Using a comprehensive hearing intervention designed, tested, and implemented by researchers at the University of South Florida, the multi-site ACHIEVE study examined the efficacy of hearing aids for reducing long-term cognitive decline in older adults.

Results from the largest randomized, controlled clinical trial testing the efficacy of hearing aids for reducing long-term cognitive decline in older adults were published July 18, 2023, in the journal Lancet, as well as reported for the first time at the Alzheimer’s Association International Conference® (AAIC®) 2023, held the same day, in Amsterdam, Netherlands.

Called the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, the multisite study found that, in older adults at increased risk for cognitive decline, hearing intervention slowed down loss of thinking and memory abilities by 48% over three years.

While the results were negative in the total study population, the hearing intervention did slow cognitive decline by 48% in a study subset of older adults with mild to moderate hearing loss who are participating in an ongoing observational study of heart health. Investigators believe that the effect of the hearing intervention on reducing cognitive decline was only apparent in the group of participants from the heart health study because this group had nearly a 3-fold faster rate of cognitive decline over the study period than the healthy volunteers that enrolled in the trial. That much faster rate of decline allowed researchers to see the beneficial effects of hearing intervention on reducing this decline within the limited 3-year period of the study.

“The hearing intervention had a significant effect on reducing cognitive change within three years in the population of older adults in the study who are at increased risk for cognitive decline,” said Frank Lin, MD, PhD, of Johns Hopkins University School of Medicine and Bloomberg School of Public Health, and co-principal investigator of the ACHIEVE study. “Hearing loss is very treatable in later life, which makes it an important public health target to reduce risk of cognitive decline and dementia, along with other dementia risk factors such as less education in early life, high blood pressure, social isolation and physical inactivity.”

The overall ACHIEVE study was led by researchers at Johns Hopkins and seven additional contributing institutions. A team of researchers from USF led the hearing intervention provided in the study. From the Department of Communication Sciences and Disorders in the USF College of Behavioral and Community Sciences, Theresa H. Chisolm, PhD, professor and vice provost for Strategic Planning, Performance and Accountability, and Michelle Arnold AuD, PhD, assistant professor, collaborated with Victoria Sanchez, AuD, PhD, assistant professor in the Department of Otolaryngology in the USF Health Morsani College of Medicine.

In addition to designing the hearing intervention, the USF team also trained the study audiologists and continuously monitored the hearing intervention that was provided in the overall study.

“The ACHIEVE Study is evidence that auditory rehabilitation, including the use of hearing aids, in older adults who had more risk factors for cognitive decline slowed the rate of cognitive decline,” said USF Health’s Dr. Sanchez. “Important risk factors for cognitive decline and dementia that could be potentially addressed to help reduce dementia include hearing loss, less education in early life, smoking, diabetes, high blood pressure, social isolation, and physical inactivity. Addressing hearing loss is one way we could reduce the increase rate of older adults living with dementia.”

Established research shows that loss of hearing can increase a person’s likelihood of cognitive decline, she said, adding that further research is needed.

“Our main trial results shared today are exciting and informative, but much more research is still needed,” Dr. Sanchez said. “Our team of multi-institution investigators are continuing to follow all participants in the ACHIEVE study beyond three years to look at longer term effects of hearing intervention on cognition and other outcomes.”

This foundational work can also help guide policymakers, she said.

“Our results will hopefully create policy changes because in many parts of the world we need improved affordable access and insurance coverage for hearing treatment/intervention,” Dr. Sanchez said. “This does not mean just a hearing aid, as hearing intervention consists of two components. First are hearing aids and related hearing technologies, and second are the diagnostic and hearing care support services of an audiologist to guide the individual in using these hearing technologies to hear and communicate optimally.

“We recommend that people who have concerns about their hearing and their risk factors for cognitive decline discuss these concerns with their doctor and be seen by an audiologist to address their hearing and communication needs.”

The ACHIEVE study is a randomized trial of older adults aged 70-84 with untreated hearing loss who were free from substantial cognitive impairment, conducted at four study sites in the United States, and 977 total participants were recruited from two study populations: 238 adults participating in the Atherosclerosis Risk in Communities (ARIC) study, and 739 healthy community volunteers newly recruited to the study.

People on cisplatin-based chemotherapy often suffer an unexpected side effect that can significantly compromise their quality of life, but new data could help improve their recovery, according to a study by USF Health researchers.

During treatment with this highly ototoxic drug, many patients experience hearing loss or tinnitus, but more specific input has been needed to address their needs, the Tampa-based team notes in the Journal of Clinical Oncology.

“The average person should care about this because lots of people who have cancer are on cisplatin,’’ said Victoria Sanchez, Au.D., Ph.D., the study’s lead author and assistant professor and chief of the Audiology Section in the Department of Otolaryngology at the USF Health Morsani College of Medicine. “Millions of people who are getting this medication can be affected with hearing loss.’’

Victoria Sanchez, Au.D., Ph.D.

Although previous studies have been published on the ototoxicity of cisplatin, patient-reported functional impairment had not been comprehensively evaluated. In the new study, USF Health researchers based their findings on feedback from patients who are or were on cisplatin.

This information could help doctors better predict side effects and improve treatment, said co-author Robert Frisina, Ph.D., a Distinguished University Professor and director of the USF Global Center for Hearing and Speech Research.

“Cisplatin also is used in childhood cancers, so you can imagine the impact this can have on their lives,’’ Dr. Frisina said. “Families would be interested in this research because these young adults and children would have to live with hearing loss and tinnitus for many years or for the rest of their lives … But we can’t treat this unless we understand all the mechanisms. Our hope is to one day prevent it altogether.’’

Specifically, testicular cancer survivors who were given cisplatin completed validated responses, including the Hearing Handicap Inventory for Adults and Tinnitus Primary Function Questionnaire. Associations between hearing loss or tinnitus and five pre-specified adverse health outcomes – cognitive dysfunction, fatigue, depression, anxiety, and overall health – were then evaluated.

The researchers concluded that one in three patients described “clinically significant functional impairment,’’ and that follow-up should include routine assessment and possible treatments for hearing loss and tinnitus by an audiologist.

“This is one of first reports where we included patient response,’’ Dr. Sanchez said, adding that hearing

Robert Frisina, Ph.D

health also is directly related to brain health.

However, many patients who suffer cisplatin-related hearing loss seldom change their behavior, even though hearing loss is the single largest modifiable risk factor for cognitive decline and dementia in the general population, the researchers said.

“Less than 10 percent of the people affected reported using hearing aids,’’ Dr. Sanchez said. “There are a lot of barriers to this, such as access and cost. And there’s the stigma some people have about wearing a hearing aid.’’

Cisplatin is used to manage and treat solid tumors and hematologic malignancies. While highly toxic, it is one of the most common chemotherapeutic agents used to treat cancer, either as a single-agent or combination therapy. Because of its success rate, it’s the preferred drug for testicular cancers, in addition to cancers of the bladder and ovaries.

But a drawback of such platinum-based drugs is the damage they can do to hearing. Cisplatin can leave between 40 to 80 percent of adults – and at least 50 percent of children – with “significant permanent hearing loss,’’ according to the National Institutes of Health.

Researchers aren’t certain on precisely why cisplatin invades the inner ear, while other organs in the body eliminate it within days or weeks. They do know that once in the ear, it usually does irreversible damage.

“Cisplatin is given to eliminate the cancer tumor, but for reasons not completely understood it goes into the inner ear and kills cells in the cochlea and does it through several mechanisms, such as inflammation, programmed cell death, or overproduction of reactive oxygen species (ROS),’’ Dr. Frisina said.

“It can kill hearing cells and they don’t grow back … So, one implication of our paper is people who have cancer-related hearing loss and tinnitus should seek treatment.’’

— By Kurt Loft for USF Health News