When Cognition & Hearing Loss Collide

If you find a loved one asking repetitive questions, becoming more confused and forgetful, you may assume they have dementia, but the cause could be hearing loss.

While it’s not “new” news, study results reported in the Journal of the Medical Association Internal Medicine confirmed what many professionals have long believed: that cognitive loss and hearing loss collide on a large scale.

The study, from the John Hopkins University School of Medicine, was the first of its kind and is viewing long-term brain function impacted by hearing loss. When the study began in 2001, the 1,984 participants (in the age range of 75 to 84) were in good health and had no cognitive impairment. Over a period of six years, hearing and brain cognition tests were administered. Study researchers determined that brain ability was in direct correlation to hearing loss. Those who did have hearing loss suffered more substantial cognitive impairment more than three years sooner than others with normal hearing levels.

When the study commenced, 1,162 of the participants had some degree of hearing loss. Sixty-six percent had mild cases, 33 percent moderate and only one percent severe. The standard cognitive tests (Modified Mini-Mental State Exam and Digit Symbol Substitution Test) given periodically over the course of the six-year study found that 609 people developed cognitive issues.

Hearing loss is considered one of the most undertreated conditions in older adults, and this study now shows why caregivers should be even more aware if a loved one is having hearing problems. Dr. Frank Lin headed the research. He is an otologist and epidemiologist, and has spent much time documenting the connection between hearing problems, falls and dementia symptoms.

He found that cognitive diminishment was 41 percent greater in the seniors with hearing problems. Dr. Lin explains that research says the link of cognitive loss and hearing loss can be from social isolation and loneliness, which is a professional established risk for cognitive struggles in the elderly. When it’s harder to hear and participate, the trend has shown declining invitations and social mingling.

He also reports that the brain may be forced to devote a large amount of energy to processing sound in loved ones with hearing loss. He says that hearing loss means that the inner ear is no longer as good at encoding signals with accuracy. “So the brain gets a very garbled message,” he adds.

This is only at the expense of the energy needed for memory and thinking. Lin says that in some cases, common, unknown damage can be leading to both the hearing and cognitive losses.

Caregiving advocates are using this study to tell those who care for loved ones to pay attention, and ask for audiology tests to be a part of annual exams. Professionals say that many seniors put off addressing hearing loss for as long as 20 years, without realizing the more severe consequences they can have long term. Lin believes a fair estimate is that as many as 27 million Americans more than 50 years of age, and two-thirds of men and women older than 70, have some form of hearing loss. The bigger concern, he believes, is that only 15 percent of those who need hearing assistance devices actually use one.

Barbara Weinstein says that a limitation to Lin’s study is the reliance on the Modified Mini-Mental State Exam, which uses an interviewer to ask questions. She is a professor and head of the audiology program at CUNY’s Graduate Center.

Research that Weinstein has done reveals that seniors with hearing loss may not understand verbally asked questions and answer incorrectly.

Lin is addressing this through hopefully another research project to follow a group of seniors and test whether the interventions for hearing loss, such as hearing aids, will help prevent the onset or slow cognitive decline.

Until those numbers become available, experts agree that the first step in preventing this collide of hearing and cognitive loss is recognizing it before any situation worsens.

HOW TO RECOGNIZE HEARING LOSS IN A LOVED ONE

  • If a loved one is asking others to repeat what they’ve said, and says people are always mumbling or not speaking clearly. Pay attention if other family members recognize the loved one is not hearing well.
  • If a loved one cups their hand behind an ear when listening.
  • If the television or radio volume is louder than usual.
  • If a loved one says they are experiencing ringing or buzzing in one or both ears, or is dizzy often.
  • If a loved one is leaning forward or turning their head to be able to listen to a conversation.
  • If a loved one is beginning to avoid certain situations because they have a hard time hearing.