The "2024 Academic Annual Meeting of the Vertigo Medicine Branch of the China Association for the Promotion of International Exchange in Health Care and the 5th China Vertigo Medicine Forum" was held in Zhuhai, Guangdong Province from May 10 to 12, sponsored by the Vertigo Medicine Branch of the China Association for the Promotion of International Exchange in Health Care and undertaken by Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine and Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology. This conference invited a number of experts from all over the country to conduct in-depth discussions on new concepts, new technologies and new products in the field of vertigo medicine, bringing a feast of academic gluttony with various forms and rich contents. At this conference, Professor Kong Weijia from Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology gave a wonderful sharing on the theme of "Research Status and Multidisciplinary Diagnosis and Treatment Trend of Ear-Brain Comorbidity".
The author of this article is the report team of the Yimaitong Vertigo Conference
Yimaitong collated the report, please do not reprint without authorization.
History of dizziness and stratification of the examination
According to the World Health Organization's (WHO) definition and classification of ageing, the proportion of people aged 65 and over in the total population > 7% mildly aged, > 14% moderately aged, and > 21% severely aged. Today, the global population is aging increasingly severe, and China is one of the fastest-aging countries. According to the 2022 statistical report, China's ≥ 65-year-old population accounts for 14.9%, which has entered a moderate aging population, and the declining birth rate will accelerate the progress of aging.
A national cross-sectional study showed that the prevalence of MCI in the elderly over 60 years old in mainland China was 15.5% (about 38.77 million cases). Cognitive impairment is an important factor in poor prognosis in older adults, and a Canadian 5-year follow-up study showed that patients with cognitive impairment but no dementia were more likely to have a poor prognosis, including higher rates of hospitalization, dementia diagnosis, and mortality, than those without cognitive impairment.
One problem that is closely related to cognitive impairment is hearing loss. According to WHO statistics in 2021, more than 1.5 billion people worldwide suffer from varying degrees of hearing loss; More than 58% of moderate and above hearing loss occurs in people aged 60 years and older. According to the data analysis of the second national sample survey of persons with disabilities in China, the total number of people with hearing disabilities in the country is estimated to reach 20.04 million, accounting for 24.61% of the total number of disabled people. The main cause of disability in the group with simple hearing disabilities is presbycusis, and the cause of hearing loss accounts for 51.61%.
Patients with cognitive impairment may often have hearing loss and vestibular dysfunction. Studies have shown that the prevalence of hearing loss is 60% in older patients (aged 53-96 years) with MCI or dementia. Other studies have shown that patients with Alzheimer's disease (AD) and MCI are more likely to have vestibular dysfunction than those with normal cognition. Correlation studies have shown that hearing loss is associated with an increased risk of cognitive impairment and dementia; Vestibular dysfunction such as vertigo may affect the patient's cognitive impairment,
As for the association mechanism between hearing loss and cognitive impairment, a single mechanism cannot be explained independently, and multiple mechanism hypotheses may exist and interact with each other.
Figure The various hypotheses can be divided into two categories: causal hypothesis and common etiology hypothesis
Current status of diagnosis and treatment of cognitive impairment
The WHO's 2019 Guidelines for Reducing the Risk of Cognitive Decline and Dementia suggest that hearing loss management is one of the measures to reduce the risk of dementia. "Healthy China 2030" also proposes cognitive and geriatric brain health action indicators, such as the decline in the prevalence of dementia in people over 65 years old. In addition, many domestic societies have successively issued a number of consensus on geriatric brain comorbidities, and experts in the industry are also continuously promoting the "Huatuo Project" to promote the sinking of high-quality medical resources.
However, there are still insufficient diagnostic evaluations in the diagnosis and treatment of cognitive impairment, and the early prevention and control of dementia is facing challenges. For example, there are still bottlenecks in the "memory clinic" in China, such as "low penetration rate, low awareness rate, low medical treatment rate and low detection rate". This leads to a low rate of missed detection of cognitive impairment and missed optimal intervention periods. Secondly, the current clinical assessment tools for detecting cognitive impairment and hearing loss in the elderly population, such as MMSE and MoCA, still have limitations. Sensory deficits, such as hearing loss, may adversely affect cognitive assessment performance, leading to subsequent overestimation of cognitive decline, and studies have shown that the rate of misdiagnosis of MMSE dementia may increase with hearing loss. Therefore, it is necessary to explore the exclusion of overdiagnosis caused by hearing interference with cognitive assessment.
The whole process of ear and brain treatment is managed
➤ Hearing interventions have a positive effect on the cognitive function of patients
Meta-analysis showed that the use of hearing restoration devices (hearing aids and cochlear implants) in participants with hearing loss was beneficial to patients' cognitive function. Hearing aid use was associated with a 19% lower risk of long-term cognitive decline compared to subjects with uncorrected hearing loss;
The use of hearing aids and cochlear implants was significantly associated with a 3% increase in scores on cognitive tests that assess general cognition in the short term. Meta-subgroup analysis showed that hearing aid use was significantly associated with the risk of cognitive decline in all three subgroups, including a reduced risk of cognitive impairment (HR=0.79), a reduced risk of progression from MCI to dementia (HR=0.73), and a reduced risk of dementia (HR=0.83).
➤ The use of hearing aids can reduce auditory energy and promote cortical restructuring and recovery, improving cognitive performance
One study showed that the use of hearing aids reduced auditory energy and mental fatigue during prolonged speech processing, and improved cognitive performance. A 6-month study of hearing aid intervention in ARHL patients showed that the cross-modal reorganization of the ARHL auditory cortex was reversed after hearing aid intervention, which was consistent with the improvement in cognitive performance. Hearing aids promote the recovery of cerebral cortical tissue and function, thereby improving cognitive function.
➤ Cochlear implants significantly improve quality of life and cognitive function in patients with severe ARHL
A French study showed that 12 months after cochlear implantation, 81% of patients with the worst pre-implant cognitive scores showed an improvement in overall cognitive function; An improvement in the patient's quality of life assessment scale score was observed 6 months after implantation.
➤ Cochlear implants may delay the progression from MCI to AD in ARHL patients
Gauthier reports that more than 50% of patients with MCI progress to dementia within 5 years. Mosnier reports that a seven-year follow-up of a study of the long-term efficacy of cochlear implants on cognitive function showed that only 2 of the 31 (45%) patients with MCI before implantation (6%) progressed to dementia.
➤ Co-interventions that are currently feasible
➤ Strengthen early detection and promote screening at the grassroots level
Early detection of hearing loss in older people is extremely important, and older people over 60 years of age should be screened for hearing and older residents in the community are encouraged to participate in cognitive screening once a year.
➤ Enrich the MDT team and improve the "sentinel" multidisciplinary diagnosis and treatment of cognitive impairment
Efficient and collaborative MDT teams are of great significance for the early identification of cognitive impairment, and relevant departments should provide talents and technical support to improve the level of specialized diagnosis and treatment of cognitive impairment, and establish a professional diagnosis and treatment system for high-risk groups of cognitive impairment that integrates pre-diagnosis self-help screening, inter-clinic evaluation, and post-diagnosis follow-up.
Finally, looking forward to the future, it is hoped that through the construction of disciplines, the improvement of talent teams, the standardization of clinical pathways, and the provision and use of effective platform tools to achieve the same treatment of the ear and brain, move forward the comprehensive prevention and control front, and draw a new future of early prevention and treatment.
A special report on the 2024 Academic Annual Meeting of the Vertigo Medicine Branch of the China Association for the Promotion of International Exchange in Health Care and the 5th China Vertigo Medicine Forum
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