​The STEADFAST Study will identify:

  • How vision and hearing loss impact the risk of developing pre-dementia and its progression to dementia. 
  • If standard treatments for vision and hearing loss (spectacles, cataract surgery, hearing aids) are effective in slowing down cognitive decline. It will also identify and support those at risk through a care team and interventions.
  • Clinical and biomarker data collected during the study to create the first local prediction tool to identify a person’s risk of dementia that can be used by primary healthcare networks.

SINGAPORE, 3 October 2023 – A pioneering multi-party collaborative study in Singapore aims to determine the impact of vision and hearing loss on the risk of developing pre-dementia and dementia and if correcting these sensory losses can reduce these risks.

Led by the National Neuroscience Institute, in partnership with Singapore Eye Research Institute, and Changi General Hospital and the Lien Foundation, the Steadfast Study is the first local interventional programme on sensory loss and cognitive decline. Historically, these interlinked conditions were explored in isolation, missing the holistic picture. In recent years, there is growing scientific evidence that sensory changes might also be interconnected with overall brain health and dementia.

Currently, one in eight Singaporeans are living with pre-dementia and nearly one third of these will go on to develop dementia. Better ways to prevent and delay this progression are urgently needed to tackle the growing tide of dementia in Singapore.

“Understanding how the presence and severity of individual and multiple sensory loss impact pre-dementia and dementia will help us develop screening tools to identify at risk individuals. In addition, vision and hearing loss can usually be improved with spectacles, hearing aids and cataract surgery, offering the potential of readily available treatment strategies to prevent and delay the onset of dementia,” says Assoc Prof Adeline Ng, Senior Consultant, Neurology, NNI and study co-lead.

The five-year study plans to recruit 300 participants aged 50 years and above who also have hearing loss, visual impairment or both. Over the course of three to five years, participants will undergo comprehensive vision, hearing and neuropsychological screening and testing by specialists in ophthalmology, ear, nose and throat (ENT) and neurology.

The prevalence of sensory loss increases with age. About 180,000 adults aged 60 years and above have some form of visual impairment, and this number is expected to double by 2030 with the country’s rapidly ageing population. Local data* shows that about 50% of Singaporean adults in their 60s have hearing loss, and for those in their 80s, about 95% are affected.

“Recent analysis of early studies suggests that the appropriate and timely management of hearing loss can lower the risk of dementia by as much as 10%. The STEADFAST study will add to this growing body of evidence, and more importantly, provide us with local data on the association between hearing loss and dementia.  This is important as it marks a paradigm shift in how hearing loss is viewed upon, as it is no longer just an impairment but a potential risk factor for a devastating disease,” Clinical Assistant Professor David Low, Senior Consultant, Department of Otorhinolaryngology – Head and Neck Surgery, Changi General Hospital and one of the site Principal Investigators of the study.

Participants will be referred for standard clinical care, such as hearing aids and cataract surgery to correct their sensory loss, as well as additional support from NNI’s care team based on their needs, such as post-diagnostic and behavioural support and counselling, cognitive rehabilitation, and psychosocial therapy. Those identified as being at higher risk of cognitive decline will also have the opportunity to join one of three pilot interventions – brain stimulation using low intensity pulsed electrical currents, Gym Tonic (a strength training programme which is safe and simple for seniors), and virtual reality therapy – to assess their effectiveness in delaying the progression to pre-dementia or dementia.

“Contemporary data on the role of vision, hearing, and dual sensory impairment in dementia development and progression, are lacking in older adults. This information is crucial in establishing sensory loss as cognitive risk factors and potential non-invasive biomarkers, for screening and clinical management,” said Professor Ecosse Lamoureux, Director, Population Research and Epidemiology, Singapore Eye Research Institute, and one of the site Principal Investigators of the study.

Considering the ease in detecting visual and hearing impairment, using validated and easily available visual and auditory screening tools, may allow for the identification of individuals with sensory impairment at risk of cognitive decline and pave the way for preventative strategies and the early initiation of appropriate treatment.

The study is supported by $4 million in funding from the Lien Foundation.

“As we confront the growing challenge of dementia, deepening our understanding of the intricate connection between our senses and brain health could predict those at risk earlier. In addition, we aspire to expand the local toolbox of drug free, non-invasive interventions, thereby bolstering strategies to combat cognitive decline and dementia,” said Lee Poh Wah, CEO, Lien Foundation.

Recruitment of study volunteers is expected to start in the 1st quarter of 2024.