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

OBJECTIVES
Late-life depression is a comorbidity which may co-occur in older adults with hearing loss- each as 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 Exam[3MS] and Digit Symbol Substitution[DSST]) differed by the presence or absence of depressive symptoms. Depressive symptoms were defined as CES-D 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 vs ≥moderate loss.


RESULTS
Having both hearing loss and depressive symptoms (vs. having neither) was associated with faster rates of decline in 3MS (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.