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George A. Gates, MD; Janet L. Cobb, MPH; Richard T. Linn, PhD; Thomas Rees, PhD; Philip A. Wolf, MD; Ralph B. D'Agostino, PhD

Arch Otolaryngol Head Neck Surg. 1996;122(2):161-167.

Abstract
Objectives
To determine in older people the relation between auditory dysfunction and cognitive dysfunction, and if central auditory test abnormalities predict the onset of clinical dementia or cognitive decline.

Design
Prospective population-based cohort study.

Setting
Framingham Heart Study outpatient biennial examinations 18 and 21.

Participants
Members of the Framingham Heart Study cohort with normal findings from cognitive screening tests at biennial examination 18.

Measurements
Peripheral audiometric thresholds and word recognition in quiet; Synthetic Sentence Identification with Ipsilateral Competing Message (SSI-ICM); Mini-Mental State Examination; and detailed neuropsychological testing of subjects with abnormal findings from the Mini-Mental State Examination. Relative risk of dementia was determined using age-adjusted Cox proportional hazards regression models.

Results
Hearing loss significantly lowered performance on the verbal parts of the Mini-Mental State Examination. The relative risk of subsequent clinical dementia or cognitive decline was 6 in subjects with very poor scores (<50%) in one ear on the SSI-ICM (P=.02); the relative risk was 12.5 if the poor scores were present in both ears (P=.001).

Conclusions
Central auditory dysfunction precedes senile dementia in a significant number of cases and may be an early marker for senile dementia. Hearing tests should be included in the evaluation of persons older than 60 years and in those suspected of having cognitive dysfunction.

(Arch Otolaryngol Head Neck Surg. 1996;122:161-167)

Author Affiliations
From the Department of Otolaryngology—Head and Neck Surgery, University of Washington School of Medicine, Seattle (Dr Gates); Department of Mathematics (Ms Cobb and Dr D'Agostino), and the Section of Preventive Medicine and Epidemiology, Evans Memorial Department of Clinical Research, and Department of Medicine (Dr Wolf), Boston University, Boston, Mass; Department of Rehabilitation Medicine, Erie County Medical Center, Buffalo, NY (Dr Linn); and Department of Otolaryngology—Head and Neck Surgery, University of Washington—Harborview Hospital, Seattle (Dr Rees).

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