The Association of Hearing Impairment and Behavioral and Psychological Symptoms in Community-Dwelling Patients with Alzheimer’s Disease

Yu-Ru Lin,1,* Ming-Che Chang,2,* Yu-Chun Tung,3,* Sheng-Chieh Lin,4,5,* Wen-Fu Wang,6,* Kai-Ming Jhang6 1Department of Medical Education, Changhua Christian Hospital, Changhua County, Taiwan; 2Department of Nuclear Medicine, Changhua Christian Hospital, Changhua County, Taiwan; 3Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan; 4Department of Orthopedics, Chung Shan Medical University Hospital, Taichung, 402 Taiwan; 5Taiwan School of Medicine, Chung Shan Medical University, Taichung, 402, Taiwan; 6Neurological Institute, Changhua Christian Hospital, Changhua County, Taiwan*These authors contributed equally to this workCorrespondence: Kai-Ming Jhang, Neurological Institute, Changhua Christian Hospital, No. 135 Nanxiao Street, Changhua County, 500, Taiwan, Tel +886 4 7238595 ext. 3521, Email [email protected]: This study aimed to investigate the relationship between hearing impairment and the longitudinal changes in behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer’s disease (AD).Materials and Methods: This case–control study enrolled 387 participants newly diagnosed with AD. Participants’ hearing status was initially assessed based on their need for hearing assistance during neuropsychological tests. BPSD was evaluated using the Neuropsychiatric Inventory (NPI) at baseline and a 1-year follow-up visit. Multivariable logistic regression models were used to examine the association between hearing status and the presence of BPSD.Results: A higher percentage of participants in the hearing-impaired group exhibited moderate to severe apathy (26% vs. 14%, p=0.01) and sleep disturbance (24% vs. 14%, p=0.042) after 1 year. Hearing impairment was found to be an associated factor for the presence of sleep disturbance (odds ratio [OR] = 1.88; 95% confidence interval [CI] = 1.09– 3.21) and moderate-to-severe apathy (OR=1.97; 95% CI=1.03– 3.72) after 1 year. After adjusting for age, sex, education, baseline Clinical Dementia Rating (CDR) and baseline Neuropsychiatric Inventory (NPI) scores, hearing impairment remained an independent associated factor for the risk of worsening symptoms in apathy and sleep disturbance symptoms, with ORs of 2.06 (95% CI=1.13– 3.70, p=0.016) and 2.13 (95% CI=1.18– 3.80, p=0.012), respectively.Conclusion: This study demonstrated that hearing impairment is associated with the longitudinal worsening of sleep and apathy symptoms in patients with AD over a 1-year follow-up period. Dementia care teams should place greater emphasis on these non-cognitive symptoms and provide appropriate management strategies.Keywords: sensory loss, auditory, sleep disturbance, insomnia, apathy