ObjectiveHearing loss (HL) is highly prevalent among older adults and may lead to increased risk ... more ObjectiveHearing loss (HL) is highly prevalent among older adults and may lead to increased risk of depressive symptoms. In both cross-sectional and longitudinal analysis, we quantified the association between HL and depressive symptoms, incorporating the variable nature of depressive symptoms and characterizing by race and gender.MethodsData were from the Health, Aging, and Body Composition study. Depressive symptoms were measured using the Center for Epidemiologic Study Depression Scale short form (CES-D 10), defined as CES-D 10 score ≥10 or treatment for depression. Hearing was defined via four-frequency pure-tone average (PTA) decibel hearing level (dB HL), categorized as normal hearing (PTA ≤25 dB HL), mild HL (PTA26-40 dB HL), and ≥moderate HL (PTA > 40 dB HL). Associations at baseline were quantified using logistic regression, incident depressive symptoms using Cox proportional hazard models, and change in depressive symptoms over time using growth mixture models and multi...
BackgroundEstablished associations between hearing loss and cognitive decline were primarily defi... more BackgroundEstablished associations between hearing loss and cognitive decline were primarily defined by pure-tone audiometry, which reflects peripheral hearing ability. Speech-in-noise performance, which reflects central hearing ability, is more limited in prior literature. We examined the longitudinal associations of audiometric hearing and speech-in-noise performance with cognitive decline.MethodsWe studied 702 participants aged ≥60 years in the Baltimore Longitudinal Study of Aging 2012–2019. Global and domain-specific (language, memory, attention, executive function, visuospatial ability) cognitive performance were assessed by the cognitive assessment battery. Hearing thresholds at 0.5, 1, 2, and 4 kilohertz obtained from pure-tone audiometry were averaged to calculate better-ear pure-tone average (PTA) and participants were categorized as having hearing loss (>25 decibels hearing level [dB HL]) or normal hearing (≤25 dB HL). Speech-in-noise performance was assessed by the Qu...
ImportanceNational prevalence estimates are needed to guide and benchmark initiatives to address ... more ImportanceNational prevalence estimates are needed to guide and benchmark initiatives to address hearing loss. However, current estimates are not based on samples that include representation of the oldest old US individuals (ie, aged ≥80 years), who are most at-risk of having hearing loss.ObjectiveTo estimate the prevalence of hearing loss and hearing aid use by age and demographic covariates in a large, nationally representative sample of adults aged 71 years and older.Design, Setting, and ParticipantsIn this cohort study, prevalence estimates of hearing loss by age, gender, race and ethnicity, education, and income were computed using data from the 2021 National Health Aging and Trends Study. Survey weights were applied to produce nationally representative estimates to the US older population. Data were collected from June to November 2021 and were analyzed from November to December 2022.Main Outcomes and MeasuresCriterion-standard audiometric measures of hearing loss and self-rep...
Background Item response theory (IRT) methods for addressing differential item functioning (DIF) ... more Background Item response theory (IRT) methods for addressing differential item functioning (DIF) can detect group differences in responses to individual items (e.g., bias). IRT and DIF-detection methods have been used increasingly often to identify bias in cognitive test performance by characteristics (DIF grouping variables) such as hearing impairment, race, and educational attainment. Previous analyses have not considered the effect of missing data on inferences, although levels of missing cognitive data can be substantial in epidemiologic studies. Methods We used data from Visit 6 (2016–2017) of the Atherosclerosis Risk in Communities Neurocognitive Study (N = 3,580) to explicate the effect of artificially imposed missing data patterns and imputation on DIF detection. Results When missing data was imposed among individuals in a specific DIF group but was unrelated to cognitive test performance, there was no systematic error. However, when missing data was related to cognitive tes...
A primary goal of longitudinal studies is to examine trends over time. Reported results from thes... more A primary goal of longitudinal studies is to examine trends over time. Reported results from these studies often depend on strong, unverifiable assumptions about the missing data. Whereas the risk of substantial bias from missing data is widely known, analyses exploring missing-data influences are commonly done either ad hoc or not at all. This article outlines one of the three primary recognized approaches for examining missing-data effects that could be more widely used, i.e. the shared-parameter model (SPM), and explains its purpose, use, limitations and extensions. We additionally provide synthetic data and reproducible research code for running SPMs in SAS, Stata and R programming languages to facilitate their use in practice and for teaching purposes in epidemiology, biostatistics, data science and related fields. Our goals are to increase understanding and use of these methods by providing introductions to the concepts and access to helpful tools.
Sensory impairment impacts over 55% of Americans aged 60 years or older and may have important do... more Sensory impairment impacts over 55% of Americans aged 60 years or older and may have important downstream consequences for the cognitive health of older adults. This session will present evidence for a relationship between sensory impairment and accelerated cognitive decline, increased risk of incident dementia, and increased mental and physical fatigability from two observational cohort studies. Additionally, this session will investigate the possible nature of these relationships. It may be that sensory impairment is a marker of dementia-related pathological changes in the brain, with potential ramifications for risk prediction and stratification. Alternatively, sensory impairment may have a direct impact on the aging brain, a potential causal mechanism liking sensory impairment and brain health, with implications for disease prevention. As part of this session, we will present evidence for associations between central auditory processing, a potential risk marker, and brain volume...
Background In older persons, neuropsychological function, especially sensorimotor function, is st... more Background In older persons, neuropsychological function, especially sensorimotor function, is strongly associated with mobility. Hearing impairment is related to poor mobility, and we hypothesize that such relationships would be stronger in persons with compromised sensorimotor function than those with preserved sensorimotor function. Methods We analyzed 601 cognitively normal (Mini-Mental State Examination ≥24 or free of cognitive impairment/dementia) Baltimore Longitudinal Study of Aging participants aged 50 or older with concurrent data on hearing (better ear pure-tone average [PTA]), mobility (6 m usual gait, 400 m endurance walk), and neuropsychological function including attention via Trail Making Test (TMT)-A, executive function via the difference between TMT-A and B, and Digit Symbol Substitution Test, and manual dexterity via Pegboard performance. We examined the association of PTA, each cognitive measure, and their interaction with mobility using multivariable linear regr...
Individual sensory deficits have been associated with adverse outcomes, including dementia, in ol... more Individual sensory deficits have been associated with adverse outcomes, including dementia, in older adults. Using data from the Baltimore Longitudinal Study of Aging (BLSA) (N=259) and Atherosclerosis Risk in Communities Study (ARIC) (N=962), we examined the prevalence of one, two, or three sensory deficits (hearing, vision, and olfaction) among older adults ≥70 years. Any hearing loss was the most prevalent sensory deficit (70-79 year-olds: 41.3% [BLSA] and 51.2% [ARIC]; ≥80 year-olds: 82.6% [BLSA] and 74.2% [ARIC]), followed by vision loss and olfactory loss. Hearing and vision impairments were more prevalent than hearing and olfactory losses as well as vision and olfactory losses in both age groups and studies There were few people with deficits in all three senses (70-79 year-olds: 3.3% [BLSA] and 2.0% [ARIC]; ≥80 year-olds: 5.8% [BLSA] and 7.4% [ARIC]). Further research should investigate the potential impact of multisensory impairments on older adults.
Speech-in-noise performance involves central auditory and cortical processing and is fundamental ... more Speech-in-noise performance involves central auditory and cortical processing and is fundamental to communication. We investigated cross-temporal associations of habitual sleep duration and stages (1996-1998) with speech-in-noise performance (2016-2017) in a subset of the Atherosclerosis Risk in Communities Study participated in the Sleep Heart Health Study(N=755, 61±5 years, 53% female). Speech-in-noise performance was measured by Quick Speech-in-Noise Test; range:0-30; lower scores=worse performance. Time spent in each stage (stage 1;2;3/4;rapid eye movement (REM)) was measured by polysomnography. Habitual sleep duration was calculated by self-reported duration on weekdays and weekends. In models adjusting for demographic and disease covariates, every 10-minute increase in REM sleep was associated with better speech-in-noise performance (0.10 points,95% CI:0.00,0.21); every 1-hour increase in habitual sleep duration was associated with worse speech-in-noise performance (-1.28 poin...
We investigated the cross-sectional associations of speech-in-noise performance with magnetic res... more We investigated the cross-sectional associations of speech-in-noise performance with magnetic resonance imaging brain volumes among 588 cognitively normal participants (77±4 years, 56% female) from the Aging and Cognitive Health Evaluation in Elders Study (randomized trial embedded in the Atherosclerosis Risk in Communities (ARIC) Study) baseline in 2018-19 (N=427, with hearing loss) and ARIC (N=161, normal hearing) Visit 6/7 in 2016-17/2018-19. Central auditory processing was measured by Quick Speech-in-Noise (QuickSIN) test; range: 0 to 30, lower scores=worse performance. In models adjusted for demographic and disease covariates, every 5-point decrease in QuickSIN score was associated with smaller volumes of the temporal lobe overall (-0.07SD, 95% CI:-0.13,-0.01) as well as subregions including but not limited to those important for auditory processing (amygdala:-0.13SD, 95% CI:-0.21,-0.04; middle temporal gyrus:-0.08SD, 95% CI:-0.15,-0.00; superior temporal gyrus:-0.08SD, 95% CI:...
Vision and hearing impairment are common and independently linked to dementia risk. Adults with c... more Vision and hearing impairment are common and independently linked to dementia risk. Adults with concurrent vision and hearing impairment (dual sensory impairment, DSI) may be particularly at-risk. Data were from the National Health and Aging Trends Study (NHATS) (2011–2018, N=7,562). Functional sensory impairments were self-reported (no impairment, vision only, hearing only, and DSI). We calculated age-specific prevalence of sensory impairments. Discrete time proportional hazards model with a complementary log-log link were used to assess 7-year dementia risk. Of 7,562 participants, overall prevalence of functional vision, hearing and DSI was 5.4%, 18.9% and 3.1%, respectively. DSI prevalence increased with age, impacting 1 in 7 adults ≥90 years. DSI was associated with a 50% increased 7-year dementia risk (adjusted hazard ratio 1.50; 95% confidence interval, 1.12–2.02) compared to no impairment. Sensory rehabilitative interventions for multiple impairments may be an avenue for cons...
Despite its high prevalence, the impact of hearing impairment on completion of cognitive tests, m... more Despite its high prevalence, the impact of hearing impairment on completion of cognitive tests, many of which rely on auditory input to access test material, has not been described. We investigated if hearing impairment is associated with missing scores in 3602 adults (72-94 years, 23% black, 60% female). Cognition was measured using 10 neurocognitive tests. Pure tone better-ear hearing thresholds (0.5-4 kHz) were averaged and categorized. ≥Moderate hearing impairment (versus none) was associated with greater missingness on two auditory tests: Logical Memory (prevalence ratio [PR]:1.40, 95% confidence interval [CI]:1.01,1.70) and Digits Backwards (PR:1.35, 95% CI:1.00,1.82); and the non-auditory Trail Making Test Part B (PR:1.48, 95% CI:1.24,1.77). Compared to models using complete cognitive data, models that imputed missing scores showed stronger associations of hearing impairment with poor cognitive performance. Older adults with HI are less likely to complete cognitive testing, r...
Objectives Late-life depression is a comorbidity that may co-occur in older adults with hearing l... more 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 sc...
BackgroundSeveral studies have demonstrated that age-related hearing loss is associated with cogn... more BackgroundSeveral studies have demonstrated that age-related hearing loss is associated with cognitive decline. We investigated whether subclinical hearing loss (SCHL) or imperfect hearing traditionally categorized as normal (pure-tone average ≤25 dB) may be similarly linked to cognitive decline and risk of incident mild cognitive impairment (MCI)/dementia.MethodsParticipants from the Baltimore Longitudinal Study of Aging were cognitively normal adults at least 50 years old with cognitive assessments from 1991 to 2019 and pure-tone average ≤25 dB measured between 1991 and 1994 (n = 263). The exposure was hearing based on the better ear pure-tone average. Outcomes were test scores in various cognitive domains. Multivariable linear-mixed effects models were developed to analyze the association between hearing and change in cognition over time, adjusting for age, sex, education, vascular burden, and race. Kaplan–Meier survival curves and Cox proportional hazards models portrayed associ...
Background Millions of older adults in the United States experience hearing, vision, and dual sen... more Background Millions of older adults in the United States experience hearing, vision, and dual sensory impairment (concurring hearing and vision impairment) yet little research exists on their needs in interactions with the healthcare system. This piece aims to determine the use of accompaniment in healthcare interactions by persons with sensory impairment. Methods These cross-sectional analyses included data from the 2015 Medicare Current Beneficiaries Survey and survey weighting provided by Centers for Medicare and Medicaid Services. Adjusted odds of reporting accompaniment to healthcare visits and given reasons for accompaniment among United States Medicare beneficiaries with self-reported sensory impairment (hearing, vision, and dual sensory impairment) were examined. Results After excluding observations with missing data, 10,748 Medicare beneficiaries remained representing a 46 million total weighted nationally representative sample, of which 88.9% reported no sensory impairment...
Purpose The purpose of this study was to investigate associations between performance on a clinic... more Purpose The purpose of this study was to investigate associations between performance on a clinical speech-in-noise measure with a comprehensive neurocognitive battery of tests. Method A group of older adults ( N = 250, M age = 77 years, age range: 67.3–89.1 years) enrolled in the Atherosclerosis Risk in Communities Neurocognitive Study took part in the hearing pilot study (2013) that included testing for audiometric thresholds and speech-in-noise performance (Quick Speech-in-Noise Test; Killion, Niquette, Gudmundsen, Revit, & Banerjee, 2004). This research study analyzed the associations between domain-specific cognitive function and speech-in-noise performance after adjusting for hearing thresholds and other demographic and cardiovascular factors. Results Multivariable-adjusted associations were found between all cognitive domains and speech-in-noise performance in the full sample, but the observed associations varied when participants with varying levels of moderate to moderately...
ObjectiveHearing loss (HL) is highly prevalent among older adults and may lead to increased risk ... more ObjectiveHearing loss (HL) is highly prevalent among older adults and may lead to increased risk of depressive symptoms. In both cross-sectional and longitudinal analysis, we quantified the association between HL and depressive symptoms, incorporating the variable nature of depressive symptoms and characterizing by race and gender.MethodsData were from the Health, Aging, and Body Composition study. Depressive symptoms were measured using the Center for Epidemiologic Study Depression Scale short form (CES-D 10), defined as CES-D 10 score ≥10 or treatment for depression. Hearing was defined via four-frequency pure-tone average (PTA) decibel hearing level (dB HL), categorized as normal hearing (PTA ≤25 dB HL), mild HL (PTA26-40 dB HL), and ≥moderate HL (PTA > 40 dB HL). Associations at baseline were quantified using logistic regression, incident depressive symptoms using Cox proportional hazard models, and change in depressive symptoms over time using growth mixture models and multi...
BackgroundEstablished associations between hearing loss and cognitive decline were primarily defi... more BackgroundEstablished associations between hearing loss and cognitive decline were primarily defined by pure-tone audiometry, which reflects peripheral hearing ability. Speech-in-noise performance, which reflects central hearing ability, is more limited in prior literature. We examined the longitudinal associations of audiometric hearing and speech-in-noise performance with cognitive decline.MethodsWe studied 702 participants aged ≥60 years in the Baltimore Longitudinal Study of Aging 2012–2019. Global and domain-specific (language, memory, attention, executive function, visuospatial ability) cognitive performance were assessed by the cognitive assessment battery. Hearing thresholds at 0.5, 1, 2, and 4 kilohertz obtained from pure-tone audiometry were averaged to calculate better-ear pure-tone average (PTA) and participants were categorized as having hearing loss (>25 decibels hearing level [dB HL]) or normal hearing (≤25 dB HL). Speech-in-noise performance was assessed by the Qu...
ImportanceNational prevalence estimates are needed to guide and benchmark initiatives to address ... more ImportanceNational prevalence estimates are needed to guide and benchmark initiatives to address hearing loss. However, current estimates are not based on samples that include representation of the oldest old US individuals (ie, aged ≥80 years), who are most at-risk of having hearing loss.ObjectiveTo estimate the prevalence of hearing loss and hearing aid use by age and demographic covariates in a large, nationally representative sample of adults aged 71 years and older.Design, Setting, and ParticipantsIn this cohort study, prevalence estimates of hearing loss by age, gender, race and ethnicity, education, and income were computed using data from the 2021 National Health Aging and Trends Study. Survey weights were applied to produce nationally representative estimates to the US older population. Data were collected from June to November 2021 and were analyzed from November to December 2022.Main Outcomes and MeasuresCriterion-standard audiometric measures of hearing loss and self-rep...
Background Item response theory (IRT) methods for addressing differential item functioning (DIF) ... more Background Item response theory (IRT) methods for addressing differential item functioning (DIF) can detect group differences in responses to individual items (e.g., bias). IRT and DIF-detection methods have been used increasingly often to identify bias in cognitive test performance by characteristics (DIF grouping variables) such as hearing impairment, race, and educational attainment. Previous analyses have not considered the effect of missing data on inferences, although levels of missing cognitive data can be substantial in epidemiologic studies. Methods We used data from Visit 6 (2016–2017) of the Atherosclerosis Risk in Communities Neurocognitive Study (N = 3,580) to explicate the effect of artificially imposed missing data patterns and imputation on DIF detection. Results When missing data was imposed among individuals in a specific DIF group but was unrelated to cognitive test performance, there was no systematic error. However, when missing data was related to cognitive tes...
A primary goal of longitudinal studies is to examine trends over time. Reported results from thes... more A primary goal of longitudinal studies is to examine trends over time. Reported results from these studies often depend on strong, unverifiable assumptions about the missing data. Whereas the risk of substantial bias from missing data is widely known, analyses exploring missing-data influences are commonly done either ad hoc or not at all. This article outlines one of the three primary recognized approaches for examining missing-data effects that could be more widely used, i.e. the shared-parameter model (SPM), and explains its purpose, use, limitations and extensions. We additionally provide synthetic data and reproducible research code for running SPMs in SAS, Stata and R programming languages to facilitate their use in practice and for teaching purposes in epidemiology, biostatistics, data science and related fields. Our goals are to increase understanding and use of these methods by providing introductions to the concepts and access to helpful tools.
Sensory impairment impacts over 55% of Americans aged 60 years or older and may have important do... more Sensory impairment impacts over 55% of Americans aged 60 years or older and may have important downstream consequences for the cognitive health of older adults. This session will present evidence for a relationship between sensory impairment and accelerated cognitive decline, increased risk of incident dementia, and increased mental and physical fatigability from two observational cohort studies. Additionally, this session will investigate the possible nature of these relationships. It may be that sensory impairment is a marker of dementia-related pathological changes in the brain, with potential ramifications for risk prediction and stratification. Alternatively, sensory impairment may have a direct impact on the aging brain, a potential causal mechanism liking sensory impairment and brain health, with implications for disease prevention. As part of this session, we will present evidence for associations between central auditory processing, a potential risk marker, and brain volume...
Background In older persons, neuropsychological function, especially sensorimotor function, is st... more Background In older persons, neuropsychological function, especially sensorimotor function, is strongly associated with mobility. Hearing impairment is related to poor mobility, and we hypothesize that such relationships would be stronger in persons with compromised sensorimotor function than those with preserved sensorimotor function. Methods We analyzed 601 cognitively normal (Mini-Mental State Examination ≥24 or free of cognitive impairment/dementia) Baltimore Longitudinal Study of Aging participants aged 50 or older with concurrent data on hearing (better ear pure-tone average [PTA]), mobility (6 m usual gait, 400 m endurance walk), and neuropsychological function including attention via Trail Making Test (TMT)-A, executive function via the difference between TMT-A and B, and Digit Symbol Substitution Test, and manual dexterity via Pegboard performance. We examined the association of PTA, each cognitive measure, and their interaction with mobility using multivariable linear regr...
Individual sensory deficits have been associated with adverse outcomes, including dementia, in ol... more Individual sensory deficits have been associated with adverse outcomes, including dementia, in older adults. Using data from the Baltimore Longitudinal Study of Aging (BLSA) (N=259) and Atherosclerosis Risk in Communities Study (ARIC) (N=962), we examined the prevalence of one, two, or three sensory deficits (hearing, vision, and olfaction) among older adults ≥70 years. Any hearing loss was the most prevalent sensory deficit (70-79 year-olds: 41.3% [BLSA] and 51.2% [ARIC]; ≥80 year-olds: 82.6% [BLSA] and 74.2% [ARIC]), followed by vision loss and olfactory loss. Hearing and vision impairments were more prevalent than hearing and olfactory losses as well as vision and olfactory losses in both age groups and studies There were few people with deficits in all three senses (70-79 year-olds: 3.3% [BLSA] and 2.0% [ARIC]; ≥80 year-olds: 5.8% [BLSA] and 7.4% [ARIC]). Further research should investigate the potential impact of multisensory impairments on older adults.
Speech-in-noise performance involves central auditory and cortical processing and is fundamental ... more Speech-in-noise performance involves central auditory and cortical processing and is fundamental to communication. We investigated cross-temporal associations of habitual sleep duration and stages (1996-1998) with speech-in-noise performance (2016-2017) in a subset of the Atherosclerosis Risk in Communities Study participated in the Sleep Heart Health Study(N=755, 61±5 years, 53% female). Speech-in-noise performance was measured by Quick Speech-in-Noise Test; range:0-30; lower scores=worse performance. Time spent in each stage (stage 1;2;3/4;rapid eye movement (REM)) was measured by polysomnography. Habitual sleep duration was calculated by self-reported duration on weekdays and weekends. In models adjusting for demographic and disease covariates, every 10-minute increase in REM sleep was associated with better speech-in-noise performance (0.10 points,95% CI:0.00,0.21); every 1-hour increase in habitual sleep duration was associated with worse speech-in-noise performance (-1.28 poin...
We investigated the cross-sectional associations of speech-in-noise performance with magnetic res... more We investigated the cross-sectional associations of speech-in-noise performance with magnetic resonance imaging brain volumes among 588 cognitively normal participants (77±4 years, 56% female) from the Aging and Cognitive Health Evaluation in Elders Study (randomized trial embedded in the Atherosclerosis Risk in Communities (ARIC) Study) baseline in 2018-19 (N=427, with hearing loss) and ARIC (N=161, normal hearing) Visit 6/7 in 2016-17/2018-19. Central auditory processing was measured by Quick Speech-in-Noise (QuickSIN) test; range: 0 to 30, lower scores=worse performance. In models adjusted for demographic and disease covariates, every 5-point decrease in QuickSIN score was associated with smaller volumes of the temporal lobe overall (-0.07SD, 95% CI:-0.13,-0.01) as well as subregions including but not limited to those important for auditory processing (amygdala:-0.13SD, 95% CI:-0.21,-0.04; middle temporal gyrus:-0.08SD, 95% CI:-0.15,-0.00; superior temporal gyrus:-0.08SD, 95% CI:...
Vision and hearing impairment are common and independently linked to dementia risk. Adults with c... more Vision and hearing impairment are common and independently linked to dementia risk. Adults with concurrent vision and hearing impairment (dual sensory impairment, DSI) may be particularly at-risk. Data were from the National Health and Aging Trends Study (NHATS) (2011–2018, N=7,562). Functional sensory impairments were self-reported (no impairment, vision only, hearing only, and DSI). We calculated age-specific prevalence of sensory impairments. Discrete time proportional hazards model with a complementary log-log link were used to assess 7-year dementia risk. Of 7,562 participants, overall prevalence of functional vision, hearing and DSI was 5.4%, 18.9% and 3.1%, respectively. DSI prevalence increased with age, impacting 1 in 7 adults ≥90 years. DSI was associated with a 50% increased 7-year dementia risk (adjusted hazard ratio 1.50; 95% confidence interval, 1.12–2.02) compared to no impairment. Sensory rehabilitative interventions for multiple impairments may be an avenue for cons...
Despite its high prevalence, the impact of hearing impairment on completion of cognitive tests, m... more Despite its high prevalence, the impact of hearing impairment on completion of cognitive tests, many of which rely on auditory input to access test material, has not been described. We investigated if hearing impairment is associated with missing scores in 3602 adults (72-94 years, 23% black, 60% female). Cognition was measured using 10 neurocognitive tests. Pure tone better-ear hearing thresholds (0.5-4 kHz) were averaged and categorized. ≥Moderate hearing impairment (versus none) was associated with greater missingness on two auditory tests: Logical Memory (prevalence ratio [PR]:1.40, 95% confidence interval [CI]:1.01,1.70) and Digits Backwards (PR:1.35, 95% CI:1.00,1.82); and the non-auditory Trail Making Test Part B (PR:1.48, 95% CI:1.24,1.77). Compared to models using complete cognitive data, models that imputed missing scores showed stronger associations of hearing impairment with poor cognitive performance. Older adults with HI are less likely to complete cognitive testing, r...
Objectives Late-life depression is a comorbidity that may co-occur in older adults with hearing l... more 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 sc...
BackgroundSeveral studies have demonstrated that age-related hearing loss is associated with cogn... more BackgroundSeveral studies have demonstrated that age-related hearing loss is associated with cognitive decline. We investigated whether subclinical hearing loss (SCHL) or imperfect hearing traditionally categorized as normal (pure-tone average ≤25 dB) may be similarly linked to cognitive decline and risk of incident mild cognitive impairment (MCI)/dementia.MethodsParticipants from the Baltimore Longitudinal Study of Aging were cognitively normal adults at least 50 years old with cognitive assessments from 1991 to 2019 and pure-tone average ≤25 dB measured between 1991 and 1994 (n = 263). The exposure was hearing based on the better ear pure-tone average. Outcomes were test scores in various cognitive domains. Multivariable linear-mixed effects models were developed to analyze the association between hearing and change in cognition over time, adjusting for age, sex, education, vascular burden, and race. Kaplan–Meier survival curves and Cox proportional hazards models portrayed associ...
Background Millions of older adults in the United States experience hearing, vision, and dual sen... more Background Millions of older adults in the United States experience hearing, vision, and dual sensory impairment (concurring hearing and vision impairment) yet little research exists on their needs in interactions with the healthcare system. This piece aims to determine the use of accompaniment in healthcare interactions by persons with sensory impairment. Methods These cross-sectional analyses included data from the 2015 Medicare Current Beneficiaries Survey and survey weighting provided by Centers for Medicare and Medicaid Services. Adjusted odds of reporting accompaniment to healthcare visits and given reasons for accompaniment among United States Medicare beneficiaries with self-reported sensory impairment (hearing, vision, and dual sensory impairment) were examined. Results After excluding observations with missing data, 10,748 Medicare beneficiaries remained representing a 46 million total weighted nationally representative sample, of which 88.9% reported no sensory impairment...
Purpose The purpose of this study was to investigate associations between performance on a clinic... more Purpose The purpose of this study was to investigate associations between performance on a clinical speech-in-noise measure with a comprehensive neurocognitive battery of tests. Method A group of older adults ( N = 250, M age = 77 years, age range: 67.3–89.1 years) enrolled in the Atherosclerosis Risk in Communities Neurocognitive Study took part in the hearing pilot study (2013) that included testing for audiometric thresholds and speech-in-noise performance (Quick Speech-in-Noise Test; Killion, Niquette, Gudmundsen, Revit, & Banerjee, 2004). This research study analyzed the associations between domain-specific cognitive function and speech-in-noise performance after adjusting for hearing thresholds and other demographic and cardiovascular factors. Results Multivariable-adjusted associations were found between all cognitive domains and speech-in-noise performance in the full sample, but the observed associations varied when participants with varying levels of moderate to moderately...
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Papers by Jennifer Deal