Isabelle Mosnier ^1,2 Joel Belmin ^3,4 Domenico Cuda ⁵ Raquel Manrique Huarte ⁶ Mathieu Marx ⁷ Angel Ramos-macias ⁸ Riad Khnifes ⁹ Ohad Hilly ¹⁰ Roberto Bovo ¹¹ Chris James ¹² Petra L. Graham ¹³ Paula Greenham ^14*

• ¹ Hôpitaux Universitaires Pitié Salpêtrière, Paris, France
• ² Intitut Pasteur, Université Paris Cité, Paris, Ile-de-France, France
• ³ Université Paris-Sorbonne, Paris, France
• ⁴ Hôpital Universitaire Charles Foix, Ivry-sur-Seine, Île-de-France, France
• ⁵ Guglielmo da Saliceto Hospital, Piacenza, Italy
• ⁶ University Clinic of Navarra, Pamplona, Navarre, Spain
• ⁷ Hôpital Purpan, Toulouse, France
• ⁸ Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
• ⁹ Bnai Zion Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Haifa, Israel
• ¹⁰ Rabin Medical Center, Petah-Tikva, Israel
• ¹¹ University Hospital of Padua, Padua, Veneto, Italy
• ¹² Other, Toulouse, France
• ¹³ Macquarie University, Sydney, Australia
• ¹⁴ Greenham Research Consulting Ltd., Swindon, United Kingdom

Untreated hearing loss has an effect on cognition. It is hypothesised that the additional processing required to compensate for the sensory loss affects the cognitive resources available for other tasks and that this could be mitigated by a hearing device.The impact on cognition of cochlear implants (CIs) was tested in 100 subjects, ≥ 60 years old, with bilateral moderately-severe to profound post linguistic deafness using hearing aids. Data was compared pre and 12 and 18 months after cochlear implantation for the speech spatial qualities questionnaire, Mini Mental State Examination (MMSE), Trail making test B (TMTB) and digit symbol coding (DSC) from the Wechsler Adult Intelligence Scale version IV and finally the timed up and go test (TUG). Subjects were divided into young old (60-64), middle old (65-75) and old old (75+) groups. Cognitive test scores and times were standardized according to available normative data.Hearing significantly improved pre-to post-operatively across all age groups. There was no change post-implant in outcomes for TMTB, TUG or MMSE tests. Age-corrected values were within normal expectations for all age groups for the TUG and MMSE. However, DSC scores and TMTB times were worse than normal. There was a significant increase in DSC scores between baseline and 12-months for 60-to 64-year-olds (t[153] = 2.608, p=0.027), which remained at 18 months (t[153] = 2.663, p=0.023).The improved attention and processing speed in the youngest age group may be a consequence of reallocation of cognitive resources away from auditory processing due to greatly improved hearing. The oldest age group of participants had cognition scores closest to normal values, suggesting that only the most able older seniors tend to come forward for a CI.Severe to profoundly deaf individuals with hearing aids or cochlear implants were still poorer than age-equivalent normally hearing individuals with respect to cognitive flexibility, attention, working memory, processing speed and visuoperceptual functions.Due to a lack of data for the TUG, TMTB and DSC in the literature for hearing impaired individuals, the results reported here provide an important set of reference data for use in future research.