Hearing loss and dementia? Sounds right

I have been reading with great interest a growing number of scientific studies on the association of age related hearing loss and dementia. Given that the majority of people over 70 have some degree of hearing loss, this is a big deal. Several large studies from multiple countries and contexts have tracked people over many years, showing not only that those with hearing loss get dementia more often, but also that their dementia worsens more quickly related to the severity of hearing loss. It is less clear whether treating hearing loss changes your risk for dementia, but the evidence is leaning that way, and optimizing your hearing just makes good sense.

There are several hypotheses about why hearing loss may affect cognition. Hearing is really about understanding speech, which a complex task. Not being able to hear can lead to social isolation and depression, both known to worsen cognition, but it can also deprive your brain precious neural inputs increasing cognitive load and even changing brain structure. There may also be a common pathway of brain degeneration leading to both hearing loss and dementia.

While hearing loss is but one risk factor for dementia, it represents a modifiable one, and these are hard to come by (a plant-strong diet, regular exercise and not smoking are others). But if you’ve ever been in a nursing home you know that affording, keeping track of and actually using hearing aids are Herculean feats. Medicare does not pay for hearing aids, which cost around $2000.00 each. They are also small, and like dentures, tend to be set aside and easily lost. I have participated in the “great hunt” more than once, digging through garbage and laundry bags for these expensive treasures. And most convincingly in my anecdotal experience, no one likes wearing them. While we should certainly encourage their use when feasible, there are a few other tips that can improve everyday hearing problems.

Visual cues and a quiet background environment
Hearing – which remember is all about recognizing speech – is dramatically improved by seeing someone’s face. Noisy settings and large crowds should be minimized; sit close and look directly at the listener; turn off the TV when having a conversation. You may think Dad wants to go to the big, fancy restaurant with the whole family – but make sure. When given the choice, small groups and take-out are often preferred. When choosing a long-term care facility, ask if they have sound-absorbing acoustical tile and private rooms. Both make a huge difference.

Remove earwax!
I like to jokingly tell the story about my greatest moment in medicine when I once irrigated a patient’s ears and out poured a beehive’s worth of wax and the exclamation “you did it – you are the best doctor ever – I can hear, I can hear, I can hear!” One statistic suggests that 25% of nursing home residents have at least one completely impacted ear canal. This is a simple procedure for a healthcare provider, and can also be done at home with a little guidance.

Low-tech, low-cost devices
Hearing assistance devices are not hearing aids, and should not be substituted as such, but they amplify sound while reducing background noise. They make a big difference in my practice for one-to-one conversations, are simple to use (basically a microphone and earphones), and cost between $100 -$200. I do not endorse a particular product, but styles like the PockeTalker have worked great for me.