Neurocognitive testing and cochlear implantation: insights into performance in older adults.
OBJECTIVE
The aim of this case series was to assess the impact of auditory rehabilitation with cochlear implantation on the cognitive function of elderly patients over time.


METHODS
This is a longitudinal case series of prospective data assessing neurocognitive function and speech perception in an elderly cohort pre- and post-implantation.


METHODS
University cochlear implant center.


METHODS
The patients were post-lingually deafened elderly female (mean, 73.6 years; SD, 5.82; range, 67-81 years) cochlear implant recipients (n=7).


METHODS
A neurocognitive battery of 20 tests assessing intellectual function, learning, short- and long-term memory, verbal fluency, attention, mental flexibility, and processing speed was performed prior to and 2-4.1 years (mean, 3.7) after cochlear implant (CI). Speech perception testing using Consonant-Nucleus-Consonant words was performed prior to implantation and at regular intervals postoperatively. Individual and aggregate differences in cognitive function pre- and post-CI were estimated. Logistic regression with cluster adjustment was used to estimate the association (%improvement or %decline) between speech understanding and years from implantation at 1 year, 2 years, and 3 years post-CI.


RESULTS
Improvements after CI were observed in 14 (70%) of all subtests administered. Declines occurred in five (25%) subtests. In 55 individual tests (43%), post-CI performance improved compared to a patient's own performance before implantation. Of these, nine (45%) showed moderate or pronounced improvement. Overall, improvements were largest in the verbal and memory domains. Logistic regression demonstrated a significant relationship between speech perception and cognitive function over time. Five neurocognitive tests were predictive of improved speech perception following implantation.


CONCLUSIONS
Comprehensive neurocognitive testing of elderly women demonstrated areas of improvement in cognitive function and auditory perception following cochlear implantation. Multiple neurocognitive tests were strongly associated with current speech perception measures. While these data shed light on the complex relationship between hearing and cognition by showing that CI may slow the expected age-related cognitive decline, further research is needed to examine the impact of hearing rehabilitation on cognitive decline.
Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA; Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Maura K
MK
Cosetti
Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
James B
JB
Pinkston
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA.
Jose M
JM
Flores
Department of Otolaryngology, New York University School of Medicine, New York, NY, USA.
David R
DR
Friedmann
Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, USA.
Callie B
CB
Jones
Department of Otolaryngology, New York University School of Medicine, New York, NY, USA; Department of Neurosurgery, New York University School of Medicine, New York, NY, USA.
J Thomas
JT
Roland
Department of Otolaryngology, New York University School of Medicine, New York, NY, USA.
Susan B
SB
Waltzman
D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D019929:Cochlear Implantation; D003054:Cochlear Implants; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D034381:Hearing Loss / Q000523:psychology* / Q000628:therapy*; D006320:Hearing Tests; D006801:Humans; D016015:Logistic Models; D009483:Neuropsychological Tests; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013067:Speech Perception; D014481:United States
aging; cochlear implant; cognitive function; cognitive impairment; dementia; hearing loss; neuropsychological testing