Cognitive Screening at Otolaryngology Practices: Good Idea or Waste of Time?

by David Bronstein •

Aging and Cognitive Health Evaluation in Elders Trial

Demonstrating that hearing loss is a strong predictor for dementia is all well and good, but the real breakthrough would be to show that treating hearing loss actually makes a difference—that it mitigates cognitive decline, according to Frank R. Lin, MD, PhD, the director of the Cochlear Center for Hearing and Public Health and a professor of otolaryngology, medicine, mental health, and epidemiology at Johns Hopkins Medicine in Baltimore. “If we can make that case, then prioritizing screening for and treating hearing loss in older adults makes a lot more sense,” he said.

This is exactly what Dr. Lin and his colleagues at the Johns Hopkins Bloomberg School of Public Health and six other institutions hope to accomplish with their ACHIEVE (Aging and Cognitive Health Evaluation in Elders) trial (ClinicalTrials.gov Identifier: NCT03243422). Supported by the National Institute on Aging, the $20 million study has recruited nearly 1,000 older adults between the ages of 70 and 84, all of whom have mild to moderate hearing loss. Participants will be randomized 1:1 to the hearing intervention (hearing needs assessment, fitting of hearing devices, education/counseling) or a successful aging education control intervention (individual sessions with a health educator covering healthy aging topics). Post baseline, participants will be followed semi-annually for three years to assess various domains of cognitive impairment and dementia. Results from the ACHIEVE trial are expected in 2023.

“As an epidemiologist, I have no idea of what the results might be, as the trial is completely blinded, and I’ve seen too many research hypotheses fail to be supported by large-scale studies,” said Dr. Lin. “But, as a clinician, my hope is that I’ll see confirmed what I have observed in my personal surgical experience: that when we intervene and treat hearing loss, whether with hearing aids or cochlear implants, the treatments often make a huge difference in patients’ lives. They no longer have to spend so much of their cognitive bandwidth on trying to hear, and instead can reconnect with family and friends and become much less isolated.”

Financial disclosure: Dr. Lin reported that he is a consultant to Frequency Therapeutics and is the director of a public health research center funded in part by a philanthropic gift from Cochlear, Ltd., to the Johns Hopkins Bloomberg School of Public Health.