Neurocogni*ve tes*ng and cochlear implanta*on: insights into performance in older adults

Transcription

1 Neurocogni*ve tes*ng and cochlear implanta*on: insights into performance in older adults Maura K Cosetti 1 MD James B. Pinkston, PhD 1 ; Jose M. Flores, MPH, PhD 3 ; David R. Friedmann, MD 2 ; Callie B. Jones, MA 1 ; J. Thomas Roland, Jr. MD 2 ; Susan B. Waltzman, PhD 2 1 Department of Otolaryngology-Head and Neck Surgery, LSU Health Sciences Center Shreveport 2 Department of Otolaryngology, NYU School of Medicine

2 none Disclosures

3 introduc*on Emerging research has established an associa*on between hearing loss and demen*a hearing loss independently associated with 40% rate of accelerated cogni*ve decline This rela*onship may be linear: those with more severe hearing loss are at highest risk individuals with mild, moderate and severe HL had a 2, 3, and 5 fold increased risk of all-cause demen*a over >10 yrs of follow-up Recent data suggest that interven*ons for hearing loss may impact cogni*on in older adults

4 objec*ve To assess the impact of auditory rehabilita*on with cochlear implanta*on (CI) on the cogni*ve func*on of elderly pa*ents over *me

5 methods N=7, post-lingually deafened female No known cogni*ve impairment age yrs at CI Tes*ng Pre-CI and follow-up 2-4 yrs (mean 3.7) Speech percep*on tes*ng: CNCw in quiet

6 Neurocogni*ve Tests: - 20 tests in 5 domains - intellectual func*on, learning, short- and longterm memory, verbal fluency, aaen*on, mental flexibility, and processing speed - 4 hours - All performed by trained neuropsychologist

7 analyses Individual and aggregate differences in cogni*on and speech percep*on over *me Δ individual = Post-CI score - Pre-CI score Δ sample=aggregate post-ci score - Aggregate pre-ci score Domain-specific Magnitude of change Logis*c Regression: rela*onship between cogni*ve performance and post-ci speech percep*on at years 1, 2 and 3

8 post-ci scores improved from pre-ci scores in 70% of tests Minimal, moderate, pronounced all improved in speech percep*on results

9 Results: domain-specific and magnitude

10 Regression analysis 5 cogni*ve tests were predic*ve of post-ci speech percep*on: WASI (IQ), vocabulary, matrix reasoning, Boston Naming Test, list learning (p< ) at 2 and 3 yrs post-ci (CI only and bi-modal)

11 discussion Longitudinal improvement in cogni*ve tes*ng in elderly pa*ents is rarely documented RBANS shown stability in community dwelling older adults (>500)over *me (4+ yrs) Robust tes*ng- same construct tested in different ways No auditory or cogni*ve training Unlikely influence of prac*ce effects given *me frame of tes*ng (ie minimal ajer 1 yr) Improvements in cogni/ve tes/ng may reflect impact of CI

12 discussion Domain-specific Improvements centered in verbal, memory, processing speed/mental flexibility domains All declines involved motor, vision Impact of prior axillary node dissec*on Support Mosnier et al Difficulty comparing exact tests as only 1 overlap Larger N, cogni*ve training, shorter follow up, minimal domain or magnitude analysis Limita*ons of current study Sample size Lack of norma*ve scores in hearing-impaired popula*on No assessment of mood

13 discussion Clinical vs. sta*s*cal significance of improved cogni*ve tes*ng is unknown (vs. speech understanding) prior data demonstrate long-term stability of neurocogni*ve test results à interpreted any improvement as clinically significant improvement in cogni*ve func*on is predic*ve of improved speech percep*on, thereby impor*ng a framework of clinical significance to these gains Future research: Larger sample sizes validate the meaning/clinical relevance of these incremental changes in neurocogni*ve tes*ng Neural plas*city in elderly Improved speech performance over *me cor*cal re-organiza*on of the central auditory system have been shown in both animals and adults Anatomic data from imaging studies shows evidence of cor*cal reorganiza*on following CI in adults and kids, no studies in elderly CI

14 conclusion comprehensive neurocogni*ve tes*ng of elderly women demonstrated areas of improvement in cogni*ve func*on and auditory percep*on following cochlear implanta*on Mul*ple neurocogni*ve tests were strongly associated with current speech percep*on measures CI may slow expected age-related cogni*ve decline, further research is needed to examine the impact of hearing restora*on on cogni*ve decline

15 References 1 Health ABC study. Associa*on of Hearing Impairment With Incident Frailty and Falls in Older Adults. J Aging Health. 2015; N=2000, 70+ yrs 2 Associa*on between hearing impairment and frailty in older adults. J Am Geriatr Soc Associa*on of Hearing Impairment and Mortality in the Na*onal Health and Nutri*on Examina*on Survey. JAMA Otolaryngol Head Neck Surg. 2015; N=1666, 70+yrs 4 Associa*on Between Hearing Impairment and Risk of Hospitaliza*on in Older Adults. J Am Geriatr Soc Health ABC study. Associa*on of hearing impairment with declines in physical func*oning and the risk of disability in older adults. J Gerontol A Biol Sci Med Sci Health ABC study. Associa*on of hearing impairment with declines in physical func*oning and the risk of disability in older adults. JGerontol A Biol Sci Med Sci Associa*on between hearing impairment and lower levels of physical ac*vity in older adults. J Am Geriatr Soc Health ABC Study Group. Hearing loss and cogni*ve decline in older adults. JAMA Intern Med Hearing loss and cogni*on in the Bal*more Longitudinal Study of Aging. Neuropsychology Hearing loss and cogni*on among older adults in the United States. J Gerontol A Biol Sci Med Sci Gurgel et al. Rela*onship of HL and Demen*a: a prospec*ve, popula*on-based study. Otol Neurotol Hearing loss and depression in older adults. J Am Geriatr Soc The associa*on between hearing loss and social isola*on in older adults. Otolaryngol Head Neck Surg. 2014

16 Thank you