Interview with Alison Huang, PhD, MPH
5:00 AM
Hearing loss is one of the most common conditions of aging, affecting nearly two-thirds of older adults over the age of 70, but it’s not just a matter of diminished hearing. Hearing loss can contribute to poor psychosocial outcomes for patients including loneliness, depression, and social isolation. New research also shows that hearing loss is linked to a higher risk of cognitive decline and dementia. In fact, the 2024 Lancet Commission on Dementia Prevention, Intervention, and Care identified hearing loss as one of 14 modifiable risk factors for dementia. According to the commission, treating hearing loss could prevent up to 7% of dementia cases globally, making it one of the most impactful areas for potential prevention. This raises the question of whether use of hearing aids in people with hearing loss can reduce or mitigate this increased dementia risk.
To help us understand these connections and the latest research in this area, we are joined today by Dr. Alison Huang, an epidemiologist and Senior Research Associate from the Johns Hopkins Cochlear Center for Hearing and Public Health. Her research studies the impact of sensory loss on cognitive and mental health in older adults. Dr. Huang was an author of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, a large, multicenter randomized controlled trial that tested whether treating hearing loss in older adults could help slow cognitive decline published in the Lancet.
Link to article:
Lin FR, Pike JR, Albert MS, Arnold M, Burgard S, Chisolm T, Couper D, Deal JA, Goman AM, Glynn NW, Gmelin T, Gravens-Mueller L, Hayden KM, Huang AR, Knopman D, Mitchell CM, Mosley T, Pankow JS, Reed NS, Sanchez V, Schrack JA, Windham BG, Coresh J; ACHIEVE Collaborative Research Group. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet. 2023 Sep 2;402(10404):786-797. doi: 10.1016/S0140-6736(23)01406-X. Epub 2023 Jul 18. PMID: 37478886; PMCID: PMC10529382.
Transcript
Matt Davis:
Welcome to Minding Memory, a podcast devoted to exploring research on Alzheimer's disease and other related dementias. Here we'll discuss some of the most compelling research and talk with leaders in the field about how their work is improving the detection and treatment of dementia. I'm Matt Davis.
Lauren Gerlach:
And I'm Lauren Gerlach.
Matt Davis:
We're both researchers at the University of Michigan. I have a PhD in data science
Lauren Gerlach:
And I'm a geriatric psychiatrist who specializes in diagnosis and management of dementia.
Matt Davis:
I'll work to minimize the use of medical jargon in our discussions.
Lauren Gerlach:
And I'll make sure that the research we talk about has practical, real-world applications to people living with dementia and their care partners.
Matt Davis:
Thanks for joining us, and let's get started.
Lauren Gerlach:
Hearing loss is one of the most common conditions of aging affecting nearly two-thirds of older adults over the age of 70, but it's not just a matter of diminished hearing. Hearing loss can also contribute to poor psychosocial outcomes for patients, including loneliness, depression, and social isolation. New research also shows that hearing loss is linked to a higher risk of cognitive decline in dementia. In fact, the 2024 Lancet Commission on Dementia Prevention Intervention and Care identified hearing loss as one of 14 modifiable risk factors for dementia. According to the commission, treating hearing loss could prevent up to 7% of dementia cases globally, making it one of the most impactful areas for prevention. This raises questions on whether the use of hearing aids in people with hearing loss can reduce or mitigate this increased dementia risk. To help us understand these connections and the latest research in this area, we're joined today by Dr. Alison Huang, an epidemiologist and senior research associate from the Johns Hopkins Cochlear Center for Hearing and Public Health. Her research studies the impact of sensory loss on cognitive and mental health in older adults. She's here today to speak with us about her recent study. Dr. Huang, welcome to our podcast.
Alison Huang:
Thank you. Thanks for having me.
Lauren Gerlach:
Alison Huang:
Yeah, and that's a great question. So I'll back up a little bit and talk more about hearing loss broadly, and we hear a lot about hearing loss in the research space and in the news right now because it is just so prevalent. You mentioned two thirds of older adults over 70 years have hearing loss, and that prevalence increases with age. So almost all older adults over 90 years have hearing loss and hearing loss is just such a... Or hearing in general is just a basic part of our ability to communicate and to relate with others, and sometimes losing or having an impaired hearing ability can really affect our day-to-day lives and how we socialize. So I think it's just one of those more fundamental components of health. There's a lot of epidemiologic research setting the association between hearing loss and dementia. And we see from that recent Lancet Commission report that hearing loss has a population attributable fraction of 7%.
So that means that if we assume a causal relationship between hearing loss and dementia, and if we eliminate hearing loss as a risk factor altogether, we could reduce the cases of dementia by 7%, which is quite impactful given the high number of dementia cases globally. And hearing loss has a 1.4 times higher hazard of dementia compared to no hearing loss. So it's quite a strong risk factor. And there are a couple hypothesized mechanisms. One is that there could just be something, a common cause that underlines both hearing loss and dementia. So it could be something like biological aging or inflammation. But we know from the research that we see that we've considered those factors in the statistical models, and there could be some other more causal mechanisms. So one is, the first is cognitive load. So for people with hearing loss, processing speech and sound is much more difficult because it takes the brain extra resources.
So in the presence of hearing loss, speech and sound is heard as garbled, it's a little bit hard to decipher. So the brain takes extra resources in terms of attention, memory, diverted to just processing that speech and sound. It's one of the terms that's called effortful listening. So it just takes a lot more cognitive resources focused on just what am I hearing? What does that mean? Which takes away from other cognitive processes like memory and executive function for some of these other tasks. And that can lead to cognitive decline. Another is through direct changes to brain structure and function. So with hearing loss, the parts of the brain that are responsible for auditory processing are less stimulated, and we know that the brain is like a muscle so it's that “use it or lose it” hypothesis in that if those parts of the brain are less stimulated, they're more prone to atrophy, which is also a factor in dementia as well.
And the third is more of those social and behavioral pathways. So things like, as you mentioned, social isolation, depression, loneliness. We know hearing loss is all related to higher risk of those social factors as well as reduced physical activity, fatigue. So there are a lot of these more social behavioral areas, and these are all risk factors for dementia as well, social isolation, depression or physical activity. So hearing loss can also exacerbate some of these other risk factors for dementia.
Lauren Gerlach:
That is really, really interesting and makes a lot of sense. What you described, that idea of it taking extra cognitive effort to decipher what someone's saying makes a lot of sense, but I don't think I've ever heard it explained that way. And so you're taking away someone's cognitive reserve or adding on another cognitive test when they're trying to interpret what's being said and that that's something else that can lead to that. So that's really interesting. I'm wondering if we know anything, is there a dose dependent relationship, meaning is a greater severity of hearing loss associated with a greater risk for cognitive decline?
Alison Huang:
Yeah, typically we see a bit of a dose response relationship in that the more severe the hearing, the higher risk for cognitive decline in dementia. But it can vary. It's really dependent on other factors in terms of how long you've had hearing loss, how long it's been severe, things like that. So typically we have seen a bit of a dose dependent relationship.
Lauren Gerlach:
And then I was just going to say, just to set the stage, are we really talking about untreated hearing loss? So for individuals with hearing loss who are managed with hearing aids, are they still at higher risk of cognitive issues later in life? And I know we'll dive into the ACHIEVE study, but what we know from some of the previous literature, it's primarily talking about untreated hearing loss.
Alison Huang:
So in the epidemiologic literature, it's mostly they just measure hearing either by self-report or objectively with audiometry. And in terms of hearing aids, it's mixed in the epidemiologic literature in terms of whether people with moderate or severe hearing loss, those people who use hearing aids, whether their risk of dementia or risk of cognitive decline, is lower. And in that literature, and this is one of the motivations of the randomized control trial, and that there's a lot of factors that go into hearing aid ownership and use. Until very recently, hearing aids were very expensive, about $5,000 for a pair of hearing aids, not covered by insurance, and you needed to go through a clinician or audiologist to obtain them. So there are a lot of barriers to hearing aid ownership and usage, as well as the general stigma of wearing hearing aids as well.
So when you just look observationally, the people who own and use hearing aids typically have higher income or have higher wealth, a little more health conscious, have health insurance, are able to get transport or transport themselves to a clinician to get their hearing checked and get the hearing aids. So those are all factors that are also protective for dementia. So it's really difficult in the observational literature to decipher whether if we see a lower risk of dementia or slower rate of cognitive decline, is it the hearing aids themselves or is it some of these other factors that are associated with hearing aid use and ownership? So that was one of the motivations of the randomized control trials is if we take all those barriers away and we just give the participants hearing aids, what do we see? So it's a little mixed, but yeah, in the observational literature, it's mixed. But in the randomized control trial, we're able to look at that without some of these barriers.
Matt Davis:
I know that scientists really want to talk about causal mechanisms because we’re interested in understanding health and healthcare phenomena, but just hearing you reflect on the different hypotheses and potential mechanisms seems really important because some of them, when we do these calculations and we say, "If we eliminate hearing issues, we could reduce dementia by X percent," it hinges on a causal mechanism rather than an associative mechanism. So it seems really important, and I'll be interested to see or to hear what you think in terms of this study and how it fed into our understanding in terms of the impact you can have by correcting hearing issues.
Alison Huang:
And I think some of those, when you talk about population attributable fraction, the limitation is that there is that very strong assumption of a causal mechanism. And well, these are hypotheses, there's some evidence that supports that, but it's not something we can say definitively yet.
Matt Davis:
Tell us a little bit about what got you interested in studying the connection between hearing loss and cognitive decline.
Alison Huang:
Yeah, I love this question. So I actually did my undergrad at Michigan. So Michigan is my alma mater, which I was very excited to be invited on this podcast. And I studied neuroscience at Michigan. And one of my favorite classes there was Aging and Cognition, I believe, taught by Dr. Lustig. And I didn't know it at the time. I went on to get an MPH and do some more community health work, but I didn't realize it at the time but I think that really was one of the starts for my interest in cognition in older adults, that paired with a very close relationship with my grandmother. So my grandmother lived with my family since I was born, so I really got a front row seat to the aging process. She took care of me when I was younger, but then as I got older, I could see some of those impacts on age in that she was less mobile.
She did have hearing loss. I know I could see some of the cognitive impacts. So I think I really had such a close relationship with her and cared for her so much and really just wanted to do something with my career and my research that benefited older adults. So my PhD is in mental health, actually from Johns Hopkins. And a lot of the cognitive aging research sits in that department but also the research on depression and social isolation, loneliness, which is a lot of what I focus on now, is the intersection between hearing loss, mental health and cognition. And I remember this one Thanksgiving with my grandmother who she must have been maybe in her high eighties or nineties, and she had hearing loss, and we were sitting at the Thanksgiving table and tons of family around, everyone's having a great time, but she really couldn't hear much of the conversation, so she wasn't interacting with the family at the table.
You could tell she wasn't really following the conversation. Of course, it's really loud. There's a lot of background noise, and she just started to withdraw. So you have that situation where you're surrounded by a ton of people that love you and you love, but she probably felt quite lonely in that moment. And that's really when I started to think about some of these mental health aspects of hearing loss in terms of that, how fundamental it is to your mental health and social health, and how you could be completely, not socially isolated, tons of people around you, but also feel quite lonely and the part that hearing plays into that.
Matt Davis:
How common is hearing loss among older adults?
Alison Huang:
Yeah, so two thirds of older adults over 70 years have hearing loss and almost all older adults, it's upwards of 95% of adults over 90 have hearing loss. And that's one reason why hearing loss is just one of these factors that's been a real focused, is that it's highly prevalent so that if we're able to do something about it that affects a large population of older adults, it's modifiable. We have established treatments and interventions that we can use to address hearing loss. I think the really most important one is that we have an infrastructure for delivering that intervention. We've got audiologists, we've got clinicians, I can talk about this as well. We've got the Over-The-Counter Hearing Aid Act that passed in the past several years and was enacted recently. So there's infrastructure to deliver some kind of intervention that can modify this risk factor.
Lauren Gerlach:
So let's dive into the ACHIEVE study a bit, which really looks at hearing interventions and potential to reduce cognitive decline. Could you give us a brief overview of the study? What was the goal of the research? Who participated in the trial, and how was the study designed?
Alison Huang:
Yeah, so as I mentioned before, one of the motivations of the study was that from this epidemiologic research, it's difficult to disentangle. Is it the hearing aids or is it some of these other factors like health and wealth? So that was a motivation of a randomized control trial. And this is funded by the National Institutes of Aging and led by Drs. Frankl Lin and Josef Coresh. I serve as more of a scientific lead role on this study. And the main goal of the research was to look at the effect of hearing intervention versus a health education control on cognitive decline over three years with the hypothesis that hearing intervention would slow cognitive decline over the study period. And the study enrolled 977 participants, and this is quite large for a hearing study of this kind, I think the largest. And participants were recruited across two sources, so it was the ARIC population, and these are participants who were already participating in the ARIC study, which is the Atherosclerosis Risk In Communities Study.
And that is a longitudinal study of heart health that started in the eighties. So these are participants who have been involved in research and were recruited from that study to participate in a randomized control trial. So that makes up about a quarter of our participants. The other three quarters were newly recruited participants from the community that were recruited through advertisements and flyers. And these participants were from four field sites in the United States. So we've got Wake Forest of North Carolina, Jackson, Mississippi, Washington County, Maryland, and Minneapolis, Minnesota. And the inclusion criteria, so participants were 70 to 84 years, had mild to moderate hearing loss because that's the range of hearing loss where hearing aids could be most effective, and were without substantial cognitive impairment. And they were randomized for a baseline and then followed for three years, and we measured cognition at every year.
Matt Davis:
Did you notice, was it a lower income population because it was untreated hearing loss, or did you see any evidence of that?
Alison Huang:
Compared to... Well, so in the ARIC cohort, which was a quarter of the study sample, we did see a little bit lower income, a little bit less education. They were older, had more chronic conditions, versus the participants that were newly recruited, those people were a little bit healthier, a little bit younger, and that might be part of that healthy volunteer effect in that if you've been involved in research for decades, you're quite different than someone who's 70 to 84 years now and is wanting to join a randomized control trial and do all the things that are required of a participant in a randomized control trial.
Matt Davis:
So in the study, you compared a hearing intervention to a health education control group. I was wondering if you could talk a little bit more about what the hearing intervention involved and what the control group received.
Alison Huang:
So the hearing intervention was four sessions with an audiologist, a study audiologist that happened every one to three weeks after randomization. And the hearing intervention itself, and it's an important distinction to make, it was providing hearing aids and fitting hearing aids, but also there was a strong education counseling component. So it wasn't just, "Here are your devices and we'll see you soon." There was a strong education counseling component that went hand in hand. So that component included goal setting. What are your goals for improving your hearing, as well as communication strategies, education on that. So really teaching participants what to expect, some strategies to help with hearing and day-to-day life.
Matt Davis:
Did you consider other controls? I mean, does anybody ever use sham hearing aids or anything like that? It seems kind of cruel, actually, come to think of it.
Alison Huang:
Yeah, so we did a health education control, which was our active control, and those participants went through... They had also four sessions with a health educator, so they had a matched amount of attention as the hearing intervention, but the health education control was based on the 10 keys to healthy aging. So it was modules of things like blood pressure monitoring, physical activity. Let me think, what else? Glucose monitoring, cancer screening, things like that that the participant could prioritize which ones they wanted to go through. And as well as a five to 10 minute upper body stretching routine at every session. So there was no masking in that the study participants knew that they were the ones that got the hearing aids, the staff could tell that they got the hearing aids, but at the end of the three years, the interventions were offered the opposite ones. So the health education control was offered the hearing intervention, hearing intervention was offered health education control. So they did, at the end of three years... By now, everyone has hearing aids if they wanted them.
Lauren Gerlach:
I guess just a comment, it seems like studying disassociation with trial designs must be challenging considering the length of time between implementing a hearing intervention and changes in cognitive outcomes. And I'm hoping you could speak to that a little bit just in thinking about the length of follow-up.
Alison Huang:
Yeah, yeah. So cognition, it doesn't change super fast. And three years, especially for something like dementia is quite a short time to observe those kinds of changes. We do have funding for six years of follow-up, so we are able to follow the cohort for six years, but we started with three years and we did see evidence of a benefit so that we were able to also continue to six years.
Lauren Gerlach:
Great. So I was hoping you could talk a little bit about what the main findings were from the study. So did the hearing intervention help slow cognitive decline in older adults with hearing loss?
Alison Huang:
Yeah, so the findings are quite complex actually. So in the main cohort, in that 977 participants, we actually did not see an effect of hearing intervention on cognitive decline, meaning that in the health education control and in the hearing intervention, the rate of cognitive decline was very similar across the three years. But in a pre-specified, what we call a pre-specified sensitivity analysis, we looked at differences between the participants recruited from the ARIC study and participants recruited de nouveau or newly recruited. And we know that people in the newly recruited cohort, they're a little younger, a little healthier, higher income, and we actually saw that in the ARIC participants that there was a 48% reduction in the rate of cognitive decline in the people in the hearing intervention versus the control. Which is pretty impactful in that your rate of cognitive decline slows by almost half in the hearing intervention within three years.
In the de nouveau though, we did not, in the participants newly recruited, we did not see a difference between hearing intervention and control. And the big question is why? So there are clear population differences. We saw that in the ARIC cohort, the rate of cognitive decline was faster than in the newly recruited participants. So in the ARIC cohort, the rate of cognitive decline was closer to about a moderate rate of cognitive decline. And one possible reason is that it's hard to observe a slowing of something that's already quite slow. So in the newly recruited participants, because their rate of cognitive decline was so slow, it's just hard to see any improvement there. Whereas in the ARIC cohort, we were able to see a little bit. There's also another possible explanation is practice effects.
So the ARIC cohort has been doing these cognitive tests for years. So the practice of effects have dissipated more than likely in the ARIC cohort, but in the newly recruited cohort, this is their first time doing these cognitive tests. So there may be a little bit of practice effect and a little bit of inflation, and that could be another reason that we're not seeing a strong difference. So I think with six years of follow-up, we'll be able to really dig more into what these differences are. But at three years, we are seeing a strong reduction in a subset of the population.
Lauren Gerlach:
I was just curious the attrition with wearing hearing aids. So for participants who are randomized to receive the hearing intervention, how many of them continued to use hearing aids throughout the duration of the trial?
Alison Huang:
So if you look at hours of use, and this was something that we also were quite surprised about, over the three-year study period, we had seven to eight hours a day on average of use, which is even through the pandemic. So ACHIEVE was fortunate in that the pandemic happened in the middle. So our baseline, we were in person or our three-year last visit was in person, but even through the pandemic, that people were using their hearing aids seven to eight hours a day. We had very little dropout in that people just didn't want to do it anymore. We did have a little bit of drop in, I think it was like 10 to 15% of people from the health education control saying, "Well, I'm just going to get a hearing aid on my own." But that happens with studies. But yeah, we actually saw a pretty high hours of use.
Matt Davis:
I'm not surprised in some ways because sometimes people don't realize how different life can be once you start. I mean, I wear glasses and if I spent some time without glasses, you get used to it and then you put the glasses on and you're like, "Oh my gosh, things are so much better," that hopefully they experience that.
Alison Huang:
Yeah, exactly. And we ask just an evaluation question of would you recommend the hearing intervention or would you recommend this intervention? And it was very positive in that I think it was upwards, the large majority would recommend the hearing intervention and rated it positively. So I think it was something that even just on a more anecdotal note, something the participants just enjoyed.
Matt Davis:
Were there any findings specifically that surprised your team?
Alison Huang:
I think the whole finding overall surprised our team. This was before my time when they were designing the study, but there's that big question of is it too late? 70 to 84 years old, people have had hearing loss. Is it too late to intervene? I remember the day when our statistician was the one unmasked person that ran the analysis and I remember the day when the results came back and we were like, "Oh, wow." And it really speaks to these interventions in terms of the broader picture of dementia prevention and intervention in that there aren't really any late life interventions. And I think this one is really impactful because it is a late life intervention in that you can still do something in late life and have it make a difference, versus the ship has sailed, and it's more about management. So I think this one's really impactful because it's really considered a late life intervention that could have some impact. But yeah, I think when they designed the study, this was all just based on hypotheses. So it could have been depending on the population or the timing or how severe your cognitive decline was, I think just to see anything in general was a pleasant surprise.
Lauren Gerlach:
So we talked a little bit about this before, but hearing aids are pretty darn expensive. And you mentioned the Over-The-Counter Act that came out a few years ago. For patients and families who are struggling to afford hearing aids, I was hoping you could say something about what's available out there currently and how are over-the-counter options?
Alison Huang:
Yeah. The Over-The-Counter Hearing Act passed in 2017, it was enacted a few years ago, and it really broke up the monopoly of hearing aid manufacturers. So previously there were, I think maybe four to five big hearing aid manufacturers that produced hearing aids, and then they were all sold through clinicians. So this act made it allowable for hearing aids to be sold over the counter, so at places where you can buy electronic devices like Best Buy or Costco or things like that. And it opened the market for other companies to be able to manufacture hearing aids. So we see companies like Apple recently putting out the software update to the AirPod Pros to allow them to be used as over-the-counter hearing aids.
And what it really does is open the market to a little bit of price competition. So there isn't just a couple big players in the market. There's a little bit of competition, which will help bring the price down. It also opens the market to some of these other companies that could have some innovation in form factor. So we know what traditional hearing aids look like, but with these AirPods Pros, it reduces, I think a little bit of the stigma in that you're wearing AirPods Pros, but are you using it for music or are you using it as a hearing aid? So it really allows a little bit more creativity in the technology and how it looks.
Lauren Gerlach:
I was just going to ask for a typical consumer, what are you still looking at in terms of price range? I mean, I used to think of this in the magnitude of $3,000 to $5,000, but has it dropped it already some, or what would a typical consumer see if they were going to purchase an over-the-counter pair?
Alison Huang:
It can range. I think the market is so new, so I think the market is still trying to figure out the price point, but it's definitely less than the hearing aids. I actually don't know how much AirPods Pros are, but I think it's a couple of hundred dollars for something like that, and I think that's quite similar across some of the other devices as well.
Lauren Gerlach:
I know as a clinician, we sometimes recommend Pocket Talkers quite a bit, or personal voice amplifiers for folks who are struggling either to afford or still ambivalent about whether wearing hearing aids would be helpful for them. And so for those who don't know what those are, it's just a small box with a microphone and a headset that people can put on and wear to help kind of amplify. It's always a gratifying personal experience clinically when you're in an appointment with someone, they can't hear, you put it on, you see someone's eyes light up, they can all of a sudden communicate. And that really, I think, highlights the story you told about your grandma. I mean, it's so true. A lot of times as a psychiatrist, I'll see people come in with depression, and hearing loss can be a big part of that, just not being included, not being able to process what people are saying. Any tips that you have in terms of broaching the subject with older adults? I mean, it can be a touchy subject for many people. It can be hard to normalize use of hearing aids. What have you found to be helpful?
Alison Huang:
Yeah, I think for a long time, hearing loss, and now still there is a little bit of stigma attached to it, but I think the conversation is more broad about just awareness right now. So the Cochlear Center has a new campaign called the Hearing Number Campaign, and it's really a health awareness campaign. So things like vision, people know if they're 20/20, 20/40, many people may know about what their blood pressure is, but for hearing there traditionally hasn't been this kind of universally known health metric for hearing. And what the Cochlear Center is doing is trying to just increase awareness of hearing in general, not just hearing loss, but just where is your hearing at? So we have the hearing number, which is the pure tone average, which is what we use clinically, what we use in research.
And it's a campaign that just tries to increase awareness by allowing people to test their hearing. So there's an app that the campaign has created through Johns Hopkins that will be available soon by the end of the year. It's in beta testing now, but it's on your phone. You just plug in your headphones or link your Bluetooth headphones and you're able to do a test of your hearing and get your hearing number and see, even if you're in the normal range or in the low normal range, are you approaching mild hearing loss, you can see what your hearing is. And then something, just like any other health metric, that you can track over time. There's other apps already available, like Mimi is an app I've used before that has a similar technology, the AirPod Pro IIs will allow you to test your hearing as well.
So I think really it's about the more just openness of just maybe just being aware, even younger adults, older adults, just being aware of what you're hearing is. And I think something like this app with Thanksgiving coming up, it could be something that when you're with family, it's like, "Oh, everyone test their hearing," and you can talk about it. We did it in the office here in the beta test, and it was fun to see everyone like, "Oh, what was your hearing number?" "Oh, this was my hearing number. My hearing number is similar to your hearing number." So I think it's really just an open conversation about hearing as a metric versus this stigmatizing part of, oh, hearing loss. And I think for older adults, for people who have hearing loss with concerned family members, it's hard. I think there's a lot of people who have hearing loss but don't want to wear hearing aids or have hearing aids, but don't wear them consistently.
And I think it is hard. I think you have to just meet them where they're at and see and talking about the goals of hearing. Is it that you want to be able to hear your friends and family over a meal? Or is it that you want to watch TV? Working with what are the goals for hearing and what's going to help improve your day-to-day life? If you're thinking all the way proximal to cognition and that's what motivates someone, then that's fine too. But usually we start with some of these more day-to-day things. How can we see that impact on your daily life now?
Matt Davis:
I'm so glad that you mentioned the stigma part of it, because on a personal note, we have a family member who doesn't want to wear hearing aids, who definitely needs them, and this person might be getting a new pair of AirPods for Christmas next year or next holiday. So I'm curious, what's next for your team? What are you thinking about next and the studies that are coming up?
Alison Huang:
Yeah, so right now, ACHIEVE didn't just measure cognition, we measured a host of other outcomes. So we've got the stuff I'm interested in from the mental health side. We've got social and mental health, we've got physical activity, health-related quality of life. We also have MRI measures of brain structure and function. So the team is really working hard to look at what is this broader picture of the impact of hearing intervention on health, not just cognition, but all these other factors that go into health. So we're working hard on doing those analyses. Already some publications have come out of that so that's something to look for soon. We have the funding for the six-year follow-up, so our participants are undergoing those study visits, and we're really digging into that MRI data. So that's done. MRI scans were done on a subset of the 977 participants. So really looking at some of those mechanistic questions of does hearing aid modify brain structure and function, and really getting at some of those mechanistic questions of how is hearing intervention slowing cognitive decline?
Lauren Gerlach:
Anything else that we haven't covered that you want our listeners to know?
Alison Huang:
The ACHIEVE data will be public by the end of this year. So for any researchers out there that are interested in looking at this data, as I said, we have the intervention data. We have all these different outcomes between cognition and brain structure function, and other factors as well. So I think the best way to get involved is to link up with our study team, and we're always open to collaborate. So that's something, it will be posted publicly by the end of the year, so that'll be something to look out for if anyone's interested in using the data.
Lauren Gerlach:
Great. Well, Dr. Huang, thank you so much for joining us, and thanks to all of you who listened in.
Matt Davis:
If you enjoyed our discussion today, please consider subscribing to our podcast. Other episodes can be found on Apple Podcasts, Spotify, and SoundCloud, as well as directly from us at capra.med.umich.edu, where a full transcript of this episode is also available. On our website you'll also find links to other resources we've created specifically for dementia research. Music and engineering for this podcast was provided by Dan Langa. More information is available at www.danlanga.com. Minding Memory is part of the Michigan Medicine podcast network. Find more shows at michiganmedicine.org/podcasts. Support for this podcast comes from the National Institute on Aging at the National Institutes of Health, as well as the Institute for Healthcare Policy and Innovation at the University of Michigan. The views expressed in this podcast do not necessarily represent the views of the NIH or the University of Michigan. Thanks for joining us, and we'll be back soon.
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