Hearing Loss and Cognition Among Older Adults in the United States

Background. To investigate the association between hearing loss and cognitive function in a nationally representative sample of older adults. Methods. We analyzed data from the 1999 to 2002 cycles of the National Health and Nutritional Examination Survey during which participants aged 60-69 years (n = 605) underwent both audiometric and cognitive testing. 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. Cognitive testing consisted of the Digit Symbol Substitution Test (DSST), a nonverbal test that assesses executive function and psychomotor processing. Data on hearing aid use, demographics, and medical history were obtained from interviews. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders. Analyses incorporated sampling weights to yield results that are generalizable to the U. S. population. Results. Greater hearing loss was significantly associated with lower scores on the DSST after adjustment for demographic factors and medical history (DSST score difference of -1.5 [95% confidence interval: -2.9 to -0.23] per 10 dB of hearing loss). Hearing aid use was positively associated with cognitive functioning (DSST score difference of 7.4 [95% confidence interval: -0.62 to 15.4]). The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 7 years. Conclusions. Hearing loss is independently associated with lower scores on the DSST. Further research is needed to determine whether hearing loss is a modifiable risk factor or an early marker of cognitive decline.