Is There A Link Between Hearing Loss And Dementia
Untreated hearing loss increases the risk for dementia . Adults with hearing loss have a faster rate of cognitive decline that adults with normal hearing . Hearing loss demands extra cognitive resources, which limits the cognitive resources that are available for memory and thinking. There are also documented changes in the brain as a result of hearing loss these changes are thought to impact cognition over time. Additionally, hearing loss can lead to a decrease in social engagement , which is a known risk factor of dementia. Although hearing loss does not cause dementia, it does place people at risk for developing dementia a supportive reason that hearing loss should not be ignored.
Many communication difficulties related to hearing loss can cross-over with difficulties related to dementia. If adults are uncertain which dysfunction may be causing difficulties, it is recommended to seek evaluation from an audiologist and a physician. A primary care physician can help patients determine if a cognitive evaluation is necessary and refer to the correct specialist for testing.
There Are Ways To Reduce The Risk Of Dementia
The 2020 Report by The Lancet Commission entitled: Dementia Prevention, Intervention and Care was released on July 30th, 2020. The latest research states that modifying 12 risk factors from childhood to late life could delay or prevent 40% of dementia cases. These lifestyle factors can be adjusted in order to reduce ones risk for developing dementia. The 12 modifiable risk factors are presented below:
Of these 12 risk factors, an untreated hearing loss in midlife is a significant modifiable risk factor of dementia. Additionally, dementia risk varies based on level of hearing loss.
- Mild hearing loss doubles dementia risk
- Moderate hearing loss triples the risk of dementia
- Severe hearing impairment increases the dementia risk by up to 5 times that of those who do not have hearing impairment1
The recent study by the Lancet also cites that hearing loss might result in cognitive decline through reduced cognitive stimulation.1
Do you suspect that you might have hearing loss?
Types Of Hearing Loss
People with hearing loss can fall into one of three groups: people who are hard of hearing, those who are deaf and those who are deafened.
In most cases people who are hard of hearing have developed age-related hearing loss. In some cases this has developed through exposure to loud sounds. This is the largest group roughly 90 per cent of the total number of people with hearing loss .
People who are deaf are severely or profoundly deaf. They use sign language as their preferred language and belong to the Deaf community . There are no reliable figures on how many people in the UK use British Sign Language : estimates vary enormously from 22,000 to over 100,000 in the UK . Read the feature on Deafness and dementia to find out more about the issues for people who are Deaf and live with dementia.
I have been a 24-hour carer for my wife for over four years. She has vascular dementia and Lewy body disease. About two years ago she suddenly became unresponsive just staring, wide-eyed when I talked to her. A conventional hearing test proved impossible to conduct but a very patient audiologist, after taking casts of her ears, made aids which could be set to amplify in steps until it provoked a response. This changed her demeanour immediately and, although I can hear the aids output from the leakage of sound from my wifes ears, she now responds and converses.
A husbands story, posted on an Alzheimers Societys website forum
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Hearing Aid Myths That Hold You Back
Can hearing aids reduce these risks? Lin hopes to find out in a new study, still in the planning stages. These studies have never been done before, he notes. What we do know is that theres no downside to using hearing aids. They help most people who try them. And in those people, they can make all the difference in the worldallowing people to reengage with friends and family and to be more involved again.
Although nearly 27 million Americans age 50 and older have hearing loss, only one in seven uses a hearing aid. If you think your hearing has diminished, its worth making an appointment with an audiologist for a hearing check, Lin says. If you have hearing loss, dont let the following myths keep you from getting help.
Hearing Loss Causes Brain Changes And Dementia
The fourth mechanism that the researchers propose relates to changes in the brains medial temporal lobe .
People with Alzheimers disease have abnormal accumulations of a protein called tau that collects inside neurons. These accumulations are called neurofibrillary tangles. People with Alzheimers disease also have excess beta-amyloid 42, a protein that clumps together to form plaques between neurons. These neuron changes appear earliest in the MTL, which is involved in auditory processing.
People with hearing loss also display changes in MTL neurons, suggesting a relationship between the two conditions. The researchers suggest that in people with hearing loss, limited auditory input leads to overactivity in the MTL, which may cause or contribute to neurofibrillary tangles and beta-amyloid plaques.
They also suggest a two-way relationship, meaning that hearing loss may exacerbate changes that lead to Alzheimers disease, while the disease may cause changes that worsen hearing loss.
The researchers conclude that more research is necessary to clarify the processes that connect hearing loss and dementia.
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Identification Of Hearing Loss
It is important that older people with dementia have regular hearing checks, particularly because the symptoms of hearing loss for example, not following a line of conversation can be mistaken for dementia. In the first instance, the GP should be contacted as they will be able to refer the person for a hearing check, where appropriate.
It can be more challenging to diagnose hearing loss for people with dementia. A person has dementia may well find it hard to understand instructions given during the diagnostic process or they may be unable to report the history of their hearing loss because of their memory problems.
It is possible to adapt testing procedures so that they meet the needs of people with dementia. This makes it vital that care providers communicate effectively, where appropriate, with health professionals to ensure that they are aware of long-term conditions, such as dementia, that may have implications for testing procedures.
Some audiology departments have specialists who are qualified to assess people with dementia. They will often use specialist diagnostic tests, which are easy to understand and take account of the communication and memory difficulties that can go along with dementia.
Association Between Hearing Loss And Incident Dementia
Twelve prospective cohort studies were analyzed in the meta-analysis of hearing loss and risk of all-cause dementia. Since one study provided separate data according to the number of ears affected , two studies according to the severity of hearing loss , and the others according to the age of the participants , these datasets were independently examined. As a result, 17 datasets were available for the outcome of all-cause dementia . Pooled results showed that hearing loss elevated the risk of subsequent dementia . Sensitivity analysis also showed consistent results . Subgroup analysis by the diagnostic methods for hearing loss, validation strategy for dementia, follow-up duration, and adjustment of APOE genotype also showed consistent results . Pooled analyses with five studies showed that loss was independently associated with a higher incidence of AD .
Figure 2. Forest plots for the meta-analysis concerning the association between hearing loss and the subsequent incidence of all-cause dementia.
Figure 3. Subgroup analyses for the outcome of all-cause dementia. Subgroup analysis according to the diagnostic methods for hearing loss, and subgroup analysis according to the validation strategy for dementia.
Figure 4. Subgroup analyses for the outcome of all-cause dementia. Subgroup analysis according to the mean follow-up duration, and subgroup analysis according to whether the status of the apolipoprotein E genotype was adjusted.
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I Heard That Hearing Aids Are Difficult To Use
There is a breaking-in period as youand your central auditory system and brainadjust to life with hearing aids. Thats why most doctors and hearing centers include a trial period, so you can be sure the type youve chosenwhether its a miniature behind-the-ear model or one that fits into your earis right for you.
Mechanism : Interaction Between Brain Activity Related To Auditory Cognition And Dementia Pathology
The previous mechanism considered the widespread brain resources used for speech-in-noise listening. A fourth possible explanation focuses on auditory cognitive mechanisms in the MTL that may be specifically linked to AD pathology in the same region. This mechanism starts from the same idea as mechanism 3, that hearing loss alters cortical activity, including in the MTL. The critical difference from mechanism 3 is the incorporation of an interaction between that altered activity and AD pathology.
The AD pathology that best correlates with the cognitive phenotype is neurofibrillary change related to tau pathology . The earliest neurofibrillary changes in typical AD are found in MTL structures, particularly the perirhinal cortex, which has a strong functional relationship to the hippocampus . This raises the possibility of an interaction between this pathological process and changes in neuronal activity in MTL structures that occur in hearing impaired individuals.
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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.
Wearing Hearing Aids Means Im Old And Im Not Ready For That
Its normal to feel worried that hearing loss means youre agingand to want to hide it. Plenty of people with a hearing impairment sit silently rather than joining in conversations and activities, because they fear that hearing problems will make them seem helpless or less than competent. The truth: Connecting with others can help your brain stay younger and keep you involved with life.
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Can Hearing Aids Help Prevent Dementia
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Hearing loss has long been considered a normal, and thus acceptable, part of aging. It is common: Estimates suggest that it affects two out of three adults age 70 and older. It is also rarely treated. In the U.S., only about 14 percent of adults who have hearing loss wear hearing aids. An emerging body of research, however, suggests that diminished hearing may be a significant risk factor for Alzheimers disease and other forms of dementia and that the association between hearing loss and cognitive decline potentially begins at very low levels of impairment.
In 2017, the medical journal The Lancet convened a commission to review all published research on risk factors for dementia that might be modified to prevent or delay the onset of symptoms. The surprising conclusion was that hearing loss is the largest accounting, statistically speaking, for approximately 9 percent of all current diagnoses. That, Lin says, was a big wake-up call. Historically, hearing loss has received relatively little attention from clinicians, scientists and the general public simply because, Lin believes, its something everyone gets as they get older. Everyone gets white hair and wrinkles, it cant really matter, right? Its an invisible disability.
Can Hearing Aids Reduce The Risk Of Dementia
Hearing aids are a type of amplification device used to manage hearing loss. Research is ongoing to determine if hearing aids can reduce cognitive decline and dementia, but findings in this area have been encouraging thus far. It is possible that treating hearing loss can have a positive impact on the risk for dementia and possibly on the rate of cognitive decline. Properly fit hearing aids are known to reduce listening effort, allowing for more cognitive resources to be available for other brain tasks. Hearing aids can also re-stimulate areas of the brain that have been neglected due to hearing loss. Lastly, hearing aids are known to improve social communication, which may prevent or delay dementia. If someone suspects they have hearing loss, it is recommended to have a hearing evaluation and discuss treatment options with an audiologist.
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Dementia And Ongoing Management Of Hearing Loss
Where a person has dementia, people working with them may need to take additional steps to help them to manage their hearing loss. For example, a person with dementia may really struggle to adjust to using a hearing aid. They may not be able to recall that they have a hearing problem or that they have a hearing aid. They may not recognise what the hearing is for or when they do remember to wear it, how to use it effectively. They may fiddle with it or refuse to wear it regularly and intermittent use may create more difficulties with remembering how to use it.
For all these sorts of problems, the help of other people can make a huge difference. If care or support staff are observant, they can pick on a persons behaviours and know what to look out for and offer in supporting that person best.
These observations should then be recorded clearly. All those offering care and support to a person with dementia need to know the persons communication needs and this should be recorded in the care or support plans. This information needs to be put to good use in day-to-day situations, but also in more complex situations, such as supporting the person at a hospital appointment.
Dementia And Hearing Loss: Are They Related
Research shows sometime hearing problems may be associated with a secondary health issue: dementia. Learn more how they are related.
In a world where staying healthy most obviously refers to staying socially distant, washing your hands, and wearing a mask to prevent the spread of COVID-19, protecting your hearing may not be at the top of your list — but at Hearing Unlimited, our experienced audiologists want you to know that it should be.
While hearing loss itself can be extremely alienating and debilitating, this isnt all you have to worry about if you find yourself straining to hear, especially if the severity of your hearing loss is increasing with age. Research shows that those hearing problems may be associated with a secondary health issue: dementia.
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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.
Making Communication As Clear As Possible
There are some general approaches that people can take to communicate more effectively with people with hearing loss all of which are applicable to communicating with a person with dementia.
Here are some of the top communication tips that Action on Hearing Loss suggest:
- Find a suitable place to talk, with good lighting and away from noise and distractions.
- Make sure you have face-to-face contact with the person you are talking to.
- Get the listeners attention before you start speaking, maybe by waving or tapping them on the arm.
- Even if someone is wearing hearing aids it doesnt mean they can hear you perfectly. Ask if they need to lipread.
- Speak clearly but not too slowly, and dont exaggerate your lip movements this can make it harder to lipread.
- Use natural facial expressions and gestures.
- Dont shout. It can be uncomfortable for hearing aid users and it looks aggressive.
- If someone doesnt understand what youve said, dont keep repeating it. Try saying it in a different way instead.
- Check that the person youre talking to is following you during the conversation. Use plain language and dont waffle. Avoid jargon and unfamiliar abbreviations.
- To make it easy to lipread, dont cover your mouth with your hands or clothing.
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Help With Hearing Aids
There is a lot to learn about using hearing aids and this can be particularly difficult if a person has dementia. Care and support staff can play a vital role in ensuring that a person with dementia benefits reliably from their hearing aid.
Here are some basic tips from Action on Hearing Loss:
- Make sure hearing aids are checked every day to make sure they are working and that the person is wearing them correctly.
- Learn how to use the t-switch and controls on hearing aids, how to change batteries and how to clean hearing aids
- Make sure arrangements are in place for hearing aid re-tubing, repairs and battery replacement. Local audiology departments should be able to help with this.
- Try to minimise the number of lost hearing aids, and ensure that lost hearing aids are replaced as quickly as possible.
- Get to know who to consult to examine ears for wax and to arrange ear syringing, where appropriate.