HI, EVERYONE.
WELCOME TO THE WEDNESDAY
AFTERNOON LECTURE SERIES.
I'M CHIEF OF THE STROKE BRANCH
AT NINDS, I'M WAIT TOED TO
INTRODUCE DR. FRANK LIN FROM
JOHNS HOPKINS WITH THE IDEA OF
HEARING LOSS WITH DEMENTIA.
WE ENCOURAGE YOU TO PARTICIPATE
IN THE Q&A AFTER TODAY'S
PRESENTATION.
CLICK ON THE BUTTON JUST BELOW
YOUR VIDEOCAST WINDOW, CLICK ON
THAT AND TYPE IN YOUR NAME AND
QUESTION AND WE'LL RELAY THIS TO
DR. LYNNE.
YOU CAN SUBMIT A QUESTION AT ANY
TIME.
FOR THOSE HERE IN PERSON IN THE
AMPHITHEATER, USE THE MICS ON
EITHER SIDE.
WE ARE OFFERING CME CREDITS.
THE CODE FOR TODAY IS 50099.
50099.
RETURN TO OUR SPEAKER FOR
TODAY'S TALK
Frank R.Lin, M.D., Ph.D. is a
Professor of Otolaryngology,
Medicine, Mental Health, and
Epidemiology and director of the
Cochlear Center for Hearing and
Public Health, a research center
based at the Bloomberg School of
Public Health. Dr. Lin completed
his medical education, residency
in Otolaryngology, and Ph.D. in
Clinical Investigation, all at
Johns Hopkins. He completed
further otologic fellowship
training in Lucerne,
Switzerland. Dr. Lin's clinical
practice is dedicated to otology
and the medical and surgical
management of hearing loss. Hi
HIS SCIENTIFIC CAREER STARTED AS
A SUMMER STUDENT HERE DURING
HIGH SCHOOL AND THEN DURING
MEDICAL SCHOOL, HERE AT THE NIH.
DID UNDERGRADUATE DEGREE AT
BROWN UNIVERSITY AND CAME TO
HOPKINS FOR HIS MEDICAL DEGREE
FOLLOWED BY SURGERY, INTERNSHIP
AND ENT RESIDENCY.
HE ALSO COMPLETED A PH.D. IN
CLINICAL INVESTIGATION AT THE
HOPKINS BLOOMBERG SCHOOL OF
PUBLIC HEALTH AND MICROSURGERY
BEFORE HE CAME BACK TO HOPKINS
AND JOINED THE FACULTY.
HE ROWS THROUGH THE RANKS
QUICKLY ACHIEVING RANK OF FULL
PROFESSOR IN 2018, WHEN HE
FOUNDED THE COCHLEAR CENTER AND
BECAME THE INAUGURAL DIRECTOR.
DR. LYNNE MADE MAJOR
CONTRIBUTIONS IN THE
INVESTIGATION ON THE ROLE OF
HEARING LOSS AS A MODIFIABLE
RISK FACTOR AND FOUNDATIONAL
WORK IN MAKING HEARING LOSS AS A
MAJOR RECOMMENDATION FROM THE
LANCET COMMISSION ON DEMENTIA AS
A POTENTIAL MODIFIABLE AS THE
RISK FACTOR FOR DEMENTIA.
IN ADDITION, HE PLAYED A MAJOR
ROLE ON THE PUBLIC HEALTH SIDE
OF THINGS AND YOU'LL HEAR A
LITTLE BIT ABOUT THIS.
HIS CONGRESSIONAL TESTIMONY WAS
REALLY LARGELY RESPONSIBLE FOR
THE ENACTMENT OF
OVER-THE-COUNTER HEARING AID ACT
IN 2022.
DR. LYNNE HAS BEEN PROLIFIC IN
PUBLICATIONS AND RECENT EXCITING
WORK, INCLUDING THE ACHIEVE
TRIAL AND HIGHLY SOUGHT OUT AS A
SPEAKER AND FUNDED THROUGH NIH
INSTITUTES.
AND REALLY ALSO BEEN A
TREMENDOUS MENTOR AND ALL THE
WHILE DOING A MASSIVE CLINICAL
PRACTICE.
WE ARE EXCITED TO HAVE HIM HERE
TODAY.
PLEASE JOIN ME IN WELCOMING
DR. LYNNE.
[ APPLAUSE ]
>> GOOD AFTERNOON, EVERYONE AND
THANK YOU ALL FOR BEING HERE IN
PERSON.
IT'S REALLY A TREATED FOR ME
COMING BACK HERE AND AS REBECCA
ALLUDED TO, I WAS HERE AS A
SUMMER STUDENT WHEN I WAS 17
YEARS OLD.
AND I HOPEFULLY WAS INSPIRED BY
THE WONDERFUL SCIENCE I HEARD
AROUND ME.
I USUALLY FELL ASLEEP.
MUCH SCIENCE WAS WAY ABOVE MY
HEAD WHEN I WAS 17 YEARS OLD.
SO MY ONE GOAL TODAY IS TO
HOPEFULLY NO ONE FALLS ASLEEP.
I HAVE A FEW DISCLOSURES.
NONE OF THESE COMPANIES WILL BE
DISCUSSED TODAY.
NOT RELEVANT TO TODAY'S TALK.
AND THE TALK IS TITLED FROM
EPIDEMIOLOGICAL INSIGHTS TO
ACHIEVE PUBLIC POLICY.
AND BEGINNING FROM CLINICAL
INSIGHTS, DURING MY TRAINING IN
ENT SURGERY AT HOPKINS, I WOULD
SEE A ROOM LIKE THIS AND THIS
SHOWS A 7-YEAR-OLD CHILD THAT
HAS A MILD PROGRESSIVE TO
MODERATE SEVERE HEARING LOSS.
DOESN'T MATTER WHO YOU ASK,
INSURANCE COMPANY, PARENT,
SCHOOLTEACHER, THEY WOULD SAY
THIS HEARING HAS TO BE
ADDRESSED.
THIS COULD IMPACT AUDITORY
CODING THAT CAN AFFECT THIS
CHILD'S BRAIN AND HOW THIS CHILD
IS IN THE CLASSROOM AND
PLAYGROUND SETTING.
THIS WOULD DEFINITELY BE
TREATED.
THE PARADOX IS THAT IF SHE WAS
72 YEARS OLD, THE SAME HEARING
TEST AND FUNCTIONAL IMPACT AND
AUDITORY CODING, SIGNALS
RECEIVED BY THE BRAIN AND FOR A
72-YEAR-OLD, THE REACTION YOU'LL
GET EVEN AMONG CLINICIANS IS A
BIT OF A OKAY, YOU HAVE A MILD
TO MODERATE HEARING LOSS.
I ALWAYS RECOGNIZE WHAT BUGGED
ME WHEN I WAS GOING THROUGH
RESIDENCY.
IMPORTANT FOR A 7-YEAR-OLD AND
NOW YOU'RE 72 AND IT MAY NOT BE
SO IMPORTANT ANYMORE.
AND I THINK A LOT OF PSYCHOLOGY
COMES FROM THIS.
IF WE LOOK AT HOW COMMON A
HEARING LOSS IS ACROSS THE
LIFESPAN IT NEARLY DOUBLES EVERY
DECADE.
THE INNER EAR IS POST MITOTIC SO
FUNDAMENTAL AGING AND
DEGENERATION IN THE INNER EAR
THAT HAPPENS ACROSS OUR LIFESPAN
NO MATTER WHO YOU ARE.
IF HEARING IS RARE IN CHILDREN,
IT'S VERY IMPORTANT BUT IF
TWO-THIRDS ARE 60 AND ABOVE HAS
A MEANINGFUL HEARING IMPAIRMENT,
THE PSYCHOLOGY IS WELL, EVERYONE
HAS IT AND SO HOW CAN IT BE
IMPORTANT?
IT BOTHERED ME BECAUSE IT DIDN'T
JIVE WITH WHAT I SAW CLINICALLY.
AND YOU CAN BACKTRACK WITH BASIC
LOGICAL QUESTIONS.
HEARING LOSS IN OLDER ADULTS, IS
IT JUST AGE IN THE INNER EAR,
MILD EFFECT ON COMMUNICATION?
THE ANSWER TO THAT QUESTION, YOU
HAVE TO HAVE EPIDEMIOLOGICAL
STUDIES.
FROM THERE IF THIS IS IMPACT,
WHAT HAPPENS?
WE TREAT THE HEARING LOSS.
DOES THAT MAKE A DIFFERENCE IN
OLDER ADULTS?
YOU HAVE TO HAVE CONTROL TRIALS.
AND FINALLY IF I'M TELLING YOU
TWO-THIRDS OF EVERYONE OVER 60
HAS HEARING, HOW DO YOU ADDRESS
THAT AT SCALE?
YOU REALIZE THESE SAME QUESTIONS
APPLY TO CHILDREN AND HAVE BEEN
ANSWERED.
THE IMPACT WITH HEARING LOSS OF
CHILDREN AND WE KNOW WHAT
HAPPENS IF YOU TREAT IT EARLY ON
AND THEN YOU HAVE HEARING
SCREENING.
THESE SAME QUESTIONS WHEN
APPLIED TO ADULTS AS I BEGAN MY
CAREER, I REALIZED MUCH OF THE
BIAS WE HAD FOR HEARING LOSS IN
ADULTS IS BECAUSE THESE BASIC
QUESTIONS HADN'T BEEN ANSWERED.
THESE DRIVE WHAT I DO TODAY WITH
ASKING THESE THREE BASIC
QUESTIONS.
WHAT I'M GOING TO FOCUS TODAY ON
IS THE WORK WE HAVE DONE AROUND
HEARING LOSS AND DEMENTIA AND
THEN TAKING YOU THROUGH THE
TRIALS AND THEN A FEW SLIDES ON
HOW IT HAS SHAPED POLICY IN THE
UNITED STATES AND AROUND THE
WORLD.
SO THE REASON WHY I LOOKED AT
THIS IN 2010 IS BECAUSE DURING
RESIDENCY, I GOT BOTHERED BY THE
FACT THERE WAS DISPARITY BETWEEN
CHILDREN AND ADULTS.
THIS STUDY IN 1989,
EPIDEMIOLOGICAL PERSPECTIVE,
MOST BASIC FORM OF EVIDENCE, A
CASE-CONTROLLED STUDY.
100 WITH DEMENTIA AND 100
WITHOUT.
ON AVERAGE DOSE DEPEND END
RELATIONSHIP BETWEEN THE
SEVERITY OF HEARING LOSS AND THE
ODDS OF HAVING DEMENTIA.
SO YOU CAN IMAGINE TYPICALLY AND
THIS JIVED WITH WHAT I SAW
CLINICALLY.
I SEEN PATIENTS AND THEY WOULD
SAY I'M STRAINING TO HEAR MORE.
MY MOTHER IS JUST NOT WHAT SHE
USED TO BE, NOT AS ENGAGED.
SO IT JIVED WITH WHAT I SAW.
SO THERE WAS NO FURTHER
CONFIRMATORY EVIDENCE.
BASIC CASE CONTROL STUDIES, AND
THEN PROGRESSED TO A
LONGITUDINAL STUDY WHEN YOU
CONFIRM PROSPECTIVELY.
IT HAD NEVER BEEN DONE BEFORE.
SO THIS BUGGED ME.
I JOINED THE FACULTY AND THEN I
CAME ACROSS A SCIENTIFIC
DIRECTOR OF THE NIA AND I'LL
FOREVER BE GRATEFUL TO HIM.
I WAS INTRODUCED TO HIM THROUGH
A FRIEND, COLLEAGUE, AND I SAID,
BACK THEN HE WAS JUST THE
DIRECTOR OF LONGITUDINAL STUDY
SECTION.
I SAID I GOT INTRODUCED TO YOU
AND I'M INTERESTED IN LOOKING
INTO THIS TOPIC.
YOU WORK WITH BLSA, WOULD YOU BE
WILLING TO COLLABORATE WITH ME?
HE SAID ABSOLUTELY.
HE INTRODUCED ME TO HIS LAB AND
IN THE EARLY 90s, THEY
MEASURED HEARING FOR ABOUT
40-YEAR PERIOD AND THEN THEY
STOPPED MEASURING HEARING, BUT
THEY HAD GOOD DATA FOR A GOOD
4-YEAR PERIOD.
WE LOOKED AT 640 ADULTS WHO HAD
BEEN FOLLOWED AND HAD
ADJUDICATED MEASURES OF DEMENTIA
OVER TIME AND SAW VERY, VERY
CLEAR RELATIONSHIP BETWEEN THE
SEVERITY OF HEARING LOSS AT
BASELINE, KAPLAN-MEIER ON THE
LEFT LOOKING AT TIME TO
DEMENTIA, BETWEEN THE SEVERITY
AT BASELINE AND THE RISK OF
PROGRESSIVE DEMENTIA.
WE ADJUST FOR NONLINEAR FACTS,
AGE, RACE, ET CETERA.
A CLEAR RELATIONSHIP ON AVERAGE
TO NORMAL HEARING, AND WITH A
MILD, MODERATE AND SEVERE
HEARING LOSS ON AVERAGE HAVING A
TWO FOLD, 3 FOLD, 5 FOLD GREATER
RISK OF DEMENTIA OVER TIME.
SO THE FIRST TIME IT WAS
CONFIRMED AND PUBLISHED 22 YEARS
EARLIER THAT NEVER HAD BEEN
CONFIRMED YET.
NOW, YOU CAN IMAGINE, AT THIS
TIME PERIOD, WHY COULDN'T THIS
BE THE CASE?
WHAT WOULD BE THE BASIS FOR
HEARING AND WILL A MEASURE OF
HEARING IS A MEASURE OF AUDITORY
PERIPHERY.
THE CLOAK LA, TRANSDUCING AND
SENDING SOUNDS TO THE BRAIN.
HOW COULD THAT BE RELATED TO THE
COGNITIVE OUTPUT OF THE BRAIN'S
FUNCTION?
YOU THINK ABOUT IT ENOUGH, OF
COURSE THEY ARE RELATED BUT
THROUGH A COMMON CAUSE.
AGING PROCESS IN THE INNER EAR
IN THE BRAIN AND MICROVASCULAR
DISEASE THAT AFFECTS THE COCHLEA
AND BRAIN AND MAYBE UNKNOWN RISK
FACTORS.
BUT THIS IS THE ONLY THING THAT
REALITIES TO THE ASSOCIATION.
IT'S JUST ACADEMICALLY
INTERESTING BUT THAT'S ABOUT IT.
IT IMPLIES NOTHING IN WHAT WE DO
TO ADDRESS HEARING LOSS AND LIKE
DEMENTIA.
WHITE HAIR IS LINKED WITH
DEMENTIA, WHICH IT IS, BUT IT IS
JUST A COMMON PATHOLOGY.
THE QUESTION AS WE BEGAN
THINKING ABOUT THIS IN EARLY
2010 AND 11, WHAT COULD THE
MECHANISMS BE THROUGH WHICH
PERIPHERAL AUDITORY IMPAIRMENTS
COULD CONTRIBUTE INCREASED RISK
FOR COGNITIVE DECLINE OVER TIME.
THIS SUMMARIZED 50 YEARS OF WORK
FROM OTHER PEOPLE WE PULLED
TOGETHER WITH THESE MODELS.
THREE MAJOR MECHANISMS AS
COMMONLY UNDERSTOOD FOR HOW
HEARING LOSS CAN CONTRIBUTE TO
THE RISK OF COGNITIVE DECLINE IN
DEMENTIA.
COGNITIVE LOAD, THE IDEA THAT
WHEN THE BRAIN IS CONSTANTLY
RECEIVING A GARBLED AUDITORY
SIGNAL FROM THE EAR, THE BRAIN
HAS TO REALLOCATE CORTICAL
RESOURCES TO DEALING WITH THE
PROCESSING AND DECODING OF THAT
CIGNA AND IS THAT LOAD COME AT
THE EXPENSE OF OTHER SYMPTOMS?
THERE IS A BUFFER, DEMENTIA
PATHOLOGY, PRESENTING
PHENOTYPICALLY.
SO HEARING LOSS CONSTANTLY TAX
OR TAP INTO THAT COGNITIVE LOAD
THAT COULD HAVE BEEN USED TO
BUFFER AGAINST PATHOLOGY AND NOW
THAT BUFFER IS BEING BEING
EXHAUSTED WITH DEALING WITH
IMPAIRED HEARING.
IT'S NOT A LOAD YOU CAN TURN ON
OR OFF.
YOUR BRAIN IS CONSTANTLY
PROCESSING AUDITORY INFORMATION.
IN THE NIGHT YOU'RE PROCESSING
AS WELL.
IT'S A FIXED LOAD.
SO ONE MECHANISM, INFORMATION
DEGRADATION.
ANOTHER MECHANISM WHICH SOUNDS
SIMILAR BUT IS VERY, VERY
DIFFERENT, THE IDEA THAT HEARING
IMPAIRMENT CAN HAVE DIRECT
EFFECTS ON THE BRAIN'S
STRUCTURAL INTEGRITY.
SO SORT OF CAUSE AUDITORY
DEPRIVATION LEADING TO FASTER A
LITTLE OF BRAIN ATROPHY AS WELL
AS REORGANIZATION OF BRAIN
NEURAL NETWORK ACTIVATION.
WE SEE THIS IN HUMAN STUDS AS
WELL AS LONGITUDINALLY IN HUMAN
STUDIES AS WELL.
THE THIRD MECHANISM MORE
NEBULOUS BUT COMMON SENSE IN
MANY WAYS, THAT IF YOU CAN'T
HEAR AS WELL, YOU MIGHT NOT BE
AS SOCIALLY ENGAGED.
IF EVEN IF YOU ARE, YOU'RE
WITHDRAWN FROM CONVERSATION.
RESEARCH SHOWING HOW THE PROCESS
OF BEING REMAINING ENGAGED WITH
PEOPLE AROUND YOU IS VERY
IMPORTANT FOR MAINTAINING
COGNITIVE FUNCTION AND VERY,
VERY DIFFERENT MECHANISMS.
SO, I'LL SUMMARIZE.
THREE MAJOR MECHANISMS TO WHICH
HEARING LOSS HYPOTHETICALLY
COULD BE RISKED WITH COGNITIVE
DECLINE OR DEMENTIA.
EVIDENCE TO SUPPORT ALL OF
THESE.
THE IMPORTANT THING TO NOTE IS
NOT ONE IS CORRECT OR OTHERS ARE
WRONG.
IT'S LIKELY A COM NATION OF ALL
OF THE ABOVE.
FAST FORWARD THE FIRST STUDY IN
2011.
SINCE THEN, THERE HADS BEEN MANY
OTHER PAPERS SHOWING THE SAME
RESULTS COMING FROM OUR RESEARCH
AS WELL AS GROUPS FROM THE
AROUND THE WORLD.
BEST SUMMARIZED THE LANCET
COMMISSION ON DEMENTIA IN 2017,
THEY DAY META-ANALYSIS OF ALL
THE EXISTING RESEARCH LOOKED
EPIDEMIOLOGICALLY AT ALL THESE
RISK FACTORS THAT ARE MODIFIABLE
FOR DEMENTIA AND HOW MUCH EACH
CONTRIBUTED TO DEMENTIA OVER
TIME.
WHEN THEY SUMMARIZED ALL THE
LITERATURE A FEW YEARS AGO, THEY
CONCLUDED 60% OF DEMENTIA RISK
IS ESSENTIALLY FROM SOURCES THAT
WE DON'T KNOW WHAT THEY ARE.
BUT 40% OF DEMENTIA MAY BE
MODIFIABLE WITH ESSENTIALLY
NEURORISK FACTORS.
WHEN THEY RANK ORDER IN TERMS OF
HOW MANY CASES CONTRIBUTE TO,
HEARING LOSS IDENTIFIES THE
SINGLE LARGEST MODIFIABLE RISK
FACTOR.
THE RISK RATIO BETWEEN HEARING
LOSS AND KIMENSIA ARE
SUBSTANTIAL AND HEARING LOSS IS
BY NO MEANS A RARE CONDITION.
THIS IS A HIGHLY PREVALENT
CONDITION.
MULTIPLY THE TWO TOGETHER AND
THAT'S WHY THEORETICALLY THEY
IDENTIFY HEARING LOSS AS THE
SINGLE LARGEST MODIFIABLE RISK
FACTOR.
POTENTIALLY MODIFIABLE BECAUSE
THESE MECHANISMS THAT LINK
HEARING WITH DEMENTIA, THE
POTENTIAL PART, AND FURTHER
POTENTIAL BECAUSE THAT IMPLIES
YOU CAN DO SOMETHING ABOUT IT.
RIGHT NOW WE CAN CERTAINLY NOT
REVERSE HEARING LOSS OR CURE IT,
BUT WE CAN REHABILITATIVELY
TREAT HEARING LOSS THROUGH THE
USE OF HEARING INTERVENTIONS
LIKE HEARING AIDS AND SUPPORT
SERVICES TO PROVIDE A CLEAR
AUDITORY SIGNAL TO THE BRAIN.
COULD THIS INTERVENTION MODIFY
THESE PATHWAYS TO REDUCE
COGNITIVE DECLINE?
AND HYPOTHETICALLY IT MAY BE
ABLE TO, WITH CLEAR AUDITORY
SIGNAL WITH A WELL FIT HEARING
AID.
HOPE YOU CAN REDUCE BY CLEARING
A CLEAR AUDITORY SIGNAL TO THE
BRAIN AND BRAIN STIMULATION WITH
THE USE OF A HEARING AID.
AND HOPEFULLY HELP PEOPLE'S
SOCIAL ENGAGEMENT.
IT BRINGS UP THE IDEA OF HEARING
LOSS OR HEARING INTERVENTION AND
POTENTIALLY REDUCING THE RISK OF
CODIFYING DEMENTIA IN LATE LIFE.
THAT IS VERY INTERESTING.
BECAUSE THERE ARE PLENTY OF
75-YEAR-OLDS WITH UNTREATED
HEARING LOSS.
THE IDEA OF INTERVENTION WHICH
IS RISK-FREE, NO MEDICAL RISK
WITH HEARING INTERVENTION THAT
COULD LOWER RISK WITHIN A FEW
YEAR PERIOD FOR INTERVENTION HAS
NO MEDICAL -- IS INCREDIBLY
APPEALING.
THE MOST IMPORTANT RISK FACTORS
FOR DEMENTIA ARE EARLY-LIFE
EDUCATION, MID-LIFE VASCULAR
DECEASE.
YOU CAN'T ADDRESS IT NOW AT 75
YEARS OLD BUT STILL BE
MODIFIABLE IN LATE LIFE IS A
PUBLIC HEALTH TARGET.
THIS QUESTION IF WE FACT TREAT
HEARING LOSS, COULD THAT REDUCE
COGNITIVE DECLINE?
THIS REMAINED UNKNOWN.
FROM OBSERVATION STUDIES THAT I
SHOWN BEFORE, PEOPLE USE HEARING
AIDS VERSUS THOSE WHO DON'T,
THEY ON ANGEL DO BETTER.
BUT YOU CAN'T ATTRIBUTE THAT
CLEARLY TO THE INTERVENTION
BECAUSE PEOPLE WHO GOT HEARING
AIDS ARE LIKELY TO BE HEALTHIER,
WEALTHIER AND BETTER EDUCATED.
UNDERLYING FACTORS THAT ALLOWED
THE INTERVENTION?
OR WAS IT THE INTERVENTION?
PEOPLE HAVE TRIED AND ONE NICE
MAJOR META-ANALYSIS OF 126,000
PEOPLE FROM AROUND THE WORLD
SUMMARIZING EPIDEMIOLOGICAL DATA
NINE MONTHS AGO PUBLISHED.
AFTER CONTROLLING FOR
EVERYTHING, THEY STILL FOUND
THAT HEARING AIDS APPEAR TO BE
ASSOCIATED WITH ROBUST RISK OF
DECLINE WITH COGNITIVE DECLINE.
NO PRIOR RANDOMIZED CONTROL
TRIAL EVER LOOKED IN THIS BASIC
QUESTION, IF WE TREAT HEARING
LOSS, CAN WE REDUCE COGNITIVE
DECLINE OVER A PENINGFUL PERIOD
OF TIME?
SO THE ACHIEVE TRIAL WAS
DESIGNED TO ANSWER THIS
QUESTION.
A STUDY FUNDED BY THE NATIONAL
INSTITUTES ON AGING FOR 10 YEARS
AND DESIGNED AS A VERY BASIC
QUESTION, IF WE TREAT HEARING
LOSS, AMONG OLDER ADULTS, CAN WE
IN FACT REDUCE THE RATE OF
COGNITIVE DECLINE WITHIN A
THREE-YEAR PERIOD?
IT'S CALLED THE ACHIEVE TRIAL
FOR AGING COGNITIVE HEALTH
EVALUATION STUDIES.
THE MAIN FOCUS WAS LOOKING AT
GLOBAL COGNITIVE DECLINE.
WE HAD HOST OF OTHER EXPLORATORY
OUTCOMES AS WELL.
THE TWO I WILL SHARE TODAY ARE
THE RESULTS OF THE PRIMARY PAPER
PUBLISHED IN LANCET A FEW MONTHS
AGO AND I'M EXCITED TO SHARE
WITH YOU TODAY THE FIRST TIME
PUBLICLY, INITIAL PRELIMINARY
UNPUBLISHED RESULTS OF DATA
LOOKING AT EFFECTIVE HEARING
INTERVENTION ON BRAIN STRUCTURAL
ATTRIBUTES.
SO I HAVE THE FIRST COMMENT
REPRESENTING THE COLLABORATIVE
WORK OF NEARLY 10 YEARS OF WORK
FUNDED BY THE NATIONAL
INSTITUTES ON AGING AND EIGHT
DIFFERENT UNIVERSITIES ACROSS
THE UNITED STATES FUNDED FROM
2014 TO PRESENT DAY.
IT TWO TWO YEARS TO TRIAL WITH A
CLINICAL PLANNING GRANT.
SO WHEN I PRESENT THIS WORK,
MUCH I'M PRESENTING ON BEHALF OF
A LOT OF PEOPLE.
I JUST HAPPEN TO BE THE PERSON
IN THE FRONT PRESENTING THIS TO
YOU.
SO, STUDY DESIGN OF WHAT WE DID
WITH THE ACHIEVE STUDY.
THE FINAL DESIGN IS SIMPLE FROM
BASIC 2018-2019, WE WERE
RECRUITING NEARLY 1000 OLDER
ADULTS.
THEY HAD UNTREATED MILD TO
MODERATE LEVELS OF HEARING LOSS.
RANGE ARE HEARING THAT COULD BE
ADDRESSED WITH A HEARING AID AND
HAD NO COGNITIVE IMPAIRMENT AT
BASELINE.
WE RECRUITED 1000 PEOPLE FROM
TWO DISTINCT STUDY POPULATIONS.
ABOUT A QUARTER OF THE 1000
PEOPLE CAME FROM EXISTING STUDY
CALLED THE ARTHROSCLEROSIS RISK
IN COMMUNITY STUDIES OF OLDER
ADULTS THAT BEGAN IN MID LIFE
FOR THEM AND THEN FOLLOWED TO
THE PRESENT DAY.
THIS REPRESENTS A RANDOM SAMPLE
OF ADULTS OVER 30 YEARS AGO
SAMPLED FROM VOTER REGISTRATION
POLES, DRIVER'S LICENSE RECORDS
AND THINGS LIKE THAT.
RANDOM SAMPLE THAT CAME INTO THE
ACHIEVE STUDY.
THE REMAINDER OF THE COHORT, SO
THREE-QUARTERS OF THE PEOPLE
CAME FROM NEW HEALTHY COMMUNITY
VOLUNTEERS, PEOPLE WHO RESPONDED
TO FACEBOOK ADS, RADIO
ADVERTISEMENTS, NEWSPAPER
ADVERTISEMENTS ABOUT A NEW STUDY
FOCUSED ON HEALTHY AGING.
EVERYONE WAS RANDOMIZED TO
EITHER THE HEARING INTERVENTION
OR A SUCCESSFUL HEALTH EDUCATION
CONTROL, AND THEN EVERYONE WAS
FOLLOWED EVERY SIX MONTHS FOR
THE NEXT THREE YEARS WITH
ESSENTIALLY ASSESSMENTS OF A
NEUROCOGNITIVE BATTERY AS WELL
AS OTHER OUTCOMES AS WELL.
SO THE REASON WHY THE SAMPLE
CAME FROM ERIC AS WELL AS
DE NOVO, THE CHIEF STUDY WAS
BASED WITHIN THE SCIENTIFIC AND
INFRASTRUCTURE OF THIS EXISTING
OBSERVATIONAL STUDY FUNDED FOR
MANY YEARS BY NHLBI INVOLVING
NEARLY 16,000 PEOPLE RECRUITED
MID LIFE 30 YEARS AGO AT 4
DIFFERENT SITES ACROSS THE
UNITED STATES AND ALL
OBSERVATIONAL ALLEY FOLLOWED
TODAY WITH CARDIOVASCULAR EVENTS
AND HEALTH.
AND THESE PEOPLE CAME FROM A
RANDOM SAMPLE FROM THE
COMMUNITIES OVER 35 YEARS AGO.
AND THEY HAVE BEEN FOLLOWED
SINCE THEN WITH ASSESSMENTS OF
CARDIOVASCULAR HEALTH WITH
DR. GOTTESMAN AND WHEN I JOINED,
ALSO INCLUDED MEASURES OF
HEARING.
WE PRE SCREENED PEOPLE FROM THE
STUDY AND RECRUDE THEM ON TO
THIS ONGOING TRIAL.
THE ACHIEVE STUDY CAME FROM TWO
COHORTS.
THE ARIC COHORT, RANDOM OF THE
U.S. POPULATION AND THE DE NOVO
COHORT, NEW HEALTHY VOLUNTEERS.
RANDOM SAMPLES VERSUS A
SELF-SELECTED VOLUNTEERS AND
YOU'LL SEE HOW DIFFERENT THEY
ARE IN THE FOLLOWING SLIDES.
ALL WHO JOINED THE STUDY THEY
WERE TOLD THEY WOULD BE
RANDOMIZED TO ONE INTERVENTION
AND THEN THREE YEARS LATER THEY
WOULD BE OFFERED THE OTHER
INTERVENTION AS WELL.
SOME INCLUSION CRITERIA BEFORE
EVERYONE WAS BETWEEN 70-84 YEARS
OLD WHEN THEY ENTERED THE STUDY.
ALL HAD A THRESHOLDLER TO MAKE
SURE NO SUBSTANTIAL COGNITIVE
IMPAIRMENT.
ALL HAD A HEARING LOSS BETWEEN
30-70 WHERE PEOPLE COULD STILL
BENEFIT FROM CONVENTIONAL
HEARING AIDS.
THAT RANGE OF HEARING, THAT IS
FULLY ABOUT 50% OF PEOPLE IN THE
70-84 RANGE.
THIS IS THE MAJORITY OF ADULTS.
THERE IS EXCLUSION TRY KIIRIA
WHO PEOPLE MAY NOT BENEFIT --
EXCLUSION CRITERIA -- IN TERMS
OF THE DESIGN, RANDOMIZED, WE
DID STRATIFIED RANDOMIZATION AND
THE HEARING INTERVENTION VERY,
VERY BRIEFLY, BASICALLY AS CLOSE
YOU CAN GET TO THE BEST PRACTICE
HEARING INTERVENTION.
A STUDY AUTOOLOGIST.
EVERY PERSON WHO IS RANDOMIZED
HAS FOUR SESSIONS WITH THE FIRST
FEW MONTHS WHERE THAT HAD A
HEARING EXAM, A NEEDS
ASSESSMENT, THEY GOT FITTED FOR
HEARING AIDS THAT ARE COVERED BY
THE STUDY AS WELL AS ANY OF THE
RELATED HEARING TECHNOLOGIES.
IF THEY WERE IN MEETINGS A LOT,
IF THEY LISTENED TO T.V. A LOT.
THEY GOT T.V. STREAMERS AND
BETTER THINGS LIKE THAT.
AND THEN SEEN EVERY SIX MONTHS
FOR A BOOSTER SESSION ON
THEOLOGIST.
WE GOT A HEALTH EDUCATION
CONTROL.
IT'S CALLED A 10 KEYS TO
SUCCESSFUL AGING PROGRAM
DESIGNED HOW YOU EDUCATE OLDER
ADULTS AROUND KEY HEALTHY AGING
TOPICS.
TOPICS LIKE NUTRITION, CANCER
SCREENING, DIET AND THINGS LIKE
THAT.
SO OVER THE BEGINNING OF THE
STUDY, YOU HAD FOUR SESSIONS
WITH A CERTIFIED
HEALTHEDGEICATOR WHERE THEY WENT
OVER EACH OF THESE TOPICS AND
EVERY SIX MONTHS THEY HAD A
BOOSTER SESSION WITH A
HEALTHEDGEICATOR TO RECEIVE
ANOTHER TOPIC.
SO BOTH GROUPS WERE EXPOSURE
MATCH IN TERMS OF AMOUNT AND
DEGREE OF EXPOSURE TO STUDY
PERSONNEL.
EXPOSURE STUDY PERSONNEL COULD
BE GOOD FOR YOUR SOCIAL AND
COGNITIVE HEALTH.
SO THERE ARE BOUNDS FOR THAT.
THE DESIGN OF THE STUDY, THERE
IS A BASELINE ASSESSMENT WHEN
THEY JOIN THE STUDY.
EVERY SIX MONTHS THEREFORE THEY
WERE SEEN IN PERSON FOR
IN-PERSON ASSESSMENT AND BOOSTER
VISIT.
THE PRIMARY ENDPOINT DEFINED IS
CHANGE FROM BASELINE TO THE YEAR
THREE GLOBAL COGNITION
STANDARDIZED FACTOR SCORE.
COMPREHENSIVE NEUROCOGNITIVE
BATTERY.
THE SECONDARY COGNITIVE DOMAINS
WERE SPECIFIC COG ENOUGH
FUNCTION FOR MEMORY, EXECUTIVE
FUNCTION AND LANGUAGE AND
ADJUDICATED BY A PANEL OF
CLINICIANS AND A WHOLE HOST OF
OTHER PRE-SPECIFIED EXPLORATORY
OUTCOMES LOOKING AT MEASURES OF
HANDICAP AND COMMUNICATION AND
SOCIAL NETWORK, DEPRESSION AND
PHYSICAL ACTIVITY.
I'M GOING TO SHARE WITH YOU
TODAY BRIEFLY THE COGNITIVE
FUNCTION DATA AS WELL AS THE
FMRI DATA.
THIS WAS DESIGNED OVER A DECADE
AGO BY OTHERS IN CONCERT WITH
THE ARIC INVESTIGATORS.
10 NEUROCOGNITIVE TESTS THAT
COMPRISE THE NEUROCOGNITIVE
BATTERY.
ONLY TWO OF THESE -- EIGHT OF
THESE 10 TESTS DO NOT HAVE
EXCLUSIVE AUDITORY.
ONLY TWO DO.
SO THE REASON I MENTION IT,
MAYBE SOMEONE IS NOT DOING WELL
ON A COGNITIVE LEVEL SO THEY
CAN'T HEAR THE EXAMINER.
THAT WOULDN'T BE THE CASE.
FOR A MILD TO MODERATE LEVEL OF
HEARING LOSS, FACE-TO-FACE AT A
QUIET ROOM AT THREE FEET
DISTANCE.
WE MEASURED IT AND VERIFY
UNDERSTANDING.
EACH IF IT WAS, EIGHT OF THESE
10 COGNITIVE TESTS DO NOT HAVE
ONLY AUDITORY EXCLUSIVE STIMULI.
YOU ALWAYS VERIFY AHEAD OF TIME.
FACE-TO-FACE, THREE FEET AWAY,
MILD TO MODERATE HEARING LOSS,
50% OF OLDER ADULTS.
JUST TO MAKE SURE WE VERIFIED
AHEAD OF TIME.
THESE 10 NEUROCOGNITIVE TESTS
SPANNING DIFFERENT DOMAINS OF
COGNITION CAN BE SUMMARIZED INTO
ONE COGNITIVE FACTOR SCORE.
IT'S LIKE A Z SCORE BUT MORE
SOPHISTICATED TO ALLOW FOR ITEM
FUNCTION SYSTEMMING AND TASKS
AND ITEMS.
BUT YOU CAN SUMMARIZE FROM THE
GLOBAL COGNITION FACTOR SCORE
THAT IS THEN STANDARDIZED TO
BASELINE.
SO ARBITRARY SCORE IS SET SO IF
YOU'RE AT ZERO IT MEANS YOU'RE
AT THE MEAN F YOU'RE ONE, YOU'RE
ONE STANDARD DEVIATION FROM THE
MEAN.
IF YOU CHANGE OVER 3 YEARS
FROM -- BY NEGATIVE .4 IT MEANS
YOU CHANGED .4 STANDARD
DEVIATIONS OVER 3 YEARS.
CLINICALLY SPEAKING HALF
STANDARD DEVIATION VERY, VERY
CLINICALLY MEANINGFUL.
BUT EVERYTHING IS STANDARDIZED
TO SD UNITS.
WITH THAT AS WELL I CAN DEFINE
THREE DIFFERENT SPECIFIC
COGNITIVE DOMAINS THAT PULL ON
DIFFERENT COGNITIVE TESTS.
LANGUAGE DOMAIN, LANGUAGE
PRODUCTION NOT RECEPTION.
THIS IS NAME ALL THE WORDS IN
THE LETTERS OF F.
EXECUTIVE FUNCTION,
MULTITASKING, MEMORY IS
PROTEINITUTIVE.
SO -- IS PRETTY INTUITIVE.
SO THE MAIN ANALYSIS IS AN
ATTENTION TO TREAT ANALYSIS.
BASICALLY LOOKING AT THE EFFECT
OF ASSIGNING TO HEARING
INTERVENTIONS VERSUS ASSIGNMENT
TO THE CONTROL OVER THREE YEARS.
THESE ALL WERE MIXED EFFECTS
MODELS SO WE ACCOUNT FOR CHANGE
OVER TIME.
AND WE ALSO ADJUST FOR ANY
POTENTIALLY RANDOM VARIATIONS ON
BASELINE VARIANTS IN TERMS OF
BASELINE DEMOGRAPHICS.
THERE WAS MISSING DAYLIGHT ADD
THAT WAS NOT VERY MUCH MISSING
DATA BUT WE IMPUTE MISSING DATA
USING CHAIN EQUATIONS TO IMPUTE
ANY MISSING DATA AT YEAR 3.
THE MAIN ANALYSIS IS BASICALLY
LOOKING AT BASELINE DATA AND
YEAR 3 DATA.
WE DO NOT USE INTERVENING YEARS
UNLESS WE HAVE TO.
IF SOMEONE DIED BEFORE YEAR 3
FOR INSTANCE.
PRE SPECIFIED, WE SAID WE WOULD
MEAN ANALYSIS THE WHOLE COHORT
BUT WE REPLICATE THE PRIMARY
ANALYSIS AND STRATIFY WITHIN ARI
R AND DE NOVO.
THEY MAY BE DIFFERENT.
ONE A RANDOM SAMPLE OF THE U.S.
POPULATION AND THE OTHER
REPRESENTS SELF-REPRESENTED
RESPONDING TO FACEBOOK ADDS.
ONE THING I'M PROUD OF IS FOR
ANY WHO HAVE DONE CLINICAL
TRIALS, YOU KNOW THAT
RECRUITMENT ALWAYS KILLS
CLINICAL TRIALS.
THIS WAS A RECRUITMENT CURVE SO
THE BLUE LINE IS IF WE EVENLY
RECRUITED 850 PEOPLE OVER YEAR
AND A HALF PERIOD.
WE ARE 2 1/2 WEEKS BEHIND
SCHEDULE.
GIVEN THAT RECRUITMENT IS GOING
VERY, VERY WELL, WE APPROACHED
THEM ABOUT KEEPING RECRUITMENT
GOING LONGER TO HAVE MORE
DEFINITIVE RESULTS.
AND THEY ALLOWED US TO DO IT.
WE HIT A SAMPLE SIZE OF 977 AND
CLOSED AT THE END OF OCTOBER TWO
THOUSAND 19.
-- 2019.
OVER 3 YEARS YOU CAN SEE THE
LOSS OVER TIME BUT THREE YEARS
LATER, THROUGH A PANDEMIC, WE
HAD COMPLETE FOLLOW-UP DATA ON
90% OF PEOPLE.
THIS WAS AMAZING.
THIS WAS A TESTAMENT TO THE
STUDY STAFF IN THE SITES.
THE INCREDIBLE PROFESSIONALS
BRINGING PEOPLE THROUGH A
PANDEMIC, IN-PERSON VISITS.
WE LOST 10% FROM LOSS OF
FOLLOW-UP.
PEOPLE DIED UNFORTUNATELY.
WE HAD BEEN BUDGETING FOR UP TO
70% LOSS -- 30% LOSS, WE SEEN IT
BY A WIDE MARGIN.
TESTAMENT TO STUDY INTERVENTION
AS WELL AS TO THE STUDY STAFF.
SO YOU'RE SEEING FROM INTERNAL
POINT OF VIEW, VERY, VERY
HIGH-QUALITY DATA.
NOW BASELINE CHARACTERISTICS BY
RECRUITMENT SOURCE.
JUST TO THE HIGHLIGHT HOW
DIFFERENT THE DE NOVO COHORT IS
COMPARED TO THE ARIC.
YOU SEE ON AVERAGE DE NOVO
COHORT AVERAGE FEWER RISK
FACTORS OF COGNITIVE DECLINE BY
VIRTUE OF BEING YOUNGER.
THEY ARE BETTER EDUCATED.
DEFINITELY MUCH HIGHER LEVELS OF
INCOME ON AVERAGE AS WELL AMONG
THE DE NOVO VERSUS ARIC.
IF WE LOOK AT RATES OF DIABETES,
HYPERTENSION, LIVING ALONE, ALSO
LOWER IN THE DE NOVO R SELF
SELECTED POPULATION IS DIFFERENT
THAN A RANDOM COHORT.
ALSO BASELINE COGNITION SCORES
AT BASELINE, YOU SEE AMONG THE
GLOBAL EXECUTIVE FUNCTION,
LANGUAGE AND MEMORY, THEY ARE
STANDARDIZED UNITS.
THE DE NOVO COHORT STARTS ABOVE
THE MEAN IN THIS GROUP SAMPLE.
SO THEY ARE STARTING AT A VERY
DIFFERENT POINT LIKELY BECAUSE
THEY ARE TWO DIFFERENT
RECRUITMENT SOURCES.
SO BEFORE THE RESULTS, YOU CAN
IMAGINE NATURAL QUESTION TO
BEGIN WITH, BEFORE JUMPING TO
THE COGNITIVE RESULTS, IS THERE
ANY EVIDENCE THAT HEARING
INTERVENTION IS EVEN WORKING?
IS THERE ANY EVIDENCE OF TARGET
ENGAGEMENT?
PEOPLE USING HEARING AIDS, ARE
THE HEARING AIDS BENEFITING
PEOPLE LIKE COMMUNICATION WISE
TO SUGGEST THE EFFECTS ON
COGNITION?
SO ONE THING I'M VERY PROUD TO
SHOW YOU.
YOU HAVE TO TURN YOUR HEAD SIDE
WAYS, HISTOGRAMS OF THE HOURS OF
HEARING AID USE AMONG PEOPLE
RANDOMIZING THE INTERVENTION.
SIX MONTHS, 1, 2, 3 YEARS.
CONSISTENTLY ROBUST AND
RELATIVELY HIGH RATES OF HEARING
SCREENING AT 10 HOURS, TRAILING
OFF THREE YEARS LATER THROUGH A
PANDEMIC ON A MEDIAN IS ABOUT 7
HOURS.
THE MEDIAN RATE OF USE THREE
YEARS LATER BEING ABOUT SEVEN
HOURS A DAY FOR A POPULATION OF
73-87-YEAR-OLDS.
DOES THAT HEARING USE TRICKLE
OUT AND MEANINGFULLY IMPACT
COMMUNICATION?
SO THIS IS THE HEARING
HANDICAPPED INVENTORY, MEASURE
OF COMMUNICATION FUNCTION.
HIGHER SCORES INDICATE MORE
COMMUNICATION IMPAIRMENT.
DO YOU FEEL EMBARRASSED WITH
FRIENDS AND FAMILY?
STRUGGLE WITH HEARING?
THEY STARTED WITH SCORE OF 14 IN
THE CONTROL GROUP AND THREE
YEARS LATER THEIR █COMMUNICATION
IMPAIRMENTS WERE GETTING WORSE
OVER TIME.
IT'S NOT BEING ADDRESSED AT ALL.
IN CONTRAST WITH THE HEARING
INTERVENTION GROUP, THAT SCORE
DROPPED AND STAYED DOWN OVER A
THREE YEAR PERIOD.
SO TARGET ENGAGEMENT IN TERMS OF
HOURS AND HEARING USE AND IT
APPEARS TO TRICKLE OUT IN TERMS
OF COMMUNICATION FUNCTION AS
WELL.
SO, YOU CAN IMAGINE THE QUESTION
IS, DOES THAT MEAN, TRICKLE OUT
THREE YEARS LATER TO REDUCE
COGNITIVE DECLINE?
ARE YOU SLOWING DOWN ANY GLOBAL
COGNITIVE DECLINE YOU SEE
NATURALLY OVER THREE-YEAR
PERIOD?
SO I'LL GIVE YOU THE SUMMARY
FIGURE FIRST AND THEN
SENSITIVITY ANALYSIS.
IF YOU LOOK BROADLY, THE TOTAL
COHORT, AND IF YOU LOOK ON THE
LEFT, IT'S A GLOBAL MEASURE OF
COGNITION.
YOU SEE THE CONTROL GROUP OVER
THREE YEARS ON AVERAGE DECLINE
NEGATIVE .2 STANDARD DEVIATION
UNITS.
HEARING INTERVENTION THREE YEARS
LATER, BASICALLY THE SAME.
SO NO APPARENT AFFECT AT ALL ON
REDUCING COGNITIVE CHANGE OVER
THREE-YEAR PERIOD.
WITHIN THE COGNITIVE DOMAINS,
MAYBE A MEMORY BUT NOTHING THAT
MEETS ANY PRE-SPECIFIED
CRITERIA.
SO SLIGHT DISCOURAGING, IT
DOESN'T APPEAR TO BE DOING
ANYTHING FOR COGNITION, AT
LEAST.
I MENTION WE ALWAYS PRE SPECIFY
THAT WE RECOGNIZE THAT A RANDOM
SAMPLE OF POPULATION VERSUS A
SELF-SELECTED DE NOVO POPULATION
RESPONDING TO FACEBOOK ADS, MAY
BE VERY DIFFERENT WE ALWAYS PRE
SPECIFY WE WOULD REPLICATE THE
ANALYSIS STRATIFIED BY COHORT.
THIS IS WHERE YOU SEE A VERY,
VERY DIFFERENT RESULT.
SO YOU SEE AMONG ARIC, THAT THE
CONTROL GROUP DECLINES MUCH
FASTER ABOUT .402 STANDARD
DEVIATION UNITS.
THE HEARING INTERVENTION GROUP
DECLINED PERSONNEDECLINED .211.
YOU SEE THAT TRICKLING OUT TO
EACH OF THE COGNITIVE DOMAINS,
STRONGEST IN LANGUAGE DOMAIN N
CONTRAST, IF YOU LOOK AT THE
DE NOVO COHORT, YOU SEE NO
EFFECT.
SO WHAT GIVES HERE?
IT BECOMES CLEAR IF YOU LOOK
MORE CLOSELY AT THE FIGURE, IF
YOU LOOK AT THE RATE OF
COGNITIVE CHANGE OVER THREE
YEARS, IN THE DE NOVO CONTROL
SUBJECTS VERSUS THE ARIC, SO A
SELF-SELECTED HEALTHY
VOLUNTEERS, RESPONDING TO
FACEBOOK ADS, VERSUS RANDOM
SAMPLE.
ON AVERAGE, THE DE NOVO HAS A
3-FOLD SLOWER RATE OF COGNITIVE
CHANGE OVER THREE-YEAR PERIOD
COMPARED TO ARIC.
WHY IS THIS?
SO I MENTIONED BEFORE, SELF
SELECTED.
MANY FEWER RISK FACTORS FOR
COGNITIVE DECLINE AT BASELINE
AND IT'S TRICKLING OUT THREES
YEARS LATER WITH 2-3 FOLD SLOWER
RATE OF COGNITIVE CHANGE IN THE
DE NOVO COHORTERS HAVES THE
OTHER REPRESENTING A RANDOM
SAMPLE OF THE U.S. POPULATION.
IF YOU HAVE AMONG THE DE NOVO, A
VERY, VERY SLOW RATE OF
COGNITIVE CHANGE OVER THREE
YEARS, A HEARING INTERVENTION
PREDICATED ON SLOWING COGNITIVE
CHANGE CAN'T SLOW DOWN SOMETHING
THAT IS ALREADY GOING DOWN VERY,
VERY SLOWLY.
AT LEAST WITHIN THREE YEARS.
THE ARIC COHORT HAVING A STEEPER
RATE OF COGNITIVE DECLINE WITH
CONTROLS, THERE IS ROOM TO SEE
REDUCTION IN THAT SLOPE WITHIN A
THREE-YEAR PERIOD.
SO BRIEF SUMMARY OF THE MAIN
COGNITIVE RESULTS SO FAR IN THE
TOTAL COMBINED COHORT, WHEN WE
DO A PRE-SPECIFIED ANALYSIS AS
INDICATED IN OUR ANALYSIS PLAN,
WE SEE VERY STRONG EFFECTS ON
ARIC, RANDOM SAMPLE, 48%
REDUCTION IN COGNITIVE DECLINE.
A POPULATION AT RISK FOR
COGNITIVE DECLINE.
IN CONTRAST, NO EFFECT OBSERVED
IN DE NOVO BUT AGAIN THE KEY
THING HERE IS WE HAVE A VERY
SLOW BACKGROUND RATE OF
COGNITIVE CHANGE OVER THREE YEAR
PERIOD.
YOU CAN'T REALLY DETECT ANY
FURTHER SLOWING OF THAT
COGNITIVE CHANGE WITHIN A
THREE-YEAR PERIOD.
IF YOU COMPARE THESE RATES OF
COGNITIVE CHANGE TO THE EXISTING
LITERATURE, YOU SEE AMONG THE
DE NOVO CONTROLS ON AVERAGE .05,
ONE 20th OF THE STANDARD
DEVIATION, THIS CORRESPONDS WITH
A SLOW VERSUS MODERATE RATE OF
COGNITIVE DECLINE.
SO RANDOM SAMPLE OF THE U.S.
POPULATION, MODERATED DECLINE.
AMONG A SELF-SELECTED GROUP OF
HEALTHY VOLUNTEERS, A VOTE RATE
OF COGNITIVE DECLINE.
WHY AMONG THE DE NOVO CONTROLS?
ONE CLEAR POTENTIAL REASON IS
THESE ARE VERY HEALTHY
VOLUNTEERS.
THEY REPRESENT A DIFFERENT STUDY
POPULATION THAN A RANDOM SAMPLE
OF THE U.S. POPULATION WHEN
RECRUITED 30 YEARS AGO.
SO I'LL MOVE ON TO SOME OTHER --
FOR US EXCITING FINDINGS TO SEE
EXPLORATORY EFFECTS OF HEARING
INTERVENTION ON BRAIN STRUCTURE.
THIS IS LITERALLY HOT OFF THE
COMPUTER RESULTS IN THE LAST
WEEK.
THESE ARE PRETTY CLOSE TO FINAL
ANALYSIS WE'LL PREPARE FOR
PUBLICATION SOON.
AND THE BACKGROUND FOR THIS,
PERIPHERAL AUDITORY INPUTS FROM
THE COCHLEA, INTEGRATED ACROSS
MULTIPLE -- NOT JUST THE
TEMPORAL LOBE OR PRIMARY
AUDITORY CORTEX.
THOSE INTEGRATED ACROSS MULTIPLE
BRAIN REGIONS AS WELL AS NEURAL
NETWORKS AND THE OTHER NETWORKS.
OUR BRAIN IS ENCASED IN OUR
SKULL FOR FIVE SENSORIES, YOU'RE
BRAIN IS NOT DOING MUCH.
HEARING IS ONE OF THE DOMINANT
CESSORIES ALONG WITH VISION THAT
SUPPLIES THE BRAIN WITH
CONTEXTURAL INFORMATION AROUND
THE ENVIRONMENT.
WHAT WE SEE EXISTING FROM
PREVIOUS OBSERVATIONAL DATA, IS
YOU SEE THAT HEARING LOSS OR
BASICALLY AUDITORY CODING IS
ASSOCIATED WITH FUNCTIONAL
CHANGES IN BOTH PATTERNS OF
RESTING STATE AS WELL AS TASK,
BASED ON HIGH DENSITY DR. ELAINE
FLORES: G OR FMRI, CHANGE OF
PEOPLE WHO HAVE HEARING LOSS AND
DON'T HAVE HEARING LOSS.
YOU'RE SEEING THAT NOT IN KIDS
BUT OLDER ADULTS WITH MODAL
PLASTICITY.
WE SEE BASED ON OBSERVATIONAL
DATA, INCREASED STRUCTURAL
ATROPHY, WHOLE BRAIN, TEMPORAL
LOBE RESEARCHONS, SINGULAR
COTEXT AND FRONTAL GYRUS AND
DEFAULT MODE REGIONS.
LONGITUDINAL CHANGE OF HEARING
LOSS ASSOCIATED WITH FASTER
RATES OF MULTIPLE BRAIN REGIONS
ATROPHY.
THERE IS NOT REALLY BEEN MUCH AT
ALL LOOKING AT HOW WOULD HEARING
AID USE INCREASE AUDITORY
SIGNALS.
HOW WOULD THAT EFFECT THE BRAIN?
ONE STUDY THAT WAS DONE
RELATIVELY SMALL, BUT VERY
INTERESTING, THAT THEY GAVE A
GROUP OF OLDER ADULTS AT
BASELINE AND MEASURED THE DEGREE
OF CROSS-MODAL PLASTICITY.
HOW MUCH A VISC TASK ACTIVATED
AUDITORY AREAS OF THE BRAIN AND
THEM SIX MONTHS LATER YOU BRING
THEM BACK IN AND SEE REVERSE OR
REORGANIZATION WITH THAT.
SO HINTING SOMEWHAT A HEARING
AID CAN DO SOMETHING
FUNCTIONALLY IN TERMS OF TASK
ACTIVATION OF THE BRAIN.
THE QUESTION IS, DOES THAT
TRIGGER SOMETHING OR CHANGE
SOMETHING THREE YEARS DOWN THE
ROAD?
DOES CONSISTENT OR USE OF A
HEARING AIDS, LEAD TO LONGER
TERM EFFECTS ON BRAIN FUNCTION
AND STRUCTURE?
THAT IS REALLY COMPLETELY
UNKNOWN AT THIS POINT.
AND GET TO THE SORT OF SECOND
MECHANISM THE IDEA THAT HEARING
LOSS MAY CHANGE BRAIN FUNCTION
AND STRUCTURE.
THE QUESTION IS DOES THAT MEAN
DOES A HEARING INTERVENTION
WHERE A HEARING AID, DOES THAT
REDUCE ANY OF THESE FUNCTIONAL
OR STRUCTURAL CHANGES WITHIN
JUST THREE YEARS?
SO THIS IS EXPLORATORY OUTCOME
PLANNED FOR THE ACHIEVE TRIAL.
HOW THIS WAS DONE, I MENTIONED
AGAIN THE FULL SAMPLE WAS 977
ADULTS RANDOMIZED.
WE HAD MRI, HALF SAMPLE AT
BASELINE, 445 PEOPLE WHO HAD A
THREE MRI SCAN AT BASELINE AND
THEN WE RECAPTURED THOSE SCANS.
BUT SOME PEOPLE ESSENTIALLY WERE
TOO UNHEALTHY TO GO THROUGH MRI
SCANS THREE YEARS LATER.
BECAUSE OF THE PAN DEMIC AND
DELAY OF THE FOLLOW-UP, SOME
PEOPLE HAD FALLEN OUT THE WINDOW
WITH WHEN THEY COULD GET A MRI
SCAN.
THESE ARE ALL THREE TESLA
SCANNERS.
OPERATIONS BY REBECCA GOTTESMAN
AS WELL AS CLIFF JACKS GROUP WHO
HAS DONE ALL OF THE MRI MEASURES
FOR THE ARIC AND ACHIEVE STUDY.
DEFINED BY MAYO CLINIC AND THEN
CORTICAL THICKNESS MEASURED FOR
EACH REGION BY THE SAME GROUP.
THE PRIMARY ANALYSIS APPLIED SO
FAR IS THE TWO-LEVEL MIXED
EFFECTS ANALYSIS.
THAT MEANS THAT WE TREAT EACH
LOAD WITH A BRAIN AS A DIFFERENT
ANALYTIC MODEL.
WE SAY, HEAR ARE THE CONTROLS ON
FRONTAL LOBE.
NEXT MODEL, EFFECTS ON TEMPORAL
LOBE, THAT WAS THE PRIMARY
MODEL.
DIFFERENT WAY OF LOOKING AT THIS
IS ASSUMING COMMONALTIES.
SENSITIVITY ANALYSIS AND THE
TEMPORAL LOBE IS NOT DISTINCT
FROM THE FRONTAL.
THERE ARE COMMONALTIES.
SO IN A SENSITIVITY ANALYSIS, WE
CAN DO IN A MODEL TO INCLUDE A
COMMON EFFECT AND THEN ALSO
INCLUDE ON TOP OF THAT A LOAD
SPECIFIC EFFECT.
SO IT ALLOWS FOR A LITTLE MORE
PRECISION IN TERMS OF HOW YOU
ESTIMATE THE EFFECTS OF HEARING
VERSUS CONTROL.
WE PRESENT BOTH HERE BECAUSE
BOTH ARE DONE FOR CONSISTENCY.
WE DO IMPUTE ANY MISSING MRI
DATA IN YEAR 3.
THE MODEL SIMILAR TO THE
COGNITIVE RESULTS ADJUSTING FOR
MAJOR BASELINE COVARIATES THAT
CAN EFFECT THE RESULTS,
RECRUITMENT SOURCE, AGE, SEX,
ET CETERA.
THIS WAS NOT POWERED TO LOOK FOR
EFFECTS SO THE P VALUES ARE
PURELY FOR THE DESCRIPTIVE
PURPOSES NOT FOR DEFINITIVE
TREATMENT EFFECTS ON THE BRAIN.
SO THE FIGURE HERE IS DESIGNED
SIMILARLY TO THE COGNITION
RESULTS.
WHAT YOU SEE IS FRONTAL LOBE ON
AVERAGE AMONG PEOPLE WHO GOT THE
CONTROL INTERVENTION, ABOUT .01
MILLIMETER THINNING OVER TIME.
COMPARE TO INTERVENTION GROUP
APPEARS TO BE SLIGHTLY LESS
THINNING.
GENERAL TRENDS ACROSS LOBES,
THESE ARE DISTRIBUTIVE ONLY.
CLEAR GENERAL DIRECTION OF TRENT
OF HEARING INTERVENTION AND
AIMED TO REDUCE CORTICAL
THINNING OVER TIME THAT ARE
PRONOUNCED FOR THE TEMPORAL AND
OTHER BRAIN REGIONS.
IF YOU APPLY AGAIN TO A
SENSITIVITY ANALYSIS WHERE YOU
OFFER MORE PRECISION BY DRAWING
INFERENCES ACROSS THE WHOLE
GROUP AS OPPOSED TO TREATING
EACH LOBE SEPARATELY, YOU SEE A
SIMILAR PATTERN, STRONGER
RESULTS LIKE TITER CONFIDENCE
INTERVALS PARTICULARLY OVER THEO
SIP TALL AND TEMPORAL LOBE.
THIS TAKES A BRAIN MAPPING DONE
BY THE UNIVERSITY OF
PENNSYLVANIA WHERE YOU CAN LOOK
AT WITHIN THE SUBLOBE REGIONS
MAP TO A BRAIN TO MAKE THE
FIGURE EASIER TO INTERPRET, THIS
SHOWS THE REDDER IT IS, THE
REDDER IMPLIES OR INDICATING
GREATER DEGREE OF REDUCED
CORTICAL THINNING WITH,ING
INTER-- HEARING INTERVENTION AND
THE BLUE INDICATES GREATER
CORTICAL THINNING.
YOU SEE A TREND HERE LIGHTING UP
WITH THE EFFECTS IS THE FRONTAL
LOBE WHICH ISISM CATTED VERY
MUCH IN LANGUAGE AND SPEECH
PROCESSING.
SO THE GREATER EFFECTS ARE ALSO
IN THE CINGULATE CORTEX VERY
CRITICAL FOR RELAYING OF
ATTENTIONAL INFORMATION.
SOME AREAS OF VERY LIGHT BLUE,
NOT MUCH IN THE TEMPORAL LOBE
BUT PRIMARILY IN THE ANTERIOR
CINGULATE.
SO A BRIEF SUMMARY MRI RESULTS
TO DATE IS THAT WE GENERALLY SEE
A TREND TOWARDS HEARING
INTERVENTION, POSSIBLY BEING
ASSOCIATED WITH REDUCED CORTICAL
THINNING OVER THREE YEARS.
WHEN WE DID THESE ANALYSIS AND
SUGGESTED MRI SCAN, WE DIDN'T
THINK WE WOULD SEE ANYTHING.
THREE YEARS IS NOT MUCH TIME.
AND THERE SEEMS TO BE A SIGNAL
THAT THE HEARING AID
INTERVENTION IS DOING SOMETHING
TO THE BRAIN, THAT THINNING IS
BAD FOR THE BRAIN AND IT IS
DOING SOMETHING GOOD.
IT NEEDS TO BE FURTHER EXPLORED.
PATTERN OF FINDINGS TO DATE,
POTENTIAL MECHANISM JUST A BIT
HAND WAVING HERE BUT BY SOME
EVIDENCE THAT MAYBE DIRECT
EFFECTS OF HEARING AID USE, HERE
ON SUSTAINED ALTERATIONS AND
PATTERNS OF ACTIVITY AND/OR
POTENTIALLY INDIRECT EFFECTS IF
YOU'RE PROMOTING INCREASING
SOCIAL PHYSICAL ACTIVITY.
THAT COULD BE GOOD FOR THE BRAIN
STRUCTURE AS WELL.
ONGOING ANALYSIS, AND THEN WE'LL
PRESENT THIS AS ANOTHER PAPER.
SO, THE LAST FIVE MINUTES A
SUMMARY OF SOME RESULTS TO DATE
AND POLICIES I WANT TO ADD IN
THE END.
MOST OF MY NIME I'M DOING MORE
POLICY, BUT THEY GO HAND-IN-HAND
AND I'M SHOW YOU WHAT THAT IS IT
GOING.
SO ACHIEVE STUDY KEY FINDINGS.
I THINK AFTER THREE YEARS IT
APPEARS TO BE HIGH ADD MEANERS
AND SATISFACTION FOR THE HEARING
INTERVENTION.
SUSTAINED OVER THREE YEARS WITH
CLEAR POSITIVE EFFECTS ON
SELF-RECEIVED COMMUNICATION
IMPAIRMENT.
WE SEE STRONG EFFECTS OF HEARING
INTERVENTION REDUCING COGNITIVE
CHANGE FOR A GROUP THAT CAME
FROM A RANDOM SAMPLE OF THE
POPULATION.
EXPLORATORY MRI ANALYSIS
BIOMARKER EFFECTS WITHIN JUST
THREE YEARS ON REDUCED CORTICAL
THINNING.
KEY INFERENCE REFLECTED IN
LANCET, HEARING INTERVENTION MAY
REDUCE COGNITIVE LOSS FOR THREE
YEARS FOR THOSE POPULATIONS AT
RIDGE FOR COGNITIVE DECLINE
WITHIN THREE YEARS.
SO IMPLICATIONS FOR POLICY.
I WOULD SAY AS WE INTERPRET
SCIENTIFIC EVIDENCE TO CLINICAL
REP RECOMMENDATIONS AND POLICY,
IT ALWAYS, ALWAYS REQUIRES
EXTRAPOLATION.
NO SCIENTIFIC STUDY EVER
REPLICATES THE EXACT STUDY YOU
WANT TO EXTRAPOLATE TO.
SO EXTRAPOLATION OF SCIENTIFIC
DATA TO CLINICAL RECOMMENDATION
OF POLICY ALWAYS DEPENDS ON
EXTRAPOLATION AND BALANCING RISK
VERSUS BENEFIT.
SO I'LL SAY BEFORE THIS TRIAL
CAME OUT, THIS IS GOING TO
HAPPEN.
SO WE LOOK AT THE PREVIOUS
RECOMMENDATIONS FROM THE 2020
LANCET COMMISSION ON DEMENTIA AS
WELL AS THE 2021 U.S. NATIONAL
PLAN FOR ALZHEIMER'S DISEASE.
THESE REPORTS ARE CALLING FOR
ADDRESSING HEARING LOSS IN THE
CONTEXT OF NATIONAL DEMENTIA
PREVENTION STRATEGIES.
THIS IS FAIR FOR THE TRIAL
BECAUSE ALL RISK VERSUS BENEFIT.
THE RISK OF HEARING INTERVENTION
IS PRIMARILY FINANCIAL RISK.
NO MEDICAL RISK.
THE BENEFITS ARE CLEARLY
COMMUNICATION, THINGS LIKE THAT
AND POSSIBLY REDUCED COGNITIVE
CHANGE.
SO I THINK EXTRAPOLATION IS
JUSTIFIABLE IN THAT SENSE.
NOW THE TRIAL RESULTS I WOULD
SAY SHOWING RELATIVELY STRONG
EFFECTS WITH RISK AS WELL AS
BIOMARKER EFFECTS ON THE BRAIN.
IT DOES CALL INTO ACTION OR
PERSPECTIVE OTHER POLICY
ACTIONS.
ONE BITTER PARADOX I FACE THAT
MANY OF YOU FACE IS THAT HEARING
INTERVENTION OFFERED IN ACHIEVE
WITH HEARING AIDS AND
AUDIOLOGISTS, THIS BEST PRACTICE
INTERVENTION WOULD NOT BE
COVERED UNDER MEDICARE.
HEARING AIDS AND RELATED
SERVICES UNDER TRADITIONAL
MEDICARE ARE STATUTORY
EXCLUSIONS WRITTEN INTO THE 1965
SOCIALITY SECURITY ACT.
YOU HAVE TO CHANGE THE
LEGISLATIVE LAW.
IT'S NOT -- IT HAS TO BE CHANGED
IN THE LAW.
IF WE BELIEVE THIS CAN MAKE A
DIFFERENCE IN SOMEONE'S LIFE
COMMUNICATION WISE AND REDUCING
COGNITIVE LOSS, YOU HAVE SHOULD
HAVE SOME INSURANCE COVERAGE.
THAT'S SOME WE HAVE TO WORK ON.
REGULATION OF HEARING AIDS ARE
RIDICULOUSLY EXPENSIVE.
ONE WAY IS HOW THEY ARE
REGULATED TO PROMOTE THE
DEVELOPMENT OF OTC HEARING
COMPANIES LIKE SAMSUNG.
SO YOU COULD NEVER GET THE
ECONOMY TO SCALE TO DRIVE
INNOVATION.
AND THE BITTER PARADOX WE THINK
HEARING IS IMPORTANT.
FOR MOST PEOPLE IN THIS ROOM,
YOU MIGHT HAVE GOTTEN YOUR
HEARING MEASURED WHEN YOU WERE 6
OR 7 AND FOR THE AVERAGE
AMERICAN YOU NEVER HAVE YOUR
HEARING TESTED EVER AGAIN UNTIL
YOU'RE 80 YEARS OLD AND YOUR
SPOUSE IS SCREAMING AT YOU TO
GET A HEARING TEST.
SO ALL THE TALK ABOUT HEARING,
NOBODY KNOWS WHERE THEIR HEARING
IS.
IT'S A BARRIER.
THESE ARE AREAS THAT WE HAVE
ALREADY MADE A LOT OF PROGRESS
ON AND THERE ARE CONTINUING
VERY, VERY QUICKLY ESPECIALLY
NOW THAT THE TRIAL RESULTS CAME
OUT.
THIS IS THE FIRST ONE WITH THE
MOST DISAPPOINTING.
TWO YEARS AGO, THE WHITE HOUSE
BUILD BACK BETTER ACT, WE GOT
WRITTEN INTO THE MEDICARE
HEARING COVERAGE.
SO THAT WAS A 1.75 TRILLION
DOLLAR SPENDING BILL FOR CHILD
CARE AND PRESCHOOL, HOME CARE,
ET CETERA.
AND THERE IS A 35 BILLION DOLLAR
OFFER FOR 10 YEARS ON MEDICARE
HEARING CARE COVERAGE.
THAT WOULD HAVE COVERED HEARING
CARE SERVICES AND DEVICES.
UNFORTUNATELY IT DIDN'T PASS OUT
OF THE SENATE.
BUT WE GOT CLOSE AND WORKING
LEGISLATIVE LANGUAGE TO BE
RESURRECTED.
HOW DID THIS HAPPEN?
THE POLICIES MAKERS I WORK WITH
IN CONGRESS AND THE SENATE PART
OF IT THE WAY THEY PUT IT, WE
CAPTURE THE IMAGINATION OF
POLICYMAKERS EARLY ON ABOUT HOW
IMPORTANT THIS COULD BE TO
PUBLIC HEALTH.
THAT'S ONE REASON WE SEE THIS
ONE 35 BILLION DOLLARICALITIA
FOR MEDICARE AMONG EVERYTHING
ELSE.
THE WHOLE BILL DIDN'T ADVANCE.
NOW THE LEGISLATIVEILABLE IS
THERE, IT MAKES IT MUCH EASIER
TO LATER RESURRECT.
IT'S CLEAR PROGRESS.
FEDERAL PASSAGE OF THE
OVER-THE-COUNTER HEARING ACT OF
2017.
THIS THE REPRESENTED MANY YEARS
OF WORK.
THE NATIONAL ECONOMIES WITH NIDC
DIRECTOR AND THEN LEADING TO THE
WHITE HOUSE PRESIDENT'S COUNSEL
OF TECHNOLOGY TAKING ON THIS
ISSUE.
THAT LED TO RECOMMENDATIONS US
GOVERNMENT SHOULD REREGULATE
HEARING AIDS TO OFFER GREATER
COMPETITION TO ALLOW FOR
COMPANIES LIKE SAMSUNG, APP EGG,
POSE TO INNOVATE IN THIS SPACE.
THAT WAS A BILL THAT RECEIVED
BIPARTISAN SUPPORT ON THE SENATE
SIDE.
ONE OF THE SIGNATURE BIPARTISAN
ACCOMPLISHMENTS.
ON THE HOUSE SIDE IT WAS JOE
KENYA AND MARSHA BLACKBURN.
YOU CAN'T GET TWO MORE OPPOSING
SIDES OF THE AISLE BUT IT CAME
TOGETHER BECAUSE THE POSITION IS
INCREASED ACCESS AND
AFFORDABILITY.
REPUBLICAN SIDE IT IS BREAKING
DOWN MONOPOLIES BARRIERS OF
INCREASED COMPETITION.
THIS GOT ADVANCED QUICKLY,
ISSUED -- INTRODUCED IN MARCH
2017.
GOT SIGNED INTO LAW 5 MONTHS
LATER.
I TESTIFIED ON BEHALF.
THERE WAS A LOT OF OPPOSITION
FROM THE ENTRENCHED HEARING AID
INDUSTRY UNFORTUNATELY.
FINAL REGULATION WENT INTO
EFFECT OVER A YEAR AGO.
YOU WILL BEGIN SEEING -- IT WILL
TAKE A FEW YEARS.
YOU WILL SEE THE WHOLE U.S.
HEARING MARKET IN THE NEXT FEW
YEARS DRAMATICALLY CHANGE AS
MUCH, MUCH BIGGER COMPANIES THAT
WE ALL HEARD OF BEGIN TO ENTER
THE SPACE.
IT WON'T TAKE TWO OR THREE
YEARS.
HOW YOU INTRODUCE IT, HOW YOU
PRICE IT, THAT'S ALL SOMETHING
TO FIGURE OUT IN REALTIME BUT
THIS IS FEDERAL LAW.
THIS MAKES THE U.S. THE FIRST
COUNTRY IN THE ENTIRE WORLD TO
HAVE A REGULATED MARKET FOR OTC
HEARING.
NOWHERE ELSE IN THE WORLD.
THIRD THING I'LL SAY AND I SPEND
A LOT OF MY TIME ON, IS A
PARADOX THAT NO ONE HERE KNOW
WHAT IS YOU'RE HEARING IS.
I'M GUESSING NO ONE KNOWS WHAT
YOU'RE HEARING IS.
WE THINK HEARING IS IMPORTANT
AND IF NO ONE KNOWS THEIR
HEARING, IT'S A PROBLEM.
SO BEGINNING -- ONE THING VERY
IMPORTANT WHEN CONSUMERS KNOW
SOMETHING ABOUT THEIR HEALTH
THROUGH A METRIC, YOUR BLOOD
PRESSURE, IT CHANGES BEARS.
IT CHANGES HOW YOU THINK ABOUT
WHAT TO DO ABOUT IT.
FOR THE PAST YEAR I WORKED WITH
CONSUMER TECHNOLOGY ASSOCIATION,
AND THANCY TO DEVELOP A
STANDARD.
CTA ANSI STANDARD FOR THE FOUR
FREQUENCY TESTING AVERAGE.
THIS MEANS THAT GOING FORWARD --
WITH FDA, AMAZON, APPLE, WE HAVE
NOW SET THE STANDARD THAT AS
THIS GETS TAKEN UP BY CONSUMER
ELECTRONSICS IN THE NEXT FEW
YEARS, EVERY CONSUMER ELECTRONIC
DEVICE, WHETHER A WIRELESS OR
PHONE OR SMARTPHONE WILL PROMPT
YOU TO MEASURE HEARING AND THEN
CUSTOMIZE YOUR HEADPHONES TO
MEET WHAT YOUR HEARING IS.
EVERYONE WILL UNDERSTAND AND
KNOWS.
HEARING LOSS, THE WORD IS
TERRIBLE.
IT WILL BEGIN SHAPING BEHAVIORS.
NYE FUNDAMENTAL GOAL IS FOR
EVERY TEENAGER AND ADULT TO
UNDERSTAND THE MEASURE AND TRACK
THEIR HEARING OVER THEIR
LIFETIME.
I THINK THAT CHANGES BEHAVIORS
AT UNPRECEDENTED SCALE.
SO I WILL FINISH UP WITH MY LAST
SLIDE -- FOR EXAMPLE, THIS IS MY
HEARING NUMBER.
MINE IS AT 12 AND MY DAUGHTER,
17, HERS IS A NEGATIVE 3.
SHE MAKES FUN OF ME NOW.
EACH THOUGH MY HEARING WOULD BE
CONSIDERED NORMAL, IT'S NOT
ANYMORE.
I SHIFTED 15DBs IN 15 YEARS.
SO THIS IS WHAT IS HAPPENING.
THIS IS THE REASON APPLE
PLATFORM, SHOULD YOU DO IT
YOURSELF, DOWNLOAD THE APP AND
IT SPITS OUT YOUR HEARING
NUMBER.
AND THE CONTEXTURALIZATION
AROUND IT.
SO I'LL BEGIN HERE.
THIS ALL BEGAN WITH CLINICAL
INSIGHTS MANY, MANY YEARS AGO.
AND I HOPE TO SHOW YOU OVER THE
LAST 45 MINUTES, HOW TO
TRANSLATE INSIGHTS TO TRIALS AND
TRIALS TO POLICY AND SOMETIMES
YOU DON'T NEED THE TRIALS FOR
THE POLICY, THEY GO HAND-IN-HAND
AS THEY PROGRESS ALONG.
BRIEF ACKNOWLEDGMENTS.
HUGE TEAM OF PEOPLE.
60 STAFF, FUNDED BY THE ACHIEVE
TRIAL TO DATE.
THIS THE IS JUST NOT EVEN A
COMPLETE SAMPLING THAT MADE ALL
THE SCIENCE POSSIBLE.
NIH VERY MUCH THANKS FOR
SUPPORTING THE CAREER
DEVELOPMENT THAT LAUNCHED ALL
THIS AND THE NIA WITH THE BULK
OF FUNDING FOR ACHIEVE TRIAL.
ALL THE HEARING AIDS WERE
DONATED BY ONE OF THE HEARING
COMPANIES.
NIH FUNDED THE TRIAL BUT THE
HEARING AIDS WERE DONATED.
AND THEN I WILL FINISH UP WITH A
COVER FROM A LANCET ARTICLE.
MORE INFORMATION ON THE ACHIEVE
STUDY AND THE HEARING NUMBER IF
YOU WANT TO LEARN WHAT YOUR
HEARING IS, YOU CAN LEARN HOW TO
GET YOUR HEARING NUMBER.
THANK YOU VERY MUCH.
>> WE HAVE LOTS OF QUESTIONS ON
LINE.
PROBABLY CAN'T GET TO THEM ALL
BUT, PLEASE.
>> FRANK, THANK YOU AND
CONGRATULATIONS.
IT'S REALLY DIFFICULT TO
OVERSTATE THE IMPORTANCE OF THIS
STUDY.
THE RAMIFICATIONS ARE
TREMENDOUS.
AND WILL CONTINUE TO BE.
I'M FASCINATED BY THE MRI DATA.
I'M SHOCKED BY THAT.
YOU THINK OF AUDITORY
DEPRIVATION IN ADULTS AND NONE
OF US WOULD HAVE EVER PREDICTED
THAT THE ADULT BRAIN IS PLASTIC
ENOUGH TO REALLY RESPOND IN THIS
WAY THAT YOU HAVE MEASURED.
AND WHEN YOU THINK ABOUT THE
AVERAGE LENGTH OF TIME BETWEEN
WHEN AN ADULT COULD BENEFIT FROM
AMPLIFICATION AND WHEN THEY
ACTUALLY GET IT, IT'S AN AVERAGE
OF NINE YEARS.
IT'S A HUGE AMOUNT OF TIME.
I'M WONDERING IF YOU CAN COMMENT
AT ALL OR IF YOU LOOKED IN YOUR
DATA TO SEE HOW LONG THE PERIOD
OF HEARING LOSS WAS IN SOME OF
THE PARTICIPANTS BEFORE THEY
ENTERED INTO YOUR STUDY.
AND IF YOU THINK THAT THERE IS A
DIFFERENCE GIVEN THE LENGTH OF
TIME OF HEARING LOSS PRIOR TO
INTERVENTION.
>> THE GREAT QUESTION.
AND I THINK THE TRICKY THING IS
ALWAYS THAT WE THINK ABOUT
HEARING LOSS BEING A BINARY,
WHEN DID HEARING LOSS BEGIN?
WHEN REALISTICALLY IT'S A
MONTONIC TRAJECTORY OF OUR
ENTIRE LIFETIME.
SO IN THE ACHIEVE TRIAL WE HAD A
ROBUST INTERVIEW SURVEY OF
HEARING LOSS.
SO THE ONE THING WE WANTED TO
EXCLUDE IS PEOPLE ANY TYPE OF
EARLY ADULT ONSET.
THEY WERE EXCLUDED.
FROM THERE, WE HAD MEASURES ON
HEARING IN PEOPLE YEARS AND
YEARS, WE DON'T KNOW AT WHAT
POINT IT ACCELERATED.
THE ONE THING WE KNOW THIS WAS
NOT EARLY-ONSET.
NOT EARLY ADULT ONSET.
THE BREAD AND BUTTER EVERYONE
EXPERIENCED OVER TIME, THAT WAS
THE MAIN THING.
THERE ARE A FEW SAMPLE OF
PARTICIPANTS WITH TRAJECTORIES.
THEY WERE PREVIOUSLY
CHARACTERIZED AS WELL.
BUT KEY THING IS NO ONE IS
CERTAINLY EARLY-ONSET.
THIS WAS ALL PEOPLE WHO WERE NOT
USING HEARING AIDS AT THE TIME.
>> LET ME GET ONE QUESTION IN
OVER HERE FROM ON LINE.
INTERESTING IT COMES FROM A
COLLEAGUE AT AARP.
VERY GOOD AUDIENCE FOR US.
CAN YOU LIST THE INCREASED RISK
FACTORS THAT MADE THE HEARING
AIDS MOST HELPFUL AND WHAT
PERCENTAGE OF OLDER POPULATIONS
FITS INTO THIS INCREASED RISK
PROFILE?
>> SO, I THINK THE QUESTIONS
SPECIFICALLY AROUND THE ARIC
VERSUS DE NOVO COHORTS.
THE ARIC COHORT WAS RANDOMLY
SAMPLED FROM A POPULATION 35
YEARS WHEN THEY WERE RECRUITED
AND THEN DE NOVO WAS SELF
SELECTED.
ON ANGEL WE SAW THE ARIC
COHORT -- DE NOVO FEWER RISK
FACTORS THAN ARIC.
BUT IT WAS JUST ON AVERAGE.
NOT LIKE A PRICE RISK FACTORS.
IN THE WHOLE COHORT PROPENSITY
SCORE ANALYSIS.
IF AWAITING MULTIPLE RISK
FACTORS AND RISK OF COGNITIVE
DECLINE, WHEN YOU ANALYZE ENTIRE
COHORTS THAT WAY, WHAT YOU SEE
AGAIN IS VERY CONSISTENT WITH
THE RESULTS, PEOPLE OF A HIGHER
PROPENSITY FOR COGNITIVE DECLINE
AND PROTECTIVE EFFECT OF HEARING
INTERVENTION.
AGAIN NOT SURPRISING.
YOU HAVE TO HAVE COGNITIVE
DECLINE TO REDUCE AN EFFECT BUT
YOU SEE THAT TYPE OF -- THERE IS
NOT A CERTAIN CONSTELLATION OR
DIRECT MEASURE.
ONE REPRESENTS A RANDOM SAMPLE
AND SELF SELECTED POPULATION.
>> YES, I AM ELDERLY MALE,
HEARING AID WEARER WITH CHRONIC
CARDIOVASCULAR DISEASE.
I TAKE STATENS AND I TAKE CLOT
BREAKERS.
AND I WAS CONCERNED ABOUT YOUR
ARIC POPULATION, WHICH WAS
UNSELECTED GROUP OF PEOPLE
MID-LIFE, WHO WE HAVE REASON TO
BELIEVE HAVE CHRONIC
CARDIOVASCULAR CONDITIONS.
SO MY QUESTION IS, DID YOU TREAT
THEM FOR THOSE CONDITIONS?
DID YOU DIAGNOSE AND TREAT THEM
AND FOLLOW THEM UP FOR THOSE
CONDITIONS?
>> GREAT QUESTION.
SO THE ARIC SAMPLE, THEY WERE
RECRUITED OVER 35 YEARS AGO IN
MID LIFE.
THEY REPRESENTED A RANDOM
SAMPLE.
SO THEY WEREN'T AT INCREASED
RISK FOR CARDIOVASCULAR EVENTS.
IT WAS A GENERAL SAMPLE OF THE
INTERVENTION.
THE STUDY WAS NOT RECEIVING
TREATMENT WITHIN THE STUDY BUT
ANY DATA REGARDING THEIR
CARDIOVASCULAR HEALTH WAS
RELAYED TO THEM AND THEIR
PHYSICIANS SO OVER TIME WE
EXPECT MANY OF THEM OBVIOUSLY
HAD THEIR CARDIOVASCULAR HEALTH
TREATED AS THEY WOULD PER USUAL
CLINICAL CARE.
IF ANYTHING, BY BEING IN ARIC,
THEY GOT ADDITIONAL DIAGNOSTICS
AND ADDITIONAL KNOWLEDGE ABOUT
THEIR CARDIOVASCULAR HEALTH.
>> BUT YOUR STUDY DIDN'T FOLLOW
THEM UP?
IT LEFT IT TO THEM TO SEEK OUT
THEIR CARE?
>> YES, CORRECT.
SO THEY HAVE BEEN FOLLOWED FOR
MANY, MANY YEARS.
ALWAYS BEEN FOLLOWED BY THEIR
ROUTINE PHYSICIANS AS WELL.
SO MANY OF THEM, IF THEY HAD ANY
TYPE OF HYPERTENSION OR
DIABETES, THEY WERE BEING
TREATED BY THEIR PRIMARY CARE
PHYSICIAN.
>> HOW MANY OF THEM HAD ROUTINE
PHYSICIANS SINCE THEY LIVED IN
COMMUNITIES WHICH HAD AIR
POLLUTION AND OTHER CRITERIA
WHICH MADE THEM THINK THAT MAKES
ME WONDER HOW MANY PHYSICIANS
THEY HAD FOR THE POPULATION AND
HOW MANY PHYSICIAN VISITS THEY
HAD?
IT RAISES IN MY MIND A QUESTION
OF ETHICS WHICH HAS AFFECTED
NEGATIVELY THIS INSTITUTION IN
THE PAST AND SO THAT'S WHY I'M
RAISING THE QUESTION.
>> I APPRECIATE YOUR POINT
BECAUSE IT COMES OUT HOW WE
TREAT STUDY POPULATIONS AND HOW
MUCH INFORMATION WE PROVIDE
THEM.
THE ARIC COHORT WAS LONGLY
FOLLOWED.
MANY, MANY PUBLICATIONS.
MUCH ENGAGEMENT STUDIES THAT'S
WHY THEY HAD BE FOLLOWED FOR SO
LONG.
SO I'M HAPPY TO TALK MORE OFF
LINE ABOUT IT.
BUT IT'S A VERY, VERY WELL
STUDIED POPULATION THAT RECEIVED
PHENOMENAL HEALTH DATA FROM THE
STUDY FOR WHICH THE STUDIES ARE
CONSTANTLY IN TOUCH WITH THE
PARTICIPANTS PHYSICIANS IN MANY
CASES TO RELAY HEALTH DATA.
I'M HAPPY TO CHAT MORE LATER AND
GIVE YOU MORE RESOURCES FOR
LEARNING MORE.
>> I'LL TAG ON TO THAT.
IS THERE ANY EVIDENCE THAT
VASCULAR RISK FACTORS ARE A
MODIFIABLE THING FOR HEARING
LOSS?
>> FOR HEARING LOSS?
I THOUGHT YOU WERE GOING TO SAY
DEMENTIA.
SO, YES AND NO.
WHAT I MEAN BY PLENTY OF
OBSERVATIONAL DATA SUGGESTING
CARDIOVASCULAR RISK FACTORS FOR
HEART HEALTH AND FOR HEARING
HEALTH.
I WOULD SAY ANECDOTAL BUT FROM
OBSERVATIONAL DATA, I NEVER
LOOKED AT TO THE CLOSELY BUT IN
TERMS OF PEOPLE WHO ARE OR HAVE
BETTER CONTROLLED OR BETTER
HEARING -- IT WOULD MAKE SENSE.
SO NOT A TRIAL LOOKING AT THAT.
THE TRIAL WOULD HAVE TO GO ON
FOR MANY, MANY DECADES AND
PROBABLY MORE PEOPLE TO LOOK AT
THAT FOR CARDIOVASCULAR HEALTH.
BUT FOR OBSERVATIONAL DATA, IF I
RECALL THERE WAS SOME STUDY
SUGGESTING BETTER CONTROL OF A
MID LIFE CARDIOVASCULAR AND
HEARING -- THERE PROBABLY IS
SOME INDICATION WHICH WOULD MAKE
SENSE WITH THE LITERATURE.
>> CONGRATULATIONS ON YOUR
BEAUTIFUL STUDY AND WONDERFUL
TALK.
I WAS WONDERING, FOR THOSE
PATIENTS WHO HAVE MILD HEARING
LOSS AND TRIED HEARING AIDS BUT
DON'T LIKE THEM, WHAT DO YOU
TELL THEM?
>> SO FOR THE ACHIEVE TRIAL AND
DR. CHEN IS ONE OF MY COLLEAGUES
AT HOPKINS, LOOKS LIKE YOU
HOPPED ACROSS THE STREET IN YOUR
SCRUBS, THANKS FOR COMING OVER.
IN THE ACHIEVE TRIAL THIS IS
INTENTION TO TREAT.
SO FUNDAMENTALLY YOU SAW THE
HISTOGRAM OF HEARING AID USE.
SOME STOPPED USING THEM.
SO THEY ARE STILL INCLUDED IN
THE COHORT WITH INTENTION TO
TREAT.
I DIDN'T SHOW THIS BUT 17% OF
THE CONTROL GROUP, THEY GOT
HEARING AIDS ON THEIR OWN BEFORE
THE END OF THE STUDY.
THIS THE IS ALL IN TENSION TO
TREAT.
THEY ARE TREATED IN THEIR
ASSIGNED GROUPS, WITH A HEARING
AID OR YOU GOT A HEARING AIDS
OUTSIDE OF THE STUDY.
SO INTENTION TO TREAT SO THE
RESULTS ARE STILL CONSERVATIVE.
IF WE APPLY A PROTOCOL ANALYSIS,
WHERE YOU EXCLUDE THOSE PEOPLE
OR TREAT THEM DIFFERENTLY IN
TERMS OF ANALYSIS, THE RESULTS
GET STRONGER.
BUT REALLY IT'S AN INTENTION TO
TREAT STUDY.
SO IF PEOPLE WANT TO USE HEARING
AIDS -- CAN'T DO ANYTHING ABOUT
IT.
I WOULD SAY IT'S THE TESTAMENT
THAT IS IMPORTANT IF YOU ARE
THINKING ABOUT SCALING.
THE TECHNOLOGY IS IMPORTANT AND
MORE IMPORTANT IN THE STUDY
ACTUALLY WAS THE AUDIOLOGIST
REMAINING ENGAGED WITH THAT
PARTICIPANT EVERY SIX MONTHS AND
CHECKING IN.
FOR 82-YEAR-OLD NOT FAMILIAR
WITH TECHNOLOGY, SAYING HERE ARE
YOUR HEARING AIDS, GOOD LUCK.
I GUARANTEED THIS TRIAL WILL
FAIL.
SOMEONE IS SUPPORTING THE USE
EVERY 6 CHOPS AND THAT MADE ALL
THE DIFFERENCE LIKELY.
SOME PEOPLE DID STOP USING
HEARING AIDS SO IT IS STILL
INTENTION TO TREAT.
>> PERHAPS WE'LL END IT HERE.
WE ARE PAST THE HOUR.
THERE WILL BE A RECEPTION OUT
THERE.
I HOPE EVERYONE CAN JOIN US.
THANK YOU, AGAIN.
THANK YOU, EVERYONE.
[ APPLAUSE ]