Hearing loss and dementia - can hearing aids reduce the risk?


#1

Dr. Cliff’s recent videos include an illuminating discussion of the strong association between hearing loss and the risk of developing dementia: The Link Between Hearing Loss and Dementia - YouTube https://www.youtube.com/watch?v=O5pVzvaYaH0&t=3s. In brief, hearing impairment is independently associated with a 30-40% acceleration in cognitive decline (Reed et al., 2018). The question is, does treating hearing impairment prevent or slow this decline?

The answer to this question depends, it seems, on the underlying mechanism – which is not understood. If the loss is caused by irreversible neurodegenerative processes that simultaneously affect cognition and the aural nerves, hearing aids would not be able to slow the process. However, impoverished sensory input and reduced stimulation may lead to neuropathological alterations in a destructive cascade… in which case it’s reasonable to assume that treatment may prove beneficial (Uchida et al., 2018).

To date, there is no consensus in the literature that hearing treatment indeed reduces the risk of cognitive decline (Reed et al., 2018, but see Allen et al., 2003). My personal reaction to this is that the studies have not been sufficiently controlled. It’s not enough to search insurance records for evidence of hearing aid claims and dementia diagnoses. The question is, have the aids been properly programmed and verified to meet the patients’ therapeutic needs? In my own experience, shelling out $8,000 for a pair of Oticon Agil Pros eight years ago did very little to reduce my social isolation and impoverished sensory input… I still couldn’t talk on the phone, avoided restaurants, and stayed away from social events. Only after purchasing a new pair of aids and verifying that they met my therapeutic goals, by means of real-ear measurement (REM), did I finally make my way back into society. In the interim, I was in a fog… and it’s frightening to think that this may have led to neurological degeneration.

In short, I strongly believe that treating hearing loss with hearing aids is a good bet… as long as you make sure your therapeutic needs are actually being met.

References

Allen, et al. 2003. Effects of improving hearing in dementia. Age and Ageing

Reed, et al. 2018. Trends in health care costs and utilization associated with untreated hearing loss over 10 years. JAMA Otolaryngology Head Neck Surgery.

Uchida et al., Age-related hearing loss and cognitive decline – the potential mechanisms linking the two. Auris Nasus Larynx


#2

Thank you, this is an excellent explanation.


#3

Another take on the topic was in AARP. I guess I’m lucky to have started wearing aids at 35, so I’m way ahead of the game in terms of keeping the ear/brain connection fired up. :wink:

Even so, one can’t rule out natural aging and the effect it has on our entire senso-neural pathways. My mom is sharper than a tack at 93, and has worn aids since she was in her 40s. By contrast, her sister and my mother-in-law were fit with aids in their late 80s. Both of them showed signs of dementia by their early 90s. I’m guessing they had some age-related hearing loss that was exacerbated by NOT having been fit with aids earlier in life.

When you consider how fast our speech comprehension scores can decline if one of our aids isn’t working … well, it seems a good idea to make sure we have our hearing checked frequently and stay on top of the situation.