Nicole M Armstrong1, Mark A Espeland2, Jiu-Chiuan Chen3, Kamal Masaki4, Jean Wactawski-Wende5, Wenjun Li6, Margery L S Gass7, Marcia L Stefanick8,9,10, JoAnn E Manson11,12, Jennifer A Deal13,14,15, Stephen R Rapp16, Frank R Lin13,14,15,17, Susan M Resnick1. 1. Laboratory of Behavioral Neuroscience, National Institute of Aging, Baltimore, Maryland. 2. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina. 3. Department of Preventive Medicine and Neurology, Keck School of Medicine of University of Southern California, Los Angeles, California. 4. Department of Geriatric Medicine, John A. Burns School of Medicine, University of Hawai`i Manoa, Honolulu, Hawaii. 5. Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University of Buffalo, New York. 6. Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts. 7. Department of Obstetrics & Gynecology, University of Cincinnati, Cincinnati, Ohio. 8. Department of Medicine, Stanford University School of Medicine, Stanford, California. 9. Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California. 10. Health Research and Policy, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California. 11. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 12. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 13. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 14. Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 15. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 16. Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 17. Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Abstract
BACKGROUND: Hearing loss (HL) and menopausal hormone therapy (conjugated equine estrogens [CEE] and/or medroxyprogesterone acetate [MPA]) are separately associated with cognitive decline and increased risk of incident cognitive impairment. Joint effects of HL and HT could be associated with additive or synergistic decline in global cognition and risk of incident cognitive impairment among postmenopausal women. METHODS: Using the Women's Health Initiative (WHI) Memory Study, 7,220 postmenopausal women with measures of HL, global cognition (Modified Mini-Mental State Examination score), and cognitive impairment (centrally adjudicated diagnoses of mild cognitive impairment and dementia) from 1996 to 2009. Multivariable linear mixed-effects models were used to analyze rate of change in global cognition. Accelerated failure time models were used to evaluate time to incident cognitive impairment, stratified by HT. RESULTS: Within the CEE-Alone trial, observed adverse effects of CEE-Alone on change in global cognition did not differ by HL, and estimated joint effects of HL and CEE-Alone were not associated with incident cognitive impairment. Within the CEE+MPA trial, while HL did not independently accelerate time to cognitive impairment, the adverse effect of CEE+MPA on global cognition was heightened in older women with HL. Older women on CEE+MPA either with HL (time ratio [TR] = 0.82, 95% confidence interval [CI]: 0.71, 0.94) or with normal hearing (TR = 0.86, 95% CI: 0.76, 0.97) had faster time to cognitive impairment than those with normal hearing and placebo. CONCLUSIONS: HL may accentuate the adverse effect of CEE+MPA, not CEE-Alone, on global cognitive decline, not incident cognitive impairment, among postmenopausal women on HT. Published by Oxford University Press on behalf of The Gerontological Society of America 2019.
BACKGROUND: Hearing loss (HL) and menopausal hormone therapy (conjugated equine estrogens [CEE] and/or medroxyprogesterone acetate [MPA]) are separately associated with cognitive decline and increased risk of incident cognitive impairment. Joint effects of HL and HT could be associated with additive or synergistic decline in global cognition and risk of incident cognitive impairment among postmenopausal women. METHODS: Using the Women's Health Initiative (WHI) Memory Study, 7,220 postmenopausal women with measures of HL, global cognition (Modified Mini-Mental State Examination score), and cognitive impairment (centrally adjudicated diagnoses of mild cognitive impairment and dementia) from 1996 to 2009. Multivariable linear mixed-effects models were used to analyze rate of change in global cognition. Accelerated failure time models were used to evaluate time to incident cognitive impairment, stratified by HT. RESULTS: Within the CEE-Alone trial, observed adverse effects of CEE-Alone on change in global cognition did not differ by HL, and estimated joint effects of HL and CEE-Alone were not associated with incident cognitive impairment. Within the CEE+MPA trial, while HL did not independently accelerate time to cognitive impairment, the adverse effect of CEE+MPA on global cognition was heightened in older women with HL. Older women on CEE+MPA either with HL (time ratio [TR] = 0.82, 95% confidence interval [CI]: 0.71, 0.94) or with normal hearing (TR = 0.86, 95% CI: 0.76, 0.97) had faster time to cognitive impairment than those with normal hearing and placebo. CONCLUSIONS:HL may accentuate the adverse effect of CEE+MPA, not CEE-Alone, on global cognitive decline, not incident cognitive impairment, among postmenopausal women on HT. Published by Oxford University Press on behalf of The Gerontological Society of America 2019.
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