全生命周期中的听力-认知关系：机制、干预与结局

文献信息

中文摘要

引言： 听力损失和认知障碍是衰老过程中最常见的慢性疾病之一，越来越多的证据将二者联系起来。2020年和2024年《柳叶刀》委员会将中年听力损失确定为痴呆最大的潜在可改变危险因素之一，这提出了听觉康复可能有助于保护认知的可能性。
方法： 本叙述性综述通过总结关于听力损失与认知下降之间关系的当前证据、受影响最大的认知领域以及用于解释该关联的拟议机制（包括认知负荷、共同原因、级联和过度诊断假说及其神经生物学相关因素），提供全生命周期的视角。
结果： 随后我们分别考察听力助听器和人工耳蜗，审视听觉干预对成人认知的影响，并讨论诸如ACHIEVE等里程碑式试验，这些试验提示认知获益在认知下降风险增加的老年人中可能最大。最后，我们讨论儿童的独特情况，在儿童中早期听觉剥夺可能塑造工作记忆和执行功能的发展，及时验配听力设备至关重要。
结论： 总体而言，证据支持听力损失是认知下降的可改变促成因素，并强调早期发现和康复是保护认知健康的有前景但并非普遍有效的策略。

英文摘要

Introduction: Hearing loss and cognitive impairment are among the most common chronic conditions of aging, and a growing body of evidence links the two. The 2020 and 2024 Lancet Commissions identified midlife hearing loss as one of the largest potentially modifiable risk factors for dementia, raising the possibility that auditory rehabilitation could help preserve cognition. Methods: This narrative review provides a lifespan perspective by summarizing current evidence on the relationship between hearing loss and cognitive decline, the cognitive domains most affected, and the mechanisms proposed to explain the association, including the cognitive load, common cause, cascade, and overdiagnosis hypotheses, together with their neurobiological correlates. Results: We then examine the effect of auditory interventions on cognition in adults, considering hearing aids and cochlear implants separately, and discuss landmark trials such as ACHIEVE, which suggest that cognitive benefits may be greatest in older adults at increased risk of decline. Finally, we address the distinct situation of children, in whom early auditory deprivation may shape the development of working memory and executive function and in whom the timely fitting of hearing devices is critical. Conclusions: Overall, the evidence supports hearing loss as a modifiable contributor to cognitive decline and highlights early detection and rehabilitation as promising, though not universally effective, strategies for protecting cognitive health.