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This study investigated the association between age-related hearing loss (ARHL) and differences in response efficiency and variability on a sustained attention task. The study population comprised 32 participants in a hearing loss group (HLG) and 34 controls without hearing loss (CG). Mean reaction time (RT) and accuracy were recorded to assess response efficiency. RT variability was decomposed to examine temporal aspects of variability associated with neural arousal and top-down executive control of vigilant attention. The HLG had a significantly longer mean RT, possibly reflecting a strategic approach to maintain accuracy. The HLG also demonstrated altered variability (indicative of greater decline in neural arousal) but maintained executive control that was significantly predictive of poorer response efficiency. Adults with ARHL may rely on higher-order attention networks to compensate for decline in both peripheral sensory function and in subcortical arousal systems which mediate lower-order automatic neurocognitive processes.

Objectives: To investigate whether the relationship between subjective age-related hearing loss (SARHL) and episodic memory functioning is mediated by measures of social functioning. Methods: Using data from 8,163 adults over 50 that participated in the Irish Longitudinal Study of Ageing (three waves, each two years apart), we used a multiple mediation model within a Structural Equation Modelling framework to explore potential social mediators of the relationship between SARHL and episodic memory functioning, controlling for demographic and health covariates. Results: Neither the direct effect of self-reported hearing difficulties on memory functioning (β = -.03), nor the total effect (β = .01), were significant. A small inconsistent indirect effect of self-reported hearing difficulties on episodic memory via weekly social activity engagement (β = -.002) was found. Conclusions: Self-reported hearing difficulties may exert an indirect effect on episodic memory via weekly social activity engagement. The findings may have implications for identification of individuals at risk of memory decline in later life.

OBJECTIVE: To assess whether the relationship between hearing and depressive symptoms is present among older adults classified as normal hearing (≤25 dB). DESIGN: Cross-sectional epidemiologic study embedded within a prospective cohort study (Hispanic Community Health Study) SETTING: Multi-centered at 4 US communities (New York, Chicago, Miami, San Diego) PARTICIPANTS: Adults ≥50 years old (n=5,499) with normal hearing or hearing loss. MEASUREMENTS: The primary exposure was hearing, defined continuously by the 4-frequency pure-tone average on audiometry (mean hearing threshold, in dB, at 500, 1000, 2000, and 4000 Hz pitch). Hearing was additionally categorized into normal hearing (≤25 dB) and hearing loss (>25 dB). The main outcome was depressive symptoms, measured with the Center for Epidemiologic Studies Depression Scale-10 (CESD-10). Depressive symptoms were defined both continuously and binarily (where CESD-10 ≥ 10 was categorized as clinically significant depressive symptoms). Multivariable linear, logistic, and generalized additive modeling (GAM) regressions were performed. RESULTS: Worse hearing was related to higher depressive symptoms among those with normal hearing in GAM regression. Among those with normal hearing, the CESD-10 score increased by 1.04 points (95% CI = 0.70, 1.37) for every 10 dB decrease in hearing, adjusting for age, gender, education, cardiovascular disease, and hearing aid use. Among those with hearing loss, the CESD-10 score increased by 0.62 points (95% CI = 0.23, 1.01) for every 10 dB decrease in hearing, adjusting for the same confounders. Similar findings were noted when the outcome was clinically significant depressive symptoms (adjusted OR=1.28 [1.14, 1.44] in normal hearing versus 1.26 [1.11, 1.44] in HL). In certain sensitivity analyses, the relationship between hearing and depressive symptoms was significantly stronger among those with normal hearing than in those with hearing loss. CONCLUSION: The relationship between hearing and clinically significant depressive symptoms is present among older adults with normal hearing (

Contradictory findings in reviews that assess the relationship between the Mediterranean Diet (MedDiet) and cognitive functioning have been attributed to heterogeneity in the criteria used to assess MedDiet and cognition, and differences in the location or cultural habits of the populations studied. Few reviews have examined the relationship between dietary adherence and cognition or considered the impact of sex differences. This systematic review and meta-analysis examines the relationship between adherence to the MedDiet and cognitive functioning of healthy older adults (50+). We included isolated data from Mediterranean regions and considered differential outcomes based on sex. A search of PubMed, Cochrane Library, EMBASE, Scopus and Web of Science from 2011 to 2018 identified five longitudinal cohort studies (n = 3368) and one randomized controlled trial (RCT; n = 239 intervention; n = 95 controls). The primary outcome of interest was global cognitive functioning. Meta-analysis of cohort studies revealed a significant association between MedDiet adherence and cognitive functioning (n = 3368, r = 0.09, p = 0.012), an effect greater than previously reported. Meta-regression demonstrated that the effect size was stronger with improved quality of study reporting (p = 0.01). Sex did not impact cognitive outcomes, but sex differences in levels of adherence were reported in individual studies. There might be a stronger association between MedDiet and cognitive functioning for older adults from Mediterranean countries compared to other geographical locations, perhaps due to higher adherence and/or longer exposure over the life course. Results are compared to those of prior meta-analyses, and the impact of sources of heterogeneity is considered. The potential influence of sex and gender, as biological and social constructs, on dietary adherence is discussed.

Age-related hearing loss (ARHL) has been posited as a possible modifiable risk factor for neurocognitive impairment and dementia. Measures sensitive to early neurocognitive changes associated with ARHL would help to elucidate the mechanisms underpinning this relationship. We hypothesized that ARHL might be associated with decline in visual short-term memory binding (VSTMB), a potential biomarker for preclinical dementia due to Alzheimer’s disease (AD). We examined differences in accuracy between older adults with hearing loss and a control group on the VSTMB task from a single feature (shapes) condition to a feature binding (shapes-colors) condition. Hearing loss was associated with a weaker capacity to process bound features which appeared to be accounted for by a weaker sensitivity for change detection (A’). Our findings give insight into the neural mechanisms underpinning neurocognitive decline with ARHL and its temporal sequence.

IMPORTANCE: Because hearing loss is highly prevalent and treatable, determining its association with morbidity has major public health implications for disease prevention and the maintenance of health in adults with hearing loss. OBJECTIVE: To investigate the association between the diagnosis of incident hearing loss and medical comorbidities in adults 50 years or older. DESIGN, SETTING, AND PARTICIPANTS: Retrospective, propensity-matched cohort study using administrative claims data from commercially insured and Medicare Advantage members in a geographically diverse US health plan. Adults 50 years or older with claims for services rendered from January 1, 2000, to December 31, 2016, were observed for 2 (n = 154 414), 5 (n = 44 852), and 10 (n = 4728) years. This research was conceptualized and data were analyzed between September 2016 and November 2017. EXPOSURES: A claim for incident hearing loss is defined as 2 claims for hearing loss within 2 consecutive years without evidence of hearing device use, excluding claims for sudden hearing loss or hearing loss secondary to medical conditions. MAIN OUTCOMES AND MEASURES: Incident claims for dementia, depression, accidental falls, nonvertebral fractures, acute myocardial infarction, and stroke. RESULTS: After cohort matching, 48% of participants were women (n = 74 464), 61% were white (n = 93 442), and 31% (n = 48 056) were Medicare Advantage insured, with a mean (SD) age of 64 (10) years. In a multivariate-adjusted modified Poisson regression with robust standard errors, relative associations were strongest for dementia (relative risk at 5 years, 1.50; 95% CI, 1.38-1.64) and depression (relative risk at 5 years, 1.41; 95% CI, 1.26-1.58). The absolute risk of all outcomes was greater in persons with hearing loss than in those without hearing loss at all times, with the greatest risk difference observed at 10 years for all outcomes. The 10-year risk attributable to hearing loss was 3.20 per 100 persons (95% CI, 1.76-4.63) for dementia, 3.57 per 100 persons (95% CI, 1.67-5.47) for falls, and 6.88 per 100 persons (95% CI, 4.62-9.14) for depression. CONCLUSIONS AND RELEVANCE: In this large observational study using administrative claims data, incident untreated hearing loss was associated with greater incident morbidity than no hearing loss across a range of health conditions. Future studies are needed to elucidate the mechanisms underlying these associations and to determine if treatment for hearing loss could reduce the risk of comorbidity.

Importance Epidemiologic research on the possible link between age-related hearing loss (ARHL) and cognitive decline and dementia has produced inconsistent results. Clarifying this association is of interest because ARHL may be a risk factor for outcomes of clinical dementia. Objectives To examine and estimate the association between ARHL and cognitive function, cognitive impairment, and dementia through a systematic review and meta-analysis. Data Sources and Study Selection A search of PubMed, the Cochrane Library, EMBASE, and SCOPUS from inception to April 15, 2016, with cross-referencing of retrieved studies and personal files for potentially eligible studies was performed. Keywords included hearing, cognition, dementia, and Alzheimer disease. Cohort and cross-sectional studies published in peer-reviewed literature and using objective outcome measures were included. Case-control studies were excluded. Data Extraction and Synthesis One reviewer extracted and another verified data. Both reviewers independently assessed study quality. Estimates were pooled using random-effects meta-analysis. Subgroup and meta-regression analyses of study-level characteristics were performed. Main Outcomes and Measures Hearing loss measured by pure-tone audiometry only and objective assessment measures of cognitive function, cognitive impairment, and dementia. Cognitive function outcomes were converted to correlation coefficients (r value); cognitive impairment and dementia outcomes, to odds ratios (ORs). Results Forty studies from 12 countries met our inclusion criteria. Of these, 36 unique studies with an estimated 20 264 unique participants were included in the meta-analyses. Based on the pooled maximally adjusted effect sizes using random-effects models, a small but significant association was found for ARHL within all domains of cognitive function. Among cross-sectional studies, a significant association was found for cognitive impairment (OR, 2.00; 95% CI, 1.39-2.89) and dementia (OR, 2.42; 95% CI, 1.24-4.72). Among prospective cohort studies, a significant association was found for cognitive impairment (OR, 1.22; 95% CI, 1.09-1.36) and dementia (OR, 1.28; 95% CI, 1.02-1.59) but not for Alzheimer disease (OR, 1.69; 95% CI, 0.72-4.00). In further analyses, study, demographic, audiometric, and analyses factors were associated with cognitive function. Vascular dysfunction and impaired verbal communication may contribute to the association between hearing loss and cognitive decline. Conclusions and Relevance Age-related hearing loss is a possible biomarker and modifiable risk factor for cognitive decline, cognitive impairment, and dementia. Additional research and randomized clinical trials are warranted to examine implications of treatment for cognition and to explore possible causal mechanisms underlying this relationship.

Evidence from epidemiologic studies suggests a relation between the Mediterranean diet (MeDi) and cognitive function, but results are inconsistent. Prior reviews have not provided pooled data from meta-analysis of longitudinal studies and randomized controlled trials (RCTs), or they included younger adult participants. This systematic review and meta-analysis examines the impact of the MeDi on the cognitive functioning of healthy older adults. Fifteen cohort studies with 41,492 participants and 2 RCTs with 309 and 162 participants in intervention and control groups, respectively, were included. The primary outcome of interest was cognitive function, divided into domains of memory and executive function. Meta-analysis of cohort studies revealed a significant association between MeDi and older adults’ episodic memory (n = 25,369, r = 0.01, P = 0.03) and global cognition (n = 41,492, r = 0.05, P ≤ 0.001), but not working memory (n = 1487, r = 0.007, P = 0.93) or semantic memory (n = 1487, r = 0.08, P = 0.28). Meta-analysis of RCTs revealed that compared with controls, the MeDi improved delayed recall (n = 429, P = 0.01), working memory (n = 566, P = 0.03), and global cognition (n = 429, P = 0.047), but not episodic memory (n = 566, P = 0.15), immediate recall (n = 566, P = 0.17), paired associates (n = 429, P = 0.20), attention (n = 566, P = 0.69), processing speed (n = 566, P = 0.35), or verbal fluency (n = 566, P = 0.12). The strongest evidence suggests a beneficial effect of the MeDi on older adults’ global cognition. This article discusses the influence of study design and components of the MeDi on cognitive function and considers possible mechanisms.

Background Social relationships, which are contingent on access to social networks, promote engagement in social activities and provide access to social support. These social factors have been shown to positively impact health outcomes. In the current systematic review, we offer a comprehensive overview of the impact of social activities, social networks and social support on the cognitive functioning of healthy older adults (50+) and examine the differential effects of aspects of social relationships on various cognitive domains. Methods We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, and collated data from randomised controlled trials (RCTs), genetic and observational studies. Independent variables of interest included subjective measures of social activities, social networks, and social support, and composite measures of social relationships (CMSR). The primary outcome of interest was cognitive function divided into domains of episodic memory, semantic memory, overall memory ability, working memory, verbal fluency, reasoning, attention, processing speed, visuospatial abilities, overall executive functioning and global cognition. Results Thirty-nine studies were included in the review; three RCTs, 34 observational studies, and two genetic studies. Evidence suggests a relationship between (1) social activity and global cognition and overall executive functioning, working memory, visuospatial abilities and processing speed but not episodic memory, verbal fluency, reasoning or attention; (2) social networks and global cognition but not episodic memory, attention or processing speed; (3) social support and global cognition and episodic memory but not attention or processing speed; and (4) CMSR and episodic memory and verbal fluency but not global cognition. Conclusions The results support prior conclusions that there is an association between social relationships and cognitive function but the exact nature of this association remains unclear. Implications of the findings are discussed and suggestions for future research provided. Systematic review registration PROSPERO 2012: CRD42012003248. Electronic supplementary material The online version of this article (10.1186/s13643-017-0632-2) contains supplementary material, which is available to authorized users.

Epidemiological studies have linked age-related hearing loss (ARHL) with an increased risk of neurocognitive decline. Difficulties in speech perception with subsequent changes in brain morphometry, including regions important for lexical-semantic memory, are thought to be a possible mechanism for this relationship. This study investigated differences in automatic and executive lexical-semantic processes on verbal fluency tasks in individuals with acquired hearing loss. The primary outcomes were indices of automatic (clustering/word retrieval at start of task) and executive (switching/word retrieval after start of the task) processes from semantic and phonemic fluency tasks. To extract indices of clustering and switching, we used both manual and computerised methods. There were no differences between groups on indices of executive fluency processes or on any indices from the semantic fluency task. The hearing loss group demonstrated weaker automatic processes on the phonemic fluency task. Further research into differences in lexical-semantic processes with ARHL is warranted.

We reviewed 31 patients in whom both bilateral inferior petrosal sinus sampling without CRH stimulation, and a CT scan of the lungs were done. Twenty-five had normal lung CT scans, of whom 23 had a higher inferior petrosal sinus: peripheral ACTH ratio > or = 1.5. After careful follow-up, none was subsequently shown to have ectopic ACTH syndrome. Six had abnormal lung CT scans, of whom two had ratios > or = 1.5. In these two patients, other investigations suggested pituitary disease, and pituitary surgery led to apparent cure. Of the remaining four patients, who had ratios < 1.5, two had incidental lung findings, and pituitary abnormalities were demonstrated at pituitary surgery. The third underwent bilateral adrenalectomy, and no evidence of ectopic ACTH syndrome has emerged as yet after 4 years follow-up. The fourth had a small-cell carcinoma of the lung, confirmed histologically. Our series suggests that whole-lung CT scanning is only necessary in cases of ACTH-dependent Cushing's syndrome where bilateral inferior petrosal sinus sampling has not demonstrated a significant increase in petrosal sinus ACTH levels as compared with the peripheral level. Thus, in our experience the test is now only necessary in those patients (approximately 25%) where the ratio is < or = 1.5.

a b s t r a c t This systematic review and meta-analysis investigates the impact of cognitive training and general mental stimulation on the cognitive and everyday functioning of older adults without known cognitive impair- ment. We examine transfer and maintenance of intervention effects, and the impact of training in group versus individual settings. Thirty-one randomised controlled trials were included, with 1806 partici- pants in cognitive training groups and 386 in general mental stimulation groups. Meta-analysis results revealed that compared to active controls, cognitive training improved performance on measures of executive function (working memory, p = 0.04; processing speed, p < 0.0001) and composite measures of cognitive function (p = 0.001). Compared to no intervention, cognitive training improved performance on measures of memory (face-name recall, p = 0.02; immediate recall, p = 0.02; paired associates, p = 0.001) and subjective cognitive function (p = 0.01). The impact of cognitive training on everyday functioning is largely under investigated. More research is required to determine if general mental stimulation can benefit cognitive and everyday functioning. Transfer and maintenance of intervention effects are most commonly reported when training is adaptive, with at least ten intervention sessions and a long-term follow-up. Memory and subjective cognitive performance might be improved by training in group versus individual settings.

The aim of this prospective study was to compare the accuracy of abdominal computed tomography (CT) and colonoscopy in diagnosing colonic pathology in an elderly population.Patients over the age of 70 for whom an outpatient diagnostic colonoscopy had been requested, were invited to attend for a CT scan of the abdomen following oral colonic preparation. CT was carried out within 1 month of the colonoscopy and all images were evaluated by a single consultant radiologist with no prior knowledge of the colonoscopy result.Of 72 patients who fulfilled entry criteria and attended for colonoscopy, 55 (29 female) had abdominal CT of the abdomen (mean age 76.6 years, range 70-92). Colonoscopy was successful in 67% of cases and the following colonoscopic diagnoses were made: diverticular disease (26), normal (14), colonic carcinoma (6), polyps (9) colitis (2) and angiodysplasia (1). There was agreement between colonoscopic and CT diagnoses in 38 patients (69%) including all those with carcinoma of the colon. There was disagreement in 12 patients with diverticular disease, CT missed three polyps in three patients and angiodysplasia in one patient. CT provided additional important information in 9 patients: gastric leiomyosarcoma (1), aortic aneurysm (1), absence of metastases (3), liver metastases (2), cirrhosis and portal hypertension (1) and a large pleural effusion (1). One patient thought to have a carcinoma of the colon by both techniques was subsequently found to have a diverticular mass at laparotomy. Two patients undergoing colonoscopy had colonic perforations and one of these died.CT may provide an alternative to colonoscopy in diagnosis of colonic disease in the elderly population.

The polar bear, Thalarctos maritimus, (Phipps) enjoys such colloquial names as: “ice-bear,” “sea-bear,” “ice-tiger” and “ice-king.” In view of its large size and its supremacy over the other beasts of the ice-floes it well deserves these epithets. Primarily the polar bear is an animal of the broken arctic pack ice and is found in greatest numbers along the southern edge of the pack. It avoids large expanses of open water or frozen sea ice. The movements of the pack ice to a large degree determine its distribution and movements. Polar bears are carried southward with the pack ice in the spring and summer. In August and September when the ice begins to break up they generally come ashore and make their way north. At this time of year they may be found in considerable numbers along certain coasts where the sea ice has been brought by the winds, tides and currents. An Eskimo from Southampton Island, in northern Hudson Bay, informed me that in August, 1948, he and a companion counted over 180 of these bears along the east coast of that island.

Fifty adult patients presenting with deliberate self-harm at the Royal Victoria Hospital were given a choice of nine reasons for their actions. Most chose more than one reason and all but two of the 24 who said that they wished to die chose at least one other motive. There were no trends with respect to sex, past history, or method of deliberate self-harm. These results illustrate the complexity of this condition and show the importance of investigating motives beyond simply the intent to die.