Hearing Loss Linked to Cognitive Decline; Hearing Aids Do Not Appear to Change Risk

Mild or disabling hearing loss (HL) among adults ages 45 to 69 may be associated with cognitive impairment, according to a report in JAMA Open Network. Further, wearing a hearing aid does not appear to significantly change the risk for cognitive impairment.

Baptiste Grenier, M.D., of the Universite Paris Cite, and colleagues noted that the prevalence of cognitive impairment is increasing, with up to 150 million individuals worldwide expected to be living with dementia by 2050. “Given the major burden of cognitive decline and the absence of curative treatment, identifying modifiable risk factors is of importance,” they wrote.

Grenier and colleagues analyzed data on 62,072 older participants (average age 57.4 years; 52% female) in the French CONSTANCES cohort, a population-based epidemiological cohort that recruited more than 200,000 randomly selected adults ages 18 to 69 from the French National Insurance Fund between January 1, 2012, and December 31, 2020.

Overall, 49% of participants (n = 30,624) had normal hearing, 38% (n= 23,768) had mild HL, 10% (n = 6,012) had disabling HL without use of a hearing aid, and 3% (n = 1,668) used a hearing aid; hearing status was objectively assessed with audiometric testing.

Upon enrollment, all participants ages 45 and older also underwent an extensive cognitive evaluation from trained neuropsychologists. The researchers computed a global cognitive score for the participants based on three of the tests:

• Digit Symbol Substitution Test of attention, psychomotor speed, and reasoning
• Free and Cued Selective Reminding Test of episodic verbal memory
• Trail Making Test of shifting abilities and executive function

Across all ages, 27% of individuals with mild HL and 37% of those with disabling HL had global cognitive scores indicative of impairment, compared with 16% among those with normal hearing. The authors found no statistical difference in cognitive impairment risk between all individuals with disabling HL who used a hearing aid and those who did not. A secondary analysis suggested that hearing aids may reduce the risk of cognitive impairment in individuals with disabling hearing loss and depression.

The authors said that HL may cause cognitive decline because of social isolation, prolonged deprivation of auditory input, and/or shared neurodegenerative processes in the brain associated with hearing loss and cognitive deterioration. HL is also associated with loss of brain volume in critical sections of the brain.

Prescription of hearing aids for patients with disabling HL “should be guided by their established benefits on quality of life and social isolation, but not to mitigate cognitive decline for which further research is needed,” the authors wrote.

For related information, see the Psychiatric News article “Late Life Anxiety Linked to Cognitive Decline.”

(Image: Getty Images/iStock/bymuratdeniz)

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Study Supports Use of Emotional Support, Service Dogs for Veterans With PTSD

Eighteen months after being paired with an emotional support or service dog, veterans with posttraumatic stress disorder (PTSD) continued to report improvements in overall functioning and quality of life, a report in Psychiatric Services in Advance has found.

While emotional support dogs can provide comfort to their handlers, service dogs for PTSD receive additional training in a variety of tasks specific to assisting individuals with PTSD (for example, turning on lights in a dark room and providing space between the individual and an approaching person), wrote Joan T. Richerson, M.S., D.V.M., of the VA Tennessee Valley Health Care System and colleagues. The researchers wanted to know whether veterans who were paired with service dogs for PTSD might experience greater therapeutic benefits than those paired with emotional support dogs.

Richerson and colleagues randomly assigned veterans who had been diagnosed with PTSD to receive either a service dog or emotional support dog. Emotional support dogs and service dogs were required to pass the American Kennel Club Canine Good Citizen and Assistance Dogs International Public Access tests. In addition, service dogs were taught to perform tasks specific to a handler’s PTSD (turn on lights in dark room; enter rooms and sweep the perimeter; bring objects; and stand in front or behind the handler, respectively, to provide space between the handler and a person approaching from front or back).

After an observation period during which the randomized participants were asked to complete a dog care course, 97 participants received a service dog, and 84 received an emotional support dog. Over 18 months, the researchers evaluated the study participants’ level of disability and health-related quality of life, using the World Health Organization Disability Assessment Scale II (WHODAS 2.0) and the Veterans RAND 12-Item Health Survey (VR-12 physical and mental scores). They also collected data on participants’ PTSD symptoms, health care use, and more.

Among the findings:

• WHODAS 2.0 scores fell in both groups from three months after pairing with the dogs to 18 months (indicating less disability).
• VR-12 mental scores in both groups increased from baseline to 18 months (indicating improvement in quality of life). There was no significant difference in VR-12 physical scores over time.
• PTSD Checklist for DSM-5 (PCL-5) scores in both groups fell over the course of the study (indicating improvement in PTSD symptoms).

“Some separation in [PCL-5] scores between the groups started to appear at 9 months, with scores for the service dog group decreasing more than those for the emotional support dog group,” the authors noted.

Receipt of a service dog compared with receipt of an emotional support dog did not significantly affect VA costs for any category of care or VA health care use, except for outpatient substance use disorder treatment, the authors continued.

“Future work should examine mechanisms by which a service or emotional support dog has an impact on patient functioning, such as by directly reducing PTSD symptoms (e.g., arousal or avoidance), indirectly reducing symptoms through improved treatment engagement (e.g., in psychotherapy) or adherence (e.g., to pharmacotherapy), or by enabling veterans to overcome challenging situations in the presence of such symptoms.”

For related information, see the Psychiatric Research & Clinical Practice article “A Qualitative Exploration of the Use of Service Dogs in Veterans with Post Traumatic Stress Disorder and Traumatic Brain Injury.”

(Image: iStock/LuPa Creative)

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Biden to End Public Health Emergency Declaration in May

The COVID-19 public health emergency (PHE) will end on Thursday, May 11, the Biden Administration announced yesterday.

The administration’s decision to end the national emergency and PHE on May 11 will result in the end of multiple federal flexibilities affecting health care programs, including regulatory and statutory flexibilities provided by HHS and other Departments. This is a developing story; more information will be provided to APA members tomorrow.

Highlights From APA Annual Meeting: Day Two

Day two of APA’s Annual Meeting included an address by psychiatrist and incoming AMA President Patrice Harris, M.D., to APA’s Board of Trustees; a discussion of the challenges that international medical graduate students face; and a recommendation that psychiatrists consider ways their own mindfulness could benefit their patients.

Through May 22, Psychiatric News will deliver an evening digest of important highlights from the meeting.

Incoming AMA President and Former APA Board Member Lays Out Plans for Presidential Year

Psychiatrist Patrice Harris, M.D., told trustees that the integration of mental health and general medical care and promoting diversity across organized medicine would be among her priorities for the year.
Read More >

Valerie Jarrett Shares Insights From Her Years in the White House

In a wide-ranging “fireside chat” with APA President Altha Stewart, M.D., Valerie Jarrett talked about the experience of serving as President Obama’s longest-serving senior adviser. Read More >

Childhood Trauma Changes Biology of Brain

Advances in neurobiology and genetics explain the links between early life adversity and increased risk for psychiatric and medical conditions later in life, but how and when does psychiatry intervene?
Read More >

Why Psychiatrists Must 'Mindfully' Embrace Nutritional Wellness for Themselves and Their Patients

As the obesity epidemic expands, psychiatrists must go beyond telling patients how to lose weight to helping them live a healthy and fit life. Applying mindfulness to eating is one technique both physicians and their patients can benefit from.
Read More >

History Track Session Focuses on Challenges Faced by IMGs

A panel discussion of IMGs described the insensitivity and isolation—ranging from cultural misunderstandings to frank discrimination—that these trainees face in the workplace. Read More >

Overlap Between PTSD, TBI Symptoms Creates Challenges for Diagnosing Patients

Experts on Saturday discussed similarities in the causes and symptoms of PTSD and TBI, which can be critical for the determination of disability. Read More >

Winners of Resident/Medical Student Poster Competition Announced

Winners were recognized for their research focused on building resilience and addressing burnout in medical students and residents, reducing agitation, and more. Read More >

Childhood Disability Rate Increases Over Decade, Study Finds

The prevalence of childhood disability rose in the decade from 2001 to 2011, continuing a long-term trend, but there were some surprising details within the bigger picture. Overall, the rate of disability for children aged younger than 18 rose from 6.87% to 7.94%, an increase of 15.6%, based on parent-reported data from the National Health Information Survey, wrote Amy Houtrow, M.D., Ph.D., an associate professor of physical medicine and pediatrics at the University of Pittsburgh, online in the journal Pediatrics.

The rise was not due to physical health conditions, whose prevalence actually declined by 11.8% over the decade. Instead, disabilities attributable to neurodevelopmental or mental health conditions increased by 20.9%. Children at the lower end of the income scale had a higher prevalence of disability, but those at the highest end (≥400 percent of the federal poverty level) showed the greatest increase over the decade, a finding that surprised the investigators. This increase, they suggested, may be due to better access to care or greater willingness to seek services among upper-income families, among other possibilities.

Commenting on the findings of the study, child and adolescent psychiatrist David Fassler, M.D., a clinical professor of psychiatry at the University of Vermont College of Medicine, said that the key finding "most likely represents multiple trends, including changes in diagnostic criteria and eligibility requirements for specialized services. Further research is needed to more fully understand the implications of the current findings on the development of programs and services designed to best meet the needs of children.”

To read more about childhood psychiatric disability, see the Psychiatric News articles, “Prevalence Rate of Autism Continues Steady Rise” and “Parents—and Others—Learn to Accept Very Different Children.” 

(Image: Wavebreakmedia/Shutterstock.com)

Psychiatric Disabilities in U.S. Show Steep Rise

About 2.7 percent of Americans aged 18 to 64 reported some level of disability due to depression, anxiety, or emotional problems in the period 2007-2009, according to a new study in the American Journal of Public Health.

That represents an increase from 2.0 percent 10 years earlier even as the prevalence of disability attributed to other chronic conditions decreased, wrote Ramin Mojtabai, M.D., Ph.D., an associate professor at the Johns Hopkins Bloomberg School of Public Health. The increase in the prevalence of psychiatric disability occurred mainly among two groups: adults with disabilities caused by other chronic conditions and adults with a greater level of psychological distress who had not had any contacts with mental health professionals during the prior year.

To read more about issues concerning psychiatric disability, see Psychiatric News at http://pn.psychiatryonline.org/content/46/16/10.1.full.

(Image: Ed Phillips/Shutterstock.com)

Mental Illness Leading Cause of Youth Disability

Junial Enterprises/Shutterstock

Young people are usually considered healthier than older people, but around the world, they lose years of their lives to disability, according to a recent study in The Lancet. Researchers used data from the World Health Organization’s 2004 Global Burden of Disease study.

The three main causes of years lost to disability in 10- to 24-year-olds were neuropsychiatric disorders—including mental illnesses and alcohol abuse. That proportion was far ahead of accidents (15 percent) and infectious and parasitic diseases (10 percent), the next leading causes of disability.

“The health of young people has been largely neglected in global public health,” concluded Fiona Gore, of the Department of Health Statistics and Informatics at the World Health Organization in Geneva, Switzerland, and colleagues. “The findings of this study suggest that adolescent health would benefit from increased public health attention.”

For more about mental health epidemiology among young people, see Psychiatric News at
http://pn.psychiatryonline.org/content/46/8/25.full.