The link between hearing loss and dementia

Hearing health care is one of the most neglected areas of treatment. There are no pills for hearing loss, the doctor can't write a script. And 15 minutes in a doctor's office, which is what most of us usually get, is not enough to determine whether a person has hearing loss bad enough to require treatment.

Most doctors evaluate hearing by simply asking the patient "how's your hearing?" Many people, particularly men, are dishonest about this because they don't want to be saddled with hearing devices. As a result, they often go undiagnosed until they really can't hear.

So you can imagine the poor folks who may have hearing loss, but who also might be suffering the first signs of dementia. There is, unquestionably, a link between hearing loss and dementia. It's one of those chicken and egg situations. A person who might have dementia might be mistaken for someone who is hard of hearing. Or a person experiencing the first signs of dementia might become more isolated because of hearing loss.

Audiologists can play an important role in detecting early onset dementia or Alzheimer's Disease because they spend more time with patients and they should start adding cognitive testing to their stable of routine tests on their elderly patients, according to Marilyn Reed, an audiologist at Baycrest in Toronto.

Her team was surprised last summer when a psychology student came to Baycrest, a facility for elderly patients, to do cognitive testing on patients. She found that the majority of patients had some degree of cognitive problems.

“We didn’t know that such a huge percentage of our patients had cognitive impairment,” she says. “We didn’t know because most of them behave normally. Since mild cognitive impairment affects memory but doesn’t necessarily affect their behavior, you wouldn’t notice it during the time you spend with them in a clinic for one appointment.”

The 2011 World Dementia Report stated that the world is facing a "global epidemic" of Alzheimer's Disease, with more than 60% of cases going undetected and undiagnosed by health practitioners.
It is evident, therefore, that health care professionals need to do more cognitive testing on elderly patients.

Mild cognitive impairment often goes undetected for months, sometimes years. Audiologists begin to notice it when patients start repeatedly complaining that their hearing aids aren’t working.

“They’re getting frustrated, upset; they’re not wearing their hearing aids. They’re forgetting to change the battery or forgetting to clean them. It’s then we realize they are having difficulty with cognitive impairment.”

But there is good news on the horizon.

The Baycrest Audiology team was awarded a clinical research grant at the fall meeting of the Canadian Academy of Audiology to assess the cognitive status of their patient s and determine a) if this corresponds to the audiologists’ impression and b) if it influences management protocols. A research assistant will use cognitive tests such as the Montreal Cognitive Assessment (MoCA) to assess the cognitive status of audiology patients. The team will report back to the CAA meeting in St. John’s, Newfoundland with the results.

Failure at the Primary Level

Missing the warning signs of early cognition problems come at a price to our society.

 

• The 85 plus population is the fastest growing segment of the Canadian population.

• The prevalence of Alzheimer’s and other forms of dementia increases with age. Its rate doubles every five years.
• ·It is a serious public health concern, as the 7^th leading cause of death in Canada with no prevention or cure.
• It costs the Canadian economy $2 billion a year in health care costs.

Patients and their families also suffer.

• The association between age-related hearing loss and social isolation is commonly accepted and profoundly important.
• Direct causal and neurobiological pathways link loneliness with psychological pathology.
• The more social stimulation and communication opportunities a person with Alzheimer’s Disease has, the more likely surviving brain cells are to restore connections.

Detecting cognitive problems in the early stages isn’t easy.

“The big problem is that people generally in health care find it difficult to tell the difference between cognitive impairment and severe hearing loss because they present themselves similarly. People give inappropriate responses or don’t respond much at all. It may be hearing; it may be cognition.  How do you know?”