听力损失与认知障碍:老年人群中的双重挑战

doi:10.3969/j.issn.1003-9198.2025.12.019

摘要/Abstract

摘要： 听力损失、认知障碍和老年痴呆已成为老年人的常见问题。大量研究聚焦于年龄相关性听力损失(age-related hearing loss, ARHL)与认知衰退(包括痴呆症)之间的关联。尽管关于老年人听觉功能障碍与认知障碍相互作用的假设众多,但ARHL被广泛认为是认知衰退的一个可干预的风险因素。本综述从病因、病理、临床表现及病变进程等多个维度探讨ARHL与认知障碍或AD之间潜在的相互关联,以及干预治疗改善听觉功能后病人认知功能的变化情况,旨在引起老年医学临床和科研人员对听觉功能下降引发认知功能障碍问题的关注,推动相关领域的进一步研究与临床实践。

关键词: 听觉系统, 认知功能, 年龄相关性听力损失, 认知障碍, 痴呆

Abstract: Hearing loss, cognitive impairment, and dementia are prevalent issues among the elderly population. Numerous studies have focused on the correlation between age-related hearing loss (ARHL) and cognitive decline (including dementia). While there are various hypotheses regarding the interaction between auditory dysfunction and cognitive impairment in older adults, ARHL is widely recognized as a modifiable risk factor for cognitive decline. This review explores the potential interconnections between ARHL and cognitive impairment or Alzheimer’s disease from multiple dimensions including etiology, pathology, clinical manifestations, and disease progression. It also introduces the changes of cognitive performance after interventions to improve auditory function. The aim is to raise awareness among geriatric medicine clinicians and researchers about the cognitive impairments caused by hearing decline, thereby promoting further research and clinical practice in this field.

Key words: auditory system, cognitive function, age-related hearing loss, cognitive impairment, dementia

中图分类号:

R 764.436

李娟娟, 魏朝刚. 听力损失与认知障碍:老年人群中的双重挑战[J]. 实用老年医学, 2025, 39(12): 1284-1288.

LI Juanjuan, WEI Chaogang. Hearing loss and cognitive impairment: twin challenges in the elderly[J]. Practical Geriatrics, 2025, 39(12): 1284-1288.

参考文献

[1] ALEXOPOULOS P, DEMERTZIS A A, BIRIS P, et al. Pragmatic questionnaire-based evaluation of auditory function in individuals with major neurocognitive disorders and hearing loss in diverse contexts[J]. Front Aging Neurosci, 2025, 17: 1504358.
[2] YANG C, ZHANG Y, LI H, et al. Sensory impairments associated with cognitive impairment among older adults in China: a community-based, 10-year prospective cohort study[J]. J Glob Health, 2024, 14: 04175.
[3] CAO X, YANG B, ZHOU J. Hearing loss and subjective well-being among older adults: mediating effect of social activity and cognitive function[J]. Clin Gerontol, 2023: 1-12.
[4] XUE T, WEI L, ZHA D J, et al. miR-29b overexpression induces cochlear hair cell apoptosis through the regulation of SIRT1/PGC-1α signaling: implications for age-related hearing loss[J]. Int J Mol Med, 2016, 38(5): 1387-1394.
[5] CHADHA S, KAMENOV K, CIEZA A. The world report on hearing, 2021[J]. Bull World Health Organ, 2021, 99(4): 242-242A.
[6] LIVINGSTON G, HUNTLEY J, SOMMERLAD A, et al. Dementia prevention, intervention, and care: 2020 report of the lancet commission[J]. Lancet, 2020, 396(10248): 413-446.
[7] LI F F, WANG J P, ZHANG W J, et al. Trends and mechanisms of Alzheimer’s disease and hearing impairment: a 20-year perspective[J]. Ageing Res Rev, 2025, 110: 102799.
[8] GOPINATH B, ROCHTCHINA E, WANG J J, et al. Prevalence of age-related hearing loss in older adults: Blue Mountains Study[J]. Arch Intern Med, 2009, 169(4): 415-416.
[9] ROQUE L, KARAWANI H, GORDON-SALANT S, et al. Effects of age, cognition, and neural encoding on the perception of temporal speech cues[J]. Front Neurosci, 2019, 13: 749.
[10] CHADHA S, CIEZA A, KRUG E. Global hearing health: future directions[J]. Bull World Health Organ, 2018, 96(3): 146.
[11] Alzheimer’s Disease International, WIMO A, ALI G C, et al. World Alzheimer Report 2015[R]. London: Alzheimer’s Disease International, 2015.
[12] JIA L, QUAN M, FU Y, et al. Dementia in China: epidemiology, clinical management, and research advances[J]. Lancet Neurol, 2020, 19(1): 81-92.
[13] TARAWNEH H Y, JAYAKODY D M P, SOHRABI H R, et al. Understanding the relationship between age-related hearing loss and Alzheimer’s disease: a narrative review[J]. J Alzheimers Dis Rep, 2022, 6(1): 539-556.
[14] THAMIZHMANI L, GANAPATHY K, PALANISWAMY H P, et al. Auditory processing and its cognitive correlates in older adults with mild cognitive impairment[J]. BMC Geriatr, 2025, 25(1): 373.
[15] JACK C R Jr, BENNETT D A, BLENNOW K, et al. NIA-AA research framework: toward a biological definition of Alzheimer’s disease[J]. Alzheimers Dement, 2018, 14(4): 535-562.
[16] VERMUNT L, SIKKES S A M, VAN DEN HOUT A, et al. Duration of preclinical, prodromal, and dementia stages of Alzheimer’s disease in relation to age, sex, and APOE genotype[J]. Alzheimers Dement, 2019, 15(7): 888-898.
[17] SIEDLECKI-WULLICH D, MIÑANO-MOLINA A J, RODRÍGUEZ-ÁLVAREZ J. MicroRNAs as early biomarkers of Alzheimer’s disease: a synaptic perspective[J]. Cells, 2021, 10(1): 113.
[18] LIN F R, YAFFE K, XIA J, et al. Hearing loss and cognitive decline in older adults[J]. JAMA Intern Med, 2013, 173(4): 293-299.
[19] HUMES L E, KIDD G R, LENTZ J J. Corrigendum: auditory and cognitive factors underlying individual differences in aided speech-understanding among older adults[J]. Front Syst Neurosci, 2016, 10: 91.
[20] UHLMANN R F, LARSON E B, KOEPSELL T D. Hearing impairment and cognitive decline in senile dementia of the Alzheimer’s type[J]. J Am Geriatr Soc, 1986, 34(3): 207-210.
[21] LIVINGSTON G, SOMMERLAD A, ORGETA V, et al. Dementia prevention, intervention, and care[J]. Lancet, 2017, 390(10113): 2673-2734.
[22] HAKIM A M. A proposed hypothesis on dementia: inflammation, small vessel disease, and hypoperfusion is the sequence that links all harmful lifestyles to cognitive impairment[J]. Front Aging Neurosci, 2021, 13: 679837.
[23] TUN P A, WILLIAMS V A, SMALL B J, et al. The effects of aging on auditory processing and cognition[J]. Am J Audiol, 2012, 21(2): 344-350.
[24] SHUKLA A, HARPER M, PEDERSEN E, et al. Hearing loss, loneliness, and social isolation: a systematic review[J]. Otolaryngol Head Neck Surg, 2020, 162(5): 622-633.
[25] GLICK H, SHARMA A. Cross-modal plasticity in developmental and age-related hearing loss: clinical implications[J]. Hear Res, 2017, 343: 191-201.
[26] LI J, ZOU Y, KONG X, et al. Exploring functional connectivity alterations in sudden sensorineural hearing loss: a multilevel analysis[J]. Brain Res, 2024, 1824: 148677.
[27] GRIFFITHS T D, LAD M, KUMAR S, et al. How can hearing loss cause dementia?[J]. Neuron, 2020, 108(3): 401-412.
[28] ALAIN C, DU Y, BERNSTEIN L J, et al. Listening under difficult conditions: an activation likelihood estimation meta-analysis[J]. Hum Brain Mapp, 2018, 39(7): 2695-2709.
[29] RASLAU F D, MARK I T, KLEIN A P, et al. Memory part 2: the role of the medial temporal lobe[J]. AJNR Am J Neuroradiol, 2015, 36(5): 846-849.
[30] LAD M, HOLMES E, CHU A, et al. Speech-in-noise detection is related to auditory working memory precision for frequency[J]. Sci Rep, 2020, 10(1): 13997.
[31] POWELL D S, BRENOWITZ W D, YAFFE K, et al. Examining the combined estimated effects of hearing loss and depressive symptoms on risk of cognitive decline and incident dementia[J]. J Gerontol B Psychol Sci Soc Sci, 2022, 77(5): 839-849.
[32] BREWSTER K K, HU M C, ZILCHA-MANO S, et al. Age-related hearing loss, late-life depression, and risk for incident dementia in older adults[J]. J Gerontol A Biol Sci Med Sci, 2021, 76(5): 827-834.
[33] DAWES P. Hearing interventions to prevent dementia[J]. HNO, 2019, 67(3): 165-171.
[34] BYUN H, CHUNG J H, LEE S H, et al. Dementia in a hearing-impaired population according to hearing aid use: a nationwide population-based study in Korea[J]. Ear Hear, 2022, 43(6): 1661-1668.
[35] SAWYER C S, ARMITAGE C J, MUNRO K J, et al. Correlates of hearing aid use in UK adults: self-reported hearing difficulties, social participation, living situation, health, and demographics[J]. Ear Hear, 2019, 40(5): 1061-1068.
[36] YEO B S Y, SONG H J J M D, TOH E M S, et al. Association of hearing aids and cochlear implants with cognitive decline and dementia: a systematic review and meta-analysis[J]. JAMA Neurol, 2023, 80(2): 134-141.
[37] MAHARANI A, DAWES P, NAZROO J, et al. Longitudinal relationship between hearing aid use and cognitive function in older Americans[J]. J Am Geriatr Soc, 2018, 66(6): 1130-1136.
[38] BOISVERT I, REIS M, AU A, et al. Cochlear implantation outcomes in adults: a scoping review[J]. PLoS One, 2020, 15(5): e0232421.
[39] AMIEVA H, OUVRARD C, GIULIOLI C, et al. Self-reported hearing loss, hearing aids, and cognitive decline in elderly adults: a 25-year study[J]. J Am Geriatr Soc, 2015, 63(10): 2099-2104.
[40] ASKAKAWA T, YANG Y, XIAO Z, et al. Stumbling blocks in the investigation of the relationship between age-related hearing loss and cognitive impairment[J]. Perspect Psychol Sci, 2024,19(1):137-150.
[41] VAN AGTMAAL M J M, HOUBEN A J H M, POUWER F, et al. Association of microvascular dysfunction with late-life depression: a systematic review and meta-analysis[J]. JAMA Psychiatry, 2017, 74(7): 729-739.
[42] FÜLLGRABE C. On the possible overestimation of cognitive decline: the impact of age-related hearing loss on cognitive-test performance[J]. Front Neurosci, 2020, 14: 454.
[43] YEO B S Y, GAO E Y, TAN B K J, et al. Dual sensory impairment: global prevalence, future projections, and its association with cognitive decline[J]. Alzheimers Dement, 2025, 21(2): e14465.