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Neural circuits and behavioral pathways linking hearing loss to affective dysregulation in older adults

This article has been updated


Substantial evidence now links age-related hearing loss to incident major depressive disorder in older adults. However, research examining the neural circuits and behavioral mechanisms by which age-related hearing loss leads to depression is at an early phase. It is known that hearing loss has adverse structural and functional brain consequences, is associated with reduced social engagement and loneliness, and often results in tinnitus, which can independently affect cognitive control and emotion processing circuits. While pathways leading from these sequelae of hearing loss to affective dysregulation and depression are intuitive to hypothesize, few studies have yet been designed to provide conclusive evidence for specific pathophysiological mechanisms. Here we review the neurobiological and behavioral consequences of age-related hearing loss, present a model linking them to increased risk for major depressive disorder and suggest how future studies may facilitate the development of rationally designed therapeutic interventions for older adults with impaired hearing to reduce risk for depression and/or ameliorate depressive symptoms.

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Fig. 1: Structural and functional consequences of hearing loss on a pathway leading to MDD.
Fig. 2: Patient profiles in hearing loss may lead to different neural and behavioral phenotypes at risk for MDD.

Change history

  • 21 February 2021

    In the version of this Review originally published, there was an erroneous empty box at the top left of Fig. 2; this has now been removed.


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The manuscript was supported by the NIMH grant T32 MH020004-22.

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All authors (K.K.B., J.S.G. and B.R.R.) contributed to the literature search, data interpretation and writing of the manuscript.

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Correspondence to Katharine K. Brewster.

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K.K.B. and B.R.R. have no competing interests or financial disclosures to report. J.S.G. received travel expenses for industry-sponsored meetings (Cochlear, Advanced Bionics and Oticon Medical), consulting fees or honoraria (Oticon Medical, Auditory Insight, Optinose, Abbott and Decibel Therapeutics), and his department received unrestricted educational grants (Storz, Stryker, Acclarent, 3NT and Decibel Therapeutics).

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Peer review information Nature Aging thanks Matthew Amans, Blake Lawrence, Helen Nuttall and Kathy Pichora-Fuller for their contribution to the peer review of this work.

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Brewster, K.K., Golub, J.S. & Rutherford, B.R. Neural circuits and behavioral pathways linking hearing loss to affective dysregulation in older adults. Nat Aging 1, 422–429 (2021).

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