Effects of hearing intervention on blood-based biomarkers of neuroinflammation and neurodegeneration: a secondary analysis of the ACHIEVE randomised controlled trial

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Background Research suggests that hearing loss in older adults is associated with elevated neuroinflammation and neurodegeneration, both of which are risk factors for dementia. In a secondary analysis of the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) randomised controlled trial (ClinicalTrials.gov identifier: NCT03243422), we examined if hearing intervention slowed 3-year change in blood-based biomarkers of neuroinflammation (glial fibrillary acidic protein [GFAP]) and neurodegeneration (neurofilament light chain [NfL]). Methods ACHIEVE, a clinical trial in the United States conducted between January 4, 2018 and November 30, 2022, tested the effects of hearing intervention (audiological counselling, provision of hearing aids) versus health education control (counselling on chronic disease prevention) on 3-year cognitive decline among older adults without substantial cognitive impairment and with untreated hearing loss. Plasma was collected at baseline and three years later among ACHIEVE participants recruited from the Atherosclerosis Risk in Communities cohort. Covariate-adjusted linear mixed effects models estimated intention-to-treat effects on 3-year change in inverse-normal transformed values of GFAP and NfL. Findings Participants in the analytic sample (n = 164) were mean (SD) age 78.1 (2.9) years, 64.0% female, and 73.2% White. Over three years, hearing intervention was associated with a slower rise in GFAP (intervention: −0.026; 95% CI: −0.144, 0.093, control: 0.149; 95% CI: 0.039, 0.260; difference: −0.175; 95% CI: −0.322, −0.028; p-difference: 0.019) and NfL (intervention: 0.171; 95% CI: 0.022, 0.319, control: 0.330; 95 %CI: 0.185, 0.475, difference: −0.159; 95 %CI: −0.348, 0.029; p-difference: 0.098). Interpretation Randomisation to hearing intervention was associated with a slower three-year rise in a blood-based biomarker of neuroinflammation. Comparable estimates were observed for neurodegeneration, although the effect was not statistically significant. Findings suggest that hearing intervention may reduce the rate of change in non-specific blood-based biomarkers associated with brain health and dementia progression. Funding US National Institutes of Health.

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