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HI, EVERYONE.

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WELCOME TO THE WEDNESDAY

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AFTERNOON LECTURE SERIES.

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I'M CHIEF OF THE STROKE BRANCH

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AT NINDS, I'M WAIT TOED TO

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INTRODUCE DR. FRANK LIN FROM

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JOHNS HOPKINS WITH THE IDEA OF

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HEARING LOSS WITH DEMENTIA.

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WE ENCOURAGE YOU TO PARTICIPATE

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IN THE Q&A AFTER TODAY'S

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PRESENTATION.

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CLICK ON THE BUTTON JUST BELOW

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YOUR VIDEOCAST WINDOW, CLICK ON

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THAT AND TYPE IN YOUR NAME AND

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QUESTION AND WE'LL RELAY THIS TO

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DR. LYNNE.

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YOU CAN SUBMIT A QUESTION AT ANY

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TIME.

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FOR THOSE HERE IN PERSON IN THE

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AMPHITHEATER, USE THE MICS ON

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EITHER SIDE.

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WE ARE OFFERING CME CREDITS.

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THE CODE FOR TODAY IS 50099.

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50099.

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RETURN TO OUR SPEAKER FOR

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TODAY'S TALK

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Frank R.Lin, M.D., Ph.D. is a

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Professor of Otolaryngology,

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Medicine, Mental Health, and

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Epidemiology and director of the

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Cochlear Center for Hearing and

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Public Health, a research center

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based at the Bloomberg School of

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Public Health. Dr. Lin completed

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his medical education, residency

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in Otolaryngology, and Ph.D. in

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Clinical Investigation, all at

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Johns Hopkins. He completed

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further otologic fellowship

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training in Lucerne,

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Switzerland. Dr. Lin's clinical

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practice is dedicated to otology

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and the medical and surgical

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management of hearing loss. Hi

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HIS SCIENTIFIC CAREER STARTED AS

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A SUMMER STUDENT HERE DURING

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HIGH SCHOOL AND THEN DURING

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MEDICAL SCHOOL, HERE AT THE NIH.

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DID UNDERGRADUATE DEGREE AT

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BROWN UNIVERSITY AND CAME TO

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HOPKINS FOR HIS MEDICAL DEGREE

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FOLLOWED BY SURGERY, INTERNSHIP

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AND ENT RESIDENCY.

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HE ALSO COMPLETED A PH.D. IN

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CLINICAL INVESTIGATION AT THE

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HOPKINS BLOOMBERG SCHOOL OF

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PUBLIC HEALTH AND MICROSURGERY

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BEFORE HE CAME BACK TO HOPKINS

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AND JOINED THE FACULTY.

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HE ROWS THROUGH THE RANKS

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QUICKLY ACHIEVING RANK OF FULL

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PROFESSOR IN 2018, WHEN HE

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FOUNDED THE COCHLEAR CENTER AND

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BECAME THE INAUGURAL DIRECTOR.

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DR. LYNNE MADE MAJOR

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CONTRIBUTIONS IN THE

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INVESTIGATION ON THE ROLE OF

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HEARING LOSS AS A MODIFIABLE

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RISK FACTOR AND FOUNDATIONAL

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WORK IN MAKING HEARING LOSS AS A

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MAJOR RECOMMENDATION FROM THE

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LANCET COMMISSION ON DEMENTIA AS

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A POTENTIAL MODIFIABLE AS THE

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RISK FACTOR FOR DEMENTIA.

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IN ADDITION, HE PLAYED A MAJOR

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ROLE ON THE PUBLIC HEALTH SIDE

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OF THINGS AND YOU'LL HEAR A

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LITTLE BIT ABOUT THIS.

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HIS CONGRESSIONAL TESTIMONY WAS

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REALLY LARGELY RESPONSIBLE FOR

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THE ENACTMENT OF

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OVER-THE-COUNTER HEARING AID ACT

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IN 2022.

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DR. LYNNE HAS BEEN PROLIFIC IN

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PUBLICATIONS AND RECENT EXCITING

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WORK, INCLUDING THE ACHIEVE

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TRIAL AND HIGHLY SOUGHT OUT AS A

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SPEAKER AND FUNDED THROUGH NIH

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INSTITUTES.

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AND REALLY ALSO BEEN A

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TREMENDOUS MENTOR AND ALL THE

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WHILE DOING A MASSIVE CLINICAL

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PRACTICE.

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WE ARE EXCITED TO HAVE HIM HERE

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TODAY.

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PLEASE JOIN ME IN WELCOMING

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DR. LYNNE.

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[ APPLAUSE ]

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>> GOOD AFTERNOON,
EVERYONE AND

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THANK YOU ALL FOR BEING HERE IN

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PERSON.

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IT'S REALLY A TREATED FOR ME

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COMING BACK HERE AND AS REBECCA

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ALLUDED TO, I WAS HERE AS A

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SUMMER STUDENT WHEN I WAS 17

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YEARS OLD.

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AND I HOPEFULLY WAS INSPIRED BY

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THE WONDERFUL SCIENCE I HEARD

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AROUND ME.

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I USUALLY FELL ASLEEP.

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MUCH SCIENCE WAS WAY ABOVE MY

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HEAD WHEN I WAS 17 YEARS OLD.

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SO MY ONE GOAL TODAY IS TO

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HOPEFULLY NO ONE FALLS ASLEEP.

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I HAVE A FEW DISCLOSURES.

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NONE OF THESE COMPANIES WILL BE

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DISCUSSED TODAY.

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NOT RELEVANT TO TODAY'S TALK.

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AND THE TALK IS TITLED FROM

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EPIDEMIOLOGICAL INSIGHTS TO

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ACHIEVE PUBLIC POLICY.

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AND BEGINNING FROM CLINICAL

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INSIGHTS, DURING MY TRAINING IN

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ENT SURGERY AT HOPKINS, I WOULD

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SEE A ROOM LIKE THIS AND THIS

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SHOWS A 7-YEAR-OLD CHILD THAT

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HAS A MILD PROGRESSIVE TO

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MODERATE SEVERE HEARING LOSS.

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DOESN'T MATTER WHO YOU ASK,

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INSURANCE COMPANY, PARENT,

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SCHOOLTEACHER, THEY WOULD SAY

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THIS HEARING HAS TO BE

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ADDRESSED.

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THIS COULD IMPACT AUDITORY

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CODING THAT CAN AFFECT THIS

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CHILD'S BRAIN AND HOW THIS CHILD

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IS IN THE CLASSROOM AND

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PLAYGROUND SETTING.

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THIS WOULD DEFINITELY BE

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TREATED.

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THE PARADOX IS THAT IF SHE WAS

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72 YEARS OLD, THE SAME HEARING

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TEST AND FUNCTIONAL IMPACT AND

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AUDITORY CODING, SIGNALS

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RECEIVED BY THE BRAIN AND FOR A

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72-YEAR-OLD, THE REACTION YOU'LL

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GET EVEN AMONG CLINICIANS IS A

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BIT OF A OKAY, YOU HAVE A MILD

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TO MODERATE HEARING LOSS.

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I ALWAYS RECOGNIZE WHAT BUGGED

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ME WHEN I WAS GOING THROUGH

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RESIDENCY.

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IMPORTANT FOR A 7-YEAR-OLD AND

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NOW YOU'RE 72 AND IT MAY NOT BE

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SO IMPORTANT ANYMORE.

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AND I THINK A LOT OF PSYCHOLOGY

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COMES FROM THIS.

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IF WE LOOK AT HOW COMMON A

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HEARING LOSS IS ACROSS THE

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LIFESPAN IT NEARLY DOUBLES EVERY

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DECADE.

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THE INNER EAR IS POST MITOTIC SO

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FUNDAMENTAL AGING AND

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DEGENERATION IN THE INNER EAR

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THAT HAPPENS ACROSS OUR LIFESPAN

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NO MATTER WHO YOU ARE.

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IF HEARING IS RARE IN CHILDREN,

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IT'S VERY IMPORTANT BUT IF

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TWO-THIRDS ARE 60 AND ABOVE HAS

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A MEANINGFUL HEARING IMPAIRMENT,

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THE PSYCHOLOGY IS WELL, EVERYONE

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HAS IT AND SO HOW CAN IT BE

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IMPORTANT?

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IT BOTHERED ME BECAUSE IT DIDN'T

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JIVE WITH WHAT I SAW CLINICALLY.

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AND YOU CAN BACKTRACK WITH BASIC

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LOGICAL QUESTIONS.

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HEARING LOSS IN OLDER ADULTS, IS

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IT JUST AGE IN THE INNER EAR,

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MILD EFFECT ON COMMUNICATION?

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THE ANSWER TO THAT QUESTION, YOU

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HAVE TO HAVE EPIDEMIOLOGICAL

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STUDIES.

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FROM THERE IF THIS IS IMPACT,

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WHAT HAPPENS?

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WE TREAT THE HEARING LOSS.

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DOES THAT MAKE A DIFFERENCE IN

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OLDER ADULTS?

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YOU HAVE TO HAVE CONTROL TRIALS.

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AND FINALLY IF I'M TELLING YOU

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TWO-THIRDS OF EVERYONE OVER 60

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HAS HEARING, HOW DO YOU ADDRESS

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THAT AT SCALE?

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YOU REALIZE THESE SAME QUESTIONS

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APPLY TO CHILDREN AND HAVE BEEN

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ANSWERED.

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THE IMPACT WITH HEARING LOSS OF

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CHILDREN AND WE KNOW WHAT

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HAPPENS IF YOU TREAT IT EARLY ON

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AND THEN YOU HAVE HEARING

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SCREENING.

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THESE SAME QUESTIONS WHEN

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APPLIED TO ADULTS AS I BEGAN MY

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CAREER, I REALIZED MUCH OF THE

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BIAS WE HAD FOR HEARING LOSS IN

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ADULTS IS BECAUSE THESE BASIC

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QUESTIONS HADN'T BEEN ANSWERED.

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THESE DRIVE WHAT I DO TODAY WITH

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ASKING THESE THREE BASIC

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QUESTIONS.

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WHAT I'M GOING TO FOCUS TODAY ON

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IS THE WORK WE HAVE DONE AROUND

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HEARING LOSS AND DEMENTIA AND

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THEN TAKING YOU THROUGH THE

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TRIALS AND THEN A FEW SLIDES ON

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HOW IT HAS SHAPED POLICY IN THE

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UNITED STATES AND AROUND THE

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WORLD.

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SO THE REASON WHY I LOOKED AT

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THIS IN 2010 IS BECAUSE DURING

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RESIDENCY, I GOT BOTHERED BY THE

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FACT THERE WAS DISPARITY BETWEEN

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CHILDREN AND ADULTS.

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THIS STUDY IN 1989,

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EPIDEMIOLOGICAL PERSPECTIVE,

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MOST BASIC FORM OF EVIDENCE, A

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CASE-CONTROLLED STUDY.

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100 WITH DEMENTIA AND 100

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WITHOUT.

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ON AVERAGE DOSE DEPEND END

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RELATIONSHIP BETWEEN THE

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SEVERITY OF HEARING LOSS AND THE

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ODDS OF HAVING DEMENTIA.

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SO YOU CAN IMAGINE TYPICALLY AND

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THIS JIVED WITH WHAT I SAW

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CLINICALLY.

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I SEEN PATIENTS AND THEY WOULD

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SAY I'M STRAINING TO HEAR MORE.

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MY MOTHER IS JUST NOT WHAT SHE

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USED TO BE, NOT AS ENGAGED.

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SO IT JIVED WITH WHAT I SAW.

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SO THERE WAS NO FURTHER

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CONFIRMATORY EVIDENCE.

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BASIC CASE CONTROL STUDIES, AND

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THEN PROGRESSED TO A

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LONGITUDINAL STUDY WHEN YOU

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CONFIRM PROSPECTIVELY.

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IT HAD NEVER BEEN DONE BEFORE.

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SO THIS BUGGED ME.

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I JOINED THE FACULTY AND THEN I

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CAME ACROSS A SCIENTIFIC

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DIRECTOR OF THE NIA AND I'LL

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FOREVER BE GRATEFUL TO HIM.

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I WAS INTRODUCED TO HIM THROUGH

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A FRIEND, COLLEAGUE, AND I SAID,

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BACK THEN HE WAS JUST THE

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DIRECTOR OF LONGITUDINAL STUDY

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SECTION.

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I SAID I GOT INTRODUCED TO YOU

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AND I'M INTERESTED IN LOOKING

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INTO THIS TOPIC.

262
00:08:34,168 --> 00:08:36,570
YOU WORK WITH BLSA, WOULD YOU BE

263
00:08:36,570 --> 00:08:38,672
WILLING TO COLLABORATE WITH ME?

264
00:08:38,672 --> 00:08:39,607
HE SAID ABSOLUTELY.

265
00:08:39,607 --> 00:08:41,542
HE INTRODUCED ME TO HIS LAB AND

266
00:08:41,542 --> 00:08:43,144
IN THE EARLY 90s, THEY

267
00:08:43,144 --> 00:08:46,313
MEASURED HEARING FOR ABOUT

268
00:08:46,313 --> 00:08:47,581
40-YEAR PERIOD AND THEN THEY

269
00:08:47,581 --> 00:08:50,518
STOPPED MEASURING HEARING, BUT

270
00:08:50,518 --> 00:08:52,920
THEY HAD GOOD DATA FOR A GOOD

271
00:08:52,920 --> 00:08:54,688
4-YEAR PERIOD.

272
00:08:54,688 --> 00:08:59,193
WE LOOKED AT 640 ADULTS WHO HAD

273
00:08:59,193 --> 00:09:00,661
BEEN FOLLOWED AND HAD

274
00:09:00,661 --> 00:09:02,062
ADJUDICATED MEASURES OF DEMENTIA

275
00:09:02,062 --> 00:09:03,964
OVER TIME AND SAW VERY, VERY

276
00:09:03,964 --> 00:09:05,399
CLEAR RELATIONSHIP BETWEEN THE

277
00:09:05,399 --> 00:09:07,168
SEVERITY OF HEARING LOSS AT

278
00:09:07,168 --> 00:09:08,269
BASELINE, KAPLAN-MEIER ON THE

279
00:09:08,269 --> 00:09:10,571
LEFT LOOKING AT TIME TO

280
00:09:10,571 --> 00:09:12,506
DEMENTIA, BETWEEN THE SEVERITY

281
00:09:12,506 --> 00:09:14,642
AT BASELINE AND THE RISK OF

282
00:09:14,642 --> 00:09:15,910
PROGRESSIVE DEMENTIA.

283
00:09:15,910 --> 00:09:19,580
WE ADJUST FOR NONLINEAR FACTS,

284
00:09:19,580 --> 00:09:20,981
AGE, RACE, ET CETERA.

285
00:09:20,981 --> 00:09:22,550
A CLEAR RELATIONSHIP ON AVERAGE

286
00:09:22,550 --> 00:09:24,218
TO NORMAL HEARING, AND WITH A

287
00:09:24,218 --> 00:09:26,053
MILD, MODERATE AND SEVERE

288
00:09:26,053 --> 00:09:27,788
HEARING LOSS ON AVERAGE HAVING A

289
00:09:27,788 --> 00:09:30,824
TWO FOLD, 3 FOLD, 5 FOLD GREATER

290
00:09:30,824 --> 00:09:32,326
RISK OF DEMENTIA OVER TIME.

291
00:09:32,326 --> 00:09:34,628
SO THE FIRST TIME IT WAS

292
00:09:34,628 --> 00:09:37,131
CONFIRMED AND PUBLISHED 22 YEARS

293
00:09:37,131 --> 00:09:38,899
EARLIER THAT NEVER HAD BEEN

294
00:09:38,899 --> 00:09:40,234
CONFIRMED YET.

295
00:09:40,234 --> 00:09:42,603
NOW, YOU CAN IMAGINE, AT THIS

296
00:09:42,603 --> 00:09:44,905
TIME PERIOD, WHY COULDN'T THIS

297
00:09:44,905 --> 00:09:47,508
BE THE CASE?

298
00:09:47,508 --> 00:09:50,945
WHAT WOULD BE THE BASIS FOR

299
00:09:50,945 --> 00:09:52,012
HEARING AND WILL A MEASURE OF

300
00:09:52,012 --> 00:09:55,349
HEARING IS A MEASURE OF AUDITORY

301
00:09:55,349 --> 00:09:55,683
PERIPHERY.

302
00:09:55,683 --> 00:09:57,718
THE CLOAK LA, TRANSDUCING AND

303
00:09:57,718 --> 00:09:58,586
SENDING SOUNDS TO THE BRAIN.

304
00:09:58,586 --> 00:10:02,122
HOW COULD THAT BE RELATED TO THE

305
00:10:02,122 --> 00:10:03,724
COGNITIVE OUTPUT OF THE BRAIN'S

306
00:10:03,724 --> 00:10:03,991
FUNCTION?

307
00:10:03,991 --> 00:10:05,626
YOU THINK ABOUT IT ENOUGH, OF

308
00:10:05,626 --> 00:10:07,695
COURSE THEY ARE RELATED BUT

309
00:10:07,695 --> 00:10:10,030
THROUGH A COMMON CAUSE.

310
00:10:10,030 --> 00:10:11,165
AGING PROCESS IN THE INNER EAR

311
00:10:11,165 --> 00:10:14,501
IN THE BRAIN AND MICROVASCULAR

312
00:10:14,501 --> 00:10:15,502
DISEASE THAT AFFECTS THE COCHLEA

313
00:10:15,502 --> 00:10:18,038
AND BRAIN AND MAYBE UNKNOWN RISK

314
00:10:18,038 --> 00:10:18,405
FACTORS.

315
00:10:18,405 --> 00:10:21,408
BUT THIS IS THE ONLY THING THAT

316
00:10:21,408 --> 00:10:22,776
REALITIES TO THE ASSOCIATION.

317
00:10:22,776 --> 00:10:23,877
IT'S JUST ACADEMICALLY

318
00:10:23,877 --> 00:10:25,713
INTERESTING BUT THAT'S ABOUT IT.

319
00:10:25,713 --> 00:10:27,748
IT IMPLIES NOTHING IN WHAT WE DO

320
00:10:27,748 --> 00:10:32,086
TO ADDRESS HEARING LOSS AND LIKE

321
00:10:32,086 --> 00:10:32,353
DEMENTIA.

322
00:10:32,353 --> 00:10:34,088
WHITE HAIR IS LINKED WITH

323
00:10:34,088 --> 00:10:36,323
DEMENTIA, WHICH IT IS, BUT IT IS

324
00:10:36,323 --> 00:10:37,458
JUST A COMMON PATHOLOGY.

325
00:10:37,458 --> 00:10:38,926
THE QUESTION AS WE BEGAN

326
00:10:38,926 --> 00:10:41,528
THINKING ABOUT THIS IN EARLY

327
00:10:41,528 --> 00:10:44,131
2010 AND 11, WHAT COULD THE

328
00:10:44,131 --> 00:10:46,700
MECHANISMS BE THROUGH WHICH

329
00:10:46,700 --> 00:10:48,335
PERIPHERAL AUDITORY IMPAIRMENTS

330
00:10:48,335 --> 00:10:50,437
COULD CONTRIBUTE INCREASED RISK

331
00:10:50,437 --> 00:10:53,073
FOR COGNITIVE DECLINE OVER TIME.

332
00:10:53,073 --> 00:10:55,075
THIS SUMMARIZED 50 YEARS OF WORK

333
00:10:55,075 --> 00:10:56,710
FROM OTHER PEOPLE WE PULLED

334
00:10:56,710 --> 00:10:58,512
TOGETHER WITH THESE MODELS.

335
00:10:58,512 --> 00:11:00,247
THREE MAJOR MECHANISMS AS

336
00:11:00,247 --> 00:11:02,283
COMMONLY UNDERSTOOD FOR HOW

337
00:11:02,283 --> 00:11:04,218
HEARING LOSS CAN CONTRIBUTE TO

338
00:11:04,218 --> 00:11:07,354
THE RISK OF COGNITIVE DECLINE IN

339
00:11:07,354 --> 00:11:07,888
DEMENTIA.

340
00:11:07,888 --> 00:11:09,323
COGNITIVE LOAD, THE IDEA THAT

341
00:11:09,323 --> 00:11:12,526
WHEN THE BRAIN IS CONSTANTLY

342
00:11:12,526 --> 00:11:13,894
RECEIVING A GARBLED AUDITORY

343
00:11:13,894 --> 00:11:15,296
SIGNAL FROM THE EAR, THE BRAIN

344
00:11:15,296 --> 00:11:17,865
HAS TO REALLOCATE CORTICAL

345
00:11:17,865 --> 00:11:20,134
RESOURCES TO DEALING WITH THE

346
00:11:20,134 --> 00:11:23,270
PROCESSING AND DECODING OF THAT

347
00:11:23,270 --> 00:11:24,171
CIGNA AND IS THAT LOAD COME AT

348
00:11:24,171 --> 00:11:27,241
THE EXPENSE OF OTHER SYMPTOMS?

349
00:11:27,241 --> 00:11:35,916
THERE IS A BUFFER, DEMENTIA

350
00:11:35,916 --> 00:11:38,252
PATHOLOGY, PRESENTING

351
00:11:38,252 --> 00:11:39,153
PHENOTYPICALLY.

352
00:11:39,153 --> 00:11:42,323
SO HEARING LOSS CONSTANTLY TAX

353
00:11:42,323 --> 00:11:44,925
OR TAP INTO THAT COGNITIVE LOAD

354
00:11:44,925 --> 00:11:46,660
THAT COULD HAVE BEEN USED TO

355
00:11:46,660 --> 00:11:48,829
BUFFER AGAINST PATHOLOGY AND NOW

356
00:11:48,829 --> 00:11:51,632
THAT BUFFER IS BEING BEING

357
00:11:51,632 --> 00:11:52,866
EXHAUSTED WITH DEALING WITH

358
00:11:52,866 --> 00:11:53,567
IMPAIRED HEARING.

359
00:11:53,567 --> 00:11:56,036
IT'S NOT A LOAD YOU CAN TURN ON

360
00:11:56,036 --> 00:11:56,770
OR OFF.

361
00:11:56,770 --> 00:11:58,505
YOUR BRAIN IS CONSTANTLY

362
00:11:58,505 --> 00:12:00,174
PROCESSING AUDITORY INFORMATION.

363
00:12:00,174 --> 00:12:01,742
IN THE NIGHT YOU'RE PROCESSING

364
00:12:01,742 --> 00:12:02,509
AS WELL.

365
00:12:02,509 --> 00:12:04,611
IT'S A FIXED LOAD.

366
00:12:04,611 --> 00:12:07,881
SO ONE MECHANISM, INFORMATION

367
00:12:07,881 --> 00:12:08,182
DEGRADATION.

368
00:12:08,182 --> 00:12:10,150
ANOTHER MECHANISM WHICH SOUNDS

369
00:12:10,150 --> 00:12:12,152
SIMILAR BUT IS VERY, VERY

370
00:12:12,152 --> 00:12:15,122
DIFFERENT, THE IDEA THAT HEARING

371
00:12:15,122 --> 00:12:16,056
IMPAIRMENT CAN HAVE DIRECT

372
00:12:16,056 --> 00:12:17,224
EFFECTS ON THE BRAIN'S

373
00:12:17,224 --> 00:12:19,159
STRUCTURAL INTEGRITY.

374
00:12:19,159 --> 00:12:21,595
SO SORT OF CAUSE AUDITORY

375
00:12:21,595 --> 00:12:24,098
DEPRIVATION LEADING TO FASTER A

376
00:12:24,098 --> 00:12:26,066
LITTLE OF BRAIN ATROPHY AS WELL

377
00:12:26,066 --> 00:12:27,067
AS REORGANIZATION OF BRAIN

378
00:12:27,067 --> 00:12:28,602
NEURAL NETWORK ACTIVATION.

379
00:12:28,602 --> 00:12:31,972
WE SEE THIS IN HUMAN STUDS AS

380
00:12:31,972 --> 00:12:32,873
WELL AS LONGITUDINALLY IN HUMAN

381
00:12:32,873 --> 00:12:33,607
STUDIES AS WELL.

382
00:12:33,607 --> 00:12:36,810
THE THIRD MECHANISM MORE

383
00:12:36,810 --> 00:12:37,378
NEBULOUS BUT COMMON SENSE IN

384
00:12:37,378 --> 00:12:39,079
MANY WAYS, THAT IF YOU CAN'T

385
00:12:39,079 --> 00:12:41,382
HEAR AS WELL, YOU MIGHT NOT BE

386
00:12:41,382 --> 00:12:43,550
AS SOCIALLY ENGAGED.

387
00:12:43,550 --> 00:12:45,986
IF EVEN IF YOU ARE, YOU'RE

388
00:12:45,986 --> 00:12:48,756
WITHDRAWN FROM CONVERSATION.

389
00:12:48,756 --> 00:12:51,125
RESEARCH SHOWING HOW THE PROCESS

390
00:12:51,125 --> 00:12:52,593
OF BEING REMAINING ENGAGED WITH

391
00:12:52,593 --> 00:12:54,695
PEOPLE AROUND YOU IS VERY

392
00:12:54,695 --> 00:12:55,896
IMPORTANT FOR MAINTAINING

393
00:12:55,896 --> 00:12:57,131
COGNITIVE FUNCTION AND VERY,

394
00:12:57,131 --> 00:13:00,367
VERY DIFFERENT MECHANISMS.

395
00:13:00,367 --> 00:13:01,502
SO, I'LL SUMMARIZE.

396
00:13:01,502 --> 00:13:03,537
THREE MAJOR MECHANISMS TO WHICH

397
00:13:03,537 --> 00:13:05,839
HEARING LOSS HYPOTHETICALLY

398
00:13:05,839 --> 00:13:07,174
COULD BE RISKED WITH COGNITIVE

399
00:13:07,174 --> 00:13:09,410
DECLINE OR DEMENTIA.

400
00:13:09,410 --> 00:13:11,678
EVIDENCE TO SUPPORT ALL OF

401
00:13:11,678 --> 00:13:11,879
THESE.

402
00:13:11,879 --> 00:13:12,513
THE IMPORTANT THING TO NOTE IS

403
00:13:12,513 --> 00:13:15,182
NOT ONE IS CORRECT OR OTHERS ARE

404
00:13:15,182 --> 00:13:15,616
WRONG.

405
00:13:15,616 --> 00:13:18,752
IT'S LIKELY A COM NATION OF ALL

406
00:13:18,752 --> 00:13:19,887
OF THE ABOVE.

407
00:13:19,887 --> 00:13:23,590
FAST FORWARD THE FIRST STUDY IN

408
00:13:23,590 --> 00:13:23,791
2011.

409
00:13:23,791 --> 00:13:26,393
SINCE THEN, THERE HADS BEEN MANY

410
00:13:26,393 --> 00:13:27,828
OTHER PAPERS SHOWING THE SAME

411
00:13:27,828 --> 00:13:29,596
RESULTS COMING FROM OUR RESEARCH

412
00:13:29,596 --> 00:13:30,831
AS WELL AS GROUPS FROM THE

413
00:13:30,831 --> 00:13:32,299
AROUND THE WORLD.

414
00:13:32,299 --> 00:13:34,501
BEST SUMMARIZED THE LANCET

415
00:13:34,501 --> 00:13:38,572
COMMISSION ON DEMENTIA IN 2017,

416
00:13:38,572 --> 00:13:41,608
THEY DAY META-ANALYSIS OF ALL

417
00:13:41,608 --> 00:13:44,011
THE EXISTING RESEARCH LOOKED

418
00:13:44,011 --> 00:13:46,513
EPIDEMIOLOGICALLY AT ALL THESE

419
00:13:46,513 --> 00:13:47,581
RISK FACTORS THAT ARE MODIFIABLE

420
00:13:47,581 --> 00:13:51,251
FOR DEMENTIA AND HOW MUCH EACH

421
00:13:51,251 --> 00:13:52,519
CONTRIBUTED TO DEMENTIA OVER

422
00:13:52,519 --> 00:13:52,753
TIME.

423
00:13:52,753 --> 00:13:54,254
WHEN THEY SUMMARIZED ALL THE

424
00:13:54,254 --> 00:13:55,989
LITERATURE A FEW YEARS AGO, THEY

425
00:13:55,989 --> 00:13:57,891
CONCLUDED 60% OF DEMENTIA RISK

426
00:13:57,891 --> 00:14:00,360
IS ESSENTIALLY FROM SOURCES THAT

427
00:14:00,360 --> 00:14:01,929
WE DON'T KNOW WHAT THEY ARE.

428
00:14:01,929 --> 00:14:05,032
BUT 40% OF DEMENTIA MAY BE

429
00:14:05,032 --> 00:14:06,366
MODIFIABLE WITH ESSENTIALLY

430
00:14:06,366 --> 00:14:07,801
NEURORISK FACTORS.

431
00:14:07,801 --> 00:14:10,270
WHEN THEY RANK ORDER IN TERMS OF

432
00:14:10,270 --> 00:14:14,908
HOW MANY CASES CONTRIBUTE TO,

433
00:14:14,908 --> 00:14:15,476
HEARING LOSS IDENTIFIES THE

434
00:14:15,476 --> 00:14:17,311
SINGLE LARGEST MODIFIABLE RISK

435
00:14:17,311 --> 00:14:18,178
FACTOR.

436
00:14:18,178 --> 00:14:20,547
THE RISK RATIO BETWEEN HEARING

437
00:14:20,547 --> 00:14:21,715
LOSS AND KIMENSIA ARE

438
00:14:21,715 --> 00:14:22,783
SUBSTANTIAL AND HEARING LOSS IS

439
00:14:22,783 --> 00:14:24,551
BY NO MEANS A RARE CONDITION.

440
00:14:24,551 --> 00:14:26,753
THIS IS A HIGHLY PREVALENT

441
00:14:26,753 --> 00:14:27,254
CONDITION.

442
00:14:27,254 --> 00:14:28,422
MULTIPLY THE TWO TOGETHER AND

443
00:14:28,422 --> 00:14:30,257
THAT'S WHY THEORETICALLY THEY

444
00:14:30,257 --> 00:14:33,060
IDENTIFY HEARING LOSS AS THE

445
00:14:33,060 --> 00:14:35,362
SINGLE LARGEST MODIFIABLE RISK

446
00:14:35,362 --> 00:14:35,896
FACTOR.

447
00:14:35,896 --> 00:14:38,999
POTENTIALLY MODIFIABLE BECAUSE

448
00:14:38,999 --> 00:14:40,567
THESE MECHANISMS THAT LINK

449
00:14:40,567 --> 00:14:42,503
HEARING WITH DEMENTIA, THE

450
00:14:42,503 --> 00:14:44,338
POTENTIAL PART, AND FURTHER

451
00:14:44,338 --> 00:14:45,506
POTENTIAL BECAUSE THAT IMPLIES

452
00:14:45,506 --> 00:14:47,608
YOU CAN DO SOMETHING ABOUT IT.

453
00:14:47,608 --> 00:14:49,776
RIGHT NOW WE CAN CERTAINLY NOT

454
00:14:49,776 --> 00:14:51,512
REVERSE HEARING LOSS OR CURE IT,

455
00:14:51,512 --> 00:14:54,081
BUT WE CAN REHABILITATIVELY

456
00:14:54,081 --> 00:14:55,082
TREAT HEARING LOSS THROUGH THE

457
00:14:55,082 --> 00:14:57,851
USE OF HEARING INTERVENTIONS

458
00:14:57,851 --> 00:14:58,952
LIKE HEARING AIDS AND SUPPORT

459
00:14:58,952 --> 00:15:01,088
SERVICES TO PROVIDE A CLEAR

460
00:15:01,088 --> 00:15:03,023
AUDITORY SIGNAL TO THE BRAIN.

461
00:15:03,023 --> 00:15:04,691
COULD THIS INTERVENTION MODIFY

462
00:15:04,691 --> 00:15:06,960
THESE PATHWAYS TO REDUCE

463
00:15:06,960 --> 00:15:09,496
COGNITIVE DECLINE?

464
00:15:09,496 --> 00:15:10,163
AND HYPOTHETICALLY IT MAY BE

465
00:15:10,163 --> 00:15:12,966
ABLE TO, WITH CLEAR AUDITORY

466
00:15:12,966 --> 00:15:14,801
SIGNAL WITH A WELL FIT HEARING

467
00:15:14,801 --> 00:15:15,636
AID.

468
00:15:15,636 --> 00:15:18,205
HOPE YOU CAN REDUCE BY CLEARING

469
00:15:18,205 --> 00:15:21,375
A CLEAR AUDITORY SIGNAL TO THE

470
00:15:21,375 --> 00:15:23,343
BRAIN AND BRAIN STIMULATION WITH

471
00:15:23,343 --> 00:15:26,146
THE USE OF A HEARING AID.

472
00:15:26,146 --> 00:15:27,915
AND HOPEFULLY HELP PEOPLE'S

473
00:15:27,915 --> 00:15:28,582
SOCIAL ENGAGEMENT.

474
00:15:28,582 --> 00:15:30,250
IT BRINGS UP THE IDEA OF HEARING

475
00:15:30,250 --> 00:15:32,419
LOSS OR HEARING INTERVENTION AND

476
00:15:32,419 --> 00:15:35,622
POTENTIALLY REDUCING THE RISK OF

477
00:15:35,622 --> 00:15:36,990
CODIFYING DEMENTIA IN LATE LIFE.

478
00:15:36,990 --> 00:15:38,325
THAT IS VERY INTERESTING.

479
00:15:38,325 --> 00:15:39,993
BECAUSE THERE ARE PLENTY OF

480
00:15:39,993 --> 00:15:41,662
75-YEAR-OLDS WITH UNTREATED

481
00:15:41,662 --> 00:15:42,396
HEARING LOSS.

482
00:15:42,396 --> 00:15:44,197
THE IDEA OF INTERVENTION WHICH

483
00:15:44,197 --> 00:15:46,833
IS RISK-FREE, NO MEDICAL RISK

484
00:15:46,833 --> 00:15:48,468
WITH HEARING INTERVENTION THAT

485
00:15:48,468 --> 00:15:50,704
COULD LOWER RISK WITHIN A FEW

486
00:15:50,704 --> 00:15:53,607
YEAR PERIOD FOR INTERVENTION HAS

487
00:15:53,607 --> 00:15:55,576
NO MEDICAL -- IS INCREDIBLY

488
00:15:55,576 --> 00:15:56,076
APPEALING.

489
00:15:56,076 --> 00:15:57,644
THE MOST IMPORTANT RISK FACTORS

490
00:15:57,644 --> 00:16:00,514
FOR DEMENTIA ARE EARLY-LIFE

491
00:16:00,514 --> 00:16:04,718
EDUCATION, MID-LIFE VASCULAR

492
00:16:04,718 --> 00:16:04,952
DECEASE.

493
00:16:04,952 --> 00:16:07,321
YOU CAN'T ADDRESS IT NOW AT 75

494
00:16:07,321 --> 00:16:10,324
YEARS OLD BUT STILL BE

495
00:16:10,324 --> 00:16:12,059
MODIFIABLE IN LATE LIFE IS A

496
00:16:12,059 --> 00:16:14,928
PUBLIC HEALTH TARGET.

497
00:16:14,928 --> 00:16:17,598
THIS QUESTION IF WE FACT TREAT

498
00:16:17,598 --> 00:16:19,499
HEARING LOSS, COULD THAT REDUCE

499
00:16:19,499 --> 00:16:20,601
COGNITIVE DECLINE?

500
00:16:20,601 --> 00:16:24,237
THIS REMAINED UNKNOWN.

501
00:16:24,237 --> 00:16:26,974
FROM OBSERVATION STUDIES THAT I

502
00:16:26,974 --> 00:16:27,908
SHOWN BEFORE, PEOPLE USE HEARING

503
00:16:27,908 --> 00:16:30,744
AIDS VERSUS THOSE WHO DON'T,

504
00:16:30,744 --> 00:16:31,511
THEY ON ANGEL DO BETTER.

505
00:16:31,511 --> 00:16:33,780
BUT YOU CAN'T ATTRIBUTE THAT

506
00:16:33,780 --> 00:16:34,715
CLEARLY TO THE INTERVENTION

507
00:16:34,715 --> 00:16:36,416
BECAUSE PEOPLE WHO GOT HEARING

508
00:16:36,416 --> 00:16:38,919
AIDS ARE LIKELY TO BE HEALTHIER,

509
00:16:38,919 --> 00:16:40,721
WEALTHIER AND BETTER EDUCATED.

510
00:16:40,721 --> 00:16:43,357
UNDERLYING FACTORS THAT ALLOWED

511
00:16:43,357 --> 00:16:44,257
THE INTERVENTION?

512
00:16:44,257 --> 00:16:45,926
OR WAS IT THE INTERVENTION?

513
00:16:45,926 --> 00:16:49,129
PEOPLE HAVE TRIED AND ONE NICE

514
00:16:49,129 --> 00:16:51,298
MAJOR META-ANALYSIS OF 126,000

515
00:16:51,298 --> 00:16:53,133
PEOPLE FROM AROUND THE WORLD

516
00:16:53,133 --> 00:16:55,435
SUMMARIZING EPIDEMIOLOGICAL DATA

517
00:16:55,435 --> 00:16:59,139
NINE MONTHS AGO PUBLISHED.

518
00:16:59,139 --> 00:17:00,907
AFTER CONTROLLING FOR

519
00:17:00,907 --> 00:17:02,743
EVERYTHING, THEY STILL FOUND

520
00:17:02,743 --> 00:17:05,212
THAT HEARING AIDS APPEAR TO BE

521
00:17:05,212 --> 00:17:07,214
ASSOCIATED WITH ROBUST RISK OF

522
00:17:07,214 --> 00:17:09,616
DECLINE WITH COGNITIVE DECLINE.

523
00:17:09,616 --> 00:17:11,551
NO PRIOR RANDOMIZED CONTROL

524
00:17:11,551 --> 00:17:13,820
TRIAL EVER LOOKED IN THIS BASIC

525
00:17:13,820 --> 00:17:15,422
QUESTION, IF WE TREAT HEARING

526
00:17:15,422 --> 00:17:17,824
LOSS, CAN WE REDUCE COGNITIVE

527
00:17:17,824 --> 00:17:19,693
DECLINE OVER A PENINGFUL PERIOD

528
00:17:19,693 --> 00:17:19,926
OF TIME?

529
00:17:19,926 --> 00:17:24,197
SO THE ACHIEVE TRIAL WAS

530
00:17:24,197 --> 00:17:25,065
DESIGNED TO ANSWER THIS

531
00:17:25,065 --> 00:17:25,465
QUESTION.

532
00:17:25,465 --> 00:17:27,734
A STUDY FUNDED BY THE NATIONAL

533
00:17:27,734 --> 00:17:29,503
INSTITUTES ON AGING FOR 10 YEARS

534
00:17:29,503 --> 00:17:31,672
AND DESIGNED AS A VERY BASIC

535
00:17:31,672 --> 00:17:33,907
QUESTION, IF WE TREAT HEARING

536
00:17:33,907 --> 00:17:35,809
LOSS, AMONG OLDER ADULTS, CAN WE

537
00:17:35,809 --> 00:17:38,612
IN FACT REDUCE THE RATE OF

538
00:17:38,612 --> 00:17:40,380
COGNITIVE DECLINE WITHIN A

539
00:17:40,380 --> 00:17:41,381
THREE-YEAR PERIOD?

540
00:17:41,381 --> 00:17:43,884
IT'S CALLED THE ACHIEVE TRIAL

541
00:17:43,884 --> 00:17:45,686
FOR AGING COGNITIVE HEALTH

542
00:17:45,686 --> 00:17:46,887
EVALUATION STUDIES.

543
00:17:46,887 --> 00:17:50,323
THE MAIN FOCUS WAS LOOKING AT

544
00:17:50,323 --> 00:17:51,491
GLOBAL COGNITIVE DECLINE.

545
00:17:51,491 --> 00:17:54,127
WE HAD HOST OF OTHER EXPLORATORY

546
00:17:54,127 --> 00:17:54,561
OUTCOMES AS WELL.

547
00:17:54,561 --> 00:17:56,463
THE TWO I WILL SHARE TODAY ARE

548
00:17:56,463 --> 00:17:59,199
THE RESULTS OF THE PRIMARY PAPER

549
00:17:59,199 --> 00:18:00,467
PUBLISHED IN LANCET A FEW MONTHS

550
00:18:00,467 --> 00:18:02,035
AGO AND I'M EXCITED TO SHARE

551
00:18:02,035 --> 00:18:05,272
WITH YOU TODAY THE FIRST TIME

552
00:18:05,272 --> 00:18:06,540
PUBLICLY, INITIAL PRELIMINARY

553
00:18:06,540 --> 00:18:08,075
UNPUBLISHED RESULTS OF DATA

554
00:18:08,075 --> 00:18:10,343
LOOKING AT EFFECTIVE HEARING

555
00:18:10,343 --> 00:18:13,180
INTERVENTION ON BRAIN STRUCTURAL

556
00:18:13,180 --> 00:18:13,480
ATTRIBUTES.

557
00:18:13,480 --> 00:18:15,282
SO I HAVE THE FIRST COMMENT

558
00:18:15,282 --> 00:18:16,316
REPRESENTING THE COLLABORATIVE

559
00:18:16,316 --> 00:18:18,452
WORK OF NEARLY 10 YEARS OF WORK

560
00:18:18,452 --> 00:18:19,786
FUNDED BY THE NATIONAL

561
00:18:19,786 --> 00:18:21,722
INSTITUTES ON AGING AND EIGHT

562
00:18:21,722 --> 00:18:22,989
DIFFERENT UNIVERSITIES ACROSS

563
00:18:22,989 --> 00:18:25,292
THE UNITED STATES FUNDED FROM

564
00:18:25,292 --> 00:18:27,227
2014 TO PRESENT DAY.

565
00:18:27,227 --> 00:18:31,598
IT TWO TWO YEARS TO TRIAL WITH A

566
00:18:31,598 --> 00:18:35,001
CLINICAL PLANNING GRANT.

567
00:18:35,001 --> 00:18:36,870
SO WHEN I PRESENT THIS WORK,

568
00:18:36,870 --> 00:18:38,171
MUCH I'M PRESENTING ON BEHALF OF

569
00:18:38,171 --> 00:18:39,673
A LOT OF PEOPLE.

570
00:18:39,673 --> 00:18:41,141
I JUST HAPPEN TO BE THE PERSON

571
00:18:41,141 --> 00:18:43,677
IN THE FRONT PRESENTING THIS TO

572
00:18:43,677 --> 00:18:45,679
YOU.

573
00:18:45,679 --> 00:18:46,413
SO, STUDY DESIGN OF WHAT WE DID

574
00:18:46,413 --> 00:18:48,782
WITH THE ACHIEVE STUDY.

575
00:18:48,782 --> 00:18:51,885
THE FINAL DESIGN IS SIMPLE FROM

576
00:18:51,885 --> 00:18:53,653
BASIC 2018-2019, WE WERE

577
00:18:53,653 --> 00:18:57,924
RECRUITING NEARLY 1000 OLDER

578
00:18:57,924 --> 00:18:58,258
ADULTS.

579
00:18:58,258 --> 00:18:59,860
THEY HAD UNTREATED MILD TO

580
00:18:59,860 --> 00:19:02,696
MODERATE LEVELS OF HEARING LOSS.

581
00:19:02,696 --> 00:19:05,632
RANGE ARE HEARING THAT COULD BE

582
00:19:05,632 --> 00:19:07,634
ADDRESSED WITH A HEARING AID AND

583
00:19:07,634 --> 00:19:09,870
HAD NO COGNITIVE IMPAIRMENT AT

584
00:19:09,870 --> 00:19:10,137
BASELINE.

585
00:19:10,137 --> 00:19:12,672
WE RECRUITED 1000 PEOPLE FROM

586
00:19:12,672 --> 00:19:14,808
TWO DISTINCT STUDY POPULATIONS.

587
00:19:14,808 --> 00:19:16,309
ABOUT A QUARTER OF THE 1000

588
00:19:16,309 --> 00:19:18,211
PEOPLE CAME FROM EXISTING STUDY

589
00:19:18,211 --> 00:19:20,480
CALLED THE ARTHROSCLEROSIS RISK

590
00:19:20,480 --> 00:19:23,016
IN COMMUNITY STUDIES OF OLDER

591
00:19:23,016 --> 00:19:24,384
ADULTS THAT BEGAN IN MID LIFE

592
00:19:24,384 --> 00:19:25,685
FOR THEM AND THEN FOLLOWED TO

593
00:19:25,685 --> 00:19:26,553
THE PRESENT DAY.

594
00:19:26,553 --> 00:19:29,723
THIS REPRESENTS A RANDOM SAMPLE

595
00:19:29,723 --> 00:19:32,559
OF ADULTS OVER 30 YEARS AGO

596
00:19:32,559 --> 00:19:33,593
SAMPLED FROM VOTER REGISTRATION

597
00:19:33,593 --> 00:19:34,694
POLES, DRIVER'S LICENSE RECORDS

598
00:19:34,694 --> 00:19:37,297
AND THINGS LIKE THAT.

599
00:19:37,297 --> 00:19:38,565
RANDOM SAMPLE THAT CAME INTO THE

600
00:19:38,565 --> 00:19:40,467
ACHIEVE STUDY.

601
00:19:40,467 --> 00:19:46,540
THE REMAINDER OF THE COHORT, SO

602
00:19:46,540 --> 00:19:47,140
THREE-QUARTERS OF THE PEOPLE

603
00:19:47,140 --> 00:19:49,209
CAME FROM NEW HEALTHY COMMUNITY

604
00:19:49,209 --> 00:19:50,911
VOLUNTEERS, PEOPLE WHO RESPONDED

605
00:19:50,911 --> 00:19:54,981
TO FACEBOOK ADS, RADIO

606
00:19:54,981 --> 00:19:55,515
ADVERTISEMENTS, NEWSPAPER

607
00:19:55,515 --> 00:19:56,650
ADVERTISEMENTS ABOUT A NEW STUDY

608
00:19:56,650 --> 00:19:59,386
FOCUSED ON HEALTHY AGING.

609
00:19:59,386 --> 00:20:00,854
EVERYONE WAS RANDOMIZED TO

610
00:20:00,854 --> 00:20:02,255
EITHER THE HEARING INTERVENTION

611
00:20:02,255 --> 00:20:06,459
OR A SUCCESSFUL HEALTH EDUCATION

612
00:20:06,459 --> 00:20:08,428
CONTROL, AND THEN EVERYONE WAS

613
00:20:08,428 --> 00:20:09,996
FOLLOWED EVERY SIX MONTHS FOR

614
00:20:09,996 --> 00:20:11,264
THE NEXT THREE YEARS WITH

615
00:20:11,264 --> 00:20:13,266
ESSENTIALLY ASSESSMENTS OF A

616
00:20:13,266 --> 00:20:14,034
NEUROCOGNITIVE BATTERY AS WELL

617
00:20:14,034 --> 00:20:16,603
AS OTHER OUTCOMES AS WELL.

618
00:20:16,603 --> 00:20:18,605
SO THE REASON WHY THE SAMPLE

619
00:20:18,605 --> 00:20:21,007
CAME FROM ERIC AS WELL AS

620
00:20:21,007 --> 00:20:22,142
DE NOVO, THE CHIEF STUDY WAS

621
00:20:22,142 --> 00:20:24,444
BASED WITHIN THE SCIENTIFIC AND

622
00:20:24,444 --> 00:20:26,746
INFRASTRUCTURE OF THIS EXISTING

623
00:20:26,746 --> 00:20:28,248
OBSERVATIONAL STUDY FUNDED FOR

624
00:20:28,248 --> 00:20:31,651
MANY YEARS BY NHLBI INVOLVING

625
00:20:31,651 --> 00:20:33,620
NEARLY 16,000 PEOPLE RECRUITED

626
00:20:33,620 --> 00:20:36,590
MID LIFE 30 YEARS AGO AT 4

627
00:20:36,590 --> 00:20:37,490
DIFFERENT SITES ACROSS THE

628
00:20:37,490 --> 00:20:40,427
UNITED STATES AND ALL

629
00:20:40,427 --> 00:20:41,027
OBSERVATIONAL ALLEY FOLLOWED

630
00:20:41,027 --> 00:20:42,896
TODAY WITH CARDIOVASCULAR EVENTS

631
00:20:42,896 --> 00:20:43,930
AND HEALTH.

632
00:20:43,930 --> 00:20:47,033
AND THESE PEOPLE CAME FROM A

633
00:20:47,033 --> 00:20:47,601
RANDOM SAMPLE FROM THE

634
00:20:47,601 --> 00:20:49,603
COMMUNITIES OVER 35 YEARS AGO.

635
00:20:49,603 --> 00:20:50,737
AND THEY HAVE BEEN FOLLOWED

636
00:20:50,737 --> 00:20:54,774
SINCE THEN WITH ASSESSMENTS OF

637
00:20:54,774 --> 00:20:58,745
CARDIOVASCULAR HEALTH WITH

638
00:20:58,745 --> 00:21:00,680
DR. GOTTESMAN AND WHEN I JOINED,

639
00:21:00,680 --> 00:21:03,049
ALSO INCLUDED MEASURES OF

640
00:21:03,049 --> 00:21:03,416
HEARING.

641
00:21:03,416 --> 00:21:04,684
WE PRE SCREENED PEOPLE FROM THE

642
00:21:04,684 --> 00:21:07,487
STUDY AND RECRUDE THEM ON TO

643
00:21:07,487 --> 00:21:08,655
THIS ONGOING TRIAL.

644
00:21:08,655 --> 00:21:12,158
THE ACHIEVE STUDY CAME FROM TWO

645
00:21:12,158 --> 00:21:13,126
COHORTS.

646
00:21:13,126 --> 00:21:17,230
THE ARIC COHORT, RANDOM OF THE

647
00:21:17,230 --> 00:21:20,033
U.S. POPULATION AND THE DE NOVO

648
00:21:20,033 --> 00:21:25,138
COHORT, NEW HEALTHY VOLUNTEERS.

649
00:21:25,138 --> 00:21:27,274
RANDOM SAMPLES VERSUS A

650
00:21:27,274 --> 00:21:28,675
SELF-SELECTED VOLUNTEERS AND

651
00:21:28,675 --> 00:21:29,643
YOU'LL SEE HOW DIFFERENT THEY

652
00:21:29,643 --> 00:21:31,211
ARE IN THE FOLLOWING SLIDES.

653
00:21:31,211 --> 00:21:33,647
ALL WHO JOINED THE STUDY THEY

654
00:21:33,647 --> 00:21:35,181
WERE TOLD THEY WOULD BE

655
00:21:35,181 --> 00:21:36,316
RANDOMIZED TO ONE INTERVENTION

656
00:21:36,316 --> 00:21:38,585
AND THEN THREE YEARS LATER THEY

657
00:21:38,585 --> 00:21:40,754
WOULD BE OFFERED THE OTHER

658
00:21:40,754 --> 00:21:41,454
INTERVENTION AS WELL.

659
00:21:41,454 --> 00:21:43,556
SOME INCLUSION CRITERIA BEFORE

660
00:21:43,556 --> 00:21:45,292
EVERYONE WAS BETWEEN 70-84 YEARS

661
00:21:45,292 --> 00:21:47,527
OLD WHEN THEY ENTERED THE STUDY.

662
00:21:47,527 --> 00:21:51,064
ALL HAD A THRESHOLDLER TO MAKE

663
00:21:51,064 --> 00:21:54,768
SURE NO SUBSTANTIAL COGNITIVE

664
00:21:54,768 --> 00:21:55,502
IMPAIRMENT.

665
00:21:55,502 --> 00:21:58,471
ALL HAD A HEARING LOSS BETWEEN

666
00:21:58,471 --> 00:22:01,174
30-70 WHERE PEOPLE COULD STILL

667
00:22:01,174 --> 00:22:02,742
BENEFIT FROM CONVENTIONAL

668
00:22:02,742 --> 00:22:03,376
HEARING AIDS.

669
00:22:03,376 --> 00:22:05,979
THAT RANGE OF HEARING, THAT IS

670
00:22:05,979 --> 00:22:12,752
FULLY ABOUT 50% OF PEOPLE IN THE

671
00:22:12,752 --> 00:22:13,787
70-84 RANGE.

672
00:22:13,787 --> 00:22:21,094
THIS IS THE MAJORITY OF ADULTS.

673
00:22:21,094 --> 00:22:23,630
THERE IS EXCLUSION TRY KIIRIA

674
00:22:23,630 --> 00:22:26,533
WHO PEOPLE MAY NOT BENEFIT --

675
00:22:26,533 --> 00:22:28,501
EXCLUSION CRITERIA -- IN TERMS

676
00:22:28,501 --> 00:22:32,172
OF THE DESIGN, RANDOMIZED, WE

677
00:22:32,172 --> 00:22:32,872
DID STRATIFIED RANDOMIZATION AND

678
00:22:32,872 --> 00:22:34,074
THE HEARING INTERVENTION VERY,

679
00:22:34,074 --> 00:22:35,542
VERY BRIEFLY, BASICALLY AS CLOSE

680
00:22:35,542 --> 00:22:37,610
YOU CAN GET TO THE BEST PRACTICE

681
00:22:37,610 --> 00:22:38,812
HEARING INTERVENTION.

682
00:22:38,812 --> 00:22:40,613
A STUDY AUTOOLOGIST.

683
00:22:40,613 --> 00:22:43,383
EVERY PERSON WHO IS RANDOMIZED

684
00:22:43,383 --> 00:22:45,585
HAS FOUR SESSIONS WITH THE FIRST

685
00:22:45,585 --> 00:22:48,121
FEW MONTHS WHERE THAT HAD A

686
00:22:48,121 --> 00:22:50,156
HEARING EXAM, A NEEDS

687
00:22:50,156 --> 00:22:51,758
ASSESSMENT, THEY GOT FITTED FOR

688
00:22:51,758 --> 00:22:53,626
HEARING AIDS THAT ARE COVERED BY

689
00:22:53,626 --> 00:22:55,328
THE STUDY AS WELL AS ANY OF THE

690
00:22:55,328 --> 00:22:56,629
RELATED HEARING TECHNOLOGIES.

691
00:22:56,629 --> 00:22:58,832
IF THEY WERE IN MEETINGS A LOT,

692
00:22:58,832 --> 00:23:01,534
IF THEY LISTENED TO T.V. A LOT.

693
00:23:01,534 --> 00:23:02,469
THEY GOT T.V. STREAMERS AND

694
00:23:02,469 --> 00:23:03,503
BETTER THINGS LIKE THAT.

695
00:23:03,503 --> 00:23:05,138
AND THEN SEEN EVERY SIX MONTHS

696
00:23:05,138 --> 00:23:09,209
FOR A BOOSTER SESSION ON

697
00:23:09,209 --> 00:23:09,809
THEOLOGIST.

698
00:23:09,809 --> 00:23:12,112
WE GOT A HEALTH EDUCATION

699
00:23:12,112 --> 00:23:12,345
CONTROL.

700
00:23:12,345 --> 00:23:15,081
IT'S CALLED A 10 KEYS TO

701
00:23:15,081 --> 00:23:17,584
SUCCESSFUL AGING PROGRAM

702
00:23:17,584 --> 00:23:18,651
DESIGNED HOW YOU EDUCATE OLDER

703
00:23:18,651 --> 00:23:20,420
ADULTS AROUND KEY HEALTHY AGING

704
00:23:20,420 --> 00:23:21,521
TOPICS.

705
00:23:21,521 --> 00:23:24,324
TOPICS LIKE NUTRITION, CANCER

706
00:23:24,324 --> 00:23:25,125
SCREENING, DIET AND THINGS LIKE

707
00:23:25,125 --> 00:23:25,525
THAT.

708
00:23:25,525 --> 00:23:27,027
SO OVER THE BEGINNING OF THE

709
00:23:27,027 --> 00:23:28,228
STUDY, YOU HAD FOUR SESSIONS

710
00:23:28,228 --> 00:23:31,064
WITH A CERTIFIED

711
00:23:31,064 --> 00:23:31,698
HEALTHEDGEICATOR WHERE THEY WENT

712
00:23:31,698 --> 00:23:33,500
OVER EACH OF THESE TOPICS AND

713
00:23:33,500 --> 00:23:35,101
EVERY SIX MONTHS THEY HAD A

714
00:23:35,101 --> 00:23:37,270
BOOSTER SESSION WITH A

715
00:23:37,270 --> 00:23:37,837
HEALTHEDGEICATOR TO RECEIVE

716
00:23:37,837 --> 00:23:38,538
ANOTHER TOPIC.

717
00:23:38,538 --> 00:23:40,073
SO BOTH GROUPS WERE EXPOSURE

718
00:23:40,073 --> 00:23:42,208
MATCH IN TERMS OF AMOUNT AND

719
00:23:42,208 --> 00:23:46,212
DEGREE OF EXPOSURE TO STUDY

720
00:23:46,212 --> 00:23:46,713
PERSONNEL.

721
00:23:46,713 --> 00:23:47,714
EXPOSURE STUDY PERSONNEL COULD

722
00:23:47,714 --> 00:23:49,849
BE GOOD FOR YOUR SOCIAL AND

723
00:23:49,849 --> 00:23:50,717
COGNITIVE HEALTH.

724
00:23:50,717 --> 00:23:52,819
SO THERE ARE BOUNDS FOR THAT.

725
00:23:52,819 --> 00:23:53,820
THE DESIGN OF THE STUDY, THERE

726
00:23:53,820 --> 00:23:55,221
IS A BASELINE ASSESSMENT WHEN

727
00:23:55,221 --> 00:23:57,123
THEY JOIN THE STUDY.

728
00:23:57,123 --> 00:23:59,092
EVERY SIX MONTHS THEREFORE THEY

729
00:23:59,092 --> 00:24:01,361
WERE SEEN IN PERSON FOR

730
00:24:01,361 --> 00:24:03,229
IN-PERSON ASSESSMENT AND BOOSTER

731
00:24:03,229 --> 00:24:03,530
VISIT.

732
00:24:03,530 --> 00:24:06,132
THE PRIMARY ENDPOINT DEFINED IS

733
00:24:06,132 --> 00:24:09,569
CHANGE FROM BASELINE TO THE YEAR

734
00:24:09,569 --> 00:24:11,071
THREE GLOBAL COGNITION

735
00:24:11,071 --> 00:24:15,108
STANDARDIZED FACTOR SCORE.

736
00:24:15,108 --> 00:24:16,476
COMPREHENSIVE NEUROCOGNITIVE

737
00:24:16,476 --> 00:24:16,876
BATTERY.

738
00:24:16,876 --> 00:24:20,780
THE SECONDARY COGNITIVE DOMAINS

739
00:24:20,780 --> 00:24:22,782
WERE SPECIFIC COG ENOUGH

740
00:24:22,782 --> 00:24:24,284
FUNCTION FOR MEMORY, EXECUTIVE

741
00:24:24,284 --> 00:24:26,052
FUNCTION AND LANGUAGE AND

742
00:24:26,052 --> 00:24:27,187
ADJUDICATED BY A PANEL OF

743
00:24:27,187 --> 00:24:29,189
CLINICIANS AND A WHOLE HOST OF

744
00:24:29,189 --> 00:24:32,092
OTHER PRE-SPECIFIED EXPLORATORY

745
00:24:32,092 --> 00:24:34,227
OUTCOMES LOOKING AT MEASURES OF

746
00:24:34,227 --> 00:24:36,796
HANDICAP AND COMMUNICATION AND

747
00:24:36,796 --> 00:24:38,465
SOCIAL NETWORK, DEPRESSION AND

748
00:24:38,465 --> 00:24:39,132
PHYSICAL ACTIVITY.

749
00:24:39,132 --> 00:24:40,834
I'M GOING TO SHARE WITH YOU

750
00:24:40,834 --> 00:24:42,969
TODAY BRIEFLY THE COGNITIVE

751
00:24:42,969 --> 00:24:45,905
FUNCTION DATA AS WELL AS THE

752
00:24:45,905 --> 00:24:48,041
FMRI DATA.

753
00:24:48,041 --> 00:24:51,544
THIS WAS DESIGNED OVER A DECADE

754
00:24:51,544 --> 00:24:53,613
AGO BY OTHERS IN CONCERT WITH

755
00:24:53,613 --> 00:24:56,216
THE ARIC INVESTIGATORS.

756
00:24:56,216 --> 00:24:58,351
10 NEUROCOGNITIVE TESTS THAT

757
00:24:58,351 --> 00:25:00,653
COMPRISE THE NEUROCOGNITIVE

758
00:25:00,653 --> 00:25:02,589
BATTERY.

759
00:25:02,589 --> 00:25:04,858
ONLY TWO OF THESE -- EIGHT OF

760
00:25:04,858 --> 00:25:08,495
THESE 10 TESTS DO NOT HAVE

761
00:25:08,495 --> 00:25:09,596
EXCLUSIVE AUDITORY.

762
00:25:09,596 --> 00:25:10,597
ONLY TWO DO.

763
00:25:10,597 --> 00:25:12,098
SO THE REASON I MENTION IT,

764
00:25:12,098 --> 00:25:13,867
MAYBE SOMEONE IS NOT DOING WELL

765
00:25:13,867 --> 00:25:15,401
ON A COGNITIVE LEVEL SO THEY

766
00:25:15,401 --> 00:25:16,302
CAN'T HEAR THE EXAMINER.

767
00:25:16,302 --> 00:25:17,670
THAT WOULDN'T BE THE CASE.

768
00:25:17,670 --> 00:25:19,806
FOR A MILD TO MODERATE LEVEL OF

769
00:25:19,806 --> 00:25:22,375
HEARING LOSS, FACE-TO-FACE AT A

770
00:25:22,375 --> 00:25:25,612
QUIET ROOM AT THREE FEET

771
00:25:25,612 --> 00:25:26,412
DISTANCE.

772
00:25:26,412 --> 00:25:27,680
WE MEASURED IT AND VERIFY

773
00:25:27,680 --> 00:25:28,014
UNDERSTANDING.

774
00:25:28,014 --> 00:25:29,682
EACH IF IT WAS, EIGHT OF THESE

775
00:25:29,682 --> 00:25:32,852
10 COGNITIVE TESTS DO NOT HAVE

776
00:25:32,852 --> 00:25:35,855
ONLY AUDITORY EXCLUSIVE STIMULI.

777
00:25:35,855 --> 00:25:40,059
YOU ALWAYS VERIFY AHEAD OF TIME.

778
00:25:40,059 --> 00:25:41,327
FACE-TO-FACE, THREE FEET AWAY,

779
00:25:41,327 --> 00:25:43,196
MILD TO MODERATE HEARING LOSS,

780
00:25:43,196 --> 00:25:45,999
50% OF OLDER ADULTS.

781
00:25:45,999 --> 00:25:47,634
JUST TO MAKE SURE WE VERIFIED

782
00:25:47,634 --> 00:25:49,469
AHEAD OF TIME.

783
00:25:49,469 --> 00:25:50,870
THESE 10 NEUROCOGNITIVE TESTS

784
00:25:50,870 --> 00:25:52,405
SPANNING DIFFERENT DOMAINS OF

785
00:25:52,405 --> 00:25:53,873
COGNITION CAN BE SUMMARIZED INTO

786
00:25:53,873 --> 00:25:56,709
ONE COGNITIVE FACTOR SCORE.

787
00:25:56,709 --> 00:25:59,379
IT'S LIKE A Z SCORE BUT MORE

788
00:25:59,379 --> 00:26:01,648
SOPHISTICATED TO ALLOW FOR ITEM

789
00:26:01,648 --> 00:26:03,183
FUNCTION SYSTEMMING AND TASKS

790
00:26:03,183 --> 00:26:04,317
AND ITEMS.

791
00:26:04,317 --> 00:26:05,785
BUT YOU CAN SUMMARIZE FROM THE

792
00:26:05,785 --> 00:26:07,353
GLOBAL COGNITION FACTOR SCORE

793
00:26:07,353 --> 00:26:09,956
THAT IS THEN STANDARDIZED TO

794
00:26:09,956 --> 00:26:10,223
BASELINE.

795
00:26:10,223 --> 00:26:12,025
SO ARBITRARY SCORE IS SET SO IF

796
00:26:12,025 --> 00:26:13,826
YOU'RE AT ZERO IT MEANS YOU'RE

797
00:26:13,826 --> 00:26:16,162
AT THE MEAN F YOU'RE ONE, YOU'RE

798
00:26:16,162 --> 00:26:17,864
ONE STANDARD DEVIATION FROM THE

799
00:26:17,864 --> 00:26:18,064
MEAN.

800
00:26:18,064 --> 00:26:21,834
IF YOU CHANGE OVER 3 YEARS

801
00:26:21,834 --> 00:26:24,170
FROM -- BY NEGATIVE .4 IT MEANS

802
00:26:24,170 --> 00:26:25,772
YOU CHANGED .4 STANDARD

803
00:26:25,772 --> 00:26:27,907
DEVIATIONS OVER 3 YEARS.

804
00:26:27,907 --> 00:26:28,575
CLINICALLY SPEAKING HALF

805
00:26:28,575 --> 00:26:31,678
STANDARD DEVIATION VERY, VERY

806
00:26:31,678 --> 00:26:32,145
CLINICALLY MEANINGFUL.

807
00:26:32,145 --> 00:26:34,113
BUT EVERYTHING IS STANDARDIZED

808
00:26:34,113 --> 00:26:35,782
TO SD UNITS.

809
00:26:35,782 --> 00:26:37,717
WITH THAT AS WELL I CAN DEFINE

810
00:26:37,717 --> 00:26:38,685
THREE DIFFERENT SPECIFIC

811
00:26:38,685 --> 00:26:40,119
COGNITIVE DOMAINS THAT PULL ON

812
00:26:40,119 --> 00:26:42,455
DIFFERENT COGNITIVE TESTS.

813
00:26:42,455 --> 00:26:43,990
LANGUAGE DOMAIN, LANGUAGE

814
00:26:43,990 --> 00:26:46,693
PRODUCTION NOT RECEPTION.

815
00:26:46,693 --> 00:26:51,130
THIS IS NAME ALL THE WORDS IN

816
00:26:51,130 --> 00:26:52,799
THE LETTERS OF F.

817
00:26:52,799 --> 00:26:54,834
EXECUTIVE FUNCTION,

818
00:26:54,834 --> 00:26:58,238
MULTITASKING, MEMORY IS

819
00:26:58,238 --> 00:26:58,738
PROTEINITUTIVE.

820
00:26:58,738 --> 00:27:01,007
SO -- IS PRETTY INTUITIVE.

821
00:27:01,007 --> 00:27:03,309
SO THE MAIN ANALYSIS IS AN

822
00:27:03,309 --> 00:27:06,112
ATTENTION TO TREAT ANALYSIS.

823
00:27:06,112 --> 00:27:07,780
BASICALLY LOOKING AT THE EFFECT

824
00:27:07,780 --> 00:27:10,016
OF ASSIGNING TO HEARING

825
00:27:10,016 --> 00:27:10,950
INTERVENTIONS VERSUS ASSIGNMENT

826
00:27:10,950 --> 00:27:12,885
TO THE CONTROL OVER THREE YEARS.

827
00:27:12,885 --> 00:27:14,721
THESE ALL WERE MIXED EFFECTS

828
00:27:14,721 --> 00:27:15,855
MODELS SO WE ACCOUNT FOR CHANGE

829
00:27:15,855 --> 00:27:16,623
OVER TIME.

830
00:27:16,623 --> 00:27:18,725
AND WE ALSO ADJUST FOR ANY

831
00:27:18,725 --> 00:27:20,560
POTENTIALLY RANDOM VARIATIONS ON

832
00:27:20,560 --> 00:27:21,828
BASELINE VARIANTS IN TERMS OF

833
00:27:21,828 --> 00:27:31,904
BASELINE DEMOGRAPHICS.

834
00:27:31,904 --> 00:27:33,473
THERE WAS MISSING DAYLIGHT ADD

835
00:27:33,473 --> 00:27:35,108
THAT WAS NOT VERY MUCH MISSING

836
00:27:35,108 --> 00:27:37,543
DATA BUT WE IMPUTE MISSING DATA

837
00:27:37,543 --> 00:27:39,879
USING CHAIN EQUATIONS TO IMPUTE

838
00:27:39,879 --> 00:27:41,614
ANY MISSING DATA AT YEAR 3.

839
00:27:41,614 --> 00:27:43,783
THE MAIN ANALYSIS IS BASICALLY

840
00:27:43,783 --> 00:27:46,052
LOOKING AT BASELINE DATA AND

841
00:27:46,052 --> 00:27:47,020
YEAR 3 DATA.

842
00:27:47,020 --> 00:27:49,055
WE DO NOT USE INTERVENING YEARS

843
00:27:49,055 --> 00:27:50,456
UNLESS WE HAVE TO.

844
00:27:50,456 --> 00:27:56,062
IF SOMEONE DIED BEFORE YEAR 3

845
00:27:56,062 --> 00:27:56,396
FOR INSTANCE.

846
00:27:56,396 --> 00:27:58,364
PRE SPECIFIED, WE SAID WE WOULD

847
00:27:58,364 --> 00:28:01,534
MEAN ANALYSIS THE WHOLE COHORT

848
00:28:01,534 --> 00:28:03,536
BUT WE REPLICATE THE PRIMARY

849
00:28:03,536 --> 00:28:07,073
ANALYSIS AND STRATIFY WITHIN ARI

850
00:28:07,073 --> 00:28:09,142
R AND DE NOVO.

851
00:28:09,142 --> 00:28:10,176
THEY MAY BE DIFFERENT.

852
00:28:10,176 --> 00:28:12,211
ONE A RANDOM SAMPLE OF THE U.S.

853
00:28:12,211 --> 00:28:13,413
POPULATION AND THE OTHER

854
00:28:13,413 --> 00:28:15,948
REPRESENTS SELF-REPRESENTED

855
00:28:15,948 --> 00:28:19,652
RESPONDING TO FACEBOOK ADDS.

856
00:28:19,652 --> 00:28:21,187
ONE THING I'M PROUD OF IS FOR

857
00:28:21,187 --> 00:28:22,455
ANY WHO HAVE DONE CLINICAL

858
00:28:22,455 --> 00:28:24,324
TRIALS, YOU KNOW THAT

859
00:28:24,324 --> 00:28:25,224
RECRUITMENT ALWAYS KILLS

860
00:28:25,224 --> 00:28:25,692
CLINICAL TRIALS.

861
00:28:25,692 --> 00:28:27,894
THIS WAS A RECRUITMENT CURVE SO

862
00:28:27,894 --> 00:28:30,229
THE BLUE LINE IS IF WE EVENLY

863
00:28:30,229 --> 00:28:32,965
RECRUITED 850 PEOPLE OVER YEAR

864
00:28:32,965 --> 00:28:33,566
AND A HALF PERIOD.

865
00:28:33,566 --> 00:28:36,336
WE ARE 2 1/2 WEEKS BEHIND

866
00:28:36,336 --> 00:28:36,669
SCHEDULE.

867
00:28:36,669 --> 00:28:37,603
GIVEN THAT RECRUITMENT IS GOING

868
00:28:37,603 --> 00:28:40,073
VERY, VERY WELL, WE APPROACHED

869
00:28:40,073 --> 00:28:43,209
THEM ABOUT KEEPING RECRUITMENT

870
00:28:43,209 --> 00:28:44,644
GOING LONGER TO HAVE MORE

871
00:28:44,644 --> 00:28:45,378
DEFINITIVE RESULTS.

872
00:28:45,378 --> 00:28:46,879
AND THEY ALLOWED US TO DO IT.

873
00:28:46,879 --> 00:28:49,415
WE HIT A SAMPLE SIZE OF 977 AND

874
00:28:49,415 --> 00:28:52,051
CLOSED AT THE END OF OCTOBER TWO

875
00:28:52,051 --> 00:28:53,953
THOUSAND 19.

876
00:28:53,953 --> 00:28:55,888
-- 2019.

877
00:28:55,888 --> 00:28:59,392
OVER 3 YEARS YOU CAN SEE THE

878
00:28:59,392 --> 00:29:01,260
LOSS OVER TIME BUT THREE YEARS

879
00:29:01,260 --> 00:29:02,862
LATER, THROUGH A PANDEMIC, WE

880
00:29:02,862 --> 00:29:05,064
HAD COMPLETE FOLLOW-UP DATA ON

881
00:29:05,064 --> 00:29:07,033
90% OF PEOPLE.

882
00:29:07,033 --> 00:29:09,268
THIS WAS AMAZING.

883
00:29:09,268 --> 00:29:12,205
THIS WAS A TESTAMENT TO THE

884
00:29:12,205 --> 00:29:13,773
STUDY STAFF IN THE SITES.

885
00:29:13,773 --> 00:29:15,308
THE INCREDIBLE PROFESSIONALS

886
00:29:15,308 --> 00:29:17,276
BRINGING PEOPLE THROUGH A

887
00:29:17,276 --> 00:29:18,644
PANDEMIC, IN-PERSON VISITS.

888
00:29:18,644 --> 00:29:20,580
WE LOST 10% FROM LOSS OF

889
00:29:20,580 --> 00:29:21,013
FOLLOW-UP.

890
00:29:21,013 --> 00:29:22,515
PEOPLE DIED UNFORTUNATELY.

891
00:29:22,515 --> 00:29:25,918
WE HAD BEEN BUDGETING FOR UP TO

892
00:29:25,918 --> 00:29:31,157
70% LOSS -- 30% LOSS, WE SEEN IT

893
00:29:31,157 --> 00:29:31,557
BY A WIDE MARGIN.

894
00:29:31,557 --> 00:29:33,292
TESTAMENT TO STUDY INTERVENTION

895
00:29:33,292 --> 00:29:35,161
AS WELL AS TO THE STUDY STAFF.

896
00:29:35,161 --> 00:29:36,963
SO YOU'RE SEEING FROM INTERNAL

897
00:29:36,963 --> 00:29:38,765
POINT OF VIEW, VERY, VERY

898
00:29:38,765 --> 00:29:40,266
HIGH-QUALITY DATA.

899
00:29:40,266 --> 00:29:45,238
NOW BASELINE CHARACTERISTICS BY

900
00:29:45,238 --> 00:29:47,573
RECRUITMENT SOURCE.

901
00:29:47,573 --> 00:29:49,275
JUST TO THE HIGHLIGHT HOW

902
00:29:49,275 --> 00:29:51,110
DIFFERENT THE DE NOVO COHORT IS

903
00:29:51,110 --> 00:29:55,515
COMPARED TO THE ARIC.

904
00:29:55,515 --> 00:29:58,384
YOU SEE ON AVERAGE DE NOVO

905
00:29:58,384 --> 00:30:00,153
COHORT AVERAGE FEWER RISK

906
00:30:00,153 --> 00:30:02,588
FACTORS OF COGNITIVE DECLINE BY

907
00:30:02,588 --> 00:30:03,756
VIRTUE OF BEING YOUNGER.

908
00:30:03,756 --> 00:30:07,226
THEY ARE BETTER EDUCATED.

909
00:30:07,226 --> 00:30:08,995
DEFINITELY MUCH HIGHER LEVELS OF

910
00:30:08,995 --> 00:30:10,396
INCOME ON AVERAGE AS WELL AMONG

911
00:30:10,396 --> 00:30:13,299
THE DE NOVO VERSUS ARIC.

912
00:30:13,299 --> 00:30:15,802
IF WE LOOK AT RATES OF DIABETES,

913
00:30:15,802 --> 00:30:18,738
HYPERTENSION, LIVING ALONE, ALSO

914
00:30:18,738 --> 00:30:22,175
LOWER IN THE DE NOVO R SELF

915
00:30:22,175 --> 00:30:23,509
SELECTED POPULATION IS DIFFERENT

916
00:30:23,509 --> 00:30:25,478
THAN A RANDOM COHORT.

917
00:30:25,478 --> 00:30:27,680
ALSO BASELINE COGNITION SCORES

918
00:30:27,680 --> 00:30:29,882
AT BASELINE, YOU SEE AMONG THE

919
00:30:29,882 --> 00:30:31,250
GLOBAL EXECUTIVE FUNCTION,

920
00:30:31,250 --> 00:30:33,152
LANGUAGE AND MEMORY, THEY ARE

921
00:30:33,152 --> 00:30:34,353
STANDARDIZED UNITS.

922
00:30:34,353 --> 00:30:38,224
THE DE NOVO COHORT STARTS ABOVE

923
00:30:38,224 --> 00:30:39,692
THE MEAN IN THIS GROUP SAMPLE.

924
00:30:39,692 --> 00:30:42,829
SO THEY ARE STARTING AT A VERY

925
00:30:42,829 --> 00:30:44,130
DIFFERENT POINT LIKELY BECAUSE

926
00:30:44,130 --> 00:30:45,431
THEY ARE TWO DIFFERENT

927
00:30:45,431 --> 00:30:48,301
RECRUITMENT SOURCES.

928
00:30:48,301 --> 00:30:49,936
SO BEFORE THE RESULTS, YOU CAN

929
00:30:49,936 --> 00:30:51,003
IMAGINE NATURAL QUESTION TO

930
00:30:51,003 --> 00:30:52,538
BEGIN WITH, BEFORE JUMPING TO

931
00:30:52,538 --> 00:30:53,873
THE COGNITIVE RESULTS, IS THERE

932
00:30:53,873 --> 00:30:55,608
ANY EVIDENCE THAT HEARING

933
00:30:55,608 --> 00:30:57,477
INTERVENTION IS EVEN WORKING?

934
00:30:57,477 --> 00:30:59,612
IS THERE ANY EVIDENCE OF TARGET

935
00:30:59,612 --> 00:30:59,912
ENGAGEMENT?

936
00:30:59,912 --> 00:31:02,748
PEOPLE USING HEARING AIDS, ARE

937
00:31:02,748 --> 00:31:03,649
THE HEARING AIDS BENEFITING

938
00:31:03,649 --> 00:31:06,652
PEOPLE LIKE COMMUNICATION WISE

939
00:31:06,652 --> 00:31:08,321
TO SUGGEST THE EFFECTS ON

940
00:31:08,321 --> 00:31:08,654
COGNITION?

941
00:31:08,654 --> 00:31:10,256
SO ONE THING I'M VERY PROUD TO

942
00:31:10,256 --> 00:31:10,790
SHOW YOU.

943
00:31:10,790 --> 00:31:13,459
YOU HAVE TO TURN YOUR HEAD SIDE

944
00:31:13,459 --> 00:31:15,228
WAYS, HISTOGRAMS OF THE HOURS OF

945
00:31:15,228 --> 00:31:17,163
HEARING AID USE AMONG PEOPLE

946
00:31:17,163 --> 00:31:18,264
RANDOMIZING THE INTERVENTION.

947
00:31:18,264 --> 00:31:20,967
SIX MONTHS, 1, 2, 3 YEARS.

948
00:31:20,967 --> 00:31:22,168
CONSISTENTLY ROBUST AND

949
00:31:22,168 --> 00:31:24,637
RELATIVELY HIGH RATES OF HEARING

950
00:31:24,637 --> 00:31:26,239
SCREENING AT 10 HOURS, TRAILING

951
00:31:26,239 --> 00:31:28,140
OFF THREE YEARS LATER THROUGH A

952
00:31:28,140 --> 00:31:34,547
PANDEMIC ON A MEDIAN IS ABOUT 7

953
00:31:34,547 --> 00:31:34,881
HOURS.

954
00:31:34,881 --> 00:31:37,016
THE MEDIAN RATE OF USE THREE

955
00:31:37,016 --> 00:31:38,651
YEARS LATER BEING ABOUT SEVEN

956
00:31:38,651 --> 00:31:43,489
HOURS A DAY FOR A POPULATION OF

957
00:31:43,489 --> 00:31:43,856
73-87-YEAR-OLDS.

958
00:31:43,856 --> 00:31:45,491
DOES THAT HEARING USE TRICKLE

959
00:31:45,491 --> 00:31:48,094
OUT AND MEANINGFULLY IMPACT

960
00:31:48,094 --> 00:31:48,561
COMMUNICATION?

961
00:31:48,561 --> 00:31:50,963
SO THIS IS THE HEARING

962
00:31:50,963 --> 00:31:53,299
HANDICAPPED INVENTORY, MEASURE

963
00:31:53,299 --> 00:31:55,468
OF COMMUNICATION FUNCTION.

964
00:31:55,468 --> 00:31:58,437
HIGHER SCORES INDICATE MORE

965
00:31:58,437 --> 00:31:59,272
COMMUNICATION IMPAIRMENT.

966
00:31:59,272 --> 00:32:01,707
DO YOU FEEL EMBARRASSED WITH

967
00:32:01,707 --> 00:32:06,379
FRIENDS AND FAMILY?

968
00:32:06,379 --> 00:32:08,014
STRUGGLE WITH HEARING?

969
00:32:08,014 --> 00:32:09,749
THEY STARTED WITH SCORE OF 14 IN

970
00:32:09,749 --> 00:32:10,883
THE CONTROL GROUP AND THREE

971
00:32:10,883 --> 00:32:13,152
YEARS LATER THEIR █COMMUNICATION

972
00:32:13,152 --> 00:32:15,555
IMPAIRMENTS WERE GETTING WORSE

973
00:32:15,555 --> 00:32:15,821
OVER TIME.

974
00:32:15,821 --> 00:32:17,557
IT'S NOT BEING ADDRESSED AT ALL.

975
00:32:17,557 --> 00:32:20,293
IN CONTRAST WITH THE HEARING

976
00:32:20,293 --> 00:32:22,061
INTERVENTION GROUP, THAT SCORE

977
00:32:22,061 --> 00:32:23,429
DROPPED AND STAYED DOWN OVER A

978
00:32:23,429 --> 00:32:24,530
THREE YEAR PERIOD.

979
00:32:24,530 --> 00:32:26,632
SO TARGET ENGAGEMENT IN TERMS OF

980
00:32:26,632 --> 00:32:28,901
HOURS AND HEARING USE AND IT

981
00:32:28,901 --> 00:32:30,536
APPEARS TO TRICKLE OUT IN TERMS

982
00:32:30,536 --> 00:32:31,604
OF COMMUNICATION FUNCTION AS

983
00:32:31,604 --> 00:32:31,904
WELL.

984
00:32:31,904 --> 00:32:34,040
SO, YOU CAN IMAGINE THE QUESTION

985
00:32:34,040 --> 00:32:35,808
IS, DOES THAT MEAN, TRICKLE OUT

986
00:32:35,808 --> 00:32:37,944
THREE YEARS LATER TO REDUCE

987
00:32:37,944 --> 00:32:39,211
COGNITIVE DECLINE?

988
00:32:39,211 --> 00:32:41,647
ARE YOU SLOWING DOWN ANY GLOBAL

989
00:32:41,647 --> 00:32:42,915
COGNITIVE DECLINE YOU SEE

990
00:32:42,915 --> 00:32:44,584
NATURALLY OVER THREE-YEAR

991
00:32:44,584 --> 00:32:44,817
PERIOD?

992
00:32:44,817 --> 00:32:46,519
SO I'LL GIVE YOU THE SUMMARY

993
00:32:46,519 --> 00:32:48,387
FIGURE FIRST AND THEN

994
00:32:48,387 --> 00:32:49,522
SENSITIVITY ANALYSIS.

995
00:32:49,522 --> 00:32:53,359
IF YOU LOOK BROADLY, THE TOTAL

996
00:32:53,359 --> 00:32:54,727
COHORT, AND IF YOU LOOK ON THE

997
00:32:54,727 --> 00:32:56,429
LEFT, IT'S A GLOBAL MEASURE OF

998
00:32:56,429 --> 00:32:56,696
COGNITION.

999
00:32:56,696 --> 00:32:59,131
YOU SEE THE CONTROL GROUP OVER

1000
00:32:59,131 --> 00:33:04,770
THREE YEARS ON AVERAGE DECLINE

1001
00:33:04,770 --> 00:33:06,872
NEGATIVE .2 STANDARD DEVIATION

1002
00:33:06,872 --> 00:33:08,674
UNITS.

1003
00:33:08,674 --> 00:33:09,442
HEARING INTERVENTION THREE YEARS

1004
00:33:09,442 --> 00:33:10,343
LATER, BASICALLY THE SAME.

1005
00:33:10,343 --> 00:33:13,446
SO NO APPARENT AFFECT AT ALL ON

1006
00:33:13,446 --> 00:33:16,482
REDUCING COGNITIVE CHANGE OVER

1007
00:33:16,482 --> 00:33:17,149
THREE-YEAR PERIOD.

1008
00:33:17,149 --> 00:33:19,485
WITHIN THE COGNITIVE DOMAINS,

1009
00:33:19,485 --> 00:33:21,287
MAYBE A MEMORY BUT NOTHING THAT

1010
00:33:21,287 --> 00:33:23,990
MEETS ANY PRE-SPECIFIED

1011
00:33:23,990 --> 00:33:24,423
CRITERIA.

1012
00:33:24,423 --> 00:33:26,826
SO SLIGHT DISCOURAGING, IT

1013
00:33:26,826 --> 00:33:27,393
DOESN'T APPEAR TO BE DOING

1014
00:33:27,393 --> 00:33:29,061
ANYTHING FOR COGNITION, AT

1015
00:33:29,061 --> 00:33:29,495
LEAST.

1016
00:33:29,495 --> 00:33:31,430
I MENTION WE ALWAYS PRE SPECIFY

1017
00:33:31,430 --> 00:33:34,066
THAT WE RECOGNIZE THAT A RANDOM

1018
00:33:34,066 --> 00:33:36,469
SAMPLE OF POPULATION VERSUS A

1019
00:33:36,469 --> 00:33:38,170
SELF-SELECTED DE NOVO POPULATION

1020
00:33:38,170 --> 00:33:40,539
RESPONDING TO FACEBOOK ADS, MAY

1021
00:33:40,539 --> 00:33:43,676
BE VERY DIFFERENT WE ALWAYS PRE

1022
00:33:43,676 --> 00:33:45,544
SPECIFY WE WOULD REPLICATE THE

1023
00:33:45,544 --> 00:33:46,612
ANALYSIS STRATIFIED BY COHORT.

1024
00:33:46,612 --> 00:33:48,280
THIS IS WHERE YOU SEE A VERY,

1025
00:33:48,280 --> 00:33:49,081
VERY DIFFERENT RESULT.

1026
00:33:49,081 --> 00:33:51,884
SO YOU SEE AMONG ARIC, THAT THE

1027
00:33:51,884 --> 00:33:54,086
CONTROL GROUP DECLINES MUCH

1028
00:33:54,086 --> 00:33:56,155
FASTER ABOUT .402 STANDARD

1029
00:33:56,155 --> 00:33:57,790
DEVIATION UNITS.

1030
00:33:57,790 --> 00:33:59,659
THE HEARING INTERVENTION GROUP

1031
00:33:59,659 --> 00:34:05,631
DECLINED PERSONNEDECLINED .211.

1032
00:34:05,631 --> 00:34:06,999
YOU SEE THAT TRICKLING OUT TO

1033
00:34:06,999 --> 00:34:09,568
EACH OF THE COGNITIVE DOMAINS,

1034
00:34:09,568 --> 00:34:11,537
STRONGEST IN LANGUAGE DOMAIN N

1035
00:34:11,537 --> 00:34:12,905
CONTRAST, IF YOU LOOK AT THE

1036
00:34:12,905 --> 00:34:15,274
DE NOVO COHORT, YOU SEE NO

1037
00:34:15,274 --> 00:34:15,875
EFFECT.

1038
00:34:15,875 --> 00:34:17,309
SO WHAT GIVES HERE?

1039
00:34:17,309 --> 00:34:18,611
IT BECOMES CLEAR IF YOU LOOK

1040
00:34:18,611 --> 00:34:20,980
MORE CLOSELY AT THE FIGURE, IF

1041
00:34:20,980 --> 00:34:23,149
YOU LOOK AT THE RATE OF

1042
00:34:23,149 --> 00:34:24,784
COGNITIVE CHANGE OVER THREE

1043
00:34:24,784 --> 00:34:27,186
YEARS, IN THE DE NOVO CONTROL

1044
00:34:27,186 --> 00:34:32,058
SUBJECTS VERSUS THE ARIC, SO A

1045
00:34:32,058 --> 00:34:32,792
SELF-SELECTED HEALTHY

1046
00:34:32,792 --> 00:34:33,926
VOLUNTEERS, RESPONDING TO

1047
00:34:33,926 --> 00:34:36,929
FACEBOOK ADS, VERSUS RANDOM

1048
00:34:36,929 --> 00:34:37,329
SAMPLE.

1049
00:34:37,329 --> 00:34:39,632
ON AVERAGE, THE DE NOVO HAS A

1050
00:34:39,632 --> 00:34:41,634
3-FOLD SLOWER RATE OF COGNITIVE

1051
00:34:41,634 --> 00:34:43,469
CHANGE OVER THREE-YEAR PERIOD

1052
00:34:43,469 --> 00:34:45,638
COMPARED TO ARIC.

1053
00:34:45,638 --> 00:34:46,472
WHY IS THIS?

1054
00:34:46,472 --> 00:34:48,708
SO I MENTIONED BEFORE, SELF

1055
00:34:48,708 --> 00:34:49,408
SELECTED.

1056
00:34:49,408 --> 00:34:51,544
MANY FEWER RISK FACTORS FOR

1057
00:34:51,544 --> 00:34:52,978
COGNITIVE DECLINE AT BASELINE

1058
00:34:52,978 --> 00:34:55,448
AND IT'S TRICKLING OUT THREES

1059
00:34:55,448 --> 00:34:58,551
YEARS LATER WITH 2-3 FOLD SLOWER

1060
00:34:58,551 --> 00:35:00,853
RATE OF COGNITIVE CHANGE IN THE

1061
00:35:00,853 --> 00:35:02,988
DE NOVO COHORTERS HAVES THE

1062
00:35:02,988 --> 00:35:05,224
OTHER REPRESENTING A RANDOM

1063
00:35:05,224 --> 00:35:07,560
SAMPLE OF THE U.S. POPULATION.

1064
00:35:07,560 --> 00:35:09,829
IF YOU HAVE AMONG THE DE NOVO, A

1065
00:35:09,829 --> 00:35:11,664
VERY, VERY SLOW RATE OF

1066
00:35:11,664 --> 00:35:13,032
COGNITIVE CHANGE OVER THREE

1067
00:35:13,032 --> 00:35:14,467
YEARS, A HEARING INTERVENTION

1068
00:35:14,467 --> 00:35:16,302
PREDICATED ON SLOWING COGNITIVE

1069
00:35:16,302 --> 00:35:17,970
CHANGE CAN'T SLOW DOWN SOMETHING

1070
00:35:17,970 --> 00:35:19,371
THAT IS ALREADY GOING DOWN VERY,

1071
00:35:19,371 --> 00:35:21,407
VERY SLOWLY.

1072
00:35:21,407 --> 00:35:22,875
AT LEAST WITHIN THREE YEARS.

1073
00:35:22,875 --> 00:35:25,177
THE ARIC COHORT HAVING A STEEPER

1074
00:35:25,177 --> 00:35:27,613
RATE OF COGNITIVE DECLINE WITH

1075
00:35:27,613 --> 00:35:30,249
CONTROLS, THERE IS ROOM TO SEE

1076
00:35:30,249 --> 00:35:34,754
REDUCTION IN THAT SLOPE WITHIN A

1077
00:35:34,754 --> 00:35:35,154
THREE-YEAR PERIOD.

1078
00:35:35,154 --> 00:35:37,189
SO BRIEF SUMMARY OF THE MAIN

1079
00:35:37,189 --> 00:35:38,791
COGNITIVE RESULTS SO FAR IN THE

1080
00:35:38,791 --> 00:35:43,295
TOTAL COMBINED COHORT, WHEN WE

1081
00:35:43,295 --> 00:35:46,065
DO A PRE-SPECIFIED ANALYSIS AS

1082
00:35:46,065 --> 00:35:47,700
INDICATED IN OUR ANALYSIS PLAN,

1083
00:35:47,700 --> 00:35:51,971
WE SEE VERY STRONG EFFECTS ON

1084
00:35:51,971 --> 00:35:53,372
ARIC, RANDOM SAMPLE, 48%

1085
00:35:53,372 --> 00:35:55,541
REDUCTION IN COGNITIVE DECLINE.

1086
00:35:55,541 --> 00:35:58,010
A POPULATION AT RISK FOR

1087
00:35:58,010 --> 00:35:58,410
COGNITIVE DECLINE.

1088
00:35:58,410 --> 00:36:00,546
IN CONTRAST, NO EFFECT OBSERVED

1089
00:36:00,546 --> 00:36:02,381
IN DE NOVO BUT AGAIN THE KEY

1090
00:36:02,381 --> 00:36:05,084
THING HERE IS WE HAVE A VERY

1091
00:36:05,084 --> 00:36:06,285
SLOW BACKGROUND RATE OF

1092
00:36:06,285 --> 00:36:07,887
COGNITIVE CHANGE OVER THREE YEAR

1093
00:36:07,887 --> 00:36:08,187
PERIOD.

1094
00:36:08,187 --> 00:36:09,989
YOU CAN'T REALLY DETECT ANY

1095
00:36:09,989 --> 00:36:11,590
FURTHER SLOWING OF THAT

1096
00:36:11,590 --> 00:36:13,425
COGNITIVE CHANGE WITHIN A

1097
00:36:13,425 --> 00:36:14,026
THREE-YEAR PERIOD.

1098
00:36:14,026 --> 00:36:16,529
IF YOU COMPARE THESE RATES OF

1099
00:36:16,529 --> 00:36:17,863
COGNITIVE CHANGE TO THE EXISTING

1100
00:36:17,863 --> 00:36:19,465
LITERATURE, YOU SEE AMONG THE

1101
00:36:19,465 --> 00:36:22,902
DE NOVO CONTROLS ON AVERAGE .05,

1102
00:36:22,902 --> 00:36:25,738
ONE 20th OF THE STANDARD

1103
00:36:25,738 --> 00:36:28,140
DEVIATION, THIS CORRESPONDS WITH

1104
00:36:28,140 --> 00:36:30,876
A SLOW VERSUS MODERATE RATE OF

1105
00:36:30,876 --> 00:36:32,244
COGNITIVE DECLINE.

1106
00:36:32,244 --> 00:36:34,814
SO RANDOM SAMPLE OF THE U.S.

1107
00:36:34,814 --> 00:36:36,015
POPULATION, MODERATED DECLINE.

1108
00:36:36,015 --> 00:36:37,850
AMONG A SELF-SELECTED GROUP OF

1109
00:36:37,850 --> 00:36:40,486
HEALTHY VOLUNTEERS, A VOTE RATE

1110
00:36:40,486 --> 00:36:42,421
OF COGNITIVE DECLINE.

1111
00:36:42,421 --> 00:36:44,657
WHY AMONG THE DE NOVO CONTROLS?

1112
00:36:44,657 --> 00:36:45,791
ONE CLEAR POTENTIAL REASON IS

1113
00:36:45,791 --> 00:36:47,159
THESE ARE VERY HEALTHY

1114
00:36:47,159 --> 00:36:47,526
VOLUNTEERS.

1115
00:36:47,526 --> 00:36:51,230
THEY REPRESENT A DIFFERENT STUDY

1116
00:36:51,230 --> 00:36:53,165
POPULATION THAN A RANDOM SAMPLE

1117
00:36:53,165 --> 00:36:54,934
OF THE U.S. POPULATION WHEN

1118
00:36:54,934 --> 00:36:57,803
RECRUITED 30 YEARS AGO.

1119
00:36:57,803 --> 00:37:01,273
SO I'LL MOVE ON TO SOME OTHER --

1120
00:37:01,273 --> 00:37:04,043
FOR US EXCITING FINDINGS TO SEE

1121
00:37:04,043 --> 00:37:06,345
EXPLORATORY EFFECTS OF HEARING

1122
00:37:06,345 --> 00:37:07,813
INTERVENTION ON BRAIN STRUCTURE.

1123
00:37:07,813 --> 00:37:12,318
THIS IS LITERALLY HOT OFF THE

1124
00:37:12,318 --> 00:37:13,652
COMPUTER RESULTS IN THE LAST

1125
00:37:13,652 --> 00:37:13,886
WEEK.

1126
00:37:13,886 --> 00:37:16,355
THESE ARE PRETTY CLOSE TO FINAL

1127
00:37:16,355 --> 00:37:17,656
ANALYSIS WE'LL PREPARE FOR

1128
00:37:17,656 --> 00:37:18,290
PUBLICATION SOON.

1129
00:37:18,290 --> 00:37:23,195
AND THE BACKGROUND FOR THIS,

1130
00:37:23,195 --> 00:37:25,030
PERIPHERAL AUDITORY INPUTS FROM

1131
00:37:25,030 --> 00:37:27,967
THE COCHLEA, INTEGRATED ACROSS

1132
00:37:27,967 --> 00:37:29,802
MULTIPLE -- NOT JUST THE

1133
00:37:29,802 --> 00:37:30,603
TEMPORAL LOBE OR PRIMARY

1134
00:37:30,603 --> 00:37:32,471
AUDITORY CORTEX.

1135
00:37:32,471 --> 00:37:36,342
THOSE INTEGRATED ACROSS MULTIPLE

1136
00:37:36,342 --> 00:37:38,611
BRAIN REGIONS AS WELL AS NEURAL

1137
00:37:38,611 --> 00:37:41,313
NETWORKS AND THE OTHER NETWORKS.

1138
00:37:41,313 --> 00:37:44,950
OUR BRAIN IS ENCASED IN OUR

1139
00:37:44,950 --> 00:37:46,685
SKULL FOR FIVE SENSORIES, YOU'RE

1140
00:37:46,685 --> 00:37:47,686
BRAIN IS NOT DOING MUCH.

1141
00:37:47,686 --> 00:37:50,656
HEARING IS ONE OF THE DOMINANT

1142
00:37:50,656 --> 00:37:52,892
CESSORIES ALONG WITH VISION THAT

1143
00:37:52,892 --> 00:37:54,093
SUPPLIES THE BRAIN WITH

1144
00:37:54,093 --> 00:37:54,894
CONTEXTURAL INFORMATION AROUND

1145
00:37:54,894 --> 00:37:55,327
THE ENVIRONMENT.

1146
00:37:55,327 --> 00:37:57,429
WHAT WE SEE EXISTING FROM

1147
00:37:57,429 --> 00:37:58,364
PREVIOUS OBSERVATIONAL DATA, IS

1148
00:37:58,364 --> 00:38:00,733
YOU SEE THAT HEARING LOSS OR

1149
00:38:00,733 --> 00:38:03,035
BASICALLY AUDITORY CODING IS

1150
00:38:03,035 --> 00:38:04,670
ASSOCIATED WITH FUNCTIONAL

1151
00:38:04,670 --> 00:38:07,973
CHANGES IN BOTH PATTERNS OF

1152
00:38:07,973 --> 00:38:10,009
RESTING STATE AS WELL AS TASK,

1153
00:38:10,009 --> 00:38:11,410
BASED ON HIGH DENSITY DR. ELAINE

1154
00:38:11,410 --> 00:38:15,514
FLORES: G OR FMRI, CHANGE OF

1155
00:38:15,514 --> 00:38:16,849
PEOPLE WHO HAVE HEARING LOSS AND

1156
00:38:16,849 --> 00:38:27,259
DON'T HAVE HEARING LOSS.

1157
00:38:30,796 --> 00:38:33,732
YOU'RE SEEING THAT NOT IN KIDS

1158
00:38:33,732 --> 00:38:36,869
BUT OLDER ADULTS WITH MODAL

1159
00:38:36,869 --> 00:38:37,169
PLASTICITY.

1160
00:38:37,169 --> 00:38:40,439
WE SEE BASED ON OBSERVATIONAL

1161
00:38:40,439 --> 00:38:43,208
DATA, INCREASED STRUCTURAL

1162
00:38:43,208 --> 00:38:46,078
ATROPHY, WHOLE BRAIN, TEMPORAL

1163
00:38:46,078 --> 00:38:47,046
LOBE RESEARCHONS, SINGULAR

1164
00:38:47,046 --> 00:38:51,684
COTEXT AND FRONTAL GYRUS AND

1165
00:38:51,684 --> 00:38:56,588
DEFAULT MODE REGIONS.

1166
00:38:56,588 --> 00:38:58,123
LONGITUDINAL CHANGE OF HEARING

1167
00:38:58,123 --> 00:38:59,992
LOSS ASSOCIATED WITH FASTER

1168
00:38:59,992 --> 00:39:02,928
RATES OF MULTIPLE BRAIN REGIONS

1169
00:39:02,928 --> 00:39:03,162
ATROPHY.

1170
00:39:03,162 --> 00:39:04,830
THERE IS NOT REALLY BEEN MUCH AT

1171
00:39:04,830 --> 00:39:08,434
ALL LOOKING AT HOW WOULD HEARING

1172
00:39:08,434 --> 00:39:11,303
AID USE INCREASE AUDITORY

1173
00:39:11,303 --> 00:39:11,537
SIGNALS.

1174
00:39:11,537 --> 00:39:12,204
HOW WOULD THAT EFFECT THE BRAIN?

1175
00:39:12,204 --> 00:39:13,772
ONE STUDY THAT WAS DONE

1176
00:39:13,772 --> 00:39:16,475
RELATIVELY SMALL, BUT VERY

1177
00:39:16,475 --> 00:39:17,776
INTERESTING, THAT THEY GAVE A

1178
00:39:17,776 --> 00:39:19,278
GROUP OF OLDER ADULTS AT

1179
00:39:19,278 --> 00:39:20,879
BASELINE AND MEASURED THE DEGREE

1180
00:39:20,879 --> 00:39:23,682
OF CROSS-MODAL PLASTICITY.

1181
00:39:23,682 --> 00:39:26,652
HOW MUCH A VISC TASK ACTIVATED

1182
00:39:26,652 --> 00:39:29,455
AUDITORY AREAS OF THE BRAIN AND

1183
00:39:29,455 --> 00:39:30,823
THEM SIX MONTHS LATER YOU BRING

1184
00:39:30,823 --> 00:39:34,660
THEM BACK IN AND SEE REVERSE OR

1185
00:39:34,660 --> 00:39:36,095
REORGANIZATION WITH THAT.

1186
00:39:36,095 --> 00:39:37,529
SO HINTING SOMEWHAT A HEARING

1187
00:39:37,529 --> 00:39:38,864
AID CAN DO SOMETHING

1188
00:39:38,864 --> 00:39:41,033
FUNCTIONALLY IN TERMS OF TASK

1189
00:39:41,033 --> 00:39:41,667
ACTIVATION OF THE BRAIN.

1190
00:39:41,667 --> 00:39:44,503
THE QUESTION IS, DOES THAT

1191
00:39:44,503 --> 00:39:46,305
TRIGGER SOMETHING OR CHANGE

1192
00:39:46,305 --> 00:39:48,774
SOMETHING THREE YEARS DOWN THE

1193
00:39:48,774 --> 00:39:48,974
ROAD?

1194
00:39:48,974 --> 00:39:50,409
DOES CONSISTENT OR USE OF A

1195
00:39:50,409 --> 00:39:52,111
HEARING AIDS, LEAD TO LONGER

1196
00:39:52,111 --> 00:39:53,545
TERM EFFECTS ON BRAIN FUNCTION

1197
00:39:53,545 --> 00:39:54,480
AND STRUCTURE?

1198
00:39:54,480 --> 00:39:56,281
THAT IS REALLY COMPLETELY

1199
00:39:56,281 --> 00:39:58,317
UNKNOWN AT THIS POINT.

1200
00:39:58,317 --> 00:40:00,519
AND GET TO THE SORT OF SECOND

1201
00:40:00,519 --> 00:40:01,820
MECHANISM THE IDEA THAT HEARING

1202
00:40:01,820 --> 00:40:03,288
LOSS MAY CHANGE BRAIN FUNCTION

1203
00:40:03,288 --> 00:40:04,656
AND STRUCTURE.

1204
00:40:04,656 --> 00:40:06,158
THE QUESTION IS DOES THAT MEAN

1205
00:40:06,158 --> 00:40:07,793
DOES A HEARING INTERVENTION

1206
00:40:07,793 --> 00:40:09,194
WHERE A HEARING AID, DOES THAT

1207
00:40:09,194 --> 00:40:10,996
REDUCE ANY OF THESE FUNCTIONAL

1208
00:40:10,996 --> 00:40:12,364
OR STRUCTURAL CHANGES WITHIN

1209
00:40:12,364 --> 00:40:14,233
JUST THREE YEARS?

1210
00:40:14,233 --> 00:40:17,302
SO THIS IS EXPLORATORY OUTCOME

1211
00:40:17,302 --> 00:40:19,638
PLANNED FOR THE ACHIEVE TRIAL.

1212
00:40:19,638 --> 00:40:21,173
HOW THIS WAS DONE, I MENTIONED

1213
00:40:21,173 --> 00:40:24,276
AGAIN THE FULL SAMPLE WAS 977

1214
00:40:24,276 --> 00:40:25,277
ADULTS RANDOMIZED.

1215
00:40:25,277 --> 00:40:28,714
WE HAD MRI, HALF SAMPLE AT

1216
00:40:28,714 --> 00:40:31,283
BASELINE, 445 PEOPLE WHO HAD A

1217
00:40:31,283 --> 00:40:33,852
THREE MRI SCAN AT BASELINE AND

1218
00:40:33,852 --> 00:40:37,556
THEN WE RECAPTURED THOSE SCANS.

1219
00:40:37,556 --> 00:40:41,293
BUT SOME PEOPLE ESSENTIALLY WERE

1220
00:40:41,293 --> 00:40:43,228
TOO UNHEALTHY TO GO THROUGH MRI

1221
00:40:43,228 --> 00:40:44,129
SCANS THREE YEARS LATER.

1222
00:40:44,129 --> 00:40:46,031
BECAUSE OF THE PAN DEMIC AND

1223
00:40:46,031 --> 00:40:47,533
DELAY OF THE FOLLOW-UP, SOME

1224
00:40:47,533 --> 00:40:50,402
PEOPLE HAD FALLEN OUT THE WINDOW

1225
00:40:50,402 --> 00:40:55,307
WITH WHEN THEY COULD GET A MRI

1226
00:40:55,307 --> 00:40:56,508
SCAN.

1227
00:40:56,508 --> 00:40:58,444
THESE ARE ALL THREE TESLA

1228
00:40:58,444 --> 00:40:58,944
SCANNERS.

1229
00:40:58,944 --> 00:41:02,915
OPERATIONS BY REBECCA GOTTESMAN

1230
00:41:02,915 --> 00:41:03,549
AS WELL AS CLIFF JACKS GROUP WHO

1231
00:41:03,549 --> 00:41:06,285
HAS DONE ALL OF THE MRI MEASURES

1232
00:41:06,285 --> 00:41:13,525
FOR THE ARIC AND ACHIEVE STUDY.

1233
00:41:13,525 --> 00:41:15,761
DEFINED BY MAYO CLINIC AND THEN

1234
00:41:15,761 --> 00:41:19,131
CORTICAL THICKNESS MEASURED FOR

1235
00:41:19,131 --> 00:41:21,834
EACH REGION BY THE SAME GROUP.

1236
00:41:21,834 --> 00:41:24,670
THE PRIMARY ANALYSIS APPLIED SO

1237
00:41:24,670 --> 00:41:27,106
FAR IS THE TWO-LEVEL MIXED

1238
00:41:27,106 --> 00:41:27,639
EFFECTS ANALYSIS.

1239
00:41:27,639 --> 00:41:29,274
THAT MEANS THAT WE TREAT EACH

1240
00:41:29,274 --> 00:41:31,210
LOAD WITH A BRAIN AS A DIFFERENT

1241
00:41:31,210 --> 00:41:32,644
ANALYTIC MODEL.

1242
00:41:32,644 --> 00:41:35,414
WE SAY, HEAR ARE THE CONTROLS ON

1243
00:41:35,414 --> 00:41:35,848
FRONTAL LOBE.

1244
00:41:35,848 --> 00:41:38,717
NEXT MODEL, EFFECTS ON TEMPORAL

1245
00:41:38,717 --> 00:41:40,752
LOBE, THAT WAS THE PRIMARY

1246
00:41:40,752 --> 00:41:40,953
MODEL.

1247
00:41:40,953 --> 00:41:42,187
DIFFERENT WAY OF LOOKING AT THIS

1248
00:41:42,187 --> 00:41:44,790
IS ASSUMING COMMONALTIES.

1249
00:41:44,790 --> 00:41:47,426
SENSITIVITY ANALYSIS AND THE

1250
00:41:47,426 --> 00:41:48,293
TEMPORAL LOBE IS NOT DISTINCT

1251
00:41:48,293 --> 00:41:49,728
FROM THE FRONTAL.

1252
00:41:49,728 --> 00:41:50,829
THERE ARE COMMONALTIES.

1253
00:41:50,829 --> 00:41:52,631
SO IN A SENSITIVITY ANALYSIS, WE

1254
00:41:52,631 --> 00:41:55,067
CAN DO IN A MODEL TO INCLUDE A

1255
00:41:55,067 --> 00:41:56,435
COMMON EFFECT AND THEN ALSO

1256
00:41:56,435 --> 00:41:58,437
INCLUDE ON TOP OF THAT A LOAD

1257
00:41:58,437 --> 00:41:59,605
SPECIFIC EFFECT.

1258
00:41:59,605 --> 00:42:01,373
SO IT ALLOWS FOR A LITTLE MORE

1259
00:42:01,373 --> 00:42:03,408
PRECISION IN TERMS OF HOW YOU

1260
00:42:03,408 --> 00:42:05,177
ESTIMATE THE EFFECTS OF HEARING

1261
00:42:05,177 --> 00:42:06,378
VERSUS CONTROL.

1262
00:42:06,378 --> 00:42:10,082
WE PRESENT BOTH HERE BECAUSE

1263
00:42:10,082 --> 00:42:11,917
BOTH ARE DONE FOR CONSISTENCY.

1264
00:42:11,917 --> 00:42:15,554
WE DO IMPUTE ANY MISSING MRI

1265
00:42:15,554 --> 00:42:16,855
DATA IN YEAR 3.

1266
00:42:16,855 --> 00:42:18,724
THE MODEL SIMILAR TO THE

1267
00:42:18,724 --> 00:42:20,759
COGNITIVE RESULTS ADJUSTING FOR

1268
00:42:20,759 --> 00:42:23,262
MAJOR BASELINE COVARIATES THAT

1269
00:42:23,262 --> 00:42:25,264
CAN EFFECT THE RESULTS,

1270
00:42:25,264 --> 00:42:30,335
RECRUITMENT SOURCE, AGE, SEX,

1271
00:42:30,335 --> 00:42:30,602
ET CETERA.

1272
00:42:30,602 --> 00:42:31,803
THIS WAS NOT POWERED TO LOOK FOR

1273
00:42:31,803 --> 00:42:34,206
EFFECTS SO THE P VALUES ARE

1274
00:42:34,206 --> 00:42:36,175
PURELY FOR THE DESCRIPTIVE

1275
00:42:36,175 --> 00:42:38,577
PURPOSES NOT FOR DEFINITIVE

1276
00:42:38,577 --> 00:42:43,382
TREATMENT EFFECTS ON THE BRAIN.

1277
00:42:43,382 --> 00:42:46,151
SO THE FIGURE HERE IS DESIGNED

1278
00:42:46,151 --> 00:42:48,854
SIMILARLY TO THE COGNITION

1279
00:42:48,854 --> 00:42:49,087
RESULTS.

1280
00:42:49,087 --> 00:42:52,658
WHAT YOU SEE IS FRONTAL LOBE ON

1281
00:42:52,658 --> 00:42:55,460
AVERAGE AMONG PEOPLE WHO GOT THE

1282
00:42:55,460 --> 00:42:57,896
CONTROL INTERVENTION, ABOUT .01

1283
00:42:57,896 --> 00:43:00,065
MILLIMETER THINNING OVER TIME.

1284
00:43:00,065 --> 00:43:01,900
COMPARE TO INTERVENTION GROUP

1285
00:43:01,900 --> 00:43:05,137
APPEARS TO BE SLIGHTLY LESS

1286
00:43:05,137 --> 00:43:05,571
THINNING.

1287
00:43:05,571 --> 00:43:09,441
GENERAL TRENDS ACROSS LOBES,

1288
00:43:09,441 --> 00:43:10,943
THESE ARE DISTRIBUTIVE ONLY.

1289
00:43:10,943 --> 00:43:13,879
CLEAR GENERAL DIRECTION OF TRENT

1290
00:43:13,879 --> 00:43:14,446
OF HEARING INTERVENTION AND

1291
00:43:14,446 --> 00:43:16,715
AIMED TO REDUCE CORTICAL

1292
00:43:16,715 --> 00:43:17,816
THINNING OVER TIME THAT ARE

1293
00:43:17,816 --> 00:43:20,485
PRONOUNCED FOR THE TEMPORAL AND

1294
00:43:20,485 --> 00:43:20,919
OTHER BRAIN REGIONS.

1295
00:43:20,919 --> 00:43:23,488
IF YOU APPLY AGAIN TO A

1296
00:43:23,488 --> 00:43:25,157
SENSITIVITY ANALYSIS WHERE YOU

1297
00:43:25,157 --> 00:43:27,359
OFFER MORE PRECISION BY DRAWING

1298
00:43:27,359 --> 00:43:28,227
INFERENCES ACROSS THE WHOLE

1299
00:43:28,227 --> 00:43:30,596
GROUP AS OPPOSED TO TREATING

1300
00:43:30,596 --> 00:43:32,564
EACH LOBE SEPARATELY, YOU SEE A

1301
00:43:32,564 --> 00:43:33,899
SIMILAR PATTERN, STRONGER

1302
00:43:33,899 --> 00:43:38,537
RESULTS LIKE TITER CONFIDENCE

1303
00:43:38,537 --> 00:43:43,575
INTERVALS PARTICULARLY OVER THEO

1304
00:43:43,575 --> 00:43:46,345
SIP TALL AND TEMPORAL LOBE.

1305
00:43:46,345 --> 00:43:48,680
THIS TAKES A BRAIN MAPPING DONE

1306
00:43:48,680 --> 00:43:50,048
BY THE UNIVERSITY OF

1307
00:43:50,048 --> 00:43:51,850
PENNSYLVANIA WHERE YOU CAN LOOK

1308
00:43:51,850 --> 00:43:54,786
AT WITHIN THE SUBLOBE REGIONS

1309
00:43:54,786 --> 00:43:57,089
MAP TO A BRAIN TO MAKE THE

1310
00:43:57,089 --> 00:43:58,123
FIGURE EASIER TO INTERPRET, THIS

1311
00:43:58,123 --> 00:44:00,792
SHOWS THE REDDER IT IS, THE

1312
00:44:00,792 --> 00:44:03,862
REDDER IMPLIES OR INDICATING

1313
00:44:03,862 --> 00:44:04,396
GREATER DEGREE OF REDUCED

1314
00:44:04,396 --> 00:44:06,798
CORTICAL THINNING WITH,ING

1315
00:44:06,798 --> 00:44:08,400
INTER-- HEARING INTERVENTION AND

1316
00:44:08,400 --> 00:44:10,569
THE BLUE INDICATES GREATER

1317
00:44:10,569 --> 00:44:12,104
CORTICAL THINNING.

1318
00:44:12,104 --> 00:44:16,174
YOU SEE A TREND HERE LIGHTING UP

1319
00:44:16,174 --> 00:44:19,878
WITH THE EFFECTS IS THE FRONTAL

1320
00:44:19,878 --> 00:44:21,546
LOBE WHICH ISISM CATTED VERY

1321
00:44:21,546 --> 00:44:23,682
MUCH IN LANGUAGE AND SPEECH

1322
00:44:23,682 --> 00:44:24,049
PROCESSING.

1323
00:44:24,049 --> 00:44:27,586
SO THE GREATER EFFECTS ARE ALSO

1324
00:44:27,586 --> 00:44:30,555
IN THE CINGULATE CORTEX VERY

1325
00:44:30,555 --> 00:44:33,725
CRITICAL FOR RELAYING OF

1326
00:44:33,725 --> 00:44:35,160
ATTENTIONAL INFORMATION.

1327
00:44:35,160 --> 00:44:36,695
SOME AREAS OF VERY LIGHT BLUE,

1328
00:44:36,695 --> 00:44:40,966
NOT MUCH IN THE TEMPORAL LOBE

1329
00:44:40,966 --> 00:44:44,670
BUT PRIMARILY IN THE ANTERIOR

1330
00:44:44,670 --> 00:44:44,936
CINGULATE.

1331
00:44:44,936 --> 00:44:50,075
SO A BRIEF SUMMARY MRI RESULTS

1332
00:44:50,075 --> 00:44:50,876
TO DATE IS THAT WE GENERALLY SEE

1333
00:44:50,876 --> 00:44:52,778
A TREND TOWARDS HEARING

1334
00:44:52,778 --> 00:44:54,179
INTERVENTION, POSSIBLY BEING

1335
00:44:54,179 --> 00:44:56,415
ASSOCIATED WITH REDUCED CORTICAL

1336
00:44:56,415 --> 00:44:57,282
THINNING OVER THREE YEARS.

1337
00:44:57,282 --> 00:44:59,251
WHEN WE DID THESE ANALYSIS AND

1338
00:44:59,251 --> 00:45:00,886
SUGGESTED MRI SCAN, WE DIDN'T

1339
00:45:00,886 --> 00:45:02,087
THINK WE WOULD SEE ANYTHING.

1340
00:45:02,087 --> 00:45:03,989
THREE YEARS IS NOT MUCH TIME.

1341
00:45:03,989 --> 00:45:05,724
AND THERE SEEMS TO BE A SIGNAL

1342
00:45:05,724 --> 00:45:07,225
THAT THE HEARING AID

1343
00:45:07,225 --> 00:45:09,328
INTERVENTION IS DOING SOMETHING

1344
00:45:09,328 --> 00:45:11,163
TO THE BRAIN, THAT THINNING IS

1345
00:45:11,163 --> 00:45:12,564
BAD FOR THE BRAIN AND IT IS

1346
00:45:12,564 --> 00:45:13,732
DOING SOMETHING GOOD.

1347
00:45:13,732 --> 00:45:17,703
IT NEEDS TO BE FURTHER EXPLORED.

1348
00:45:17,703 --> 00:45:19,871
PATTERN OF FINDINGS TO DATE,

1349
00:45:19,871 --> 00:45:21,473
POTENTIAL MECHANISM JUST A BIT

1350
00:45:21,473 --> 00:45:23,742
HAND WAVING HERE BUT BY SOME

1351
00:45:23,742 --> 00:45:25,577
EVIDENCE THAT MAYBE DIRECT

1352
00:45:25,577 --> 00:45:27,579
EFFECTS OF HEARING AID USE, HERE

1353
00:45:27,579 --> 00:45:29,681
ON SUSTAINED ALTERATIONS AND

1354
00:45:29,681 --> 00:45:31,616
PATTERNS OF ACTIVITY AND/OR

1355
00:45:31,616 --> 00:45:32,718
POTENTIALLY INDIRECT EFFECTS IF

1356
00:45:32,718 --> 00:45:34,886
YOU'RE PROMOTING INCREASING

1357
00:45:34,886 --> 00:45:37,422
SOCIAL PHYSICAL ACTIVITY.

1358
00:45:37,422 --> 00:45:39,691
THAT COULD BE GOOD FOR THE BRAIN

1359
00:45:39,691 --> 00:45:40,592
STRUCTURE AS WELL.

1360
00:45:40,592 --> 00:45:46,198
ONGOING ANALYSIS, AND THEN WE'LL

1361
00:45:46,198 --> 00:45:49,301
PRESENT THIS AS ANOTHER PAPER.

1362
00:45:49,301 --> 00:45:52,170
SO, THE LAST FIVE MINUTES A

1363
00:45:52,170 --> 00:45:54,439
SUMMARY OF SOME RESULTS TO DATE

1364
00:45:54,439 --> 00:45:56,708
AND POLICIES I WANT TO ADD IN

1365
00:45:56,708 --> 00:45:58,910
THE END.

1366
00:45:58,910 --> 00:46:00,011
MOST OF MY NIME I'M DOING MORE

1367
00:46:00,011 --> 00:46:01,780
POLICY, BUT THEY GO HAND-IN-HAND

1368
00:46:01,780 --> 00:46:03,815
AND I'M SHOW YOU WHAT THAT IS IT

1369
00:46:03,815 --> 00:46:04,082
GOING.

1370
00:46:04,082 --> 00:46:06,218
SO ACHIEVE STUDY KEY FINDINGS.

1371
00:46:06,218 --> 00:46:07,886
I THINK AFTER THREE YEARS IT

1372
00:46:07,886 --> 00:46:09,588
APPEARS TO BE HIGH ADD MEANERS

1373
00:46:09,588 --> 00:46:15,093
AND SATISFACTION FOR THE HEARING

1374
00:46:15,093 --> 00:46:15,427
INTERVENTION.

1375
00:46:15,427 --> 00:46:16,428
SUSTAINED OVER THREE YEARS WITH

1376
00:46:16,428 --> 00:46:18,630
CLEAR POSITIVE EFFECTS ON

1377
00:46:18,630 --> 00:46:19,798
SELF-RECEIVED COMMUNICATION

1378
00:46:19,798 --> 00:46:20,098
IMPAIRMENT.

1379
00:46:20,098 --> 00:46:22,567
WE SEE STRONG EFFECTS OF HEARING

1380
00:46:22,567 --> 00:46:26,471
INTERVENTION REDUCING COGNITIVE

1381
00:46:26,471 --> 00:46:28,507
CHANGE FOR A GROUP THAT CAME

1382
00:46:28,507 --> 00:46:30,475
FROM A RANDOM SAMPLE OF THE

1383
00:46:30,475 --> 00:46:31,710
POPULATION.

1384
00:46:31,710 --> 00:46:34,780
EXPLORATORY MRI ANALYSIS

1385
00:46:34,780 --> 00:46:35,847
BIOMARKER EFFECTS WITHIN JUST

1386
00:46:35,847 --> 00:46:38,617
THREE YEARS ON REDUCED CORTICAL

1387
00:46:38,617 --> 00:46:38,884
THINNING.

1388
00:46:38,884 --> 00:46:42,687
KEY INFERENCE REFLECTED IN

1389
00:46:42,687 --> 00:46:43,622
LANCET, HEARING INTERVENTION MAY

1390
00:46:43,622 --> 00:46:45,157
REDUCE COGNITIVE LOSS FOR THREE

1391
00:46:45,157 --> 00:46:48,160
YEARS FOR THOSE POPULATIONS AT

1392
00:46:48,160 --> 00:46:48,727
RIDGE FOR COGNITIVE DECLINE

1393
00:46:48,727 --> 00:46:49,728
WITHIN THREE YEARS.

1394
00:46:49,728 --> 00:46:51,930
SO IMPLICATIONS FOR POLICY.

1395
00:46:51,930 --> 00:46:54,232
I WOULD SAY AS WE INTERPRET

1396
00:46:54,232 --> 00:46:55,967
SCIENTIFIC EVIDENCE TO CLINICAL

1397
00:46:55,967 --> 00:46:57,803
REP RECOMMENDATIONS AND POLICY,

1398
00:46:57,803 --> 00:47:00,338
IT ALWAYS, ALWAYS REQUIRES

1399
00:47:00,338 --> 00:47:00,672
EXTRAPOLATION.

1400
00:47:00,672 --> 00:47:02,340
NO SCIENTIFIC STUDY EVER

1401
00:47:02,340 --> 00:47:03,842
REPLICATES THE EXACT STUDY YOU

1402
00:47:03,842 --> 00:47:05,277
WANT TO EXTRAPOLATE TO.

1403
00:47:05,277 --> 00:47:06,578
SO EXTRAPOLATION OF SCIENTIFIC

1404
00:47:06,578 --> 00:47:08,079
DATA TO CLINICAL RECOMMENDATION

1405
00:47:08,079 --> 00:47:10,282
OF POLICY ALWAYS DEPENDS ON

1406
00:47:10,282 --> 00:47:12,050
EXTRAPOLATION AND BALANCING RISK

1407
00:47:12,050 --> 00:47:13,118
VERSUS BENEFIT.

1408
00:47:13,118 --> 00:47:14,753
SO I'LL SAY BEFORE THIS TRIAL

1409
00:47:14,753 --> 00:47:16,121
CAME OUT, THIS IS GOING TO

1410
00:47:16,121 --> 00:47:16,488
HAPPEN.

1411
00:47:16,488 --> 00:47:18,323
SO WE LOOK AT THE PREVIOUS

1412
00:47:18,323 --> 00:47:20,725
RECOMMENDATIONS FROM THE 2020

1413
00:47:20,725 --> 00:47:21,526
LANCET COMMISSION ON DEMENTIA AS

1414
00:47:21,526 --> 00:47:23,562
WELL AS THE 2021 U.S. NATIONAL

1415
00:47:23,562 --> 00:47:25,797
PLAN FOR ALZHEIMER'S DISEASE.

1416
00:47:25,797 --> 00:47:27,499
THESE REPORTS ARE CALLING FOR

1417
00:47:27,499 --> 00:47:28,433
ADDRESSING HEARING LOSS IN THE

1418
00:47:28,433 --> 00:47:30,235
CONTEXT OF NATIONAL DEMENTIA

1419
00:47:30,235 --> 00:47:31,336
PREVENTION STRATEGIES.

1420
00:47:31,336 --> 00:47:32,704
THIS IS FAIR FOR THE TRIAL

1421
00:47:32,704 --> 00:47:34,172
BECAUSE ALL RISK VERSUS BENEFIT.

1422
00:47:34,172 --> 00:47:36,341
THE RISK OF HEARING INTERVENTION

1423
00:47:36,341 --> 00:47:37,843
IS PRIMARILY FINANCIAL RISK.

1424
00:47:37,843 --> 00:47:38,910
NO MEDICAL RISK.

1425
00:47:38,910 --> 00:47:40,545
THE BENEFITS ARE CLEARLY

1426
00:47:40,545 --> 00:47:41,346
COMMUNICATION, THINGS LIKE THAT

1427
00:47:41,346 --> 00:47:44,049
AND POSSIBLY REDUCED COGNITIVE

1428
00:47:44,049 --> 00:47:44,382
CHANGE.

1429
00:47:44,382 --> 00:47:46,418
SO I THINK EXTRAPOLATION IS

1430
00:47:46,418 --> 00:47:47,352
JUSTIFIABLE IN THAT SENSE.

1431
00:47:47,352 --> 00:47:49,788
NOW THE TRIAL RESULTS I WOULD

1432
00:47:49,788 --> 00:47:52,757
SAY SHOWING RELATIVELY STRONG

1433
00:47:52,757 --> 00:47:54,226
EFFECTS WITH RISK AS WELL AS

1434
00:47:54,226 --> 00:47:55,527
BIOMARKER EFFECTS ON THE BRAIN.

1435
00:47:55,527 --> 00:47:58,196
IT DOES CALL INTO ACTION OR

1436
00:47:58,196 --> 00:47:59,331
PERSPECTIVE OTHER POLICY

1437
00:47:59,331 --> 00:47:59,831
ACTIONS.

1438
00:47:59,831 --> 00:48:02,834
ONE BITTER PARADOX I FACE THAT

1439
00:48:02,834 --> 00:48:05,403
MANY OF YOU FACE IS THAT HEARING

1440
00:48:05,403 --> 00:48:07,405
INTERVENTION OFFERED IN ACHIEVE

1441
00:48:07,405 --> 00:48:10,442
WITH HEARING AIDS AND

1442
00:48:10,442 --> 00:48:11,676
AUDIOLOGISTS, THIS BEST PRACTICE

1443
00:48:11,676 --> 00:48:12,811
INTERVENTION WOULD NOT BE

1444
00:48:12,811 --> 00:48:14,212
COVERED UNDER MEDICARE.

1445
00:48:14,212 --> 00:48:15,447
HEARING AIDS AND RELATED

1446
00:48:15,447 --> 00:48:17,115
SERVICES UNDER TRADITIONAL

1447
00:48:17,115 --> 00:48:19,551
MEDICARE ARE STATUTORY

1448
00:48:19,551 --> 00:48:22,420
EXCLUSIONS WRITTEN INTO THE 1965

1449
00:48:22,420 --> 00:48:22,921
SOCIALITY SECURITY ACT.

1450
00:48:22,921 --> 00:48:23,922
YOU HAVE TO CHANGE THE

1451
00:48:23,922 --> 00:48:25,156
LEGISLATIVE LAW.

1452
00:48:25,156 --> 00:48:27,092
IT'S NOT -- IT HAS TO BE CHANGED

1453
00:48:27,092 --> 00:48:28,927
IN THE LAW.

1454
00:48:28,927 --> 00:48:31,096
IF WE BELIEVE THIS CAN MAKE A

1455
00:48:31,096 --> 00:48:32,464
DIFFERENCE IN SOMEONE'S LIFE

1456
00:48:32,464 --> 00:48:35,133
COMMUNICATION WISE AND REDUCING

1457
00:48:35,133 --> 00:48:37,202
COGNITIVE LOSS, YOU HAVE SHOULD

1458
00:48:37,202 --> 00:48:37,936
HAVE SOME INSURANCE COVERAGE.

1459
00:48:37,936 --> 00:48:39,971
THAT'S SOME WE HAVE TO WORK ON.

1460
00:48:39,971 --> 00:48:41,940
REGULATION OF HEARING AIDS ARE

1461
00:48:41,940 --> 00:48:42,974
RIDICULOUSLY EXPENSIVE.

1462
00:48:42,974 --> 00:48:44,342
ONE WAY IS HOW THEY ARE

1463
00:48:44,342 --> 00:48:45,243
REGULATED TO PROMOTE THE

1464
00:48:45,243 --> 00:48:48,613
DEVELOPMENT OF OTC HEARING

1465
00:48:48,613 --> 00:48:55,220
COMPANIES LIKE SAMSUNG.

1466
00:48:55,220 --> 00:48:56,688
SO YOU COULD NEVER GET THE

1467
00:48:56,688 --> 00:48:58,557
ECONOMY TO SCALE TO DRIVE

1468
00:48:58,557 --> 00:48:59,224
INNOVATION.

1469
00:48:59,224 --> 00:49:01,560
AND THE BITTER PARADOX WE THINK

1470
00:49:01,560 --> 00:49:02,360
HEARING IS IMPORTANT.

1471
00:49:02,360 --> 00:49:03,628
FOR MOST PEOPLE IN THIS ROOM,

1472
00:49:03,628 --> 00:49:04,996
YOU MIGHT HAVE GOTTEN YOUR

1473
00:49:04,996 --> 00:49:06,531
HEARING MEASURED WHEN YOU WERE 6

1474
00:49:06,531 --> 00:49:08,733
OR 7 AND FOR THE AVERAGE

1475
00:49:08,733 --> 00:49:10,068
AMERICAN YOU NEVER HAVE YOUR

1476
00:49:10,068 --> 00:49:11,536
HEARING TESTED EVER AGAIN UNTIL

1477
00:49:11,536 --> 00:49:13,138
YOU'RE 80 YEARS OLD AND YOUR

1478
00:49:13,138 --> 00:49:14,472
SPOUSE IS SCREAMING AT YOU TO

1479
00:49:14,472 --> 00:49:15,640
GET A HEARING TEST.

1480
00:49:15,640 --> 00:49:18,043
SO ALL THE TALK ABOUT HEARING,

1481
00:49:18,043 --> 00:49:19,544
NOBODY KNOWS WHERE THEIR HEARING

1482
00:49:19,544 --> 00:49:19,744
IS.

1483
00:49:19,744 --> 00:49:21,680
IT'S A BARRIER.

1484
00:49:21,680 --> 00:49:22,814
THESE ARE AREAS THAT WE HAVE

1485
00:49:22,814 --> 00:49:24,649
ALREADY MADE A LOT OF PROGRESS

1486
00:49:24,649 --> 00:49:25,617
ON AND THERE ARE CONTINUING

1487
00:49:25,617 --> 00:49:27,819
VERY, VERY QUICKLY ESPECIALLY

1488
00:49:27,819 --> 00:49:28,987
NOW THAT THE TRIAL RESULTS CAME

1489
00:49:28,987 --> 00:49:29,487
OUT.

1490
00:49:29,487 --> 00:49:31,256
THIS IS THE FIRST ONE WITH THE

1491
00:49:31,256 --> 00:49:32,324
MOST DISAPPOINTING.

1492
00:49:32,324 --> 00:49:34,960
TWO YEARS AGO, THE WHITE HOUSE

1493
00:49:34,960 --> 00:49:36,294
BUILD BACK BETTER ACT, WE GOT

1494
00:49:36,294 --> 00:49:37,596
WRITTEN INTO THE MEDICARE

1495
00:49:37,596 --> 00:49:38,830
HEARING COVERAGE.

1496
00:49:38,830 --> 00:49:41,733
SO THAT WAS A 1.75 TRILLION

1497
00:49:41,733 --> 00:49:42,534
DOLLAR SPENDING BILL FOR CHILD

1498
00:49:42,534 --> 00:49:45,470
CARE AND PRESCHOOL, HOME CARE,

1499
00:49:45,470 --> 00:49:46,271
ET CETERA.

1500
00:49:46,271 --> 00:49:47,939
AND THERE IS A 35 BILLION DOLLAR

1501
00:49:47,939 --> 00:49:49,975
OFFER FOR 10 YEARS ON MEDICARE

1502
00:49:49,975 --> 00:49:51,409
HEARING CARE COVERAGE.

1503
00:49:51,409 --> 00:49:52,544
THAT WOULD HAVE COVERED HEARING

1504
00:49:52,544 --> 00:49:54,546
CARE SERVICES AND DEVICES.

1505
00:49:54,546 --> 00:49:55,513
UNFORTUNATELY IT DIDN'T PASS OUT

1506
00:49:55,513 --> 00:49:56,348
OF THE SENATE.

1507
00:49:56,348 --> 00:49:59,784
BUT WE GOT CLOSE AND WORKING

1508
00:49:59,784 --> 00:50:01,586
LEGISLATIVE LANGUAGE TO BE

1509
00:50:01,586 --> 00:50:01,886
RESURRECTED.

1510
00:50:01,886 --> 00:50:03,521
HOW DID THIS HAPPEN?

1511
00:50:03,521 --> 00:50:05,657
THE POLICIES MAKERS I WORK WITH

1512
00:50:05,657 --> 00:50:06,291
IN CONGRESS AND THE SENATE PART

1513
00:50:06,291 --> 00:50:08,493
OF IT THE WAY THEY PUT IT, WE

1514
00:50:08,493 --> 00:50:10,795
CAPTURE THE IMAGINATION OF

1515
00:50:10,795 --> 00:50:11,896
POLICYMAKERS EARLY ON ABOUT HOW

1516
00:50:11,896 --> 00:50:12,864
IMPORTANT THIS COULD BE TO

1517
00:50:12,864 --> 00:50:13,732
PUBLIC HEALTH.

1518
00:50:13,732 --> 00:50:15,367
THAT'S ONE REASON WE SEE THIS

1519
00:50:15,367 --> 00:50:17,702
ONE 35 BILLION DOLLARICALITIA

1520
00:50:17,702 --> 00:50:21,640
FOR MEDICARE AMONG EVERYTHING

1521
00:50:21,640 --> 00:50:21,873
ELSE.

1522
00:50:21,873 --> 00:50:23,642
THE WHOLE BILL DIDN'T ADVANCE.

1523
00:50:23,642 --> 00:50:25,710
NOW THE LEGISLATIVEILABLE IS

1524
00:50:25,710 --> 00:50:28,013
THERE, IT MAKES IT MUCH EASIER

1525
00:50:28,013 --> 00:50:29,414
TO LATER RESURRECT.

1526
00:50:29,414 --> 00:50:34,219
IT'S CLEAR PROGRESS.

1527
00:50:34,219 --> 00:50:35,820
FEDERAL PASSAGE OF THE

1528
00:50:35,820 --> 00:50:37,188
OVER-THE-COUNTER HEARING ACT OF

1529
00:50:37,188 --> 00:50:37,389
2017.

1530
00:50:37,389 --> 00:50:38,289
THIS THE REPRESENTED MANY YEARS

1531
00:50:38,289 --> 00:50:43,561
OF WORK.

1532
00:50:43,561 --> 00:50:44,896
THE NATIONAL ECONOMIES WITH NIDC

1533
00:50:44,896 --> 00:50:46,364
DIRECTOR AND THEN LEADING TO THE

1534
00:50:46,364 --> 00:50:49,300
WHITE HOUSE PRESIDENT'S COUNSEL

1535
00:50:49,300 --> 00:50:49,934
OF TECHNOLOGY TAKING ON THIS

1536
00:50:49,934 --> 00:50:50,235
ISSUE.

1537
00:50:50,235 --> 00:50:52,771
THAT LED TO RECOMMENDATIONS US

1538
00:50:52,771 --> 00:50:54,039
GOVERNMENT SHOULD REREGULATE

1539
00:50:54,039 --> 00:50:55,640
HEARING AIDS TO OFFER GREATER

1540
00:50:55,640 --> 00:50:57,275
COMPETITION TO ALLOW FOR

1541
00:50:57,275 --> 00:51:00,345
COMPANIES LIKE SAMSUNG, APP EGG,

1542
00:51:00,345 --> 00:51:01,780
POSE TO INNOVATE IN THIS SPACE.

1543
00:51:01,780 --> 00:51:04,115
THAT WAS A BILL THAT RECEIVED

1544
00:51:04,115 --> 00:51:06,985
BIPARTISAN SUPPORT ON THE SENATE

1545
00:51:06,985 --> 00:51:07,252
SIDE.

1546
00:51:07,252 --> 00:51:09,654
ONE OF THE SIGNATURE BIPARTISAN

1547
00:51:09,654 --> 00:51:10,021
ACCOMPLISHMENTS.

1548
00:51:10,021 --> 00:51:11,723
ON THE HOUSE SIDE IT WAS JOE

1549
00:51:11,723 --> 00:51:14,426
KENYA AND MARSHA BLACKBURN.

1550
00:51:14,426 --> 00:51:17,495
YOU CAN'T GET TWO MORE OPPOSING

1551
00:51:17,495 --> 00:51:19,064
SIDES OF THE AISLE BUT IT CAME

1552
00:51:19,064 --> 00:51:20,465
TOGETHER BECAUSE THE POSITION IS

1553
00:51:20,465 --> 00:51:22,600
INCREASED ACCESS AND

1554
00:51:22,600 --> 00:51:23,535
AFFORDABILITY.

1555
00:51:23,535 --> 00:51:26,104
REPUBLICAN SIDE IT IS BREAKING

1556
00:51:26,104 --> 00:51:27,739
DOWN MONOPOLIES BARRIERS OF

1557
00:51:27,739 --> 00:51:28,973
INCREASED COMPETITION.

1558
00:51:28,973 --> 00:51:32,510
THIS GOT ADVANCED QUICKLY,

1559
00:51:32,510 --> 00:51:33,812
ISSUED -- INTRODUCED IN MARCH

1560
00:51:33,812 --> 00:51:34,412
2017.

1561
00:51:34,412 --> 00:51:36,081
GOT SIGNED INTO LAW 5 MONTHS

1562
00:51:36,081 --> 00:51:36,347
LATER.

1563
00:51:36,347 --> 00:51:37,382
I TESTIFIED ON BEHALF.

1564
00:51:37,382 --> 00:51:39,984
THERE WAS A LOT OF OPPOSITION

1565
00:51:39,984 --> 00:51:41,119
FROM THE ENTRENCHED HEARING AID

1566
00:51:41,119 --> 00:51:43,321
INDUSTRY UNFORTUNATELY.

1567
00:51:43,321 --> 00:51:44,556
FINAL REGULATION WENT INTO

1568
00:51:44,556 --> 00:51:45,623
EFFECT OVER A YEAR AGO.

1569
00:51:45,623 --> 00:51:47,325
YOU WILL BEGIN SEEING -- IT WILL

1570
00:51:47,325 --> 00:51:48,293
TAKE A FEW YEARS.

1571
00:51:48,293 --> 00:51:51,096
YOU WILL SEE THE WHOLE U.S.

1572
00:51:51,096 --> 00:51:52,664
HEARING MARKET IN THE NEXT FEW

1573
00:51:52,664 --> 00:51:53,765
YEARS DRAMATICALLY CHANGE AS

1574
00:51:53,765 --> 00:51:55,333
MUCH, MUCH BIGGER COMPANIES THAT

1575
00:51:55,333 --> 00:51:57,102
WE ALL HEARD OF BEGIN TO ENTER

1576
00:51:57,102 --> 00:51:57,368
THE SPACE.

1577
00:51:57,368 --> 00:52:01,339
IT WON'T TAKE TWO OR THREE

1578
00:52:01,339 --> 00:52:01,539
YEARS.

1579
00:52:01,539 --> 00:52:02,674
HOW YOU INTRODUCE IT, HOW YOU

1580
00:52:02,674 --> 00:52:04,209
PRICE IT, THAT'S ALL SOMETHING

1581
00:52:04,209 --> 00:52:05,610
TO FIGURE OUT IN REALTIME BUT

1582
00:52:05,610 --> 00:52:06,711
THIS IS FEDERAL LAW.

1583
00:52:06,711 --> 00:52:08,413
THIS MAKES THE U.S. THE FIRST

1584
00:52:08,413 --> 00:52:10,048
COUNTRY IN THE ENTIRE WORLD TO

1585
00:52:10,048 --> 00:52:13,818
HAVE A REGULATED MARKET FOR OTC

1586
00:52:13,818 --> 00:52:14,052
HEARING.

1587
00:52:14,052 --> 00:52:16,755
NOWHERE ELSE IN THE WORLD.

1588
00:52:16,755 --> 00:52:18,323
THIRD THING I'LL SAY AND I SPEND

1589
00:52:18,323 --> 00:52:21,226
A LOT OF MY TIME ON, IS A

1590
00:52:21,226 --> 00:52:22,527
PARADOX THAT NO ONE HERE KNOW

1591
00:52:22,527 --> 00:52:24,262
WHAT IS YOU'RE HEARING IS.

1592
00:52:24,262 --> 00:52:25,563
I'M GUESSING NO ONE KNOWS WHAT

1593
00:52:25,563 --> 00:52:26,664
YOU'RE HEARING IS.

1594
00:52:26,664 --> 00:52:28,433
WE THINK HEARING IS IMPORTANT

1595
00:52:28,433 --> 00:52:31,603
AND IF NO ONE KNOWS THEIR

1596
00:52:31,603 --> 00:52:32,737
HEARING, IT'S A PROBLEM.

1597
00:52:32,737 --> 00:52:34,839
SO BEGINNING -- ONE THING VERY

1598
00:52:34,839 --> 00:52:36,641
IMPORTANT WHEN CONSUMERS KNOW

1599
00:52:36,641 --> 00:52:37,842
SOMETHING ABOUT THEIR HEALTH

1600
00:52:37,842 --> 00:52:40,612
THROUGH A METRIC, YOUR BLOOD

1601
00:52:40,612 --> 00:52:41,780
PRESSURE, IT CHANGES BEARS.

1602
00:52:41,780 --> 00:52:42,947
IT CHANGES HOW YOU THINK ABOUT

1603
00:52:42,947 --> 00:52:44,616
WHAT TO DO ABOUT IT.

1604
00:52:44,616 --> 00:52:46,951
FOR THE PAST YEAR I WORKED WITH

1605
00:52:46,951 --> 00:52:48,486
CONSUMER TECHNOLOGY ASSOCIATION,

1606
00:52:48,486 --> 00:52:50,355
AND THANCY TO DEVELOP A

1607
00:52:50,355 --> 00:52:52,090
STANDARD.

1608
00:52:52,090 --> 00:52:54,559
CTA ANSI STANDARD FOR THE FOUR

1609
00:52:54,559 --> 00:52:55,426
FREQUENCY TESTING AVERAGE.

1610
00:52:55,426 --> 00:52:57,529
THIS MEANS THAT GOING FORWARD --

1611
00:52:57,529 --> 00:53:01,032
WITH FDA, AMAZON, APPLE, WE HAVE

1612
00:53:01,032 --> 00:53:03,067
NOW SET THE STANDARD THAT AS

1613
00:53:03,067 --> 00:53:07,138
THIS GETS TAKEN UP BY CONSUMER

1614
00:53:07,138 --> 00:53:08,406
ELECTRONSICS IN THE NEXT FEW

1615
00:53:08,406 --> 00:53:11,109
YEARS, EVERY CONSUMER ELECTRONIC

1616
00:53:11,109 --> 00:53:12,644
DEVICE, WHETHER A WIRELESS OR

1617
00:53:12,644 --> 00:53:15,880
PHONE OR SMARTPHONE WILL PROMPT

1618
00:53:15,880 --> 00:53:17,949
YOU TO MEASURE HEARING AND THEN

1619
00:53:17,949 --> 00:53:19,450
CUSTOMIZE YOUR HEADPHONES TO

1620
00:53:19,450 --> 00:53:22,253
MEET WHAT YOUR HEARING IS.

1621
00:53:22,253 --> 00:53:25,256
EVERYONE WILL UNDERSTAND AND

1622
00:53:25,256 --> 00:53:25,924
KNOWS.

1623
00:53:25,924 --> 00:53:27,826
HEARING LOSS, THE WORD IS

1624
00:53:27,826 --> 00:53:28,660
TERRIBLE.

1625
00:53:28,660 --> 00:53:31,296
IT WILL BEGIN SHAPING BEHAVIORS.

1626
00:53:31,296 --> 00:53:33,998
NYE FUNDAMENTAL GOAL IS FOR

1627
00:53:33,998 --> 00:53:35,099
EVERY TEENAGER AND ADULT TO

1628
00:53:35,099 --> 00:53:36,234
UNDERSTAND THE MEASURE AND TRACK

1629
00:53:36,234 --> 00:53:37,802
THEIR HEARING OVER THEIR

1630
00:53:37,802 --> 00:53:38,069
LIFETIME.

1631
00:53:38,069 --> 00:53:40,405
I THINK THAT CHANGES BEHAVIORS

1632
00:53:40,405 --> 00:53:43,575
AT UNPRECEDENTED SCALE.

1633
00:53:43,575 --> 00:53:45,944
SO I WILL FINISH UP WITH MY LAST

1634
00:53:45,944 --> 00:53:47,512
SLIDE -- FOR EXAMPLE, THIS IS MY

1635
00:53:47,512 --> 00:53:47,946
HEARING NUMBER.

1636
00:53:47,946 --> 00:53:50,415
MINE IS AT 12 AND MY DAUGHTER,

1637
00:53:50,415 --> 00:53:52,150
17, HERS IS A NEGATIVE 3.

1638
00:53:52,150 --> 00:53:53,651
SHE MAKES FUN OF ME NOW.

1639
00:53:53,651 --> 00:53:55,653
EACH THOUGH MY HEARING WOULD BE

1640
00:53:55,653 --> 00:53:56,287
CONSIDERED NORMAL, IT'S NOT

1641
00:53:56,287 --> 00:53:56,588
ANYMORE.

1642
00:53:56,588 --> 00:53:59,023
I SHIFTED 15DBs IN 15 YEARS.

1643
00:53:59,023 --> 00:54:00,758
SO THIS IS WHAT IS HAPPENING.

1644
00:54:00,758 --> 00:54:02,861
THIS IS THE REASON APPLE

1645
00:54:02,861 --> 00:54:03,895
PLATFORM, SHOULD YOU DO IT

1646
00:54:03,895 --> 00:54:06,464
YOURSELF, DOWNLOAD THE APP AND

1647
00:54:06,464 --> 00:54:07,665
IT SPITS OUT YOUR HEARING

1648
00:54:07,665 --> 00:54:07,999
NUMBER.

1649
00:54:07,999 --> 00:54:09,300
AND THE CONTEXTURALIZATION

1650
00:54:09,300 --> 00:54:10,501
AROUND IT.

1651
00:54:10,501 --> 00:54:11,269
SO I'LL BEGIN HERE.

1652
00:54:11,269 --> 00:54:12,871
THIS ALL BEGAN WITH CLINICAL

1653
00:54:12,871 --> 00:54:14,138
INSIGHTS MANY, MANY YEARS AGO.

1654
00:54:14,138 --> 00:54:17,208
AND I HOPE TO SHOW YOU OVER THE

1655
00:54:17,208 --> 00:54:20,311
LAST 45 MINUTES, HOW TO

1656
00:54:20,311 --> 00:54:22,146
TRANSLATE INSIGHTS TO TRIALS AND

1657
00:54:22,146 --> 00:54:24,282
TRIALS TO POLICY AND SOMETIMES

1658
00:54:24,282 --> 00:54:25,683
YOU DON'T NEED THE TRIALS FOR

1659
00:54:25,683 --> 00:54:28,019
THE POLICY, THEY GO HAND-IN-HAND

1660
00:54:28,019 --> 00:54:30,622
AS THEY PROGRESS ALONG.

1661
00:54:30,622 --> 00:54:32,090
BRIEF ACKNOWLEDGMENTS.

1662
00:54:32,090 --> 00:54:34,359
HUGE TEAM OF PEOPLE.

1663
00:54:34,359 --> 00:54:36,594
60 STAFF, FUNDED BY THE ACHIEVE

1664
00:54:36,594 --> 00:54:37,528
TRIAL TO DATE.

1665
00:54:37,528 --> 00:54:41,432
THIS THE IS JUST NOT EVEN A

1666
00:54:41,432 --> 00:54:42,800
COMPLETE SAMPLING THAT MADE ALL

1667
00:54:42,800 --> 00:54:47,672
THE SCIENCE POSSIBLE.

1668
00:54:47,672 --> 00:54:49,507
NIH VERY MUCH THANKS FOR

1669
00:54:49,507 --> 00:54:50,441
SUPPORTING THE CAREER

1670
00:54:50,441 --> 00:54:51,542
DEVELOPMENT THAT LAUNCHED ALL

1671
00:54:51,542 --> 00:54:53,945
THIS AND THE NIA WITH THE BULK

1672
00:54:53,945 --> 00:54:55,647
OF FUNDING FOR ACHIEVE TRIAL.

1673
00:54:55,647 --> 00:54:57,749
ALL THE HEARING AIDS WERE

1674
00:54:57,749 --> 00:54:59,350
DONATED BY ONE OF THE HEARING

1675
00:54:59,350 --> 00:54:59,884
COMPANIES.

1676
00:54:59,884 --> 00:55:01,286
NIH FUNDED THE TRIAL BUT THE

1677
00:55:01,286 --> 00:55:03,955
HEARING AIDS WERE DONATED.

1678
00:55:03,955 --> 00:55:06,991
AND THEN I WILL FINISH UP WITH A

1679
00:55:06,991 --> 00:55:09,694
COVER FROM A LANCET ARTICLE.

1680
00:55:09,694 --> 00:55:11,329
MORE INFORMATION ON THE ACHIEVE

1681
00:55:11,329 --> 00:55:12,297
STUDY AND THE HEARING NUMBER IF

1682
00:55:12,297 --> 00:55:13,965
YOU WANT TO LEARN WHAT YOUR

1683
00:55:13,965 --> 00:55:15,700
HEARING IS, YOU CAN LEARN HOW TO

1684
00:55:15,700 --> 00:55:23,207
GET YOUR HEARING NUMBER.

1685
00:55:23,207 --> 00:55:23,641
THANK YOU VERY MUCH.

1686
00:55:23,641 --> 00:55:25,443
>> WE HAVE LOTS OF
QUESTIONS ON

1687
00:55:25,443 --> 00:55:25,877
LINE.

1688
00:55:25,877 --> 00:55:29,781
PROBABLY CAN'T GET TO THEM ALL

1689
00:55:29,781 --> 00:55:30,481
BUT, PLEASE.

1690
00:55:30,481 --> 00:55:33,284
>> FRANK, THANK YOU AND

1691
00:55:33,284 --> 00:55:34,986
CONGRATULATIONS.

1692
00:55:34,986 --> 00:55:36,087
IT'S REALLY DIFFICULT TO

1693
00:55:36,087 --> 00:55:37,355
OVERSTATE THE IMPORTANCE OF THIS

1694
00:55:37,355 --> 00:55:37,755
STUDY.

1695
00:55:37,755 --> 00:55:39,557
THE RAMIFICATIONS ARE

1696
00:55:39,557 --> 00:55:40,591
TREMENDOUS.

1697
00:55:40,591 --> 00:55:43,461
AND WILL CONTINUE TO BE.

1698
00:55:43,461 --> 00:55:46,030
I'M FASCINATED BY THE MRI DATA.

1699
00:55:46,030 --> 00:55:46,764
I'M SHOCKED BY THAT.

1700
00:55:46,764 --> 00:55:50,835
YOU THINK OF AUDITORY

1701
00:55:50,835 --> 00:55:51,569
DEPRIVATION IN ADULTS AND NONE

1702
00:55:51,569 --> 00:55:53,571
OF US WOULD HAVE EVER PREDICTED

1703
00:55:53,571 --> 00:55:56,207
THAT THE ADULT BRAIN IS PLASTIC

1704
00:55:56,207 --> 00:55:58,443
ENOUGH TO REALLY RESPOND IN THIS

1705
00:55:58,443 --> 00:56:01,579
WAY THAT YOU HAVE MEASURED.

1706
00:56:01,579 --> 00:56:03,781
AND WHEN YOU THINK ABOUT THE

1707
00:56:03,781 --> 00:56:05,416
AVERAGE LENGTH OF TIME BETWEEN

1708
00:56:05,416 --> 00:56:07,585
WHEN AN ADULT COULD BENEFIT FROM

1709
00:56:07,585 --> 00:56:09,354
AMPLIFICATION AND WHEN THEY

1710
00:56:09,354 --> 00:56:11,889
ACTUALLY GET IT, IT'S AN AVERAGE

1711
00:56:11,889 --> 00:56:13,224
OF NINE YEARS.

1712
00:56:13,224 --> 00:56:14,959
IT'S A HUGE AMOUNT OF TIME.

1713
00:56:14,959 --> 00:56:17,528
I'M WONDERING IF YOU CAN COMMENT

1714
00:56:17,528 --> 00:56:20,064
AT ALL OR IF YOU LOOKED IN YOUR

1715
00:56:20,064 --> 00:56:22,266
DATA TO SEE HOW LONG THE PERIOD

1716
00:56:22,266 --> 00:56:24,035
OF HEARING LOSS WAS IN SOME OF

1717
00:56:24,035 --> 00:56:25,737
THE PARTICIPANTS BEFORE THEY

1718
00:56:25,737 --> 00:56:27,271
ENTERED INTO YOUR STUDY.

1719
00:56:27,271 --> 00:56:30,308
AND IF YOU THINK THAT THERE IS A

1720
00:56:30,308 --> 00:56:31,676
DIFFERENCE GIVEN THE LENGTH OF

1721
00:56:31,676 --> 00:56:34,846
TIME OF HEARING LOSS PRIOR TO

1722
00:56:34,846 --> 00:56:35,313
INTERVENTION.

1723
00:56:35,313 --> 00:56:36,514
>> THE GREAT QUESTION.

1724
00:56:36,514 --> 00:56:38,716
AND I THINK THE TRICKY THING IS

1725
00:56:38,716 --> 00:56:40,184
ALWAYS THAT WE THINK ABOUT

1726
00:56:40,184 --> 00:56:41,853
HEARING LOSS BEING A BINARY,

1727
00:56:41,853 --> 00:56:44,022
WHEN DID HEARING LOSS BEGIN?

1728
00:56:44,022 --> 00:56:47,025
WHEN REALISTICALLY IT'S A

1729
00:56:47,025 --> 00:56:47,859
MONTONIC TRAJECTORY OF OUR

1730
00:56:47,859 --> 00:56:49,494
ENTIRE LIFETIME.

1731
00:56:49,494 --> 00:56:51,796
SO IN THE ACHIEVE TRIAL WE HAD A

1732
00:56:51,796 --> 00:56:52,830
ROBUST INTERVIEW SURVEY OF

1733
00:56:52,830 --> 00:56:53,431
HEARING LOSS.

1734
00:56:53,431 --> 00:56:55,933
SO THE ONE THING WE WANTED TO

1735
00:56:55,933 --> 00:56:59,871
EXCLUDE IS PEOPLE ANY TYPE OF

1736
00:56:59,871 --> 00:57:00,271
EARLY ADULT ONSET.

1737
00:57:00,271 --> 00:57:01,572
THEY WERE EXCLUDED.

1738
00:57:01,572 --> 00:57:03,274
FROM THERE, WE HAD MEASURES ON

1739
00:57:03,274 --> 00:57:04,776
HEARING IN PEOPLE YEARS AND

1740
00:57:04,776 --> 00:57:06,544
YEARS, WE DON'T KNOW AT WHAT

1741
00:57:06,544 --> 00:57:08,613
POINT IT ACCELERATED.

1742
00:57:08,613 --> 00:57:10,148
THE ONE THING WE KNOW THIS WAS

1743
00:57:10,148 --> 00:57:12,650
NOT EARLY-ONSET.

1744
00:57:12,650 --> 00:57:14,085
NOT EARLY ADULT ONSET.

1745
00:57:14,085 --> 00:57:18,189
THE BREAD AND BUTTER EVERYONE

1746
00:57:18,189 --> 00:57:19,390
EXPERIENCED OVER TIME, THAT WAS

1747
00:57:19,390 --> 00:57:20,291
THE MAIN THING.

1748
00:57:20,291 --> 00:57:24,395
THERE ARE A FEW SAMPLE OF

1749
00:57:24,395 --> 00:57:27,598
PARTICIPANTS WITH TRAJECTORIES.

1750
00:57:27,598 --> 00:57:29,801
THEY WERE PREVIOUSLY

1751
00:57:29,801 --> 00:57:30,435
CHARACTERIZED AS WELL.

1752
00:57:30,435 --> 00:57:35,706
BUT KEY THING IS NO ONE IS

1753
00:57:35,706 --> 00:57:36,174
CERTAINLY EARLY-ONSET.

1754
00:57:36,174 --> 00:57:38,443
THIS WAS ALL PEOPLE WHO WERE NOT

1755
00:57:38,443 --> 00:57:40,878
USING HEARING AIDS AT THE TIME.

1756
00:57:40,878 --> 00:57:42,980
>> LET ME GET ONE QUESTION
IN

1757
00:57:42,980 --> 00:57:44,482
OVER HERE FROM ON LINE.

1758
00:57:44,482 --> 00:57:45,683
INTERESTING IT COMES FROM A

1759
00:57:45,683 --> 00:57:47,351
COLLEAGUE AT AARP.

1760
00:57:47,351 --> 00:57:48,553
VERY GOOD AUDIENCE FOR US.

1761
00:57:48,553 --> 00:57:51,989
CAN YOU LIST THE INCREASED RISK

1762
00:57:51,989 --> 00:57:53,591
FACTORS THAT MADE THE HEARING

1763
00:57:53,591 --> 00:57:55,326
AIDS MOST HELPFUL AND WHAT

1764
00:57:55,326 --> 00:57:57,595
PERCENTAGE OF OLDER POPULATIONS

1765
00:57:57,595 --> 00:58:00,898
FITS INTO THIS INCREASED RISK

1766
00:58:00,898 --> 00:58:01,699
PROFILE?

1767
00:58:01,699 --> 00:58:03,734
>> SO, I THINK THE
QUESTIONS

1768
00:58:03,734 --> 00:58:05,636
SPECIFICALLY AROUND THE ARIC

1769
00:58:05,636 --> 00:58:07,038
VERSUS DE NOVO COHORTS.

1770
00:58:07,038 --> 00:58:11,075
THE ARIC COHORT WAS RANDOMLY

1771
00:58:11,075 --> 00:58:11,676
SAMPLED FROM A POPULATION 35

1772
00:58:11,676 --> 00:58:13,511
YEARS WHEN THEY WERE RECRUITED

1773
00:58:13,511 --> 00:58:15,913
AND THEN DE NOVO WAS SELF

1774
00:58:15,913 --> 00:58:16,180
SELECTED.

1775
00:58:16,180 --> 00:58:19,717
ON ANGEL WE SAW THE ARIC

1776
00:58:19,717 --> 00:58:21,619
COHORT -- DE NOVO FEWER RISK

1777
00:58:21,619 --> 00:58:23,754
FACTORS THAN ARIC.

1778
00:58:23,754 --> 00:58:26,290
BUT IT WAS JUST ON AVERAGE.

1779
00:58:26,290 --> 00:58:30,962
NOT LIKE A PRICE RISK FACTORS.

1780
00:58:30,962 --> 00:58:34,031
IN THE WHOLE COHORT PROPENSITY

1781
00:58:34,031 --> 00:58:34,765
SCORE ANALYSIS.

1782
00:58:34,765 --> 00:58:36,534
IF AWAITING MULTIPLE RISK

1783
00:58:36,534 --> 00:58:38,035
FACTORS AND RISK OF COGNITIVE

1784
00:58:38,035 --> 00:58:40,238
DECLINE, WHEN YOU ANALYZE ENTIRE

1785
00:58:40,238 --> 00:58:41,973
COHORTS THAT WAY, WHAT YOU SEE

1786
00:58:41,973 --> 00:58:42,940
AGAIN IS VERY CONSISTENT WITH

1787
00:58:42,940 --> 00:58:45,243
THE RESULTS, PEOPLE OF A HIGHER

1788
00:58:45,243 --> 00:58:46,644
PROPENSITY FOR COGNITIVE DECLINE

1789
00:58:46,644 --> 00:58:49,247
AND PROTECTIVE EFFECT OF HEARING

1790
00:58:49,247 --> 00:58:49,580
INTERVENTION.

1791
00:58:49,580 --> 00:58:50,348
AGAIN NOT SURPRISING.

1792
00:58:50,348 --> 00:58:51,949
YOU HAVE TO HAVE COGNITIVE

1793
00:58:51,949 --> 00:58:53,551
DECLINE TO REDUCE AN EFFECT BUT

1794
00:58:53,551 --> 00:58:56,420
YOU SEE THAT TYPE OF -- THERE IS

1795
00:58:56,420 --> 00:58:58,422
NOT A CERTAIN CONSTELLATION OR

1796
00:58:58,422 --> 00:58:59,524
DIRECT MEASURE.

1797
00:58:59,524 --> 00:59:01,926
ONE REPRESENTS A RANDOM SAMPLE

1798
00:59:01,926 --> 00:59:10,334
AND SELF SELECTED POPULATION.

1799
00:59:10,334 --> 00:59:14,672
>> YES, I AM ELDERLY MALE,

1800
00:59:14,672 --> 00:59:19,277
HEARING AID WEARER WITH CHRONIC

1801
00:59:19,277 --> 00:59:21,445
CARDIOVASCULAR DISEASE.

1802
00:59:21,445 --> 00:59:30,922
I TAKE STATENS AND I TAKE CLOT

1803
00:59:30,922 --> 00:59:31,189
BREAKERS.

1804
00:59:31,189 --> 00:59:35,660
AND I WAS CONCERNED ABOUT YOUR

1805
00:59:35,660 --> 00:59:42,200
ARIC POPULATION, WHICH WAS

1806
00:59:42,200 --> 00:59:47,071
UNSELECTED GROUP OF PEOPLE

1807
00:59:47,071 --> 00:59:50,274
MID-LIFE, WHO WE HAVE REASON TO

1808
00:59:50,274 --> 00:59:54,845
BELIEVE HAVE CHRONIC

1809
00:59:54,845 --> 00:59:56,247
CARDIOVASCULAR CONDITIONS.

1810
00:59:56,247 --> 01:00:00,484
SO MY QUESTION IS, DID YOU TREAT

1811
01:00:00,484 --> 01:00:03,054
THEM FOR THOSE CONDITIONS?

1812
01:00:03,054 --> 01:00:04,989
DID YOU DIAGNOSE AND TREAT THEM

1813
01:00:04,989 --> 01:00:07,892
AND FOLLOW THEM UP FOR THOSE

1814
01:00:07,892 --> 01:00:08,192
CONDITIONS?

1815
01:00:08,192 --> 01:00:08,693
>> GREAT QUESTION.

1816
01:00:08,693 --> 01:00:11,195
SO THE ARIC SAMPLE, THEY WERE

1817
01:00:11,195 --> 01:00:12,296
RECRUITED OVER 35 YEARS AGO IN

1818
01:00:12,296 --> 01:00:13,598
MID LIFE.

1819
01:00:13,598 --> 01:00:18,202
THEY REPRESENTED A RANDOM

1820
01:00:18,202 --> 01:00:18,436
SAMPLE.

1821
01:00:18,436 --> 01:00:20,004
SO THEY WEREN'T AT INCREASED

1822
01:00:20,004 --> 01:00:22,206
RISK FOR CARDIOVASCULAR EVENTS.

1823
01:00:22,206 --> 01:00:24,342
IT WAS A GENERAL SAMPLE OF THE

1824
01:00:24,342 --> 01:00:24,675
INTERVENTION.

1825
01:00:24,675 --> 01:00:26,811
THE STUDY WAS NOT RECEIVING

1826
01:00:26,811 --> 01:00:27,912
TREATMENT WITHIN THE STUDY BUT

1827
01:00:27,912 --> 01:00:30,314
ANY DATA REGARDING THEIR

1828
01:00:30,314 --> 01:00:31,449
CARDIOVASCULAR HEALTH WAS

1829
01:00:31,449 --> 01:00:32,483
RELAYED TO THEM AND THEIR

1830
01:00:32,483 --> 01:00:33,451
PHYSICIANS SO OVER TIME WE

1831
01:00:33,451 --> 01:00:34,919
EXPECT MANY OF THEM OBVIOUSLY

1832
01:00:34,919 --> 01:00:37,421
HAD THEIR CARDIOVASCULAR HEALTH

1833
01:00:37,421 --> 01:00:38,656
TREATED AS THEY WOULD PER USUAL

1834
01:00:38,656 --> 01:00:39,390
CLINICAL CARE.

1835
01:00:39,390 --> 01:00:43,294
IF ANYTHING, BY BEING IN ARIC,

1836
01:00:43,294 --> 01:00:44,629
THEY GOT ADDITIONAL DIAGNOSTICS

1837
01:00:44,629 --> 01:00:46,097
AND ADDITIONAL KNOWLEDGE ABOUT

1838
01:00:46,097 --> 01:00:49,100
THEIR CARDIOVASCULAR HEALTH.

1839
01:00:49,100 --> 01:00:50,701
>> BUT YOUR STUDY DIDN'T
FOLLOW

1840
01:00:50,701 --> 01:00:51,369
THEM UP?

1841
01:00:51,369 --> 01:00:55,640
IT LEFT IT TO THEM TO SEEK OUT

1842
01:00:55,640 --> 01:00:57,241
THEIR CARE?

1843
01:00:57,241 --> 01:00:58,209
>> YES, CORRECT.

1844
01:00:58,209 --> 01:00:59,410
SO THEY HAVE BEEN FOLLOWED FOR

1845
01:00:59,410 --> 01:01:00,645
MANY, MANY YEARS.

1846
01:01:00,645 --> 01:01:01,612
ALWAYS BEEN FOLLOWED BY THEIR

1847
01:01:01,612 --> 01:01:02,446
ROUTINE PHYSICIANS AS WELL.

1848
01:01:02,446 --> 01:01:04,448
SO MANY OF THEM, IF THEY HAD ANY

1849
01:01:04,448 --> 01:01:07,118
TYPE OF HYPERTENSION OR

1850
01:01:07,118 --> 01:01:07,818
DIABETES, THEY WERE BEING

1851
01:01:07,818 --> 01:01:11,522
TREATED BY THEIR PRIMARY CARE

1852
01:01:11,522 --> 01:01:11,822
PHYSICIAN.

1853
01:01:11,822 --> 01:01:17,428
>> HOW MANY OF THEM HAD
ROUTINE

1854
01:01:17,428 --> 01:01:21,232
PHYSICIANS SINCE THEY LIVED IN

1855
01:01:21,232 --> 01:01:23,234
COMMUNITIES WHICH HAD AIR

1856
01:01:23,234 --> 01:01:26,137
POLLUTION AND OTHER CRITERIA

1857
01:01:26,137 --> 01:01:30,841
WHICH MADE THEM THINK THAT MAKES

1858
01:01:30,841 --> 01:01:33,077
ME WONDER HOW MANY PHYSICIANS

1859
01:01:33,077 --> 01:01:35,846
THEY HAD FOR THE POPULATION AND

1860
01:01:35,846 --> 01:01:39,116
HOW MANY PHYSICIAN VISITS THEY

1861
01:01:39,116 --> 01:01:39,283
HAD?

1862
01:01:39,283 --> 01:01:46,157
IT RAISES IN MY MIND A QUESTION

1863
01:01:46,157 --> 01:01:50,294
OF ETHICS WHICH HAS AFFECTED

1864
01:01:50,294 --> 01:01:53,798
NEGATIVELY THIS INSTITUTION IN

1865
01:01:53,798 --> 01:01:56,567
THE PAST AND SO THAT'S WHY I'M

1866
01:01:56,567 --> 01:01:58,569
RAISING THE QUESTION.

1867
01:01:58,569 --> 01:01:59,337
>> I APPRECIATE YOUR POINT

1868
01:01:59,337 --> 01:02:00,671
BECAUSE IT COMES OUT HOW WE

1869
01:02:00,671 --> 01:02:02,173
TREAT STUDY POPULATIONS AND HOW

1870
01:02:02,173 --> 01:02:03,541
MUCH INFORMATION WE PROVIDE

1871
01:02:03,541 --> 01:02:03,741
THEM.

1872
01:02:03,741 --> 01:02:06,977
THE ARIC COHORT WAS LONGLY

1873
01:02:06,977 --> 01:02:07,244
FOLLOWED.

1874
01:02:07,244 --> 01:02:09,013
MANY, MANY PUBLICATIONS.

1875
01:02:09,013 --> 01:02:10,881
MUCH ENGAGEMENT STUDIES THAT'S

1876
01:02:10,881 --> 01:02:12,483
WHY THEY HAD BE FOLLOWED FOR SO

1877
01:02:12,483 --> 01:02:12,683
LONG.

1878
01:02:12,683 --> 01:02:13,851
SO I'M HAPPY TO TALK MORE OFF

1879
01:02:13,851 --> 01:02:15,286
LINE ABOUT IT.

1880
01:02:15,286 --> 01:02:17,221
BUT IT'S A VERY, VERY WELL

1881
01:02:17,221 --> 01:02:19,223
STUDIED POPULATION THAT RECEIVED

1882
01:02:19,223 --> 01:02:20,391
PHENOMENAL HEALTH DATA FROM THE

1883
01:02:20,391 --> 01:02:23,694
STUDY FOR WHICH THE STUDIES ARE

1884
01:02:23,694 --> 01:02:25,129
CONSTANTLY IN TOUCH WITH THE

1885
01:02:25,129 --> 01:02:27,698
PARTICIPANTS PHYSICIANS IN MANY

1886
01:02:27,698 --> 01:02:28,799
CASES TO RELAY HEALTH DATA.

1887
01:02:28,799 --> 01:02:30,768
I'M HAPPY TO CHAT MORE LATER AND

1888
01:02:30,768 --> 01:02:33,204
GIVE YOU MORE RESOURCES FOR

1889
01:02:33,204 --> 01:02:34,705
LEARNING MORE.

1890
01:02:34,705 --> 01:02:36,774
>> I'LL TAG ON TO THAT.

1891
01:02:36,774 --> 01:02:39,310
IS THERE ANY EVIDENCE THAT

1892
01:02:39,310 --> 01:02:41,278
VASCULAR RISK FACTORS ARE A

1893
01:02:41,278 --> 01:02:43,047
MODIFIABLE THING FOR HEARING

1894
01:02:43,047 --> 01:02:43,714
LOSS?

1895
01:02:43,714 --> 01:02:45,216
>> FOR HEARING LOSS?

1896
01:02:45,216 --> 01:02:49,520
I THOUGHT YOU WERE GOING TO SAY

1897
01:02:49,520 --> 01:02:51,422
DEMENTIA.

1898
01:02:51,422 --> 01:02:52,790
SO, YES AND NO.

1899
01:02:52,790 --> 01:02:54,992
WHAT I MEAN BY PLENTY OF

1900
01:02:54,992 --> 01:02:57,194
OBSERVATIONAL DATA SUGGESTING

1901
01:02:57,194 --> 01:02:59,897
CARDIOVASCULAR RISK FACTORS FOR

1902
01:02:59,897 --> 01:03:05,469
HEART HEALTH AND FOR HEARING

1903
01:03:05,469 --> 01:03:05,703
HEALTH.

1904
01:03:05,703 --> 01:03:08,873
I WOULD SAY ANECDOTAL BUT FROM

1905
01:03:08,873 --> 01:03:10,074
OBSERVATIONAL DATA, I NEVER

1906
01:03:10,074 --> 01:03:11,275
LOOKED AT TO THE CLOSELY BUT IN

1907
01:03:11,275 --> 01:03:14,612
TERMS OF PEOPLE WHO ARE OR HAVE

1908
01:03:14,612 --> 01:03:17,348
BETTER CONTROLLED OR BETTER

1909
01:03:17,348 --> 01:03:18,749
HEARING -- IT WOULD MAKE SENSE.

1910
01:03:18,749 --> 01:03:20,518
SO NOT A TRIAL LOOKING AT THAT.

1911
01:03:20,518 --> 01:03:21,685
THE TRIAL WOULD HAVE TO GO ON

1912
01:03:21,685 --> 01:03:24,221
FOR MANY, MANY DECADES AND

1913
01:03:24,221 --> 01:03:25,423
PROBABLY MORE PEOPLE TO LOOK AT

1914
01:03:25,423 --> 01:03:27,525
THAT FOR CARDIOVASCULAR HEALTH.

1915
01:03:27,525 --> 01:03:29,493
BUT FOR OBSERVATIONAL DATA, IF I

1916
01:03:29,493 --> 01:03:31,762
RECALL THERE WAS SOME STUDY

1917
01:03:31,762 --> 01:03:33,097
SUGGESTING BETTER CONTROL OF A

1918
01:03:33,097 --> 01:03:36,333
MID LIFE CARDIOVASCULAR AND

1919
01:03:36,333 --> 01:03:38,068
HEARING -- THERE PROBABLY IS

1920
01:03:38,068 --> 01:03:38,969
SOME INDICATION WHICH WOULD MAKE

1921
01:03:38,969 --> 01:03:41,806
SENSE WITH THE LITERATURE.

1922
01:03:41,806 --> 01:03:42,406
>> CONGRATULATIONS ON YOUR

1923
01:03:42,406 --> 01:03:44,809
BEAUTIFUL STUDY AND WONDERFUL

1924
01:03:44,809 --> 01:03:45,009
TALK.

1925
01:03:45,009 --> 01:03:46,644
I WAS WONDERING, FOR THOSE

1926
01:03:46,644 --> 01:03:48,579
PATIENTS WHO HAVE MILD HEARING

1927
01:03:48,579 --> 01:03:50,881
LOSS AND TRIED HEARING AIDS BUT

1928
01:03:50,881 --> 01:03:51,916
DON'T LIKE THEM, WHAT DO YOU

1929
01:03:51,916 --> 01:03:53,217
TELL THEM?

1930
01:03:53,217 --> 01:03:56,320
>> SO FOR THE ACHIEVE
TRIAL AND

1931
01:03:56,320 --> 01:03:58,122
DR. CHEN IS ONE OF MY COLLEAGUES

1932
01:03:58,122 --> 01:04:00,624
AT HOPKINS, LOOKS LIKE YOU

1933
01:04:00,624 --> 01:04:02,259
HOPPED ACROSS THE STREET IN YOUR

1934
01:04:02,259 --> 01:04:03,127
SCRUBS, THANKS FOR COMING OVER.

1935
01:04:03,127 --> 01:04:05,129
IN THE ACHIEVE TRIAL THIS IS

1936
01:04:05,129 --> 01:04:05,996
INTENTION TO TREAT.

1937
01:04:05,996 --> 01:04:08,232
SO FUNDAMENTALLY YOU SAW THE

1938
01:04:08,232 --> 01:04:09,834
HISTOGRAM OF HEARING AID USE.

1939
01:04:09,834 --> 01:04:10,901
SOME STOPPED USING THEM.

1940
01:04:10,901 --> 01:04:12,670
SO THEY ARE STILL INCLUDED IN

1941
01:04:12,670 --> 01:04:14,305
THE COHORT WITH INTENTION TO

1942
01:04:14,305 --> 01:04:14,572
TREAT.

1943
01:04:14,572 --> 01:04:19,710
I DIDN'T SHOW THIS BUT 17% OF

1944
01:04:19,710 --> 01:04:21,946
THE CONTROL GROUP, THEY GOT

1945
01:04:21,946 --> 01:04:22,847
HEARING AIDS ON THEIR OWN BEFORE

1946
01:04:22,847 --> 01:04:23,781
THE END OF THE STUDY.

1947
01:04:23,781 --> 01:04:25,115
THIS THE IS ALL IN TENSION TO

1948
01:04:25,115 --> 01:04:25,516
TREAT.

1949
01:04:25,516 --> 01:04:27,017
THEY ARE TREATED IN THEIR

1950
01:04:27,017 --> 01:04:28,252
ASSIGNED GROUPS, WITH A HEARING

1951
01:04:28,252 --> 01:04:30,788
AID OR YOU GOT A HEARING AIDS

1952
01:04:30,788 --> 01:04:31,722
OUTSIDE OF THE STUDY.

1953
01:04:31,722 --> 01:04:33,991
SO INTENTION TO TREAT SO THE

1954
01:04:33,991 --> 01:04:35,459
RESULTS ARE STILL CONSERVATIVE.

1955
01:04:35,459 --> 01:04:42,500
IF WE APPLY A PROTOCOL ANALYSIS,

1956
01:04:42,500 --> 01:04:44,268
WHERE YOU EXCLUDE THOSE PEOPLE

1957
01:04:44,268 --> 01:04:45,202
OR TREAT THEM DIFFERENTLY IN

1958
01:04:45,202 --> 01:04:46,637
TERMS OF ANALYSIS, THE RESULTS

1959
01:04:46,637 --> 01:04:47,838
GET STRONGER.

1960
01:04:47,838 --> 01:04:49,740
BUT REALLY IT'S AN INTENTION TO

1961
01:04:49,740 --> 01:04:50,708
TREAT STUDY.

1962
01:04:50,708 --> 01:04:53,310
SO IF PEOPLE WANT TO USE HEARING

1963
01:04:53,310 --> 01:04:59,683
AIDS -- CAN'T DO ANYTHING ABOUT

1964
01:04:59,683 --> 01:04:59,850
IT.

1965
01:04:59,850 --> 01:05:02,286
I WOULD SAY IT'S THE TESTAMENT

1966
01:05:02,286 --> 01:05:03,821
THAT IS IMPORTANT IF YOU ARE

1967
01:05:03,821 --> 01:05:05,456
THINKING ABOUT SCALING.

1968
01:05:05,456 --> 01:05:06,490
THE TECHNOLOGY IS IMPORTANT AND

1969
01:05:06,490 --> 01:05:08,259
MORE IMPORTANT IN THE STUDY

1970
01:05:08,259 --> 01:05:11,495
ACTUALLY WAS THE AUDIOLOGIST

1971
01:05:11,495 --> 01:05:12,963
REMAINING ENGAGED WITH THAT

1972
01:05:12,963 --> 01:05:14,798
PARTICIPANT EVERY SIX MONTHS AND

1973
01:05:14,798 --> 01:05:15,332
CHECKING IN.

1974
01:05:15,332 --> 01:05:16,901
FOR 82-YEAR-OLD NOT FAMILIAR

1975
01:05:16,901 --> 01:05:19,837
WITH TECHNOLOGY, SAYING HERE ARE

1976
01:05:19,837 --> 01:05:20,905
YOUR HEARING AIDS, GOOD LUCK.

1977
01:05:20,905 --> 01:05:22,806
I GUARANTEED THIS TRIAL WILL

1978
01:05:22,806 --> 01:05:23,007
FAIL.

1979
01:05:23,007 --> 01:05:25,576
SOMEONE IS SUPPORTING THE USE

1980
01:05:25,576 --> 01:05:26,210
EVERY 6 CHOPS AND THAT MADE ALL

1981
01:05:26,210 --> 01:05:28,746
THE DIFFERENCE LIKELY.

1982
01:05:28,746 --> 01:05:30,314
SOME PEOPLE DID STOP USING

1983
01:05:30,314 --> 01:05:32,816
HEARING AIDS SO IT IS STILL

1984
01:05:32,816 --> 01:05:36,487
INTENTION TO TREAT.

1985
01:05:36,487 --> 01:05:37,721
>> PERHAPS WE'LL END IT
HERE.

1986
01:05:37,721 --> 01:05:38,856
WE ARE PAST THE HOUR.

1987
01:05:38,856 --> 01:05:40,791
THERE WILL BE A RECEPTION OUT

1988
01:05:40,791 --> 01:05:41,025
THERE.

1989
01:05:41,025 --> 01:05:42,693
I HOPE EVERYONE CAN JOIN US.

1990
01:05:42,693 --> 01:05:43,894
THANK YOU, AGAIN.

1991
01:05:43,894 --> 01:05:44,862
THANK YOU, EVERYONE.

1992
01:05:44,862 --> 01:05:55,072
[ APPLAUSE ]