Hearing in noise and cognitive status in older adults: Biomarker associations and bidirectional survival analyses

BackgroundHearing impairment (HI) has been identified as a potentially modifiable risk factor for dementia, yet its relationship with Alzheimer's disease (AD) neuropathology and the temporal directionality remain unclear, particularly in late life.ObjectiveTo examine cross-sectional and longitudinal associations between HI, clinical cognitive status, and AD biomarkers in community-dwelling older adults.MethodsWe included 474 DRIVES Project participants (mean age 73.5 ± 5.2 years). Hearing was assessed using the NIH Toolbox Words-in-Noise (WIN) test. Clinical cognitive status was assessed using Clinical Dementia Rating (CDR). AD biomarkers included cerebrospinal fluid (CSF) Aβ₄₂/Aβ₄₀, t-tau/Aβ₄₂, and p-tau/Aβ₄₂ ratios and amyloid PET imaging. Multivariable linear, logistic, Cox proportional hazards, and Fine-Gray competing-risk models were used.ResultsHI was more prevalent among participants with mild cognitive impairment (MCI; defined as CDR = 0.5) than cognitively normal individuals (50% versus 24%, p < 0.001), and MCI status was independently associated with worse baseline WIN thresholds (β = 1.55 dB SNR; 95% CI 0.72-2.37). HI was not cross-sectionally associated with CSF amyloid or tau ratios or amyloid PET positivity. Longitudinally, baseline MCI was associated with a higher risk of incident HI (Cox HR = 2.63, 95% CI 1.48-4.67; Fine-Gray sHR = 2.79, 95% CI 1.06-7.40), whereas baseline HI was not associated with subsequent CDR progression.ConclusionsIn older adults, HI was associated with MCI but not core AD biomarkers or future CDR progression, suggesting that late-life HI may reflect cognitive vulnerability or broader brain aging rather than independently driving AD pathology.