Recent research has linked age-related hearing loss to impaired performance across cognitive domains and increased risk for dementia diagnosis. The data linking hearing impairment to incident late-life depression are more mixed but suggest that diminished hearing does increase risk for depression. Behavioral mechanisms may explain these associations, such as the withdrawal of older adults from situations in which they may have difficulty hearing and communicating, which may contribute to the development of social isolation, loneliness, and consequent cognitive decline and depression. At a neural level, chronic hearing loss leads to reduced activation in central auditory pathways, resulting in compensatory increased activation in the cognitive control network, dysfunctional auditory–limbic connectivity, and deafferentation-induced atrophy in frontal brain regions. These pathologic changes decrease cognitive performance and increase depression risk by reducing cognitive reserve, increasing executive dysfunction, and disrupting normative emotion reactivity and regulation. Based on the available data and informed by this model, evidence-based suggestions are proposed for clinicians treating older adults, and a research agenda is advanced to facilitate the development of rationally designed and age-appropriate psychiatric treatments for older adults with age-related hearing loss. First and foremost, treating hearing loss should be investigated as a means of improving cognitive and depressive outcomes in well-designed studies incorporating comprehensive psychiatric assessments, randomization, objective documentation of compliance, and analyses of treatment mediators that will facilitate further therapeutic development. Multimodal neuroimaging studies integrating audiometric, neuropsychological, and clinical assessments also are needed to further evaluate the model proposed.

[AJP at 175: Remembering Our Past As We Envision Our Future

April 1995: Effect of Hearing Enhancement on Medical Status Ratings

Twenty-one elderly psychiatric patients had lower levels of psychopathology when assessed while wearing hearing aids. (Am J Psychiatry 1995; 152:629–631)]

最近的研究发现，与年龄相关的听力损失与认知领域的表现受损以及痴呆症诊断风险增加有关。将听力障碍与晚年抑郁症联系起来的数据比较复杂，但表明听力下降确实会增加患抑郁症的风险。行为机制可以解释这些关联，例如老年人从可能有听力和交流困难的情况中退出，这可能导致社会孤立、孤独感以及随之而来的认知能力下降和抑郁。在神经水平上，慢性听力损失导致中枢听觉通路的激活减少，导致认知控制网络的补偿性激活增加、听觉-边缘连接功能障碍以及传入神经阻滞引起的额叶脑区域萎缩。这些病理变化通过减少认知储备、增加执行功能障碍以及破坏正常的情绪反应和调节来降低认知表现并增加抑郁风险。根据现有数据和该模型的信息，为治疗老年人的临床医生提出了基于证据的建议，并提出了研究议程，以促进为具有年龄相关听力的老年人开发合理设计和适合年龄的精神治疗方法损失。首先，治疗听力损失应作为改善认知和抑郁结果的一种手段，在精心设计的研究中进行研究，其中包括全面的精神病学评估、随机化、客观的依从性记录以及治疗介质的分析，以促进进一步的治疗发展。 还需要整合听力、神经心理学和临床评估的多模态神经影像研究来进一步评估所提出的模型。

[AJP 175：在展望未来时铭记我们的过去

1995 年 4 月：听力增强对医疗状况评级的影响

佩戴助听器进行评估时，21 名老年精神病患者的精神病理学水平较低。 （美国精神病学杂志 1995 年；152：629–631）]