Longitudinal associations between hearing aid usage and cognition in community-dwelling Japanese older adults with moderate hearing loss

Saiko Sugiura; Yukiko Nishita; Yasue Uchida; Mariko Shimono; Hirokazu Suzuki; Masaaki Teranishi; Tsutomu Nakashima; Chikako Tange; Rei Otsuka; Fujiko Ando; Hiroshi Shimokata

doi:10.1371/journal.pone.0258520

Peer Review History

Original SubmissionApril 23, 2021
11 May 2021 Decision Letter - Masaki Mogi, Editor PONE-D-21-13516 Longitudinal effects of hearing aid usage on cognition in community-dwelling Japanese older adults with moderate hearing loss. PLOS ONE Dear Dr. Sugiura, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The manuscript does not reach to an enough level for the acceptance in the Journal. See the Reviewers' comments carefully and respond them appropriately. Please submit your revised manuscript by Jun 21 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Masaki Mogi Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. In your revised cover letter, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information) and who has imposed them (e.g., an ethics committee). 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The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ******** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This epidemiologic study focused on the protective effect of hearing aids in older adults. The experiment itself is carried out with careful treatments, but the reviewer thinks the sample size is too small. Methods Why were the participants under 60 years old excluded? Please explain the reason. Usually, the definition of old age is over 65 years old. Table 1 This table was not informative. Please create a flow-chart. The number of participants on each group should be shown. Table 1 The follow-up rates were under 20% from “Time 6”. How were the results changed, if the analysis was performed until “Time5”? Methods Were the participants with otological diseases, like otitis media excluded? Please explain it. Methods The reviewer thought that the covariates were not enough in this study. The previous report which the authors published on Auris Nasus Larynx included more covariates than this study. Please include more covariates and re-calculate the data. Obesity, history of hyperlipidemia, alcohol intake and history of cardiovascular disease, like stroke and ischemic heart disease are essential covariates, when the cognitive functions are analyzed. Results Why were the picture completion scores higher than baseline on both groups? Are the picture completion tests not useful tests on evaluating cognitive function? Please explain it. Results Only one model was shown on Table 3. Please create more than two models. Discussion from 297 to 308 This paragraph should be stated at method section. Abbreviations about hearing aids were incorrect like “Has” at some points. Please correct them to “HA”. Reviewer #2: This is a well-conducted study of the association of hearing aid usage with longitudinal cognitive function among 407 older adults with moderate hearing impairment. Given the prevalence of hearing impairment, and prevalence of cognitive decline with age, this is an important and relatively under-studied area. This study represents an important contribution to the literature. Strengths include the relatively large number of participants; objective measures of hearing thresholds; control for many important potentially confounding factors; longitudinal measures, and use of general linear mixed effects regression models. Limitations are adequately noted. However, I have several suggestions for improvement: Title: Since this is an observational study that describes the association between hearing aid usage and cognitive decline it is important to avoid language the implies causation. Thus the word “Effects” should be changed to “Associations” in the title and throughout the text. For the full implication of the results to be appreciated from the abstract, it is important to state that slopes did not differ between HA users and non-users for the Similarities, Picture Completion and Digit Symbol Substitution tests. Line 49 include “is”: The global population of older adults is expected to reach 1.4 billion by 2030 and 2.1 billion by 2050. Line 88: avoid causal language such as “HAS use influenced changes…” since differences between HA users and non-users may arise from uncontrolled confounding. In a few places in the manuscript, hearing aid use is sometimes abbreviated as “ha” or “has” – rather than HA or HAs. It would be helpful if Table 1 was stratified by hearing aid use and non-hearing aid use to allow the reader to appreciate the difference in participation/follow-up time between these two groups. It would be helpful to report on the average time interval between baseline and report of HA use, as well as the range of that interval. This is important to appreciate how much time may have passed between the onset of hearing impairment and beginning of use of hearing aids, which could affect associations with cognitive function. Line 312-313. It is unclear why being a local resident would affect whether participants considered PSAPs as HAs. It is not clear whether the authors are implying that participants may have indicated HA use when they were not using HA, but were using PSAPs? "In addition, personal sound amplification products (PSAPs) may be treated as HAs, because the participants were local residents so they may not be able to distinguish HA from PSAPs”. Conclusion: As with the abstract, it is important to note the implications of the non-significant findings as well. That is, these results shows that HA usage is not associated with reduction in rate of cognitive decline in some tasks that show significantly higher rates of decline among individuals with hearing impairment relative to those without hearing impairment. Authors indicate that they are unable to share their data due to third party restrictions. ******* 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0258520.r001
Revision 1
3 Sep 2021 Author Response Our incorporation of the Reviewer comments is as follows:     The changed part in the manuscript was shown in red color. To reviewer #1: This epidemiologic study focused on the protective effect of hearing aids in older adults. The experiment itself is carried out with careful treatments, but the reviewer thinks the sample size is too small. →Thank you for reviewing our manuscript. As you pointed out, the sample size was not large. However, NILS-LSA is one of the largest cohort studies in Japan that assessed pure-tone audiometry, and we tried to increase the sample size by collecting and reconstructing the samples with moderate hearing loss from all participants. We mentioned this limitation in discussion. (Line 107-110, 345-350) Methods Why were the participants under 60 years old excluded? Please explain the reason. Usually, the definition of old age is over 65 years old. →In Japan, people over 60 have been regarded as elderly and retired. Of course, the current situation is that they are being reviewed to make them over 65. Also, the NILS-LSA was designed to have the same number of participants in each decade (40s, 50s, 60s, 70s). Thus, we did not change the definition of old age as over 65 years old in accordance with our previous study. Table 1 This table was not informative. Please create a flow-chart. The number of participants on each group should be shown. →We added a flow-chart (Fig 1). We also added the number of HA users to Table 1 as the reviewer#2 suggested. Table 1 The follow-up rates were under 20% from “Time 6”. How were the results changed, if the analysis was performed until “Time5”? →We performed additional analyses excluding Time 6-8, and added these results as S1 Table. (Line 200, 201, 261-264) Methods Were the participants with otological diseases, like otitis media excluded? Please explain it. →We did not exclude the participants who had the history of ontological diseases because there were 50 participants of 407 whose data was missing. We added the explanation and discussed it. (Line 114, 115, 345-350) Methods The reviewer thought that the covariates were not enough in this study. The previous report which the authors published on Auris Nasus Larynx included more covariates than this study. Please include more covariates and re-calculate the data. Obesity, history of hyperlipidemia, alcohol intake and history of cardiovascular disease, like stroke and ischemic heart disease are essential covariates, when the cognitive functions are analyzed. →Choice of covariates is difficult problem. We added obesity, history of hyperlipidemia, and history of ischemic heart disease as suggested. We did not add alcohol intake because there were 48 participants of 407 who lack an answer for the questionnaire about alcohol intake. Again, we discussed this limitation. (Line 345-350) Results Why were the picture completion scores higher than baseline on both groups? Are the picture completion tests not useful tests on evaluating cognitive function? Please explain it. →It has been suggested that the Picture completion might be resilient to the impact of brain damage (Kaufman AS & Lichtenberger EO, Assessing adolescent and adult intelligence. 3rd ed. Hoboken, NJ: John Wiley & Sons, 2006), and to hold up with age better than most other performance tests (Wechsler D. The measurement of adult intelligence. 3rd et. Baltimore, OH: The Williams & Wilkins Company, 1944). Thus, we thought scores of Picture completion did not decrease after adjusting for covariates such as practice effects. We discussed it in previous study (Niahita Y, et al. Does high educational level protect against intellectual decline in older adults? : A 10-year longitudinal study. Jpn Psychol Res 2013;55:378-389). We added the reference and mentioned it. (Line 246, 247, 289-294) Results Only one model was shown on Table 3. Please create more than two models. →We create two models, model 1 is adjusted with covariates same as our previous study (Uchida Y, et al. The longitudinal impact of hearing impairment on cognition differs according to cognitive domain. Front Aging Neurosci 2016;8:201), and model 2 is adjusted with covariates model 1 + depression, income, obesity, and history of dyslipidemia. Discussion from 297 to 308 This paragraph should be stated at method section. →We moved this paragraph to method section. (Line 154-165) Abbreviations about hearing aids were incorrect like “Has” at some points. Please correct them to “HA”. →We corrected as suggested. To reviewer #2: This is a well-conducted study of the association of hearing aid usage with longitudinal cognitive function among 407 older adults with moderate hearing impairment. Given the prevalence of hearing impairment, and prevalence of cognitive decline with age, this is an important and relatively under-studied area. This study represents an important contribution to the literature. Strengths include the relatively large number of participants; objective measures of hearing thresholds; control for many important potentially confounding factors; longitudinal measures, and use of general linear mixed effects regression models. Limitations are adequately noted. However, I have several suggestions for improvement: →We deeply appreciate your kind comments. Title: Since this is an observational study that describes the association between hearing aid usage and cognitive decline it is important to avoid language the implies causation. Thus the word “Effects” should be changed to “Associations” in the title and throughout the text. →We changed as suggested. For the full implication of the results to be appreciated from the abstract, it is important to state that slopes did not differ between HA users and non-users for the Similarities, Picture Completion and Digit Symbol Substitution tests. →We added a sentence as suggested. (Line 44, 45) Line 49 include “is”: The global population of older adults is expected to reach 1.4 billion by 2030 and 2.1 billion by 2050. →We changed as suggested. (Line 51) Line 88: avoid causal language such as “HAs use influenced changes…” since differences between HA users and non-users may arise from uncontrolled confounding. →We changed as suggested. (Line 89, 90) In a few places in the manuscript, hearing aid use is sometimes abbreviated as “ha” or “has” – rather than HA or HAs. →We corrected as suggested. It would be helpful if Table 1 was stratified by hearing aid use and non-hearing aid use to allow the reader to appreciate the difference in participation/follow-up time between these two groups. →We added the number of HA users to Table 1 as suggested. It would be helpful to report on the average time interval between baseline and report of HA use, as well as the range of that interval. This is important to appreciate how much time may have passed between the onset of hearing impairment and beginning of use of hearing aids, which could affect associations with cognitive function. →There were 66 participants who had moderate hearing loss and use HA from the first participation, and we could not know when they began to use HA. So, we added the average time interval between baseline and report of HA use in remaining 62 participants. (Line 121-124) Line 312-313. It is unclear why being a local resident would affect whether participants considered PSAPs as HAs. It is not clear whether the authors are implying that participants may have indicated HA use when they were not using HA, but were using PSAPs? "In addition, personal sound amplification products (PSAPs) may be treated as HAs, because the participants were local residents so they may not be able to distinguish HA from PSAPs”. →Opposite to the United States, HA has been available to the consumer through Internet or retail outlets, for example, eyeglass shop, in Japan for a long time. Also, pre-purchase hearing evaluation is not necessary to buy HA. So, people sometimes mistake PSAPs as HA in Japan. We added a sentence explaining the above. (Line 337-341) Conclusion: As with the abstract, it is important to note the implications of the non-significant findings as well. That is, these results shows that HA usage is not associated with reduction in rate of cognitive decline in some tasks that show significantly higher rates of decline among individuals with hearing impairment relative to those without hearing impairment. →We added a sentence as suggested. (Line 355, 356) We corrected some errors, and added one recent study (Line 285, 286, Reference number 33). Attachments Attachment Submitted filename: response to reviewers.docx https://doi.org/10.1371/journal.pone.0258520.r002
21 Sep 2021 Decision Letter - Masaki Mogi, Editor PONE-D-21-13516R1Longitudinal associations between hearing aid usage and cognition in community-dwelling Japanese older adults with moderate hearing loss.PLOS ONE Dear Dr. Sugiura, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== Minor revisions are still necessary in the present study. See the Reviewer's comments and respond them appropriately. ============================== Please submit your revised manuscript by Nov 05 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Masaki Mogi Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments (if provided): [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The reviewer thinks authors properly responded to the reviewers' comments and precisely revised the manuscript. Reviewer #2: The authors have been responsive to prior reviewers and have improved the manuscript. I note below a few minor suggestions to improve clarity: Abstract line 40 : remove “therefore” Abstract lines 41 – 43: The following sentence is unclear: “The model-predicted 12-year slope with centralizing age indicated that the Information score showed no significant decline in the participants using HA, although this tolerance was not found in the participants not using HA.” Do the authors mean that non-HA users showed significant decline in Information scores over the 12 year follow-up period whereas HA users did not? Since the slope in the HA group approached significance, I believe a better interpretation would be that the non HA users showed greater decline over time on Information scores than did HA users. Results, pg 17, line 242 change were to are: “are shown in Fig 2” Results, pg 18, line 261 change were to are: “are shown in S1 Table. Also, please change the table title to be more informative. Eg. “Results of general linear mixed model for WAIS-R-SF scores excluding data from Times 6-8; 7-8 and 8” Results Line 246 – 247. This sentence is unclear: “The Picture completion scores did not decrease especially in the non-users, however, there was no significant difference in the rate of change between two groups”. This would be better expressed as “There were no significant changes in Picture completion scores over time in either the HA or non HA users.” Table 3: I am not sure it is necessary to show the results from model 1 and model 2. There was no a priori reason for assessing differences between these models, although I understand that additional covariates were added in response to review. However, it would be more meaningful to show results of an unadjusted (or minimally adjusted model – including eg. age, sex, education) and the model with all the covariates (fully adjusted model). ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0258520.r003
Revision 2
26 Sep 2021 Author Response Our incorporation of the Reviewer comments is as follows:     The changed part in the manuscript was shown in red color. To Reviewer #1: The reviewer thinks authors properly responded to the reviewers' comments and precisely revised the manuscript. →Thanks to your kind review, our manuscript is better. To Reviewer #2: The authors have been responsive to prior reviewers and have improved the manuscript. I note below a few minor suggestions to improve clarity: →Thank you for reviewing our manuscript. Abstract line 40 : remove “therefore” →We corrected as suggested. Abstract lines 41 – 43: The following sentence is unclear: “The model-predicted 12-year slope with centralizing age indicated that the Information score showed no significant decline in the participants using HA, although this tolerance was not found in the participants not using HA.” Do the authors mean that non-HA users showed significant decline in Information scores over the 12 year follow-up period whereas HA users did not? Since the slope in the HA group approached significance, I believe a better interpretation would be that the non HA users showed greater decline over time on Information scores than did HA users. →We corrected as suggested. Results, pg 17, line 242 change were to are: “are shown in Fig 2” →We corrected the sentence as suggested. Results, pg 18, line 261 change were to are: “are shown in S1 Table. Also, please change the table title to be more informative. Eg. “Results of general linear mixed model for WAIS-R-SF scores excluding data from Times 6-8; 7-8 and 8” →We corrected the sentence and changed the title as suggested. Results Line 246 – 247. This sentence is unclear: “The Picture completion scores did not decrease especially in the non-users, however, there was no significant difference in the rate of change between two groups”. This would be better expressed as “There were no significant changes in Picture completion scores over time in either the HA or non HA users.” →We corrected the sentence as suggested. Table 3: I am not sure it is necessary to show the results from model 1 and model 2. There was no a priori reason for assessing differences between these models, although I understand that additional covariates were added in response to review. However, it would be more meaningful to show results of an unadjusted (or minimally adjusted model – including eg. age, sex, education) and the model with all the covariates (fully adjusted model). →We changed the model 1 as minimally adjusted model. The sentences of results (Line 221-231) were also changed. Attachments Attachment Submitted filename: response to reviewers0926.docx https://doi.org/10.1371/journal.pone.0258520.r004
30 Sep 2021 Decision Letter - Masaki Mogi, Editor Longitudinal associations between hearing aid usage and cognition in community-dwelling Japanese older adults with moderate hearing loss. PONE-D-21-13516R2 Dear Dr. Sugiura, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Masaki Mogi Academic Editor PLOS ONE Additional Editor Comments (optional): No further comment. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: (No Response) ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: (No Response) ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: (No Response) ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: (No Response) ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #2: No https://doi.org/10.1371/journal.pone.0258520.r005
Formally Accepted
4 Oct 2021 Acceptance Letter - Masaki Mogi, Editor PONE-D-21-13516R2 Longitudinal associations between hearing aid usage and cognition in community-dwelling Japanese older adults with moderate hearing loss. Dear Dr. Sugiura: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Masaki Mogi Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0258520.r006

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