Can cochlear implantation improve neurocognition in the aging population?

Christiane Völter,1 Lisa Götze,1 Stefan Dazert,1 Michael Falkenstein,2,3 Jan Peter Thomas1 1Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University Bochum, St. Elisabeth-Hospital, Bochum, Germany; 2Institute for Work, Learning and Ageing (ALA), Bochum, Germany; 3Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany Introduction: The relationship between cognition and the ability to hear is well known. Due to changes in demographics, the number of people with sensorineural hearing loss and cognitive impairment is increasing. The aim of this study was to identify the impact of hearing rehabilitation via cochlear implantation on cognitive decline among the aging population. Patients and methods: This prospective study included 60 subjects aged between 50 and 84 years (mean 65.8 years, SD=8.9) with a severe to profound bilateral hearing impairment. A computer-based evaluation of short- and long-term memory, processing speed, attention, working memory and inhibition was performed prior to surgery as well as 6 and 12 months after cochlear implantation. Additionally, speech perception at 65 and 80 dB (Freiburger monosyllabic speech test) as well as disease-related (Nijmegen Cochlear Implant Questionnaire) and general (WHOQOL-OLD) quality of life were assessed. Results: Six months postimplantation, speech perception, quality of life and also neurocognitive abilities significantly increased. The most remarkable improvement after 6 months was detected in executive functions such as attention (p<0.001), inhibition (p=0.025) and working memory (n-back: p=0.002; operation span task: p=0.008), followed by delayed recall (p=0.03). In contrast, long-term memory showed a significant change of performance only after 12 months (p=0.021). After 6 months, most cognitive domains remained stable, except working memory assessed by the operation span task, which significantly improved between 6 and 12 months (p<0.001). No correlation was found between cognitive results and duration of deafness, speech perception or quality of life. Conclusion: Cochlear implantation does not only lead to better speech perception and quality of life, but has also been shown to improve cognitive skills in hearing impaired adults aged 50 years or more. These effects seem to be independent of each other. Keywords: neurocognition, cochlear implantation, hearing rehabilitation, agin