Prevalence of hearing impairment in patients with mild cognitive impairment

Lopes, Leonardo da Costa; Magaldi, Regina Miksian; Gândara, Mara Edwirges Rocha; Reis, Ana Carolina de Barros; Jacob-Filho, Wilson

doi:10.1590/S1980-57642008DN10300006

Abstract

The correlation between hearing and cognition is well established in dementia, but not in mild cognitive impairment (MCI). Objective: The aim of the present study was to define the prevalence of hearing impairment in elderly patients with MCI and in controls. Methods: Twenty-nine patients with MCI and 24 control subjects were analyzed. We evaluated memory and hearing impairments through clinical tests, including the Mini Mental Status Examination, Clinical Dementia Rating (CDR) and Hearing Handicap Inventory for the Elderly Screening (HHIE-S). Audiometries were performed in 22 patients with MCI and 19 subjects in a control group. Results: MCI patients showed more hearing complaints (68.9%) compared to the control group (25%) (p=0.001). No differences in the intensity of hearing complaints, measured by the HHIE-S, were detected. Nonetheless, differences between mean hearing threshold (MCI group=23.4±11.3 dB and control group=16.0±10.1dB) (p=0.03) were identified. Conclusions: There is a significant association between MCI and hearing impairment. Hearing impairment in MCI patients may be a contributory factor to cognitive decline. This may however be related to the same neuropathological process, due to lesions of cortical areas related to hearing. The early diagnosis of hearing impairment in MCI patients may offer a more appropriate approach to this disease.

Key words:
dementia; memory; hearing; audiometry; elderly; aged.

Resumo

A relação entre audição e cognição está bem estabelecida em demências, porém não no comprometimento cognitivo leve (CCL). Objetivo: Propomos um estudo para determinar a prevalência de deficit auditivo em idosos portadores de CCL e controles. Métodos: Foram avaliados 29 pacientes com CCL e 24 controles. Analisamos as perdas de memória e de audição através de testes, como o Mini Exame do Estado Mental, o Escore Clínico de Demência e o HHIE-S (Hearing Handicap Inventory for the Elderly Screening). Vinte e dois pacientes com CCL e 19 controles foram submetidos a audiometrias. Resultados: O grupo CCL apresentou mais queixas auditivas (68,9%) se comparado com o controle (25%) (p=0.001). Não foram encontradas diferenças na intensidade da queixa auditiva, medida pelo HHIE-S. Foram detectadas diferenças entre a média dos limiares auditivos de pacientes com CCL (23,4±11,3 dB) e de controles (16,0±10,1 dB) (p=0,03). Conclusões: Existe significativa associação entre CCL e perdas auditivas. O deficit auditivo em pacientes com CCL pode ser um fator contribuinte para o declínio cognitivo ou estar relacionado a um mesmo processo neuropatológico, devido à lesão de áreas corticais relacionadas à audição. O diagnóstico precoce de perdas auditivas em pacientes com CCL pode permitir uma abordagem mais adequada desta doença.

Palavras-chave:
demência; memória; audição; audiometria; idosos.

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References

¹
Uhlmann RF, Larson EB, Rees TS, Koepsell TD, Duckert LG. Relationship of hearing impairment to dementia and cognitive dysfunction in older adults. JAMA 1989; 261:1916-1919.
²
van Boxtel MP, van Beijsterveldt CE, Houx P, et al. Mild hearing impairment can reduce verbal memory performance in a healthy adult population. J Clin Exp Neuropsychol 2000;22:147-154.
³
Kay DW, Roth M, Beamish P. Old age mental disorders in Newcastle upon Tyne; II: a study of possible social and medical causes. Br J Psychol 1964;110:668-682.
⁴
Gurland BJ, Kuriansky JB, Sharpe L, et al. The Comprehensive Assessment and Referral Evaluation (CARE): rationale, development, and reliability. Int J Aging Hum Dev 1977;8:9-42.
⁵
Gold M, Lightfoot LA, Hnath-Chisolm T. Hearing loss in a memory disorders clinic: a specially vulnerable population. Arch Neurol 1996;53:922-928.
⁶
Luis CA, Barker WW, Loewenstein DA, et al. Conversion to Dementia among two groups with cognitive impairment. Dement Geriatr Cogn Disord 2004;18:307-313.
⁷
Voisin T, Touchon J, Vellas B. Mild cognitive impairment: a nosological entity? Curr Opin Neurol 2003;16(Suppl 2):S43-S45.
⁸
Folstein MF, Folstein SE, Mc Hugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
⁹
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414. ?
¹⁰
Roth M, Tym E, Mountjoy CQ, et al. CAMDEX : a standardised instrument for diagnosis of mental disorders in elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.
¹¹
Bottino CMC, Stoppe Jr A, Scalco AZ, et al. Validade e confiabilidade da versão Brasileira do CAMDEX. Arq Neuropsiquiatr 2001;59(Suppl 3):20.
¹²
Wilson BA, Cockburn J, Baddeley A. The Rivermead Behavioral Memory Test. Reading: Thames Valley Test Co; 1991.
¹³
Wechsler D. WAIS-R Manual. New York: Psycological Corporation; 1981.
¹⁴
MacPhee GJ, Crowther JA, McAlpine CH. A simple screening test for hearing impairment in elderly patients. Age Ageing 1988;17:347-351.
¹⁵
Lichtenstein MJ, Bess FH, Logan AS. Validation of screening tools for identifying hearing-impaired elderly in primary care. JAMA 1988;259:2875-2878.
¹⁶
Herrera Jr E, Caramelli P, Nitrini R. Estudo epidemiológico populacional de demência na cidade de Catanduva: estudo de São Paulo, Brasil. Rev Psiq Clin 1998;25:70-73.
¹⁷
Yueh B, Shapiro N, MacLean CH, Shekelle PG. Screening and management of adult hearing loss in primary care. JAMA 2003;289:1976-1985.
¹⁸
Arlinger S. Audiometric profile in presbycusis. Acta Otolaryngol (Stockh) 1991;(Suppl 4/6):85-90.
¹⁹
Naramura H, Nakanishi N, Tatara K, et al. Physical and mental correlates of hearing impairment in the elderly in Japan. Audiology 1999;38:24-29.
²⁰
Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment. Clinical characterization and outcome. Arch Neurol 1999;56:303-308.
²¹
Portet F, Ousset P, Visser P, et al. Mild cognitive impairment in medical practice: critical review of the concept and new diagnostic procedure. Report of the MCI working group of the European Consortium on Alzheimer´s disease (EADC). J Neurol Neuosurg Psychiatry 2006;77:714-718.
²²
Gold M, Lightfoot LA, Hnath-Chisolm T. Hearing loss in a memory disorders clinic. Arch Neurol 1996;53:922-928.
²³
Herbst KG, Humphrey C. Hearing impairment and mental state in the elderly living at home. BMJ 1980;281:903-905.
²⁴
Bottino CMC, Louzã Neto MR, Castro CC, Gomes RLE. Doença de Alzheimer, transtorno cognitivo leve e envelhecimento normal: avaliação por medidas de ressonância magnética volumétricas. Rev Psiq Clin 1998;25:88-97.
²⁵
Vesterager V, Salomon G. Psychosocial aspects of hearing impairment in the elderly. Acta Otolaryngol (Stockh) 1991;476(Suppl):215-220.
²⁶
Working Group on Speech Understanding and aging (CHABA). Speech understanding and aging. J Acoust Soc Am 1988;83:859-893.
²⁷
Gates GA, Karzon RK, Garcia P, et al. Auditory dysfunction in aging and senile dementia of the Alzheimer`s type. Arch Neurol 1995;52:626-634.
²⁸
Strouse AL, Hall III JW, Burger MC. Central Auditory Processing in Alzheimer´s Disease. Ear Hear 1995;16:230-238.
²⁹
Schuknecht HF, Woellner RC. Experimental and clinical study of deafness for lesions of the cochlear nerve. J Laryngol Otol 1955;69:75-97.
³⁰
Nebes R, Madden D. Different patterns of cognitive slowing produced by Alzheimer´s disease and normal ageing. Psychol Ageing 1988;3:102-104.
³¹
Jobst KA, Smith AD, Barker CS, et al. Association of atrophy of the medial temporal lobe with reduced blood flow in the posterior parieto-temporal cortex in patients with a clinical and pathological diagnosis of Alzheimer´s disease. J Neurol Neurosurg Psychiatry 1992;55:190-194.
³²
Sinha UK, Hollen KM, Rodriguez R, Miller CA. Auditory system degeneration in Alzheimer´s disease. Neurology 1993;43:779-785.
³³
Haroutunian V, Perl DP, Purohit DP, et al. Regional distribution of neuritic plaques in the nondemented elderly and subjects with very mild Alzheimer disease. Arch Neurol 1998;55:1185-1191.
³⁴
Alexander GE, Newman JD, Symmes D. Convergence of prefrontal and acoustic inputs upon neurons in the superior temporal gyrus of the awake squirrel monkey. Brain Res 1976;116:334-338.
³⁵
Alho K, Woods DL, Algazi A, Knight RT, Naatanen R. Lesions of frontal cortex diminish the auditory mismatch negativity. Electroenceph Clin Neurophysiol 1994; 91:353-362.
³⁶
Pekkonen E, Huotilanen M, Virtanen J, et al. Age-related functional differences between auditory cortices: A whole-head magnetic study. NeuroReport 1995;6:1803-1806.
³⁷
Pekkonen E, Huotilanen M, Virtanen J, et al. Alzheimer´s disease affects parallel processing between the auditory cortices. NeuroReport 1996;7:1365-1368.
³⁸
Golob EJ, Johnson JK, Starr A. Auditory event-related potentials during target detection are abnormal in mild cognitive impairment. Clin Neurophysiol. 2002 Jan;113(1):151-161.
³⁹
Benson DF, Kuhl DE, Hawkins RA, Phelps ME, Cummings JL. The fluorodeoxyglucose F scan in Alzheimer´s disease and multiinfarct dementia. Arch Neurol 1983;16:649-654.

Publication Dates

Publication in this collection
Jul-Sep 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Uhlmann RF, Larson EB, Rees TS, Koepsell TD, Duckert LG. Relationship of hearing impairment to dementia and cognitive dysfunction in older adults. JAMA 1989; 261:1916-1919.

[2] ²
van Boxtel MP, van Beijsterveldt CE, Houx P, et al. Mild hearing impairment can reduce verbal memory performance in a healthy adult population. J Clin Exp Neuropsychol 2000;22:147-154.

[3] ³
Kay DW, Roth M, Beamish P. Old age mental disorders in Newcastle upon Tyne; II: a study of possible social and medical causes. Br J Psychol 1964;110:668-682.

[4] ⁴
Gurland BJ, Kuriansky JB, Sharpe L, et al. The Comprehensive Assessment and Referral Evaluation (CARE): rationale, development, and reliability. Int J Aging Hum Dev 1977;8:9-42.

[5] ⁵
Gold M, Lightfoot LA, Hnath-Chisolm T. Hearing loss in a memory disorders clinic: a specially vulnerable population. Arch Neurol 1996;53:922-928.

[6] ⁶
Luis CA, Barker WW, Loewenstein DA, et al. Conversion to Dementia among two groups with cognitive impairment. Dement Geriatr Cogn Disord 2004;18:307-313.

[7] ⁷
Voisin T, Touchon J, Vellas B. Mild cognitive impairment: a nosological entity? Curr Opin Neurol 2003;16(Suppl 2):S43-S45.

[8] ⁸
Folstein MF, Folstein SE, Mc Hugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[9] ⁹
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412-2414. ?

[10] ¹⁰
Roth M, Tym E, Mountjoy CQ, et al. CAMDEX : a standardised instrument for diagnosis of mental disorders in elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.

[11] ¹¹
Bottino CMC, Stoppe Jr A, Scalco AZ, et al. Validade e confiabilidade da versão Brasileira do CAMDEX. Arq Neuropsiquiatr 2001;59(Suppl 3):20.

[12] ¹²
Wilson BA, Cockburn J, Baddeley A. The Rivermead Behavioral Memory Test. Reading: Thames Valley Test Co; 1991.

[13] ¹³
Wechsler D. WAIS-R Manual. New York: Psycological Corporation; 1981.

[14] ¹⁴
MacPhee GJ, Crowther JA, McAlpine CH. A simple screening test for hearing impairment in elderly patients. Age Ageing 1988;17:347-351.

[15] ¹⁵
Lichtenstein MJ, Bess FH, Logan AS. Validation of screening tools for identifying hearing-impaired elderly in primary care. JAMA 1988;259:2875-2878.

[16] ¹⁶
Herrera Jr E, Caramelli P, Nitrini R. Estudo epidemiológico populacional de demência na cidade de Catanduva: estudo de São Paulo, Brasil. Rev Psiq Clin 1998;25:70-73.

[17] ¹⁷
Yueh B, Shapiro N, MacLean CH, Shekelle PG. Screening and management of adult hearing loss in primary care. JAMA 2003;289:1976-1985.

[18] ¹⁸
Arlinger S. Audiometric profile in presbycusis. Acta Otolaryngol (Stockh) 1991;(Suppl 4/6):85-90.

[19] ¹⁹
Naramura H, Nakanishi N, Tatara K, et al. Physical and mental correlates of hearing impairment in the elderly in Japan. Audiology 1999;38:24-29.

[20] ²⁰
Petersen RC, Smith GE, Waring SC, et al. Mild cognitive impairment. Clinical characterization and outcome. Arch Neurol 1999;56:303-308.

[21] ²¹
Portet F, Ousset P, Visser P, et al. Mild cognitive impairment in medical practice: critical review of the concept and new diagnostic procedure. Report of the MCI working group of the European Consortium on Alzheimer´s disease (EADC). J Neurol Neuosurg Psychiatry 2006;77:714-718.

[22] ²²
Gold M, Lightfoot LA, Hnath-Chisolm T. Hearing loss in a memory disorders clinic. Arch Neurol 1996;53:922-928.

[23] ²³
Herbst KG, Humphrey C. Hearing impairment and mental state in the elderly living at home. BMJ 1980;281:903-905.

[24] ²⁴
Bottino CMC, Louzã Neto MR, Castro CC, Gomes RLE. Doença de Alzheimer, transtorno cognitivo leve e envelhecimento normal: avaliação por medidas de ressonância magnética volumétricas. Rev Psiq Clin 1998;25:88-97.

[25] ²⁵
Vesterager V, Salomon G. Psychosocial aspects of hearing impairment in the elderly. Acta Otolaryngol (Stockh) 1991;476(Suppl):215-220.

[26] ²⁶
Working Group on Speech Understanding and aging (CHABA). Speech understanding and aging. J Acoust Soc Am 1988;83:859-893.

[27] ²⁷
Gates GA, Karzon RK, Garcia P, et al. Auditory dysfunction in aging and senile dementia of the Alzheimer`s type. Arch Neurol 1995;52:626-634.

[28] ²⁸
Strouse AL, Hall III JW, Burger MC. Central Auditory Processing in Alzheimer´s Disease. Ear Hear 1995;16:230-238.

[29] ²⁹
Schuknecht HF, Woellner RC. Experimental and clinical study of deafness for lesions of the cochlear nerve. J Laryngol Otol 1955;69:75-97.

[30] ³⁰
Nebes R, Madden D. Different patterns of cognitive slowing produced by Alzheimer´s disease and normal ageing. Psychol Ageing 1988;3:102-104.

[31] ³¹
Jobst KA, Smith AD, Barker CS, et al. Association of atrophy of the medial temporal lobe with reduced blood flow in the posterior parieto-temporal cortex in patients with a clinical and pathological diagnosis of Alzheimer´s disease. J Neurol Neurosurg Psychiatry 1992;55:190-194.

[32] ³²
Sinha UK, Hollen KM, Rodriguez R, Miller CA. Auditory system degeneration in Alzheimer´s disease. Neurology 1993;43:779-785.

[33] ³³
Haroutunian V, Perl DP, Purohit DP, et al. Regional distribution of neuritic plaques in the nondemented elderly and subjects with very mild Alzheimer disease. Arch Neurol 1998;55:1185-1191.

[34] ³⁴
Alexander GE, Newman JD, Symmes D. Convergence of prefrontal and acoustic inputs upon neurons in the superior temporal gyrus of the awake squirrel monkey. Brain Res 1976;116:334-338.

[35] ³⁵
Alho K, Woods DL, Algazi A, Knight RT, Naatanen R. Lesions of frontal cortex diminish the auditory mismatch negativity. Electroenceph Clin Neurophysiol 1994; 91:353-362.

[36] ³⁶
Pekkonen E, Huotilanen M, Virtanen J, et al. Age-related functional differences between auditory cortices: A whole-head magnetic study. NeuroReport 1995;6:1803-1806.

[37] ³⁷
Pekkonen E, Huotilanen M, Virtanen J, et al. Alzheimer´s disease affects parallel processing between the auditory cortices. NeuroReport 1996;7:1365-1368.

[38] ³⁸
Golob EJ, Johnson JK, Starr A. Auditory event-related potentials during target detection are abnormal in mild cognitive impairment. Clin Neurophysiol. 2002 Jan;113(1):151-161.

[39] ³⁹
Benson DF, Kuhl DE, Hawkins RA, Phelps ME, Cummings JL. The fluorodeoxyglucose F scan in Alzheimer´s disease and multiinfarct dementia. Arch Neurol 1983;16:649-654.

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