Clinical trial NCT06495268: Healthy HeaAring for Healthy Ageing: Data-driven Hearing Rehabilitation Intervention to Promote Healthy Hearing
Official title: Healthy Hearing for Healthy Ageing: a Proof-of-concept Randomized Controlled Trial of Data-driven Hearing Rehabilitation Versus Standard Care in Older Adults with Hearing Impairment.
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Sensorineural Hearing Loss
Cognitive Decline
Keywords: Hearing Impairment
Hearing Rehabilitation
Hearing Loss
Cognition
Data-driven rehabilitation
Lead sponsor: Kuopio University Hospital
Sponsor class: OTHER
Collaborators: name: University of Eastern Finland
First posted: 2024-07-10
Enrollment: 200
Sex: ALL
Minimum age (years): 65
Maximum age (years): 84
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Participants are randomly assigned to either intervention (individualised data-driven hearing rehabilitation) or control group (standard care hearing rehabilitation) by computer-generated allocation in blocks of four (two individuals randomly allocated to each group).

The intervention group will receive individually fitted HAs with immediate SPIN-based benefit validation. HA selection and individual tailoring will also be based on hearing questionnaires data. Participants are invited to intervention-related monitoring appointments at 3, 6 and 12 months.

The control group will receive the same HAs fitted according to the standard care protocol. Standard care follow-up includes a phone call check 3 months after the primary fitting. Additional monitoring/re-fitting may be offered based on the participant's feedback and hearing rehabilitator's clinical judgement.

12-month and 24-months follow-up appointments are arranged for both groups.
Primary purpose: SUPPORTIVE_CARE

Brief summary: The goal of the HAHA trial is to prove that the treatment of HI and prevention of HI-related cognitive decline are most likely to be effective if HI is approached as a broader neurodegenerative entity with multifaceted manifestations currently unaddressed in clinical practice and managed using a novel individualised data-driven protocol for early hearing rehabilitation. The main hypothesis is that, compared with standard care, the data-driven rehabilitation will likely have broader benefits manifested in three key areas: hearing, cognition, and quality of life and psychosocial outcomes.

Participants will be randomized 1:1 to either intervention (individualised data-driven hearing rehabilitation) or control group (standard care hearing rehabilitation). The primary objective of this study is to investigate the effect of an optimized data-driven hearing rehabilitation protocol versus standard care protocol on change in speech perception in noise (SPIN) in older adults with mild to moderately severe sensorineural HI and without dementia.

Detailed description: Hearing impairment (HI) is a major public health problem. HI has also been identified as a significant potentially modifiable risk factor for dementia. Thus, hearing rehabilitation may contribute to dementia risk reduction, although a causal HI-dementia relation is not fully established.

The HAHA trial will test an individualised, data-driven hearing rehabilitation protocol based on the ongoing BREM (Benefits of Real-Ear Measurement) study at KUH (clinicaltrials.gov ID NCT05621798). HAHA will use a pragmatic approach incorporated into routine specialized care (Hearing Center at the Dept of Otorhinolaryngology of KUH), to facilitate optimisation of the current HI clinical pathway and treatment process. This study is a proof-of-concept, single-site, 2-arm parallel group 12-month randomized controlled trial with a 12-month extended follow-up.

The investigators will recruite 200 participants referred to the Kuopio University Hospital Hearing Center from primary care that are aged 65 to 84 years with mild to moderately severe sensorineural HI and are about to receive their first HAs.

The intervention group will receive individually fitted HAs based on preliminary results from the ongoing BREM study at KUH to ensure adequate amplification, with immediate SPIN-based benefit validation. HA selection and individual tailoring will also be based on hearing questionnaires data. Participants are invited to intervention-related monitoring appointments at 3, 6 and 12 months after the primary HA fitting.

The control group will receive the same HAs fitted according to the standard care protocol. Standard care follow-up includes a phone call check 3 months after the primary fitting. Additional monitoring/re-fitting may be offered based on the participant's feedback and hearing rehabilitator's clinical judgement.

A range of auditory, cognitive, quality of life and psychosocial measures as well as exploratory measures such as EEG, MRI and vision-related measures are assessed at 12-month and 24-month visits on both groups. These assessments are included to investigate potential mechanisms underlying associations between HI, hearing rehabilitation, vision and cognition. The overall duration of the this trial is 2 years.

Eligibility criteria: Inclusion Criteria:

* Mild to moderately severe sensorineural HI (PTA (0,5-4kHz) between 20-64 dB (HL), as per Global Burden of Disease Expert Group on Hearing loss criteria)
* Community-dwelling, i.e. living at home / not living in a care home or nursing home
* Proficiency in Finnish language
* First-time hearing aid user

Exclusion Criteria:

* Conductive hearing loss (air-bone gap more than 20 dB HL in two consecutive frequencies)
* Difference between hearing levels of the ears is more than 15dB (HL) in three consecutive frequencies
* Hearing aid contraindication
* Previously diagnosed dementia, or current use of cholinesterase inhibitors and/or memantine. If there is a current ongoing diagnostic process for suspected dementia, the decision on eligibility will be made by an experienced study physician based on medical records and clinical judgement.
* Any health conditions severely impairing vision, mobility, communication, and/or ability to participate in study visits and complete study assessments, as judged by the study nurse and/or physician.

Primary outcomes:
measure: Finnish Matrix Sentence Test (FMST)
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Digits in Noise test (DIN)
timeFrame: Change measures: 0 months, 12 months, 24 months
Secondary outcomes:
measure: Speech, Spatial and Quality questionnaires - SSQ
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Hearing aid usage (self-report and HAs log data)
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Listening effort questionnaire
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Response time (DIN test)
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Tinnitus Handicap Inventory (THI)
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: CERAD-nb (global and domain scores)
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Clinical Dementia Rating Sum of Boxes (CDR-SoB)
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: 15D questionnaire
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: EQ5-D-5L questionnaire
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Beck Depression Inventory (BDI)
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Hearing in real-life environment - HERE
timeFrame: Change measures: 0 months, 12 months, 24 months
Other outcomes:
measure: EEG-derived cortical auditory evoked potentials (CAEPs)
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Structural MRI
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Functional MRI
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Ultra-short echo time MRI / Zero echo time MRI
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Measures related to active lifestyle
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: Digital cognitive test battery
timeFrame: Change measures: 0 months, 12 months, 24 months
measure: 1: Vision-related outcomes
timeFrame: Change measures: 0 months, 24 months
measure: 2: Vision-related outcomes
timeFrame: Change measures: 0 months, 24 months
measure: 3: Vision-related outcomes
timeFrame: Change measures: 0 months, 24 months
measure: 4: Vision-related outcomes
timeFrame: Change measures: 0 months, 24 months
measure: Blood samples
timeFrame: Change measures: 0 months, 24 months
measure: Intervention-related acitivities, intervention group
timeFrame: Change measures: 0 months, 3 months, 6 months, 12 months
measure: Intervention-related acitivities, standard group
timeFrame: Change measures: 0 months
Locations:
city: Kuopio
country: Finland
facility: Kuopio University Hospital
Study officials:
affiliation: Kuopio University Hospital and University of Eastern Finland
name: Aarno Dietz, prof.
role: PRINCIPAL_INVESTIGATOR
affiliation: University of Eastern Finland
name: Alina Solomon, prof.
role: PRINCIPAL_INVESTIGATOR
References:
citation: GBD 2019 Hearing Loss Collaborators. Hearing loss prevalence and years lived with disability, 1990-2019: findings from the Global Burden of Disease Study 2019. Lancet. 2021 Mar 13;397(10278):996-1009. doi: 10.1016/S0140-6736(21)00516-X.
citation: Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen-Mansfield J, Cooper C, Costafreda SG, Dias A, Fox N, Gitlin LN, Howard R, Kales HC, Kivimaki M, Larson EB, Ogunniyi A, Orgeta V, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbaek G, Teri L, Mukadam N. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug 8;396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6. Epub 2020 Jul 30. No abstract available.
citation: Brewster KK, Deal JA, Lin FR, Rutherford BR. Considering hearing loss as a modifiable risk factor for dementia. Expert Rev Neurother. 2022 Sep;22(9):805-813. doi: 10.1080/14737175.2022.2128769. Epub 2022 Sep 27.
citation: Sanders ME, Kant E, Smit AL, Stegeman I. The effect of hearing aids on cognitive function: A systematic review. PLoS One. 2021 Dec 31;16(12):e0261207. doi: 10.1371/journal.pone.0261207. eCollection 2021.
citation: Lin MY, Gutierrez PR, Stone KL, Yaffe K, Ensrud KE, Fink HA, Sarkisian CA, Coleman AL, Mangione CM; Study of Osteoporotic Fractures Research Group. Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women. J Am Geriatr Soc. 2004 Dec;52(12):1996-2002. doi: 10.1111/j.1532-5415.2004.52554.x.
citation: Gadkaree SK, Sun DQ, Li C, Lin FR, Ferrucci L, Simonsick EM, Agrawal Y. Does Sensory Function Decline Independently or Concomitantly with Age? Data from the Baltimore Longitudinal Study of Aging. J Aging Res. 2016;2016:1865038. doi: 10.1155/2016/1865038. Epub 2016 Sep 27.
citation: Hong T, Mitchell P, Burlutsky G, Liew G, Wang JJ. Visual Impairment, Hearing Loss and Cognitive Function in an Older Population: Longitudinal Findings from the Blue Mountains Eye Study. PLoS One. 2016 Jan 25;11(1):e0147646. doi: 10.1371/journal.pone.0147646. eCollection 2016.
citation: Brenowitz WD, Kaup AR, Lin FR, Yaffe K. Multiple Sensory Impairment Is Associated With Increased Risk of Dementia Among Black and White Older Adults. J Gerontol A Biol Sci Med Sci. 2019 May 16;74(6):890-896. doi: 10.1093/gerona/gly264.
citation: Campbell J, Sharma A. Cross-modal re-organization in adults with early stage hearing loss. PLoS One. 2014 Feb 28;9(2):e90594. doi: 10.1371/journal.pone.0090594. eCollection 2014.
citation: Tarawneh HY, Menegola HK, Peou A, Tarawneh H, Jayakody DMP. Central Auditory Functions of Alzheimer's Disease and Its Preclinical Stages: A Systematic Review and Meta-Analysis. Cells. 2022 Mar 16;11(6):1007. doi: 10.3390/cells11061007.
citation: Davis A, Smith P, Ferguson M, Stephens D, Gianopoulos I. Acceptability, benefit and costs of early screening for hearing disability: a study of potential screening tests and models. Health Technol Assess. 2007 Oct;11(42):1-294. doi: 10.3310/hta11420.
citation: Timmer BHB, Hickson L, Launer S. Do Hearing Aids Address Real-World Hearing Difficulties for Adults With Mild Hearing Impairment? Results From a Pilot Study Using Ecological Momentary Assessment. Trends Hear. 2018 Jan-Dec;22:2331216518783608. doi: 10.1177/2331216518783608.
citation: Wright D, Gagne JP. Acclimatization to Hearing Aids by Older Adults. Ear Hear. 2021 Jan/Feb;42(1):193-205. doi: 10.1097/AUD.0000000000000913.
citation: Panza F, Lozupone M, Solfrizzi V, Sardone R, Dibello V, Di Lena L, D'Urso F, Stallone R, Petruzzi M, Giannelli G, Quaranta N, Bellomo A, Greco A, Daniele A, Seripa D, Logroscino G. Different Cognitive Frailty Models and Health- and Cognitive-related Outcomes in Older Age: From Epidemiology to Prevention. J Alzheimers Dis. 2018;62(3):993-1012. doi: 10.3233/JAD-170963.
citation: Yeo BSY, Song HJJMD, Toh EMS, Ng LS, Ho CSH, Ho R, Merchant RA, Tan BKJ, Loh WS. Association of Hearing Aids and Cochlear Implants With Cognitive Decline and Dementia: A Systematic Review and Meta-analysis. JAMA Neurol. 2023 Feb 1;80(2):134-141. doi: 10.1001/jamaneurol.2022.4427.
citation: Lin FR, Pike JR, Albert MS, Arnold M, Burgard S, Chisolm T, Couper D, Deal JA, Goman AM, Glynn NW, Gmelin T, Gravens-Mueller L, Hayden KM, Huang AR, Knopman D, Mitchell CM, Mosley T, Pankow JS, Reed NS, Sanchez V, Schrack JA, Windham BG, Coresh J; ACHIEVE Collaborative Research Group. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet. 2023 Sep 2;402(10404):786-797. doi: 10.1016/S0140-6736(23)01406-X. Epub 2023 Jul 18.
citation: Dietz A, Heinrich A, Tormakangas T, Iso-Mustajarvi M, Miettinen P, Willberg T, Linder PH. The Effectiveness of Unilateral Cochlear Implantation on Performance-Based and Patient-Reported Outcome Measures in Finnish Recipients. Front Neurosci. 2022 Jun 6;16:786939. doi: 10.3389/fnins.2022.786939. eCollection 2022.
citation: Karawani H, Jenkins K, Anderson S. Restoration of sensory input may improve cognitive and neural function. Neuropsychologia. 2018 Jun;114:203-213. doi: 10.1016/j.neuropsychologia.2018.04.041. Epub 2018 May 2.
citation: Glick H, Sharma A. Cross-modal plasticity in developmental and age-related hearing loss: Clinical implications. Hear Res. 2017 Jan;343:191-201. doi: 10.1016/j.heares.2016.08.012. Epub 2016 Sep 6.
citation: Gommeren H, Bosmans J, Cardon E, Mertens G, Cras P, Engelborghs S, Van Ombergen A, Gilles A, Lammers M, Van Rompaey V. Cortical Auditory Evoked Potentials in Cognitive Impairment and Their Relevance to Hearing Loss: A Systematic Review Highlighting the Evidence Gap. Front Neurosci. 2021 Nov 18;15:781322. doi: 10.3389/fnins.2021.781322. eCollection 2021.
citation: Pereira-Jorge MR, Andrade KC, Palhano-Fontes FX, Diniz PRB, Sturzbecher M, Santos AC, Araujo DB. Anatomical and Functional MRI Changes after One Year of Auditory Rehabilitation with Hearing Aids. Neural Plast. 2018 Sep 10;2018:9303674. doi: 10.1155/2018/9303674. eCollection 2018.
citation: Cheung CY, Mok V, Foster PJ, Trucco E, Chen C, Wong TY. Retinal imaging in Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2021 Sep;92(9):983-994. doi: 10.1136/jnnp-2020-325347. Epub 2021 Jun 9.
citation: Solomon A, Stephen R, Altomare D, Carrera E, Frisoni GB, Kulmala J, Molinuevo JL, Nilsson P, Ngandu T, Ribaldi F, Vellas B, Scheltens P, Kivipelto M; European Task Force for Brain Health Services. Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services-part 4 of 6. Alzheimers Res Ther. 2021 Oct 11;13(1):171. doi: 10.1186/s13195-021-00875-8.
citation: Dietz A, Buschermohle M, Aarnisalo AA, Vanhanen A, Hyyrynen T, Aaltonen O, Lopponen H, Zokoll MA, Kollmeier B. The development and evaluation of the Finnish Matrix Sentence Test for speech intelligibility assessment. Acta Otolaryngol. 2014 Jul;134(7):728-37. doi: 10.3109/00016489.2014.898185. Epub 2014 May 7.
citation: Smits C, Kapteyn TS, Houtgast T. Development and validation of an automatic speech-in-noise screening test by telephone. Int J Audiol. 2004 Jan;43(1):15-28. doi: 10.1080/14992020400050004.
citation: Willberg T, Buschermohle M, Sivonen V, Aarnisalo AA, Lopponen H, Kollmeier B, Dietz A. The development and evaluation of the Finnish digit triplet test. Acta Otolaryngol. 2016 Oct;136(10):1035-40. doi: 10.1080/00016489.2016.1175662. Epub 2016 Apr 28.
citation: Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189-98. doi: 10.1016/0022-3956(75)90026-6. No abstract available.
citation: Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993 Nov;43(11):2412-4. doi: 10.1212/wnl.43.11.2412-a. No abstract available.
citation: Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982 Jun;140:566-72. doi: 10.1192/bjp.140.6.566.
citation: Berg L. Clinical Dementia Rating (CDR). Psychopharmacol Bull. 1988;24(4):637-9. No abstract available.
citation: Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med. 2001 Jul;33(5):328-36. doi: 10.3109/07853890109002086.
citation: Renvall H, Seol J, Tuominen R, Sorger B, Riecke L, Salmelin R. Selective auditory attention within naturalistic scenes modulates reactivity to speech sounds. Eur J Neurosci. 2021 Nov;54(10):7626-7641. doi: 10.1111/ejn.15504. Epub 2021 Nov 3.
citation: Renvall H, Formisano E, Parviainen T, Bonte M, Vihla M, Salmelin R. Parametric merging of MEG and fMRI reveals spatiotemporal differences in cortical processing of spoken words and environmental sounds in background noise. Cereb Cortex. 2012 Jan;22(1):132-43. doi: 10.1093/cercor/bhr095. Epub 2011 May 25.