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Understanding the Hearing Loss-Dementia Relationship: What Epidemiologic Studies Can and Cannot Tell Us

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1.  Which of the following is not a pathway by which hearing loss may potentially cause dementia in older adults? Increased cognitive load Common cause Changes in brain structure and function Increased social isolation

2.  Which epidemiologic study design would provide the strongest evidence that hearing aid use prevents dementia and cognitive decline? Cross-sectional study Case study of one patient Prospective study Randomized controlled trial

3.  In 2017, the Lancet Commission on Dementia Prevention, Intervention and Care estimated that hearing loss is associated with a 94% increased risk of developing dementia. An 80-year old patient who has a moderate hearing loss asks you what his risk of getting dementia is. How do you interpret the finding from the Lancet Commission for your patient? 94 out of 100 adults with hearing loss will get dementia Compared to someone who has normal hearing, your risk of getting dementia is 94% higher Compared to a group of people who had normal hearing, risk was 94% greater in participants with hearing loss, but your individual risk may be lower or higher You will not be at increased risk if you use hearing aids

4.  Which of the following is not a guideline to consider if trying to determine if an epidemiologic association between an exposure and an outcome may represent a true causal relationship? The novelty of the finding (i.e., no one else has studied it before) As the exposure increases, risk of the outcome increases (i.e., dose-response) If the exposure precedes the outcome (i.e., temporality) If there is a plausible biological mechanism supporting the association

5.  Which of the following question(s) remain unanswered? If there is an association between hearing loss and dementia in older adults If treatment with hearing aids can prevent or delay dementia and cognitive decline If hearing loss causes dementia in older adults Both B & C

6.  In 2017, the Lancet Commission on Dementia Prevention, Intervention and Care estimated that hearing loss confers the greatest amount of risk for dementia compared to the other factors they studied. Which of the following contributes to hearing loss having such a large impact? Bias in the studies that have been conducted The high prevalence of (proportion of the older adult population with) hearing loss The low uptake of hearing aids The lack of access to hearing health care

7.  Which of the following is not a reason that an association between an exposure and outcome may be observed in an epidemiologic study? Bias in the design of the study Chance Bias in the interpretation of the findings The findings are true in the population that was studied but do not apply to the general US population

8.  A colleague shows you a new observational epidemiologic study published in a prestigious journal. The study’s authors recruited over 10,000 adults aged 65 years or older. In their study, they found that self-reported hearing aid use was associated with a lower risk of developing dementia over 5 years compared to older adults with hearing loss who did not use a hearing aid. They conclude that hearing aid use prevents dementia. Do you agree? Why or why not? Yes, because of the large number of participants in the study Yes, because it was published in a prestigious, peer-reviewed journal Maybe, but caution is warranted in interpreting the study findings, because people who choose to wear hearing aids probably differ fundamentally from people who choose not to wear hearing aids (e.g., higher socioeconomic status, greater education) and these factors may protect against dementia No, because epidemiologic studies only show correlation and correlation does not equal causation

9.  Which of the following statements regarding the relationship between hearing loss and brain health in older adults is not true? Hearing loss is associated with smaller gray matter volume in the primary auditory cortex Hearing loss only affects the primary auditory cortex Hearing loss is associated with faster rates of brain atrophy in the temporal lobe and whole brain In imaging studies, there appears to be activation/recruitment of additional executive networks in people with hearing loss

10.  Complete the following sentence, “An older adult with untreated hearing loss…” will develop dementia will not develop dementia if appropriately fit for a hearing aid will likely benefit from treatment, but may still develop dementia should have their cognition checked whenever they visit the audiologist