The American Journal of Geriatric Psychiatry · Oct 22, 2026

Cognitive Vulnerability and Subsequent Audiometric Hearing Change in Later Life: Implications for Dementia Assessment in Geriatric Psychiatry

By Rajashekara Swamy M, Chen W, Zeh E et al.

OBJECTIVE: To determine whether a demographically referenced multidomain cognitive-vulnerability phenotype predicts subsequent audiometric hearing change among older adults with study-defined normal baseline hearing and to clarify its relevance to longitudinal dementia assessment in geriatric psychiatry. DESIGN: Longitudinal observational cohort study. SETTING: National Health and Aging Trends Study, Rounds 11-13 (2021-2023). PARTICIPANTS: 569 older adults with baseline better-ear pure-tone average (PTA) ≤25 dB HL and complete baseline and final-round data. INTERVENTION: None. MEASUREMENTS: We constructed an age- and education-adjusted cognitive-risk composite integrating immediate and delayed recall, clock drawing, and temporal orientation and classified risk as low, intermediate, or high. Better-ear PTA at 0.5, 1, 2, and 4 kHz was measured up to three times over approximately 2 years. Linear mixed-effects models estimated PTA change; Cox and logistic sensitivity analyses evaluated threshold-defined hearing loss. RESULTS: Across 1,687 observations, each one-category increase in cognitive risk was associated with an additional 0.53 dB HL/year increase in PTA (95% CI, 0.22-0.85; p = 0.001). Cognitive risk was also associated with first-observed PTA > 25 gt; 25 dB HL (HR, 1.50; 95% CI, 1.15-1.96; p = 0.003) and hearing loss at Round 13 (OR, 2.19; 95% CI, 1.43-3.35; p < 0.001). CONCLUSION: Cognitive vulnerability preceded modestly faster measured hearing-threshold worsening across continuous and threshold-defined outcomes. Shared multisystem aging and cognition-related variation in behavioral audiometry remain plausible explanations. Evolving auditory function should be considered a time-varying component of longitudinal neurocognitive assessment in geriatric psychiatry.

doi.org/10.1016/j.jagp.2026.10.009PubMed 42998957Populations