knowledge of the benefits of treating hearing loss on cognitive outcomes is urgent.
Objective
Whereas cognitive deficits are known to be detectable long before the typical symptoms of Alzheimer's disease (AD) are evident, previous studies have failed to determine when cognitive ...functioning actually begins to decline before dementia. Utilizing the long follow‐up of the PAQUID study, we examined the emergence of the first clinical symptoms over a 14‐year period of follow‐up before the dementia phase of AD.
Methods
This study relies on a case–control sample selected from the PAQUID cohort. Of the 3,777 initial subjects of the cohort, 350 subjects experienced development of AD during the 14 years of follow‐up. The cases were matched to 350 elderly control subjects. The evolution of scores on cognitive, functional, and depression scales was described throughout the 14‐year follow‐up using a semiparametric extension of the mixed‐effects linear model.
Results
The first decline in cognitive performances appeared as early as 12 years before dementia in measures of semantic memory and conceptual formation. Then, more global deficits appeared that were concomitant with an increase in memory complaints and depressive symptoms. About 2 years later, as a consequence of cognitive dysfunction, the subjects started to become slightly dependent in their activities of daily living. In the last 3 years, the impairment significantly worsened until the subjects reached the dementia phase.
Interpretation
This approach, describing the 14 years preceding dementia, provides a clear illustration of the particularly long and progressive prodromal phase of AD, and shows the successive emergence of cognitive deficits, depressive symptoms, and functional impairment during this phase. Ann Neurol 2008;64:492–498
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract Health expectancies (HEs) have become a key indicator for monitoring healthy aging. So far, they have mainly been calculated based on functional rather than subjective health measures. Yet, ...by integrating several dimensions (medical, social, and cultural), subjective health is also an important measure of an older person’s health status. In this study, we first estimated HEs using self-rated health (SRH), by age and sex. Second, we compared these results to those obtained when using a disability measure. We used pooled data from three prospective population-based cohorts including adults aged 65 years and over, living in Southwestern France (N = 4468). SRH was assessed using a single question and disability was measured using the Lawton scale. Healthy/Unhealthy Life Expectancies (HLE/UHLE) and Disability/Disability-Free Life Expectancies (DLE/DFLE) were estimated using the Interpolated Markov Chain program (IMaCh), separately in men and women. Women lived longer than men, with similar HLE but longer UHLE at all ages. The proportion of HLE in total LE decreased with age for both sexes and for women, it became smaller than the proportion of UHLE from age 73 onward. In both sexes, while the DLE was shorter than the UHLE in the youngest, a reversal was observed with advancing age. This change occurred earlier in women. Our study supports that SRH and disability showed different aging patterns, with sex and age differences. From a public health perspective, SRH and disability indicators appeared not interchangeable as they uncovered complementary but different information on the needs of aging people.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Hearing loss in older adults is suspected to play a role in social isolation, depression, disability, lower quality of life, and risk of dementia. Such suspected associations still need to be ...consolidated with additional research. With a particularly long follow-up, this study assessed the relationship between hearing status and four major adverse health events: death, dementia, depression, and disability.
Prospective community-based study of 3,777 participants aged ≥65 followed up for 25 years. At baseline, 1,289 reported hearing problems and 2,290 reported no trouble. The risk of occurrence of the negative outcomes, including death, dementia, depressive symptoms, disability in activities of daily living (ADL), and instrumental ADL (IADL), was assessed with Cox proportional hazards models.
Adjusting for numerous confounders, an increased risk of disability and dementia was found for participants reporting hearing problems. An increased risk of depression was found in men reporting hearing problems. In additional exploratory analyses, such associations were not found in those participants using hearing aids. Mortality was not associated with self-reported hearing loss.
Our study confirms the strong link between hearing status and the risk of disability, dementia, and depression. These results highlight the importance of assessing the consequences of treating hearing loss in elders in further studies.
The authors examined longitudinal change in positive affect (PA), a component of subjective well-being. Positive affect was assessed with the PA subscale of the Center for Epidemiologic ...Studies-Depression Scale (Radloff, 1977) in a sample of individuals from the PAQUID cohort (n = 3,777; age 62-101 years, M = 75.46, SD = 6.91 at Wave 1) over a period of 22 years (10 waves of data). Latent growth curve modeling was used to assess change in PA. A quadratic latent growth curve was found to characterize the latent growth pattern of PA in our sample, indicating linear change before a decline phase. These results were discussed with reference to the well-being paradox.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ, UPUK
Abstract The influence of education, occupation, and leisure activities on the passive and active components of reserve capacity remains unclear. We used the voxel-based morphometry (VBM) technique ...in a population-based sample of 331 nondemented people in order to investigate the relationship between these factors and the cerebral volume (a marker of brain reserve). The results showed a positive and significant association between education, occupation, and leisure activities and the cognitive performances on Isaac's set test. Among these factors, only education was significantly associated with a cerebral volume including gray and white matter ( p = 0.01). In voxel-based morphometry analyses, the difference in gray matter volume was located in the temporoparietal lobes and in the orbitofrontal lobes bilaterally (a p -value corrected <0.05 by false discovery rate FDR). Although smaller, the education-related difference in white matter volume appeared in areas connected to the education-related difference in gray matter volume. Education, occupation attainment, and leisure activities were found to contribute differently to reserve capacity. Education could play a role in the constitution of cerebral reserve capacity.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background Foster families may represent an alternative model for dependent older adults in many countries where nursing homes are insufficiently developed. This study aimed to assess the prevalence ...of malnutrition and its determinants in older adults living in foster families in Guadeloupe (French West Indies). Methods This cross-sectional study was gathered from the KASAF (Karukera Study of Ageing in Foster families) study (n = 107, 41M/66F, Mdn 81.8 years). Nutritional status was assessed with the Mini Nutritional Assessment Short‐Form (MNA‐SF). Clinical characteristics and scores on geriatric scales (Mini-Mental State Examination (MMSE), Activities of Daily Living (ADL), Short Physical Performance Battery (SPPB), Center for Epidemiologic Studies- Depression (CESD) and Questionnaire Quality of Life Alzheimer’s Disease (QoL-AD)) were extracted. Bivariate analysis and logistic models adjusted for age and gender were performed to test the association of nutritional status with socio-demographic variables and geriatric scales. Results Thirty (28.0%) older adults were malnourished (MNA-SF score ≤7). In bivariate analysis, malnutrition was associated with an increased prevalence of cardiovascular diseases (46.7% versus 19.5%, p = 0.004), the presence of hemiplegia (30.0% versus 6.5%, p = 0.003), a poorer cognitive status (MMSE score 4.7 ± 7.1versus 9.7 ± 10.7; p = 0.031), higher risk of depression (CESD score 27.3 ± 23.0 versus 13.5 ± 14.4; p = 0.035) and dependency (ADL score 1.9 ± 1.9 versus 2.3 ± 2.1; p<0.001). Malnutrition was also associated with lower caregivers’rating of QoL (QoL-AD score 21.8 ± 6.4 versus 26.0 ± 5.7; p = 0.001) but not by older adult’s rating (24.1 ± 11.2 versus 28.3 ± 7.7; p = 0.156). Similar associations were observed in logistic models adjusted for age and gender. Conclusion Malnutrition was common among foster families for older adults. Special attention towards the prevention and treatment of malnutrition in older adults from cardiovascular diseases, cognitive impairment, dependency and depression is necessary in this model of dependency support.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Chronic pain (CP) was associated with impaired cognitive performance in several cross-sectional studies conducted in older adults; however, fewer longitudinal studies assessed this link that remains ...still debated. With a prospective design, the present analysis was aimed at evaluating the relationship between CP and the change in several tests assessing memory, attention, verbal fluency, and processing speed. The study population was selected from the PAQUID study, a cohort of community dwellers aged 65 years and older; 693 subjects receiving a pain assessment were included. Chronic pain was evaluated using a questionnaire administered at 3-year follow-up. Cognitive performances were assessed every 2 to 3 years between 3 and 15 years assessing general cognition (Mini-Mental State Examination), verbal and visual memory (word paired-associate test and Benton test), attention and speed processing (Wechsler Digit Symbol Substitution Test and Zazzo's Cancellation Task), and language skills and executive functions (Isaacs Set Test). The link between CP and the change in cognitive function was assessed with latent process mixed models controlled for age, sex, education, comorbidities, depression, and analgesic drugs. The association between CP and each of the cognitive scores was then tested with the same procedure. A significant relationship was observed between CP and poorer 15-year scores on global cognitive performance (P = 0.004), and specifically, the Digit Symbol Substitution Test (P = 0.002) was associated with a higher slope of decline (P = 0.02). Chronic pain is associated with a higher cognitive decline, particularly in processing speed. This result reinforces the importance of actively treating CP with pharmacological and nonpharmacological strategies to prevent its consequences, including cognitive consequences.
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