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. 2023 Apr 1;149(4):310-316.
doi: 10.1001/jamaoto.2022.5046.

Evaluation of Cognitive Functioning Before and After Cochlear Implantation in Adults Aged 55 Years and Older at Risk for Mild Cognitive Impairment

Ellen Andries  1   2 , Joyce Bosmans  2 , Sebastiaan Engelborghs  3   4 , Patrick Cras  2   5 , Olivier M Vanderveken  1   2 , Marc J W Lammers  1   2 , Paul H Van de Heyning  1   2 , Vincent Van Rompaey  1   2 , Griet Mertens  1   2
Affiliations

Evaluation of Cognitive Functioning Before and After Cochlear Implantation in Adults Aged 55 Years and Older at Risk for Mild Cognitive Impairment

Ellen Andries et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Given the rapidly rising dementia incidence, management of modifiable risk factors, such as hearing loss, is vital. Multiple studies have demonstrated an improvement of cognitive functioning in older adults with severe hearing loss after cochlear implantation; however, few of these studies, to the authors' knowledge, specifically analyzed participants achieving poor cognitive results preoperatively.

Objective: To evaluate the cognitive functioning of older adults with severe hearing loss at risk for mild cognitive impairment (MCI) before and after cochlear implantation.

Design, setting, and participants: This prospective, longitudinal cohort study performed at a single center reports data obtained over a 6-year period (April 2015 to September 2021) of an ongoing prospective, longitudinal cohort study on cochlear implant outcomes in older adults. A consecutive sample of older adults with severe hearing loss eligible for cochlear implantation was included. All participants obtained a Repeatable Battery for the Assessment of Neuropsychological Status for hearing-impaired patients (RBANS-H) total score indicative of MCI preoperatively. Participants were assessed before cochlear implant activation and 12 months after cochlear implant activation.

Intervention: The intervention consisted of cochlear implantation.

Main outcome and measure: The primary outcome measure was cognition, measured by the RBANS-H.

Results: A total of 21 older adult cochlear implant candidates were included in the analysis (mean [SD] age, 72 [9] years; 13 [62%] men). Cochlear implantation was associated with an improvement of overall cognitive functioning 12 months after activation (median [IQR] percentile, 5 [2-8] vs 12 [7-19]; difference, 7 [95% CI, 2-12]). Eight participants (38%) surpassed the MCI cutoff (16th percentile) postoperatively, while the overall median cognitive score remained under this cutoff. In addition, participants' speech recognition in noise improved, with a lower score indicating improvement (mean [SD] score, +17.16 [5.45] vs +5.67 [6.3]; difference, -11.49 [95% CI, -14.26 to -8.72]), after cochlear implant activation. Improvement of speech recognition in noise was positively associated with improvement in cognitive functioning (rs, -0.48 [95% CI, -0.69 to -0.19]). Years of education, sex, RBANS-H version, and symptoms of depression and anxiety were not related to the evolution in RBANS-H scores.

Conclusions and relevance: In this prospective, longitudinal cohort study, cognitive functioning and speech perception in noise showed a clinically meaningful improvement 12 months after cochlear implant activation in older adults with severe hearing loss at risk for MCI, suggesting that cochlear implantation is not contraindicated in cochlear implant candidates with cognitive decline and should be considered after multidisciplinary evaluation.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Engelborghs reported grants from Janssen Pharmaceuticals, ADx Neurosciences, and icometrix; and personal fees from Biogen, Roche, Pfizer/Eisai, and Novartis outside the submitted work. Dr Vanderveken and Van Rompaey reported grants from Cochlear during the conduct of the study. Dr Lammers reported travel expenses reimbursed by MED-EL outside the submitted work. Dr Van de Heyning reported grants from MED-EL outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of the Study Population
RBANS-H indicates Repeatable Battery for the Assessment of Neuropsychological Status for hearing-impaired patients. aThese participants were included in a more extensive prospective study on cognitive evolution in older cochlear implant users at the Antwerp University Hospital (NCT02794350).
Figure 2.
Figure 2.. Overview of the Cognitive Score Percentiles Preoperatively and 12 Months After Cochlear Implant Activation
A, The cutoff value of the 16th percentile (ie, 1 standard deviation below the mean) was chosen based on the guidelines by Albert et al on the diagnosis of mild cognitive impairment. B, The preoperative mean RBANS-H total percentile was 6. The postoperative mean RBANS-H total percentile was 15. The difference between preoperative and postoperative mean RBANS-H total percentile was 9 (Cohen d = 0.6). The horizontal bar inside the box indicates the median; the lower and upper ends of the boxes, the IQR; and the whiskers, values within 1.5-times the IQR above the upper quartile and below the lower quartile. The colored lines in the box plot connect the preoperative score to the postoperative score for each participant.
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References

    1. World Health Organization . Risk reduction of cognitive decline and dementia: WHO guidelines. January 2019. Accessed January 10, 2023. https://www.who.int/publications/i/item/9789241550543 - PubMed
    1. Livingston G, Sommerlad A, Orgeta V, et al. . Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673-2734. doi:10.1016/S0140-6736(17)31363-6 - DOI - PubMed
    1. Bruscoli M, Lovestone S. Is MCI really just early dementia: a systematic review of conversion studies. Int Psychogeriatr. 2004;16(2):129-140. doi:10.1017/S1041610204000092 - DOI - PubMed
    1. Gauthier S, Reisberg B, Zaudig M, et al. ; International Psychogeriatric Association Expert Conference on Mild Cognitive Impairment . Mild cognitive impairment. Lancet. 2006;367(9518):1262-1270. doi:10.1016/S0140-6736(06)68542-5 - DOI - PubMed
    1. Albert MS, DeKosky ST, Dickson D, et al. . The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging–Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):270-279. doi:10.1016/j.jalz.2011.03.008 - DOI - PMC - PubMed

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