Hearing Loss, Hearing Aid Use, and Neuropsychiatric Symptoms Among Persons Living With Dementia: Findings From NACC

Hearing loss is a common comorbidity among persons living with dementia (PLWD), affecting >90% of individuals. Sensory impairments have been associated with an increased risk of neuropsychiatric symptoms (NPS), while hearing aid use may be protective.

We analyzed cross sectional data from the National Alzheimer's Coordinating Center's Uniform Data Set. We estimated the association between functional hearing loss and number or severity of NPS in a negative binomial regression with robust variance adjusting for demographic and clinical characteristics. In the subsample with hearing loss, we estimated the association between hearing aid use and number or severity of NPS. Selection bias for hearing aid use was addressed using nearest neighbor matching (NNM) based on respondent demographic characteristics.

10,054 participants were included with a mean age of 75 (SD 8) years. 2,416 (24%) self-reported functional hearing loss with 3.4 (standard deviation [SD] 2.5) mean total number of NPS and mean NPS severity of 5.1 (SD 4.9). In fully adjusted models, hearing loss was not associated with more NPS (predicted prevalence difference (PPD):0.09; 95% confidence interval (CI):-0.06,0.25) or more severe (PPD = 0.25; 95% CI:-0.06,0.56) NPS. In PLWD reporting hearing loss, 1,325 (54.8%) reported hearing aid use. After well-balanced matching, in adjusted models, hearing aid use was associated with fewer (PPD:-0.71; 95% CI:-0.93,-0.50) and less severe NPS (PPD:-1.79; 95% CI:-2.23,-1.34).

Hearing aid use may represent an underutilized, nonpharmacological intervention to address NPS. These findings suggest that hearing care may represent a promising nonpharmacological strategy to explore in managing NPS.