Sensation and Psychiatry: Linking Age-Related Hearing Loss to Late-Life Depression and Cognitive Decline.
Sensation and Psychiatry: Linking Age-Related Hearing Loss to Late-Life Depression and Cognitive Decline.
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DOI：
10.1176/appi.ajp.2017.17040423
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发表时间：
2018-03-01
期刊：
影响因子：
--
通讯作者：
Roose SP
中科院分区：
文献类型：
--
作者：
Rutherford BR;Brewster K;Golub JS;Kim AH;Roose SP
最近的研究将年龄相关的听力损失与认知领域的表现受损以及痴呆症诊断风险增加联系起来。将听力障碍与晚年抑郁症事件联系起来的数据更为复杂，但表明听力下降确实会增加抑郁症的风险。行为机制可以解释这些关联，例如老年人从他们可能有听力和沟通困难的情况下退缩，这可能有助于社会孤立，孤独和随之而来的认知能力下降和抑郁的发展。在神经水平上，慢性听力损失导致中枢听觉通路的激活减少，导致认知控制网络的代偿性激活增加，神经系统-边缘系统连接功能障碍，以及额叶脑区的传入阻滞诱导的萎缩。这些病理变化通过减少认知储备、增加执行功能障碍和破坏正常的情绪反应和调节来降低认知表现并增加抑郁风险。根据现有的数据和该模型的信息，为临床医生治疗老年人提出了基于证据的建议，并提出了一个研究议程，以促进为老年人提供合理设计和适合年龄的心理治疗。首先，治疗听力损失应作为改善认知和抑郁结局的一种手段，在设计良好的研究中进行研究，包括全面的精神病学评估，随机化，依从性的客观记录以及治疗介质的分析，这将促进进一步的治疗发展。多模态神经影像学研究整合听力，神经心理学和临床评估也需要进一步评估提出的模型。
Recent research has linked age-related hearing loss to impaired performance across cognitive domains and increased risk for dementia diagnosis. The data linking hearing impairment to incident late-life depression are more mixed but suggest that diminished hearing does increase risk for depression. Behavioral mechanisms may explain these associations, such as the withdrawal of older adults from situations in which they may have difficulty hearing and communicating, which may contribute to the development of social isolation, loneliness, and consequent cognitive decline and depression. At a neural level, chronic hearing loss leads to reduced activation in central auditory pathways, resulting in compensatory increased activation in the cognitive control network, dysfunctional auditory–limbic connectivity, and deafferentation-induced atrophy in frontal brain regions. These pathologic changes decrease cognitive performance and increase depression risk by reducing cognitive reserve, increasing executive dysfunction, and disrupting normative emotion reactivity and regulation. Based on the available data and informed by this model, evidence-based suggestions are proposed for clinicians treating older adults, and a research agenda is advanced to facilitate the development of rationally designed and age-appropriate psychiatric treatments for older adults with age-related hearing loss. First and foremost, treating hearing loss should be investigated as a means of improving cognitive and depressive outcomes in well-designed studies incorporating comprehensive psychiatric assessments, randomization, objective documentation of compliance, and analyses of treatment mediators that will facilitate further therapeutic development. Multimodal neuroimaging studies integrating audiometric, neuropsychological, and clinical assessments also are needed to further evaluate the model proposed.
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