New ways of treating dementia? Don´t miss Charlie Huins´ presentation

We are proud to announce that Mr Charlie Huins FRCS (ORL-HNS) - Consultant ENT Surgeon at Queen Elizabeth Hospital Birmingham NHS Foundation Trust, UK is confirmed speaker for session two on January 23rd. He will be speaking on the topic "Is cochlea implantation the new treatment for dementia?".

Mr Charlie Huins FRCS (ORL-HNS) - Consultant ENT Surgeon
Mrs Louise Craddock - Audiological Scientist
Midlands Hearing Implant Programme (Adult service)
Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK

Introduction
Hearing loss is estimated to affect up to 30% of the adult population in developed countries and has been independently associated with accelerated cognitive decline. Globally, 0.9% of the elderly have profound hearing loss and, in the UK, it is estimated that there are currently 855,500 severe to profoundly deaf adults. We reviewed the current literature and performed a retrospective analysis of outcomes together with a subjective assessment of outcomes of 100 patients.

Method
A review of the literature was performed using search terms ‘hearing loss’, ‘cognition’, ‘dementia’, ‘quality of life’, ‘elderly’ and ‘mental health’. Papers were identified and selected for relevant content. A meta-analysis was not possible due to the heterogeneity of the results. Outcome data of two groups was compared - over 65 years and under 65 years - via a retrospective review of 100 newly implanted adults’ notes. Analysis of age at implantation and outcomes was performed together with a survey completed by patients to evaluate self-reported benefits, including aspects unrelated to hearing.

Results
Collectively, the literature has identified hearing loss as a risk factor for incident dementia and cognitive decline in the elderly. Patients over the age of 70 have lower baseline cognitive scores and a 41% greater rate of annual cognitive decline compared to those with normal hearing. Cochlear implants (CI) have been shown to reduce depression and improve cognitive function, concentration and executive function. Analysis of speech perception outcomes shows that all post-lingually deaf patients achieve significant improvements in the first year at each test interval. Moreover, there was no statistical difference in group performance of the over 65s and under 65s at any test interval.

The survey indicated that all patients reported greatest subjective benefits since they were implanted in the following areas: hearing, confidence, listening and overall quality of life. Moderate improvements were reported in social life, concentration and general health. There were no significant differences in subjective ratings relative to age at implantation in any aspect.

Conclusion 
CIs for severe to profoundly deaf patients are known to improve hearing and speech perception, irrespective of age. However, hearing loss may be causally related to dementia, possibly through exhaustion of cognitive reserve, social isolation, environmental deafferentation, or a combination of these pathways. Therefore, the benefits of CI to elderly patients appear to go far beyond hearing and speech understanding alone. Our data suggests elderly CI recipients adapt well to CI and report a higher quality of life, better general health and less depression. Moreover, the improvements in hearing result, together with reduced listening effort, in this patient group has a beneficial effect on cognitive function. Both age groups gain equivalent measurable benefits in speech perception and subjective benefits are reported in many other aspects of daily life, including areas unrelated to hearing, which is irrespective of age at implantation.