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Hearing Loss and Dementia

March 6, 2023
Amy Sarow, AuD, CCC-A
Written by
Amy Sarow, AuD, CCC-A
Amy Sarow, AuD, CCC-A

Dr. Amy Sarow is a practicing clinical audiologist and serves as Audiology Lead for Soundly. Her expertise and experience span topics including tinnitus, cochlear implants, hearing aid technology, and hearing testing. She holds a doctoral degree in audiology from the University of Iowa. During her residency at Mayo Clinic, Dr. Sarow was inspired by the three-tiered, patient-centered approach, incorporating clinical work, teaching and research.

Soundly Staff
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Soundly Staff
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Is there a link between hearing loss and dementia? Many patients ask me about this potential health condition connection. While research is still developing, hearing loss is a leading, but potentially modifiable risk factor. It makes sense when you think about it: Our ears connect us socially, help preserve our safety, and facilitate working memory. After all, the brain wants to receive auditory stimulation; and therefore, it makes sense that treating hearing loss helps keep us healthy socially, emotionally, and cognitively. So what exactly does the research say in terms of the role that hearing loss has on cognitive decline? In this article, we’ll explore the connection, what we do and don’t know about hearing loss and dementia, and how to be proactive about your hearing healthcare.

An Audiologist’s Perspective

It’s essential not to underestimate the impact of hearing loss intervention. In particular, one experience with a patient solidified my stance on health intervention: During an appointment with routine questions, the patient sometimes had difficulty answering and seemed puzzled. And, the patient’s family had concerns about whether there may be signs of cognitive decline. At first, the patient’s response to my questions didn’t always fit with the question that I asked. We proceeded with the hearing test, and I asked the patient some of the same questions, this time at a more appropriate volume, through the headphones in the booth. I suddenly saw the patient’s eyes light up, and my questions were met with confident and appropriate answers. 

While I work with patients with hearing loss daily, it reminded me that untreated hearing loss could look like other health concerns. Before we can adequately evaluate cognitive health, assessing and treating hearing loss is crucial. This patient had moderate to severe hearing loss and after being fitted with hearing aids, experienced a better quality of life. The patient can have meaningful, socially engaging conversations and notice a significant improvement in their life overall.

What does the research say?

Research on hearing healthcare and cognitive decline is evolving, but treating hearing loss helps support our overall health and well-being. The World Health Organization has identified hearing loss as a potentially modifiable risk factor. Additionally, hearing influences other factors when we look at the list of risk factors. For example, untreated hearing loss can increase the risk of social isolation and depression. According to a JAMA study on hearing loss and depression, patients with untreated hearing loss were twice as likely to develop depression.

Hearing Loss Requires More Listening Effort

Individuals with hearing loss exert more effort to understand individual words and therefore have fewer cognitive resources available for higher-level processing. A recent neuroimaging study supports this finding that high-level processing is affected in those with hearing loss. Furthermore, spending more time trying to tease out the individual words makes it harder to process and create memories of what was said. So, easier listening supports memory and cognitive function.

Treating Hearing Loss Protects Brain Health

Interestingly, a growing body of research backs this up and shows that early hearing loss intervention can slow cognitive decline. For example, an fMRI study found that before being fitted with a hearing aid, individuals had less activation in areas of the brain for auditory and language processing and more in the visual. However, after one year of hearing aid use, participants had increased brain activity in auditory and language centers and areas for multimodal integration (pretty neat, right?). This means that participants were much better able to process and make sense of the information coming in, freeing up cognitive resources for higher-level processing.

Does hearing loss cause dementia?

While hearing loss and cognitive decline are connected, we cannot say that one causes the other. Medical conditions are complex and there are both genetic and environmental factors that influence our health. Keeping ourselves healthy mentally and physically is beneficial for our cognitive health, and hearing healthcare is one key component. Research also shows that early intervention is much more effective than intervention at the later stages of illness. For example, the adoption of hearing aids before the onset of dementia or at mild cognitive impairment can help to slow the progression much more effectively than intervention at a moderate or severe stage of cognitive impairment.

Prevention and Taking Proactive Steps

I recommend every patient have a baseline hearing test by age 50 or sooner if concerns arise. A baseline test is helpful because it lets you know whether there is any hearing loss, and you’ll notice changes in hearing that occur in the future compared to the initial hearing test. As we know, early intervention is much more helpful and effective.

Management 

After your baseline hearing test—if you discover hearing loss—it’s time to consider intervention. Many patients who try hearing loss after years of struggling find that they’re much happier and wish they had sought help sooner. Preventative measures are the best way to moderate our risk for disease. With age-related hearing loss, changes in hearing happen gradually over time. It can be hard to notice as hearing starts to change. Re-evaluating hearing at regular intervals will help to catch any changes early on.

How often should I test my hearing?

Most of us check our eyes yearly because we know that vision is integral to health. It’s helpful to think of hearing in the same way. If your baseline hearing test revealed hearing loss, you should return for regular checks every one to two years.

Support 

Involving a family member in your hearing healthcare journey increases success and satisfaction with hearing aids. Consider bringing a family member to your hearing test and hearing aid evaluation appointments. It’s beneficial to have a support system in the process. Additionally, it’s also helpful to have a second set of ears to hear and help process information. It takes time to adjust to wearing hearing aids. There’s a lot to learn, and having another person support you can be beneficial.

Conclusion

Research is still exploring the relationship between hearing loss and cognition. Early intervention and treatment of hearing loss can protect your overall and cognitive health. I encourage everyone to consider a baseline hearing test. Encourage your family members to have a hearing evaluation. Staying proactive is the best way to promote optimal health.

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