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April 7, 1989, Vol 261, No. 13 >
ARTICLE | April 7, 1989

Relationship of Hearing Impairment to Dementia and Cognitive Dysfunction in Older Adults FREE

Richard F. Uhlmann, MD, MPH; Eric B. Larson, MD, MPH; Thomas S. Rees, PhD; Thomas D. Koepsell, MD, MPH; Larry G. Duckert, MD, PhD
[+] Author Affiliations

The views expressed within are not necessarily those of The Robert Wood Johnson Foundation.

Reprint requests to the Division of Gerontology and Geriatric Medicine, Harborview Medical Center (ZA-87), 325 Ninth Ave, Seattle, WA 98104 (Dr Uhlmann).


JAMA. 1989;261(13):1916-1919. doi:10.1001/jama.1989.03420130084028
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References

We conducted a case-control study in 100 cases who had Alzheimer's-type dementia and 100 age-, sex-, and education-matched, nondemented controls to evaluate the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults. The prevalence of a hearing loss of 30 dB or greater was significantly higher in cases than in controls (odds ratio, 2.0; 95% confidence interval, 1.2 to 3.4), even when adjusted for potentially confounding variables. In addition, we observed a dose-response relationship in which greater hearing loss was associated with a higher adjusted relative odds of having dementia. Hearing loss was also significantly and independently correlated with the severity of cognitive dysfunction, as measured by the Mini-Mental State Examination, in nondemented as well as demented patients. These results demonstrate an association between hearing impairment and dementia and lend support to the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults.

(JAMA. 1989;261:1916-1919)

REFERENCES

1 +
Herbst HG, Humphrey C.  Prevalence of hearing impairment in the elderly living at home . J R Coll Gen Pract. 1981;;31:155-160.
2 +
Moscicki E, Elkins E, Baum H, McNamara PM.  Hearing loss in the elderly: an epidemiologic study of the Framingham Heart Study cohort . Ear Hear. 1985;;6:184-190.
3 +
Williamson J, Stokoe IH, Gray S.  Old people at home: their unreported needs . Lancet . 1964;;1:1117-1120.
4 +
Sackett DL, Haynes RB, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Mass: Little Brown & Co Inc; 1985;.
5 +
Hodkinson HM.  Mental impairment in the elderly . J R Coll Physicians (Lond) . 1973;;7:305-317.
6 +
Herbst KG, Humphrey C.  Hearing impairment and mental state in the elderly living at home . Br Med J. 1980;;281:903-905.
7 +
Thomas PD, Hunt WC, Garry PJ, Hood RB, Goodwin JM, Goodwin JS.  Hearing acuity in a healthy elderly population: effects on emotional, cognitive, and social status . J Gerontol. 1983;;38:321-325.
8 +
Jones DA, Victor CR, Vetter NJ.  Hearing difficulty and its psychological implications for the elderly . J Epidemiol Community Health . 1984;; 38:75-78.
9 +
Uhlmann RF, Larson EB, Koepsell TD.  Hearing impairment and cognitive decline in senile dementia of the Alzheimer's type . J Am Geriatr Soc. 1986;;34:207-210.
10 +
Weinstein BE, Amsel L.  Hearing loss and senile dementia in the institutionalized elderly . Clin Gerontologist . 1986;;4:3-15.
11 +
Cutler SJ, Grams AE.  Correlates of self-reported everyday memory problems . J Gerontol. 1988;;43:S82-S90.
12 +
Larson EB, Reifler BV, Featherstone HJ, English DR.  Dementia in elderly outpatients: a prospective study . Ann Intern Med. 1984;;100:417-423.
13 +
McKhann G, Drachman D, Folstein M.  Clinical diagnosis of Alzheimer's disease . Neurology . 1984;;34:939-944.
14 +
Folstein MF, Folstein SE, McHugh PR.  Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;;12:189-198.
15 +
Anthony JC, LeResche L, Niaz U, Von Korff MR, Folstein MF.  Limits of the `Mini-Mental State' as a screening test for dementia and delirium among hospital patients . Psychol Med. 1982;;12:397-408.
16 +
Hamilton M.  A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;;23:56-62.
17 +
Farber JF, Schmitt FA, Logue PE.  Predicting intellectual level from the Mini-Mental State Examination . J Am Geriatr Soc. 1988;;36:509-510.
18 +
American Academy of Otolaryngology Committee on Hearing and Equilibrium, and the American Council of Otolaryngology Committee on the Medical Aspects of Noise.  Guide for the evaluation of hearing handicap . JAMA . 1979;;241:2055-2059.
19 +
Breslow NE, Day NE. Statistical Methods in Cancer Research: Volume 1, The Analysis of Case-Control Studies . Lyons, France: IARC Scientific Publishing; 1980;.
20 +
Miettinen OS.  Proportion of disease caused or prevented by a given exposure trait or intervention . Am J Epidemiol. 1974;;99:325-332.
21 +
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982;.
22 +
Larson EB, Buchner DM, Uhlmann RF, Reifler BV.  Caring for elderly patients with dementia . Arch Intern Med. 1986;;146:1909-1910.
23 +
Thomas A, Herbst KG.  Social and psychological implications of acquired deafness for adults of employment age . Br J Audiol. 1980;;14:76-85.
24 +
Reifler BV, Larson E, Hanley R.  Coexistence of cognitive impairment and depression in geriatric outpatients . Am J Psychiatry. 1982;;139:623-626.
25 +
Ohta RJ, Carlin MF, Harmon BM.  Auditory acuity and performance on the mental status questionnaire in the elderly . J Am Geriatr Soc. 1981;; 29:476-478.
26 +
Sulkava R, Haltia M, Paetau A, Wikstrom J, Palo J.  Accuracy of clinical diagnosis in primary degenerative dementia: correlation with neuropathological findings . J Neurol Neurosurg Psychiatry . 1983;;46:9-13.
27 +
Joachim CL, Morris J, Selkoe DJ.  Autopsy neuropathology in 76 cases of clinically diagnosed Alzheimer's disease . Neurology . 1986;;36( (suppl 1) ): 226. Abstract.
28 +
Wade JPH, Mirsen TR, Hachinski VC, Fisman M, Lau C, Merskey H.  The clinical diagnosis of Alzheimer's disease . Arch Neurol. 1987;;44:24-29.
29 +
Uhlmann RF, Teri L, Rees TS, Mozlowski KJ, Larson EB.  Impact of mild to moderate hearing loss on mental status testing: comparability of standard and written Mini-Mental State Examinations . J Am Geriatr Soc. 1989;;37:223-228.
30 +
Harkins SW.  Effects of presenile dementia of the Alzheimer's type on brainstem transmission time . Int J Neurosci. 1981;;15:165-170.
31 +
Grimes AM, Grady CL, Foster NL, Sunderland T, Patronas NJ.  Central auditory function in Alzheimer's disease . Neurology . 1985;;35:352-358.

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1 +
Herbst HG, Humphrey C.  Prevalence of hearing impairment in the elderly living at home . J R Coll Gen Pract. 1981;;31:155-160.
2 +
Moscicki E, Elkins E, Baum H, McNamara PM.  Hearing loss in the elderly: an epidemiologic study of the Framingham Heart Study cohort . Ear Hear. 1985;;6:184-190.
3 +
Williamson J, Stokoe IH, Gray S.  Old people at home: their unreported needs . Lancet . 1964;;1:1117-1120.
4 +
Sackett DL, Haynes RB, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine . Boston, Mass: Little Brown & Co Inc; 1985;.
5 +
Hodkinson HM.  Mental impairment in the elderly . J R Coll Physicians (Lond) . 1973;;7:305-317.
6 +
Herbst KG, Humphrey C.  Hearing impairment and mental state in the elderly living at home . Br Med J. 1980;;281:903-905.
7 +
Thomas PD, Hunt WC, Garry PJ, Hood RB, Goodwin JM, Goodwin JS.  Hearing acuity in a healthy elderly population: effects on emotional, cognitive, and social status . J Gerontol. 1983;;38:321-325.
8 +
Jones DA, Victor CR, Vetter NJ.  Hearing difficulty and its psychological implications for the elderly . J Epidemiol Community Health . 1984;; 38:75-78.
9 +
Uhlmann RF, Larson EB, Koepsell TD.  Hearing impairment and cognitive decline in senile dementia of the Alzheimer's type . J Am Geriatr Soc. 1986;;34:207-210.
10 +
Weinstein BE, Amsel L.  Hearing loss and senile dementia in the institutionalized elderly . Clin Gerontologist . 1986;;4:3-15.
11 +
Cutler SJ, Grams AE.  Correlates of self-reported everyday memory problems . J Gerontol. 1988;;43:S82-S90.
12 +
Larson EB, Reifler BV, Featherstone HJ, English DR.  Dementia in elderly outpatients: a prospective study . Ann Intern Med. 1984;;100:417-423.
13 +
McKhann G, Drachman D, Folstein M.  Clinical diagnosis of Alzheimer's disease . Neurology . 1984;;34:939-944.
14 +
Folstein MF, Folstein SE, McHugh PR.  Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res. 1975;;12:189-198.
15 +
Anthony JC, LeResche L, Niaz U, Von Korff MR, Folstein MF.  Limits of the `Mini-Mental State' as a screening test for dementia and delirium among hospital patients . Psychol Med. 1982;;12:397-408.
16 +
Hamilton M.  A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;;23:56-62.
17 +
Farber JF, Schmitt FA, Logue PE.  Predicting intellectual level from the Mini-Mental State Examination . J Am Geriatr Soc. 1988;;36:509-510.
18 +
American Academy of Otolaryngology Committee on Hearing and Equilibrium, and the American Council of Otolaryngology Committee on the Medical Aspects of Noise.  Guide for the evaluation of hearing handicap . JAMA . 1979;;241:2055-2059.
19 +
Breslow NE, Day NE. Statistical Methods in Cancer Research: Volume 1, The Analysis of Case-Control Studies . Lyons, France: IARC Scientific Publishing; 1980;.
20 +
Miettinen OS.  Proportion of disease caused or prevented by a given exposure trait or intervention . Am J Epidemiol. 1974;;99:325-332.
21 +
Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods . Belmont, Calif: Lifetime Learning Publications; 1982;.
22 +
Larson EB, Buchner DM, Uhlmann RF, Reifler BV.  Caring for elderly patients with dementia . Arch Intern Med. 1986;;146:1909-1910.
23 +
Thomas A, Herbst KG.  Social and psychological implications of acquired deafness for adults of employment age . Br J Audiol. 1980;;14:76-85.
24 +
Reifler BV, Larson E, Hanley R.  Coexistence of cognitive impairment and depression in geriatric outpatients . Am J Psychiatry. 1982;;139:623-626.
25 +
Ohta RJ, Carlin MF, Harmon BM.  Auditory acuity and performance on the mental status questionnaire in the elderly . J Am Geriatr Soc. 1981;; 29:476-478.
26 +
Sulkava R, Haltia M, Paetau A, Wikstrom J, Palo J.  Accuracy of clinical diagnosis in primary degenerative dementia: correlation with neuropathological findings . J Neurol Neurosurg Psychiatry . 1983;;46:9-13.
27 +
Joachim CL, Morris J, Selkoe DJ.  Autopsy neuropathology in 76 cases of clinically diagnosed Alzheimer's disease . Neurology . 1986;;36( (suppl 1) ): 226. Abstract.
28 +
Wade JPH, Mirsen TR, Hachinski VC, Fisman M, Lau C, Merskey H.  The clinical diagnosis of Alzheimer's disease . Arch Neurol. 1987;;44:24-29.
29 +
Uhlmann RF, Teri L, Rees TS, Mozlowski KJ, Larson EB.  Impact of mild to moderate hearing loss on mental status testing: comparability of standard and written Mini-Mental State Examinations . J Am Geriatr Soc. 1989;;37:223-228.
30 +
Harkins SW.  Effects of presenile dementia of the Alzheimer's type on brainstem transmission time . Int J Neurosci. 1981;;15:165-170.
31 +
Grimes AM, Grady CL, Foster NL, Sunderland T, Patronas NJ.  Central auditory function in Alzheimer's disease . Neurology . 1985;;35:352-358.

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