Hearing Loss and Auditory-Visual Episodic Memory among Urban-Dwelling American Indian and Alaska Native Elders in the URBANE Study

Abstract

Hearing loss is an increasingly recognized risk factor for cognitive decline and Alzheimer’s Disease and Related Dementias (ADRD), yet cognitive assessments rarely account for hearing status despite relying heavily on auditory stimuli. Consequently, it remains unclear whether poorer episodic memory performance reflects cognitive decline or suboptimal sensory conditions. Using data from the URBAn Native Elders (URBANE) study (2021-2024), we examined the association between hearing handicap and auditory versus visually presented episodic memory among urban-dwelling American Indian and Alaska Native (AI/AN) Elders. Participants (n = 901) self-identified as AI/AN, were aged 55 years and older, and lived in or commuted to urban areas defined by Rural-Urban Commuting Area codes. Participants completed neurocognitive assessments and structured medical interviews. Self-perceived hearing loss was measured using the Hearing Handicap Inventory for the Elderly-Screening version (HHIE-S). Episodic memory was assessed using the NIH Toolbox Picture Sequence Memory Test (visual episodic memory) and the National Alzheimer’s Coordinating Center (NACC) Craft Story immediate recall tests (auditory episodic memory). Multivariable linear regression models estimated associations between hearing handicap severity and episodic memory performance while adjusting for demographic and cognitive covariates. Higher hearing handicap severity was associated with slightly lower performance across episodic memory measures, though estimates were small and not statistically significant (all p-values > 0.05). Although we did not observe associations of self-perceived hearing loss with markers of auditory and visual episodic memory tasks, our findings highlight the potential burden of hearing loss in this population of AI/AN Elders, and support continued research on hearing health and cognitive function among AI/AN Elders.