title: Improvement of cognitive function after cochlear implantation in elderly patients.
abstract: OBJECTIVE
  The association between hearing impairment and cognitive decline has been established; however, the effect of cochlear implantation on cognition in profoundly deaf elderly patients is not known.
  
  
  OBJECTIVE
  To analyze the relationship between cognitive function and hearing restoration with a cochlear implant in elderly patients.
  
  
  METHODS
  Prospective longitudinal study performed in 10 tertiary referral centers between September 1, 2006, and June 30, 2009. The participants included 94 patients aged 65 to 85 years with profound, postlingual hearing loss who were evaluated before, 6 months after, and 12 months after cochlear implantation.
  
  
  METHODS
  Cochlear implantation and aural rehabilitation program.
  
  
  METHODS
  Speech perception was measured using disyllabic word recognition tests in quiet and in noise settings. Cognitive function was assessed using a battery of 6 tests evaluating attention, memory, orientation, executive function, mental flexibility, and fluency (Mini-Mental State Examination, 5-word test, clock-drawing test, verbal fluency test, d2 test of attention, and Trail Making test parts A and B). Quality of life and depression were evaluated using the Nijmegen Cochlear Implant Questionnaire and the Geriatric Depression Scale-4.
  
  
  RESULTS
  Cochlear implantation led to improvements in speech perception in quiet and in noise (at 6 months: in quiet, 42% score increase [95% CI, 35%-49%; P < .001]; in noise, at signal to noise ratio [SNR] +15 dB, 44% [95% CI, 36%-52%, P < .001], at SNR +10 dB, 37% [95% CI 30%-44%; P < .001], and at SNR +5 dB, 27% [95% CI, 20%-33%; P < .001]), quality of life, and Geriatric Depression Scale-4 scores (76% of patients gave responses indicating no depression at 12 months after implantation vs 59% before implantation; P = .02). Before cochlear implantation, 44% of the patients (40 of 91) had abnormal scores on 2 or 3 of 6 cognition tests. One year after implant, 81% of the subgroup (30 of 37) showed improved global cognitive function (no or 1 abnormal test score). Improved mean scores in all cognitive domains were observed as early as 6 months after cochlear implantation. Cognitive performance remained stable in the remaining 19% of the participants (7 of 37). Among patients with the best cognitive performance before implantation (ie, no or 1 abnormal cognitive test score), 24% (12 of 50) displayed a slight decline in cognitive performance. Multivariate analysis to examine the association between cognitive abilities before implantation and the variability in cochlear implant outcomes demonstrated a significant effect only between long-term memory and speech perception in noise at 12 months (SNR +15 dB, P = .01; SNR +10 dB, P < .001; and SNR +5 dB, P = .02).
  
  
  CONCLUSIONS
  Rehabilitation of hearing communication through cochlear implantation in elderly patients results in improvements in speech perception and cognitive abilities and positively influences their social activity and quality of life. Further research is needed to assess the long-term effect of cochlear implantation on cognitive decline.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants Auditifs et Chirurgie de la base du crâne, Paris, France2Unité Mixte de Recherche-Sante, 1159 Inserm/Université Paris 6, Pierre et Marie Curie, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mosnier
authors.affiliation: Service Oto-rhino-laryngologie, Hôpital Pellegrin, Bordeaux, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bebear
authors.affiliation: Service Oto-rhino-laryngologie, Hôpital Purpan, Toulouse, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Marx
authors.affiliation: Service Oto-rhino-laryngologie, Hôpital Purpan, Toulouse, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Fraysse
authors.affiliation: Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, University Lyon 1, Lyon, France6Département Oto-rhino-laryngologie, Hopital Edouard Herriot, Lyon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Truy
authors.affiliation: Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, University Lyon 1, Lyon, France6Département Oto-rhino-laryngologie, Hopital Edouard Herriot, Lyon, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Lina-Granade
authors.affiliation: Service Oto-rhino-laryngologie, Hôpital Gui de Chauliac, Montpellier, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Mondain
authors.affiliation: Service Oto-rhino-laryngologie, Hôpital Gui de Chauliac, Montpellier, France8Service d'Audiophonologie, Institut Saint-Pierre, Palavas les Flots, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Sterkers-Artières
authors.affiliation: Service Oto-rhino-laryngologie, Hôpital Hôtel Dieu, Nantes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bordure
authors.affiliation: Service Oto-rhino-laryngologie, Hôpital Bretonneau, Tours, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Robier
authors.affiliation: Service Oto-rhino-laryngologie, Hôpital Pontchailloux, Rennes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Godey
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants Auditifs et Chirurgie de la base du crâne, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Service Oto-rhino-laryngologie et Centre de réglage des implants cochléaires, Hôpital Rothschild, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Frachet
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Service Oto-rhino-laryngologie et Centre de réglage des implants cochléaires, Hôpital Rothschild, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Poncet-Wallet
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants Auditifs et Chirurgie de la base du crâne, Paris, France2Unité Mixte de Recherche-Sante, 1159 Inserm/Université Paris 6, Pierre et Marie Curie, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Bouccara
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, Unité Otologie, Implants Auditifs et Chirurgie de la base du crâne, Paris, France2Unité Mixte de Recherche-Sante, 1159 Inserm/Université Paris 6, Pierre et Marie Curie, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Sterkers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019929:Cochlear Implantation; D003054:Cochlear Implants; D003072:Cognition Disorders / Q000534:rehabilitation*; D003863:Depression / Q000175:diagnosis; D005260:Female; D015577:Geriatric Assessment; D006320:Hearing Tests; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011788:Quality of Life; D013067:Speech Perception / Q000502:physiology