Lately, I have been trying to take the time and really help my community understand the effects of hearing loss. Seeing as this month is Alzheimer’s & Brain Awareness Month, I thought it would be a good idea to share a short story regarding dementia and hearing loss. This story is inspired by real-life events that I encounter as an audiologist!
As we walk into the exam room, Mary’s daughter pulled me aside as if she didn’t want her mother to hear what she was about to say:
“I can’t tell if she can’t hear me or if there is something else going on,” said Mary’s daughter. “Her primary care provider is concerned that she may be showing signs of dementia.”
I gently smiled and nodded my head in understanding, and we sat down in the exam room.
“Hi, Mary! My name is Dr. Huch, and I am an audiologist. It’s so nice to meet both of you! Usually, before we evaluate your hearing I like to ask simple questions regarding hearing and health history.”
“Mary,” I asked, “Do you feel as though you have any difficulties understanding conversation?”
“No,” said Mary. “Sometimes people mumble, and I have to ask them to repeat but overall I think I do okay.”
“Can you tell me a little bit about why you are here today?” I said.
Mary looked at her daughter and said, “Well I had my regular Medicare Wellness Visit and my doctor didn’t think I did very well on the memory section.” Mary’s daughter nodded in agreement.
“Mom mentioned to me that she thought maybe she didn’t understand the test or misinterpreted what to do so that’s why she didn’t do well on the visit. We both agreed a hearing test would be a good place to start!” said Mary’s daughter.
After obtaining a routine health history it was time for the hearing evaluation. Mary raised her hand when she heard tones varying in pitch and intensity in a sound booth.
Once the test was completed, I had Mary come back out and all three of us went over the results.
“Mary,” I said. “It looks as though you do have some hearing loss. We call this type of hearing loss a mild to moderate sensori-neural hearing loss. There are some frequencies where you can hear within the normal range but in the mid to high frequencies where speech occurs, you have a mild sloping to moderate hearing loss. People with this type of hearing loss usually complain that others mumble, or they know someone is talking but they don’t understand what they’re saying.”
“Wow,” Mary said. “I really didn’t think I had a hearing loss at all. So, does that mean some people really are not mumbling, it’s me that hears the mumbling?”
“Yes. Based on your hearing test, you cannot hear the high frequencies in speech. However, you can hear the low frequencies of speech well. That’s why everyone sounds like they’re mumbling,” I said.
Mary’s daughter asked, “Do you think this is why she did poorly at her wellness visit?”
“I wish I could give you a definite answer, but I’m not sure,” I explained. “There is a significant correlation between hearing loss and cognitive impairment; however, regardless of what your memory test indicates, you would greatly benefit from amplification.”
Since Mary was a candidate for hearing aids, she decided to move ahead with devices to aid in her hearing, and during the first month, she noticed an improvement. During the adjustment period, Mary and her daughter both noticed she was communicating more effectively and participating socially in more conversations.
At their follow up visit, Mary’s daughter said to her mother, “I didn’t realize how much you were missing because I feel as though you were just agreeing to most of our conversations. I got so used to you taking a back seat to most conversations, I was shocked when you started participating more and engaging in our family conversations again! I have noticed a significant improvement in your confidence when you communicate, Mom.”
Mary just smiled and said, “You’re right. It happened so slowly over time I guess I just got used to not hearing and engaging in conversations.”
What We Do Know
Although it will never be known if hearing loss is a contributing factor to Mary’s signs of dementia, studies have shown that being fitted with hearing aids sooner may have delayed her cognitive decline by a few years. Overall, her family noticed a significant improvement in her engagement with others and have reported hearing aids being a positive impact on her life.
A recent study by Uchida theorized that hearing loss causes the brain to put extreme effort into listening. This extreme effort actually diverts it from cognitive tasks which keep reducing the amount of cognitive function.
The same study identified that hearing impairment causes accelerated rates of brain atrophy. Imaging identified that elderly individuals with hearing loss identified by an audiologist had decreased volumes in their primary auditory cortex where sound is processed in the brain. If you don’t use it, you’ll lose it.
Overall, hearing care is low risk. Hearing aids that are properly fit by an audiologist will not make your hearing loss worse but rather stimulate your brain in areas that would not have been stimulated without the use of hearing aids.
I also made sure to explain to Mary and her daughter that hearing care is a form of non-pharmacologic intervention. It’s not meant to replace any recommended prescriptions from her primary care physician of course, but research has suggested that for those with even a mild form of hearing loss, amplification may be able to reduce or prolong the onset of cognitive decline.
Even if you or a family member is not suffering from any known hearing loss or cognitive decline, a baseline hearing test is always great to have. I hope this short story helped you better understand how hearing aids can help those with even mild to moderate permanent hearing loss and why hearing loss is associated with cognitive decline.