Importance: Given the rapidly rising dementia incidence, management of modifiable risk factors such as hearing loss is vital. Multiple studies have demonstrated an improvement of cognitive functioning in severely hearing-impaired older adults after cochlear implantation. However, few of these studies specifically analyzed participants achieving poor cognitive results preoperatively.
Objective: To study the evolution of cognitive functioning in severely hearing-impaired older adults at risk for mild cognitive impairment (MCI) after cochlear implantation.
Design: This prospective, longitudinal cohort study reports data obtained over a six year period (April 2015 – September 2021) of an ongoing prospective, longitudinal cohort study on CI outcomes in older adults.
Setting: single center
Participants: A consecutive sample of severely hearing-impaired older adults eligible for cochlear implantation were included. All participants obtained a Repeatable Battery for the Assessment of Neuropsychological Status for Hearing-impaired patients (RBANS-H) total score indicative of MCI preoperatively. Participants were assessed before and 12 months after CI activation.
Intervention: Cochlear implantation
Main outcomes and measures: The primary outcome measure was cognition, measured by the RBANS-H.
Results: A total of 21 older adult CI candidates were included in the analysis (mean [SD] age: 72 [9] years; 13 [62%] men). Cochlear implantation resulted in an improvement of overall cognitive functioning 12 months after activation (median [IQR] percentile, 5 [2;8] vs 12 [7;19]; difference [95% CI], 7 [2;12]). Eight participants (38%) surpassed the MCI cut-off (16th percentile) postoperatively, while the overall median cognitive score remained under this cut-off. In addition, participants’ speech recognition in noise improved (mean [SD] score, +17.16 [5.45] vs +5.67 [6.3]; difference [95% CI], -11.49 [-14.26;-8.72]) after CI activation. Improvement of speech recognition in noise was positively related to improvement in cognitive functioning (rs [95% CI], -0.48 [-0.69;-0.19]). Years of education, sex, RBANS-H version and symptoms of depression and anxiety were not related to the evolution in RBANS-H scores.
Conclusions and relevance: Cognitive functioning and speech perception in noise showed a clinically meaningful improvement 12 months after CI activation in severely hearing-impaired older adults at risk for MCI. Hence, cochlear implantation is not contraindicated in CI candidates with cognitive decline and should be considered after multidisciplinary evaluation.
Trial registration: clinicaltrials.gov (NCT02794350)

**Importance:** Given the rapidly rising dementia incidence, management of modifiable risk factors such as hearing loss is vital**.** Multiple studies have demonstrated an improvement of cognitive functioning in severely hearing-impaired older adults after cochlear implantation. However, few of these studies specifically analyzed participants achieving poor cognitive results preoperatively.
**Objective:** To study the evolution of cognitive functioning in severely hearing-impaired older adults at risk for mild cognitive impairment (MCI) after cochlear implantation.
**Design:** This prospective, longitudinal cohort study reports data obtained over a six year period (April 2015 – September 2021) of an ongoing prospective, longitudinal cohort study on CI outcomes in older adults.
**Setting:** single center
**Participants:** A consecutive sample of severely hearing-impaired older adults eligible for cochlear implantation were included. All participants obtained a Repeatable Battery for the Assessment of Neuropsychological Status for Hearing-impaired patients (RBANS-H) total score indicative of MCI preoperatively. Participants were assessed before and 12 months after CI activation.
**Intervention:** Cochlear implantation
**Main outcomes and measures:** The primary outcome measure was cognition, measured by the RBANS-H.
**Results:** A total of 21 older adult CI candidates were included in the analysis (mean [SD] age: 72 [9] years; 13 [62%] men). Cochlear implantation resulted in an improvement of overall cognitive functioning 12 months after activation (median [IQR] percentile, 5 [2;8] vs 12 [7;19]; difference [95% CI], 7 [2;12]). Eight participants (38%) surpassed the MCI cut-off (16th percentile) postoperatively, while the overall median cognitive score remained under this cut-off. In addition, participants’ speech recognition in noise improved (mean [SD] score, +17.16 [5.45] vs +5.67 [6.3]; difference [95% CI], -11.49 [-14.26;-8.72]) after CI activation. Improvement of speech recognition in noise was positively related to improvement in cognitive functioning (rs [95% CI], -0.48 [-0.69;-0.19]). Years of education, sex, RBANS-H version and symptoms of depression and anxiety were not related to the evolution in RBANS-H scores.
**Conclusions and relevance:** Cognitive functioning and speech perception in noise showed a clinically meaningful improvement 12 months after CI activation in severely hearing-impaired older adults at risk for MCI. Hence, cochlear implantation is not contraindicated in CI candidates with cognitive decline and should be considered after multidisciplinary evaluation.
**Trial registration:** clinicaltrials.gov (NCT02794350)

Evaluation of Cognitive Functioning Before and After Cochlear Implantation in Adults Aged 55 Years and Older at Risk for Mild Cognitive Impairment

It is with great pleasure and enthusiasm, that on behalf of the Cochlear Implant centers of the Radboud UMC in Nijmegen and Erasmus MC Sophia Children’s Hospital in Rotterdam to invite you to attend the 16th European Symposium on Pediatric Cochlear Implantation to Rotterdam, the Netherlands in 2023.

Yours sincerely, on behalf of the CI Centers at Radboud UMC and Erasmus MC,