Hearing Loss Is Not Good For The BrainBarbara E. Weinstein, PH.D.
In light of the growing emphasis on healthy lifestyles and scientific, medical and technological advances, people are living longer. The increase in life expectancy is accompanied by a rise in the prevalence of several major public health issues which impact quality of life and health care costs substantially: age related hearing loss and dementia. Age related hearing loss (ARHL) is a chronic condition which is on the rise with an aging society. More than two-third of adults 70 years of age or older have hearing loss which interferes with communication thereby impacting social engagement, physical activity levels, and quality of health care. When untreated, ARHL can be disabling especially in settings which are less than ideal (e.g. when the speaker turns away from the listener, when there are multiple talkers speaking simultaneously, or when background noise is present). Persons with hearing loss must work harder in these situations if they are to be successful at extracting meaning from speech and remember what has been said. The need to listen more intently in challenging environments is often stressful and fatigue inducing. This can lead to withdrawal from conversation and activities once enjoyed. This “social disengagement” is bad for overall well-being in general and brain health. We now know that social isolation/withdrawal is a modifiable risk factor for dementia.
Age related hearing loss, as well, is considered a modifiable risk factor for dementia because it has a marked impact on social and physical function, yet when identified and treated early some of the symptoms have the potential to reverse themselves. There are a number of theories which attempt to explain why hearing loss may be a modifiable risk factor for dementia. Simply put, hearing loss is not good for the brain which undergoes neurodegenerative changes associated with sensory deprivation. In turn, the speech understanding difficulties and sensory deprivation associated with hearing loss can use up the cognitive resources necessary to understand what others are saying. Depression and the tendency to decrease socialization with others may ensue. In turn, the impoverished sensory input in to the brain coupled with the social isolation may cascade into cognitive decline and in time, dementia. It is critical to emphasize that the relationship between hearing loss and dementia is not causal and that the goal of hearing restoration is to optimize speech understanding to enable maintenance of social and physical engagement.
It is often difficult to distinguish the communicative behaviors associated with hearing loss from those of dementia. If an individual misses the thread of a conversation, appears to strain to follow conversation, struggles to understand speakers on television or radio, or sometimes withdraws from conversations with others, consider going for a hearing test and if needed, seek advice on the variety of solutions available to manage hearing loss. Hearing health care treatments which can optimize communication and improve safety in the home can transform the lives of people with dementia and their families. Of course, timely diagnosis is a prerequisite for maximal benefit from audiologic interventions.
Auditory-based interventions exist along a range and many of the low- cost interventions can improve communication and help people stay engaged. In fact, according to caregiver reports, inexpensive hearing interventions enable persons with dementia to be connected with life in a renewed way. Interventions are quite varied ranging from adoption of basic communication strategies (e.g. speak distinctly and at a natural rate of speed, resist the temptation to speak loudly), use of commercially available personal sound amplification devices to purchase of hearing aids or cochlear implantation. The stage of dementia will dictate the sophistication of the intervention to be adopted. It is imperative that caregivers or family members are part of the conversation when decisions regarding hearing based solutions are reached. Irrespective of the stage of dementia, home safety is a priority for persons with hearing loss. To make homes safer for example, smoke alarms/carbon monoxide detectors should be equipped with both flashing or strobe lights and devices with vibration notification capabilities (e.g. pillow or bed shakers) which emit loud low frequency sounds and are activated by the sound of a smoke alarm or carbon monoxide detector.
In sum, hearing loss may be a forerunner of cognitive decline. Older adults of all ages should be referred for a hearing test to determine presence of hearing loss and to assist in selecting auditory interventions which can optimize communication and social engagement with friends and family members, reduce the burden associated with dementia and optimize safety in the home.
A leader in the field of Geriatric Audiology, Dr. Weinstein has developed several of the world’s most widely used tools to identify patients with hearing loss. Dr. Weinstein has also researched widely in geriatric audiology around screening and around social factors associated with hearing loss and hearing aid use.
An accomplished and award-winning clinician and educator, Dr. Weinstein founded and directed the Doctoral Program in Audiology at the City College of New York. Dr. Weinstein has authored both editions of the major textbook, Geriatric Audiology. Her research on hearing loss and dementia, and research on the social consequences of hearing loss, have profound implications for the intersection of audiology, geriatric medicine, and gerontology.