INTRODUCTION

Dr. Frank Lin presented the results of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study at the Alzheimer’s Association International Conference in the Netherlands on Tuesday 18 July.

Entitled Effects of hearing intervention on cognitive decline and brain health: Results of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomized trial, the session highlighted that while across the total cohort there was no effect on cognitive decline at 3 years,​ for an at-risk group of older adults aged 70-84 who were at higher risk of cognitive decline, the hearing intervention resulted in a 48% reduction in cognitive decline.

The study was led by Dr Frank Lin and Dr Josef Coresh of Johns Hopkins University and funded by a $USD 20 million grant from the National Institute on Aging which is part of the US National Institutes of Health. With 977 participants consisted of older adults aged 70-84 with untreated mild to moderate hearing loss, ACHIEVE is a large scale Randomised Controlled Trial (RCT) designed to determine if treating hearing loss with hearing aids in older adults with untreated mild to moderate hearing loss could reduce the loss of thinking and memory abilities (cognitive decline) that can precede dementia.

According to Dig Howitt, CEO and President of Cochlear, the result is a major advancement in understanding the broader impact of hearing loss and the need for adults, policy makers and health professionals to prioritise hearing health care.

“Healthy hearing is more than just being able to hear—it’s directly connected to our everyday health and wellbeing. Proactively treating hearing loss helps keep people socially connected, mentally well, and physically safe.”

ARTICLE

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

Prof Frank R Lin, MD, James R Pike, MBA, Prof Marilyn S Albert, PhD, Michelle Arnold, PhD, Sheila Burgard, MS, Prof Theresa Chisolm, PhD et al.
Published: July 17, 2023: DOI:https://doi.org/10.1016/S0140-6736(23)01406-X

Accessed: August 1, 2023: The Lancet

Summary

Background
Hearing loss is associated with increased cognitive decline and incident dementia in older adults. We aimed to investigate whether a hearing intervention could reduce cognitive decline in cognitively healthy older adults with hearing loss.

Methods
The ACHIEVE study is a multicentre, parallel-group, unmasked, randomised controlled trial of adults aged 70–84 years with untreated hearing loss and without substantial cognitive impairment that took place at four community study sites across the USA. Participants were recruited from two study populations at each site: (1) older adults participating in a long-standing observational study of cardiovascular health (Atherosclerosis Risk in Communities [ARIC] study), and (2) healthy de novo community volunteers. Participants were randomly assigned (1:1) to a hearing intervention (audiological counselling and provision of hearing aids) or a control intervention of health education (individual sessions with a health educator covering topics on chronic disease prevention) and followed up every 6 months. The primary endpoint was 3-year change in a global cognition standardised factor score from a comprehensive neurocognitive battery. Analysis was by intention to treat. This trial was registered at ClinicalTrials.gov, NCT03243422.

Findings
From Nov 9, 2017, to Oct 25, 2019, we screened 3004 participants for eligibility and randomly assigned 977 (32·5%; 238 [24%] from ARIC and 739 [76%] de novo). We randomly assigned 490 (50%) to the hearing intervention and 487 (50%) to the health education control. The cohort had a mean age of 76·8 years (SD 4·0), 523 (54%) were female, 454 (46%) were male, and most were White (n=858 [88%]). Participants from ARIC were older, had more risk factors for cognitive decline, and had lower baseline cognitive scores than those in the de novo cohort. In the primary analysis combining the ARIC and de novo cohorts, 3-year cognitive change (in SD units) was not significantly different between the hearing intervention and health education control groups (–0·200 [95% CI –0·256 to –0·144] in the hearing intervention group and –0·202 [–0·258 to –0·145] in the control group; difference 0·002 [–0·077 to 0·081]; p=0·96). However, a prespecified sensitivity analysis showed a significant difference in the effect of the hearing intervention on 3-year cognitive change between the ARIC and de novo cohorts (pinteraction=0·010). Other prespecified sensitivity analyses that varied analytical parameters used in the total cohort did not change the observed results. No significant adverse events attributed to the study were reported with either the hearing intervention or health education control.

Interpretation
The hearing intervention did not reduce 3-year cognitive decline in the primary analysis of the total cohort. However, a prespecified sensitivity analysis showed that the effect differed between the two study populations that comprised the cohort. These findings suggest that a hearing intervention might reduce cognitive change over 3 years in populations of older adults at increased risk for cognitive decline but not in populations at decreased risk for cognitive decline.

Funding
US National Institutes of Health.

You can find more about the ACHIEVE study by clicking the icon below.