Frontiers In Aging Neuroscience
University of Southern California, United States
Columbia University, United States
The editor and reviewers’ affiliations are the latest provided on their Loop research profiles and may not reflect their situation at the time of review.
Opportunities For Further Research
Because the onset of dementia remains so unpredictable, many patients and family members are unable to recognize the development of the condition until it has become more severe. Because hearing loss is now considered to be a potential early sign of dementia, it may help loved ones and medical professionals identify symptoms more quickly. Researchers are also considering the efficacy of utilizing hearing aids and other forms of hearing recovery as a preventative treatment for early stages of dementia.
Further research is needed to verify the exact relationship between hearing loss and dementia, but the recently uncovered correlation has already led to new insights surrounding the condition. If uncovered, hearing loss could become both a widely acknowledged risk factor for dementia, and a means of initiating early forms of preventative treatment.
How Does Dementia Affect Someone
Dementia affects each person differently. The illness can be described in 3 stages. The onset of dementia is gradual and because of this symptoms of the early stage are often overlooked but may include forgetfulness, losing track of the time, and becoming lost in familiar places. As dementia progresses to the middle stage, the signs and symptoms become obvious and concerning. These include becoming lost at home, forgetting events and peoples names, struggling with communication, needing help with personal care, and experiencing behavior changes such as wandering and repeating questions. In the late stage of dementia, symptoms are severe, and individuals become almost totally dependent on others for care. The person may be unaware of the time and place, become aggressive, have difficulty recognizing relatives and friends, and have difficulty walking.
Dementia can be overwhelming for the families of affected people and their carers. Physical, emotional, and financial pressures can cause great stress and difficulty.
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Making Communication As Clear As Possible
There are some general approaches that people can take to communicate more effectively with people with hearing loss all of which are applicable to communicating with a person with dementia.
Here are some of the top communication tips that Action on Hearing Loss suggest:
- Find a suitable place to talk, with good lighting and away from noise and distractions.
- Make sure you have face-to-face contact with the person you are talking to.
- Get the listeners attention before you start speaking, maybe by waving or tapping them on the arm.
- Even if someone is wearing hearing aids it doesnt mean they can hear you perfectly. Ask if they need to lipread.
- Speak clearly but not too slowly, and dont exaggerate your lip movements this can make it harder to lipread.
- Use natural facial expressions and gestures.
- Dont shout. It can be uncomfortable for hearing aid users and it looks aggressive.
- If someone doesnt understand what youve said, dont keep repeating it. Try saying it in a different way instead.
- Check that the person youre talking to is following you during the conversation. Use plain language and dont waffle. Avoid jargon and unfamiliar abbreviations.
- To make it easy to lipread, dont cover your mouth with your hands or clothing.
Coping With Dementia And Hearing Loss
Living with both conditions is more difficult than living with either on its own. Both dementia and hearing loss can have an impact on how someone copes day to day for example, making it harder to communicate. They can also both lead to increased social isolation, loss of independence, and problems with everyday activities, and as a result make the persons dementia seem worse.
However, there are things that can help.
- Having regular hearing checks and making the most of the hearing the person does have for example, by using hearing aids.
- Improving the environment, for example by reducing background noise and distractions and making sure the area is well lit.
- Finding out the persons preferred way of communicating for example, lip reading.
- Using gestures and expressions, and letting people see your face when communicating.
- Using visual clues and prompts.
If the person needs hearing aids, these are available free on the NHS, or you can buy one privately. Many older people struggle to use a hearing aid correctly all the time. It can take time for a person to get used to a hearing aid, and it will take a person with dementia longer. It is also important to consider whether a hearing aid is the best option an audiologist should be able to advise.
Dementia Connect support line
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Identification Of Hearing Loss
It is important that older people with dementia have regular hearing checks, particularly because the symptoms of hearing loss for example, not following a line of conversation can be mistaken for dementia. In the first instance, the GP should be contacted as they will be able to refer the person for a hearing check, where appropriate.
It can be more challenging to diagnose hearing loss for people with dementia. A person has dementia may well find it hard to understand instructions given during the diagnostic process or they may be unable to report the history of their hearing loss because of their memory problems.
It is possible to adapt testing procedures so that they meet the needs of people with dementia. This makes it vital that care providers communicate effectively, where appropriate, with health professionals to ensure that they are aware of long-term conditions, such as dementia, that may have implications for testing procedures.
Some audiology departments have specialists who are qualified to assess people with dementia. They will often use specialist diagnostic tests, which are easy to understand and take account of the communication and memory difficulties that can go along with dementia.
Certain Forms Of Dementia Can Fluctuate Differently
A post on the Journal of Neurology, Neurosurgery & Psychiatry explains that LBD can cause sudden changes in behavior that are unlike Alzheimers.
While patients with LBD also have abnormal protein clumps in their brains, the study detailed on the site mentions fluctuating cognition in LBD had a spontaneous, periodic, transient quality, compared to fluctuations associated with Alzheimers, which have a more enduring state shift in the form of good and bad days.
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Ways Hearing Loss Can Lead To Dementia
How might hearing loss contribute to cognitive problems and dementia? Lin suggests four possibilities. The most obvious is a common physiological pathway that contributes to both hearing loss and cognitive decline something like high blood pressure, for instance. But he and other researchers used statistical methods to take into account the factors known to be associated with both conditions, so Lin doesn’t give this explanation much credence.
Another possibility has to do with what researchers refer to as “cognitive load” essentially, that the effort of constantly straining to understand stresses the brain. This one makes intuitive sense.
“If you put in a lot of effort just to comprehend what you’re hearing, it takes resources that would otherwise be available for encoding in memory,” says Arthur Wingfield, professor of neuroscience at Brandeis University. Research in Wingfield’s lab has documented this effect on a short-term basis. The big question, he says, is whether years of drawing resources away from brain functions such as working memory will eventually reduce the brain’s resilience.
Finally, it seems very likely that social isolation plays a part. Being hard of hearing tends to isolate people from others: When you have to struggle to converse, you’re less likely to want to socialize in groups or go out to restaurants. And being socially isolated has long been recognized as a risk factor for cognitive decline and dementia.
Hearing Loss And Dementia: A Meta
- 1Jiangsu Provincial Key Medical Discipline , Department of Otolaryngology Head and Neck Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- 2Department of Neurology, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, China
Background: Consensus is lacking with regard to whether hearing loss is an independent risk factor for dementia. We therefore conducted a meta-analysis to clarify the relationship of hearing loss and dementia.
Methods: Prospective cohort studies investigating the association between hearing loss and the incidence of dementia in a community-derived population were included by searching electronic databases that included PubMed, Embase, and Cochrane’s Library. A random-effects model was adopted to combine the results.
Results: Fourteen cohorts including 726,900 participants were analyzed. It was shown that hearing loss was independently associated with dementia . Sensitivity analysis sequentially excluding any of the individual studies included showed similar results. Subgroup analysis according to the diagnostic methods for hearing loss, validation strategy for dementia, follow-up duration, and adjustment of apolipoprotein E genotype also showed consistent results . Meta-analysis with five studies showed that hearing loss was also connected to higher risk of Alzheimer’s disease .
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Early Symptoms Can Vary
A blog post from the Mayo Clinic explains there can be some clear differences between Alzheimers and other forms dementia in the early stages. One form of the syndrome called Lewy body dementia which can mimic symptoms of a variety of diseases, does not have the memory loss associated with Alzheimers, the clinic explains.
LBD is the second most common form of dementia , notes the source, and instead of forgetfulness can be marked early on by hallucinations and confusion. However, the source explains as dementia progresses, it can be more difficult to distinguish one type from another.
Other Diseases Can Trigger Dementia
While Alzheimers is a disease unto itself, dementia symptoms could result from other diseases, notes Alzheimers.net. For example, according to the source, common causes of dementia are Huntingtons disease, Parkinsons disease, and Creutzfeldt-Jakob disease.
The latter example is actually a fatal neurodegenerative disease, while Huntingtons disease results in the death of brain cells . Those who have Parkinsons disease, which is most often associated with shaking, will typically develop dementia over a long period of time following the initial diagnosis.
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Hearing Loss And Social Isolation
The third link between hearing loss and Alzheimers is social isolation. A study by The National Council on the Aging of 2,300 hearing impaired adults found that people with untreated hearing loss are more likely to experience loneliness, worry, depression, anxiety, and paranoiaand are less likely to join organized and casual social activities. When a person withdraws from life, their risk for dementia intensifies. In short, the less we stimulate our brains by interacting with other people, places, and thingsand the less we use our brains to hear and listenthe more quickly our brains decline, putting us at greater risk for dementia.
Wearing Hearing Aids Means Im Old And Im Not Ready For That
Its normal to feel worried that hearing loss means youre agingand to want to hide it. Plenty of people with a hearing impairment sit silently rather than joining in conversations and activities, because they fear that hearing problems will make them seem helpless or less than competent. The truth: Connecting with others can help your brain stay younger and keep you involved with life.
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Misdiagnosis And Further Links
Hearing loss can sometimes be misdiagnosed as dementia. People with dementia can have difficulty communicating with others, including finding the right words, or signs, for what they want to say. They may have difficulty processing what theyve heard, particularly if there are distractions. According to some researchers, this difficulty in processing information can be one of the first signs of cognitive impairment.
We also know that hearing loss can speed up the onset of dementia, or make the symptoms of dementia appear worse, and dementia can heighten the impact of hearing loss.
Trial Launched To Test Hearing Intervention Impact On Cognitive Decline
The NIA has recently funded the Aging, Cognition, and Hearing Evaluation in Elders clinical trial led by Drs. Frank Lin and Josef Coresh at Johns Hopkins University to examine the potential benefits of hearing rehabilitation. ACHIEVE will recruit 850 cognitively normal adults aged 70-84 with hearing loss from four locations . Individuals will be randomly assigned to either the hearing intervention or control intervention .
ACHIEVE participants will be followed for three years and information on hearing function, cognition, and demographics will be collected at several timepoints. The primary outcome of the study will be to determine if the hearing rehabilitative intervention changes the rates of cognitive decline as compared to the group receiving health education. Additionally, the researchers will examine if the intervention impacts physical and social functioning, quality of life, and physical activity.
This trial should further our knowledge on the relationship between age-related hearing loss and cognition and dementia. For further information on the trial, please visit www.achievestudy.org .
Lin FR, Metter EJ, OBrien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Arch Neurol. 2011 68:214220.
Lin FR, Yaffe K, Xia J, Xue Q, Harris TB, Purchase-Helzner E, Satterfield S, Ayonayon HN, Ferrucci L, Simonsick EM, Health ABC Study Group. Hearing loss and cognitive decline in older adults. JAMA Intern Med. 2013 173:293299.
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Hearing Loss And Dementia
Fortunately, there’s a potential upside. If this connection shown in several recent and well-regarded studies holds up, it raises the possibility that treating hearing loss more aggressively could help stave off cognitive decline and dementia. Lin and other researchers have several theories about the possible explanation for the link between hearing and dementia, although they aren’t yet sure which of them if any will prove true.
Lin is the author of several recent studies pointing to a link between hearing and cognitive problems ranging from mild impairment all the way to dementia.
In a 2013 study, he and his colleagues tracked the overall cognitive abilities of nearly 2,000 older adults whose average age was 77. After six years, those who began the study with hearing loss severe enough to interfere with conversation were 24 percent more likely than those with normal hearing to see their cognitive abilities diminish. Essentially, the researchers said, hearing loss seemed to speed up age-related cognitive decline.
Lin is quick to point out that simply being at increased risk does not mean a person is certain to develop dementia.
“I have a 92-year-old grandmother who’s had a moderately severe hearing loss for many years now,” Lin says. “She’s sharp as a tack. I was talking to her about my research and she looks at me and says, ‘Are you telling me I’m definitely going to get dementia?’ “
“I said, ‘Not by any means.’ “
Data Extracting And Quality Evaluation
Two authors implemented database search, data extraction, and study quality assessment separately. If disagreements occurred, they were discussed with the corresponding author. These data were recorded: author and study year participant characteristics, including number of participants included, mean age, and sex methods for the evaluation of hearing loss follow-up durations methods for validation of dementia or AD outcomes, and numbers of cases with outcomes reported in each study and potential confounding factors adjusted in the multivariate analyses. The NewcastleOttawa Scale was used for study quality evaluation. This scale is rated from 1 to 9 stars and reflected the quality of the study by aspects of participants selection, comparability between groups, and outcome validation.
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The Link Between Hearing Loss And Dementia
Medically Reviewed By: Avia James
Alzheimers Is Only Properly Diagnosed After Death
Further to the last point about doctors being able to see the effects of Alzheimers on the brain tissue, this can only be confirmed after the patient has died, notes LiveScience.com. Alzheimers can be diagnosed with complete accuracy only after death, when the brain is thoroughly examined during an autopsy, explains the source.
It notes a microscopic analysis of the brain tissue will reveal the plaques and tangles, which are the proteins we mentioned that are connected to Alzheimers disease. Until the patient passes away, doctors cannot rule out other causes, but can provide a diagnosis of dementia based on certain criteria.
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The Auditory Brain: Structural And Functional Substrates For Neurodegeneration
The auditory system has evolved to allow adaptive behavioural responses to complex, dynamic acoustic environments . However, its structural and functional characteristics confer specific vulnerabilities to neurodegenerative pathologies.
Anatomically, the hierarchy of auditory processing relays and in particular the large-scale cerebral networks that process sound information are highly distributed. The spread of pathogenic proteins in neurodegenerative dementias targets these networks rather than the peripheral organs of hearing. Though histopathological data remain limited, neurodegenerative pathologies may preferentially involve auditory association cortex and cortico-cortical projections rather than primary sensory cortex , thereby striking the integrative mechanisms that are most critical for auditory object analysis.
Two additional, related guiding principles of auditory system operation that are critical for adaptive functioning in complex, dynamic auditory environments are functional plasticity and reciprocity. Reciprocity is mediated by recursive, afferent-efferent feedback that supports auditory change detection and top-down tracking of behaviourally relevant sound sources , as well as predictive decoding and filling-in of ambiguous and varying auditory inputs, such as degraded speech . Plasticity enables dynamic neural adaptation to auditory experience.
Study Confirms The Link Between Hearing Loss And Dementia In Older Adults
On World Hearing Day, the BIHIMA highlight an important new study into the link between hearing loss and the risk of dementia in older adults.
Conducted by Professor Helene Amieva in France, the study followed 3,777 participants aged over 65 for up to 25 years. Of these, 1,289 reported hearing problems and 2,290 reported no trouble. The researchers also looked at the impact of hearing loss on depression, disability and death.
The study found an increased risk of disability and dementia in those with hearing loss, and, in men only, an increased risk of depression. These associations were not found in the participants using hearing aids.
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