Hearing Loss And Dementia: The Silent Connection
Hearing loss and dementia are more common as you get older. The latest research shows thatâs no coincidence. The two are linked.
Scientists are finding more and more evidence that trouble with hearing makes you more likely to go on to have dementia, a condition marked by memory loss and trouble with thinking, problem-solving, and other mental tasks.
That doesnât mean that people with hearing loss are guaranteed to have dementia — simply that the odds are higher. There may be things you can do to lower your chances for mental decline, even if you start to have trouble hearing.
Mechanism : Common Pathology
A first possible mechanism is common pathology affecting the cochlea and ascending auditory pathway and the cortex . AD-related pathology has been observed in the retina , but it is not well established as occurring in the cochlea. Transgenic mouse models of AD suggest that AD may be associated with cochlear pathology and hearing loss, but the loss is early onset , unlike the midlife impairment in humans mentioned above. In humans, pathological changes related to AD have been described in nuclei in the ascending auditory pathway . Pathological changes also occur in the auditory cortex , with limited data suggesting a relative sparing of primary auditory cortex by the disease process as compared to higher auditory areas . However, hearing loss due to brainstem or cortical pathology is uncommon and is generally associated with obvious macroscopic lesions , as opposed to the more subtle microscopic changes described in these studies. Moreover, the hearing loss demonstrated in the studies relating it to dementia is typically pronounced at high frequencies, which is consistent with age-related deterioration in the cochlea rather than damage to the central pathways caused by AD.
The Hidden Risks Of Hearing Loss
Hearing loss is frustrating for those who have it and for their loved ones. But recent research from Johns Hopkins reveals that it also is linked with walking problems, falls and even dementia.
In a study that tracked 639 adults for nearly 12 years, Johns Hopkins expert Frank Lin, M.D., Ph.D., and his colleagues found that mild hearing loss doubled dementia risk. Moderate loss tripled risk, and people with a severe hearing impairment were five times more likely to develop dementia.
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What Assistive Devices Would Be Helpful To Those With Dementia
For patients diagnosed with dementia, hearing loss should be considered and treated. In early dementia, and with patients who have in-tact support systems, hearing aids may still be a good treatment option. For patients without the option of hearing aids, there are other assistive listening devices that could be helpful, such as remote microphones. See our pages on assistive listening devices and aural rehabilitation for more information.
The Prevalence And Cost Of Hearing Loss
Hearing loss currently impacts an estimated 20% of the global population, or more than 1.5 billion people . By 2050, estimates now project nearly 2.5 billion people with hearing loss, such that nearly 1 in 4 individuals will have some degree of loss . The breakdown in hearing loss prevalence by age category varies by country, with Western countries demonstrating greater prevalence at older ages. In the United States, over two-thirds of adults age 70 years and older have a bilateral hearing loss . It was estimated over 44 million older adults would have hearing loss in 2020 with expected increase to over 73 million by 2060 . However, analysis in a nationally representative sample of older adults suggests that while the overall prevalence of hearing loss is increasing due to greater numbers of older adults, the age-specific prevalence of hearing loss in the United States appears to be decreasing over the last decade, by about 2% in adults compared to the prior decade . This age-specific decrease may be related to improvements in health care or access to care and prevention of known risk factors for hearing loss, improved education, environmental noise protections , and management of vascular or disease risk factors.
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The Link Between Hearing Loss & Cognitive Disorders
What we do know is that studies show a very strong causative link between untreated hearing loss and more rapid cognitive decline. These studies only address the link between the hearing loss and the rate of cognitive decline. They show that there is a link between untreated hearing loss and more rapid cognitive decline in the people who suffer it. They do not show that that cognitive decline is directly linked to or may lead to Dementia or other cognitive disorders.
A study undertaken by Deal et al show that the rate of 20-year memory decline for people with untreated hearing loss in a group, was twice the average rate of decline reported in national studies of cognitive change in older adults . In comparison, the hearing aid users in this study with moderate/severe hearing loss showed a rate of cognitive decline that was only slightly higher than the rate for subjects with normal hearing. This seems to prove that treating hearing loss when needed reduces cognitive decline.
Exposure To Excessively Loud Noise Can Permanently Damage Your Hearing
Approximately 10 million Americans have hearing loss associated with noise-induced hearing loss. NIHL is permanent and cannot be reversed medically or surgically. Excessively loud sounds damage the tiny sensory receptors, or hair cells, in the inner ear. To prevent damage, avoid loud sounds or wear hearing protection.
How Much Noise is Damaging to Ears?Normal conversation reaches 60-65 decibels. Lengthy or repeated exposure to noise above 85 decibels can damage your hearing:
- Fireworks can reach up to 155 decibels
- Jet plane taking off can be 150 decibels
- Shooting a gun can reach 140-175 decibels
- Music concerts and a high-volume MP3 player can reach 120 decibels
- Movie action scenes in the theater can reach 100 decibels
- Lawn mowers can reach 85 decibels
- Chain saws can reach 115-120 decibels
Four Ways to Protect Your HearingE earplugsR reduce the level of soundsS shorten time in loud environments
According to the NIH, age is the strongest predictor of hearing loss among adults aged 20-69, with the greatest amount of hearing loss in the 60 to 69 age group. Given that 20% of those with hearing loss dont seek treatment, its imperative to make them aware of the debilitating physiological and sociological effects that can ensue if hearing loss is left untreated.
~ Dr. Lana B. Patitucci, D.O.
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Are Dementia And Cognitive Decline The Same
Cognitive decline is a general term that can be used to describe common effects of brain aging. Even healthy aging may include a slow decline in memory and thinking abilities. Dementia is a syndrome that can impact memory and thinking abilities, particularly activities of daily living or social functioning. It may affect judgment, problem solving, and even personality. There are many different types of dementia Alzheimers disease is the most well-known and most common.
Of the early signs of dementia, some minor changes may be expected indications of slight cognitive decline. The following are typical changes in memory and thinking, and are likely normal :
- Occasionally forgetting and misplacing things, especially if you remember later
- Occasionally forgetting what you were planning to do or say
- Sometimes having trouble finding words
- Losing track of day of week or date but can think through to figure it out
- Occasional bad decision unless increasing frequency
- Occasional error paying bills, forgetting medications
- Misplacing keys or wallet, but finding them later
- Occasionally feeling sad or moody
- Tired with demands of work, family, life.
- Occasional irritability especially if long standing routine is disrupted
Can We Modify Dementia Risk And Its Associated Behaviors By Treating Hearing Loss
Recent decades have seen an accumulation of evidence for the impact of treating hearing loss on cognitive decline or dementia. Our observational studies have provided foundational and pivotal insights into the hearing-dementia association, however, evidence of causality for decreased or delayed cognitive decline due to hearing aid use is more challenging. From a neurocognitive perspective on this investigation, challenges include selection effects of older adults into studies. Individuals who pursue and obtain a hearing aid are generally a select group of adultsâ often with higher education, higher income, and greater health seeking behaviorsâ all of which are considered protective factors for cognitive decline .
Without understanding the mechanism behind the hearing-dementia association, it is challenging to determine how and when is best to intervene on cognitive decline and dementia. Evidence for treatment of hearing loss throughout the dementia continuum is growing, yet many questions remain. Evidence of efficacy, effectiveness and cost efficiency will aid in determining the best aural rehabilitation choices for prevention â all areas with extensive gaps in evidence for hearing loss and dementia.
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The Emotional Effects Of Untreated Hearing Loss
Studies have linked untreated hearing loss to a number of emotional health conditions, including:
- Irritability, negativism and anger
- Fatigue, tension, stress and depression
- Avoidance or withdrawal from social situations
- Social rejection and loneliness
- Reduced alertness and increased risk to personal safety
When you have hearing loss, you may experience difficulty following conversations in a group setting. Due to this problem, youre more likely to socially withdraw from visits with friends and family, which, over time, leads to depression and anxiety. The prospect of being immersed in a work meeting or large gathering, where numerous conversations will occur, can leave you feeling anxious.
My Hearings Not That Bad
Hearing aid users wait, on average, 10 years before getting help for hearing loss. But during that time, communication with loved ones becomes more difficult, and isolation and health risks increase. Our findings emphasized just how important it is to be proactive in addressing any hearing declines over time, says Lin.
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Benefits Of Wearing A Hearing Aid
Treating your hearing loss is the first step toward a healthier, happier life. Wearing a hearing aid can enrich your life and reopen many doors that may have closed for you over the years. Other benefits of treating your hearing loss with hearing aids include:
- Hearing your grandchilds first words
- Hearing nature again
- Attending dinners in noisy environments
- Enjoying parties and understanding conversation
Evidence That Hearing Aids May Improve Cognitive Function
A recent study by Jamie Desjardins, PhD, an assistant professor in the speech-language pathology program at The University of Texas at El Paso, has shown that hearing aids actually improve the function of the brain in people with hearing loss. We know that untreated hearing loss can lead to emotional and social difficulties, reduced job performance, and a diminished quality of life. As people age, cognitive skills like working memory, the ability to pay attention to a speaker in a noisy environment, or the ability to process information rapidly, begin to decline.
The study was designed to explore the effects of hearing loss on brain function. The study was undertaken on a group of individuals in their 50s and 60s with bilateral sensorineural hearing loss who had never used hearing aids. The study participants took cognitive tests to measure their working memory, selective attention, and processing speed abilities before and after using hearing aids.
Two Weeks Of Hearing Aid Use Showed Improvement
Just two weeks of hearing aid use showed improvements in cognitive abilities, tests revealed an increase in percent scores for recalling words in working memory and selective attention tests. They also showed an increase in cognitive processing speed, in essence the time for participants to select the correct response was faster. By the end of the study, participants had shown significant improvement in their cognitive function..
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How To Get Help
Hearing loss isnt age-specific it can affect everyone, from babies to adults and seniors. The best way to know how to get help is to schedule an appointment with a hearing specialist. He or she will be able to help determine the type and degree of hearing loss you have. From there, the hearing care professional will be able to suggest a type and style of hearing aid that can help you begin to live a happier, more fulfilled life.
If you think you or a loved one suffers from hearing loss, don’t delay another day. Visit a hearing healthcare professional and take the first step toward a world of better hearing.
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Hearing Loss Linked To Alzheimers Diseasewhats The Connection
Studies suggest that hearing loss causes brain changes that raise the risk for dementia. Brain atropy When the hearing section of the brain becomes less active because it is not stimulated by everyday sounds, due to hearing loss, it causes changes in brain structure, and thus brain function. Atrophy occurs more quickly in people with hearing loss could be the first link between hearing loss and cognitive decline.Studies show that the brains of people with hearing loss shrinkor atrophymore quickly than the brains of people with normal hearing.Brain overload An overwhelmed brain creates the second link between hearing loss and dementia. When it is difficult to hear, the brain must work overtime just to understand what people are saying. Straining to hear all day, every day, depletes a persons mental energy and steals brain power needed for other crucial functions like remembering, thinking, and acting. This can further set the stage for cognitive decline including Alzheimers disease and dementia.
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How Hearing Loss May Change The Brain
Hearing loss does seem to shrink some parts of the brain responsible for auditory response. In a study led by Jonathan Peelle, now at Washington University in St. Louis, older adults underwent brain scans while they listened to sentences of varying complexity. They also took tests that measured gray matter, the regions of the brain involved in muscle control, and sensory perception such as seeing and hearing, memory, emotions, speech, decision making, and self-control.
It turned out that the neurons in people with hearing loss were less active when they focused on complex sentences. They also had less gray matter in the auditory areas. These effects may accumulate with time or be triggered by age: In other research, Peelle found that older adults with hearing loss do worse on speech comprehension tasks than younger adults with hearing loss.
The Presentation Of Age
Age-related hearing loss , also known as presbycusis, accounts for the largest percentage of hearing loss cases around the world and presents as a gradual decrease in hearing ability. The outer hair cells and other sensory cells in the cochlea are progressively damaged and unable to regenerate . The result is the impaired encoding of sound, decreased precision, and a distorted auditory signal sent to the brain. This form of hearing loss commonly leads to decreased detection of the higher frequency sounds of speech before lower frequency sounds. The result is reduced ability to hear high-frequency consonants , the parts of speech that provide crispness and clarity. In turn, many with ARHL do not necessarily report difficulty with volume of speech but instead indicate speech sounds muddled or garbled, especially when in the presence of background noise. For everyday function, this may lead to difficulty communicating or interacting with others depending on the listening environment. Those with ARHL may have difficulty hearing or understanding what others are saying in a crowded or noisy setting, such as a restaurant. They may also have difficulty hearing and understanding the television, on the phone, when someone speaks from another room or with their back turned.
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Does Hearing Loss Change Your Brain
There are studies that suggest hearing loss has an impact on brain function. It may result in a change in your brain structure, which directly increases your risk for cognitive impairment and dementia. But another possibility is that hearing loss can demand so much additional attention and effort to decode meaning in words and sounds that it takes up remaining brain capacity needed to process the actual meaning of messages.
More studies are needed to determine the direct cause hearing loss has on brain function and whether that decline is reversible, but hearing loss itself should be paid close attention to.
Some people ignore signs of hearing loss, or chalk them up to aging and just live with it. But hearing loss can affect your life in many ways. If you suspect youre at risk, talk to your doctor and ask for an audiology evaluation to determine how severe your hearing loss is.
If you do have hearing loss and your physician offers a solution like hearing aids, try them out, advises Dr. Factora. If you wait too long and develop memory problems, it will be more difficult for you to learn how to use these devices. Its best to get used to them while the mind is still sharp so you can improve your quality of life.
Impact Of Hearing Loss
The impact of hearing loss is not simply measured in decibels. Hearing loss is an individual experience, and how the individual copes will depend on a great many factors, including early versus late onset, the progressive nature of the loss , the severity of the loss, communication demands, and personality . Regardless of the combination of these presenting factors, hearing loss has been linked to feelings of depression, anxiety, frustration, social isolation, and fatigue.
Several studies have documented the impact of untreated hearing loss. An often cited survey was commissioned by the National Council on Aging in 1999 . This nationwide survey of nearly 4,000 adults with hearing loss and their significant others showed significantly higher rates of depression, anxiety, and other psychosocial disorders in individuals with hearing loss who were not wearing hearing aids. This survey looked at the positive benefits of amplification and showed that hearing aid use positively affected quality of life for both the hearing aid wearer and his or her significant other. These findings were consistent with the findings of a large randomized controlled study which found that hearing loss was associated with decreased social/emotional, communication, and cognitive function in addition to increased depression for subjects who were unaided as compared to those who received hearing aids. These conditions were improved after hearing aids were fit .
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