Hearing and Dementia
How hearing loss changes the brain and leads to isolation
Hearing loss can mean more than just missing out on what people are saying. In fact, it can accelerate the onset of dementia. While that might strike you as an exaggerated statement, there is a high amount of medical research linking hearing loss to dementia. A study by Johns Hopkins University found that people with hearing loss were 24 percent more likely to experience cognitive decline compared to people with “normal” hearing.
As hearing loss can cause brain cells to decline or atrophy it contributes to the brain damage that results in dementia. At the Deanna and Sidney Wolk Center for Memory Health, where I work as a nurse practitioner, we take a comprehensive approach to diagnosing and treating dementia. Because we know hearing problems can contribute to dementia, it is one of the first things we assess a patient for.
But why does hearing loss quicken cognitive decline?
Hearing and the Brain
A healthy mind needs to stay active. Hearing loss dampers one of your major senses, restricting some of the stimulation the brain needs to thrive. The resulting stagnation will atrophy the cells responsible for processing audio signals.
Hearing loss can result in isolation as you might shy away from interacting with people if you have trouble understanding what they’re saying. That isolation will exacerbate the lack of stimulation and lead to other health concerns as well.
Additionally, hearing problems will shift the structure of the brain and the connections created between nerve cells. Cells that originally processed sounds will shrivel or be reassigned to different parts of the brain. A study conducted by the Hearing Journal demonstrated a marked decline in brain tissue: participants with hearing issues lost more than a cubic centimeter of brain tissue each year compared with those without impaired hearing.
The loss of brain tissue essentially means less brainpower. As the areas used for speech and sound shrink, the brain has to work harder to collect information. This increased strain means that there is less energy for other parts of the brain—such as memory cells— to help process the information.
But the situation isn’t hopeless - there are ways to mitigate the effects of hearing loss. Keep reading to learn how.
Social Isolation and Depression vs. Dementia
There’s a complex interrelationship between hearing loss, social isolation, depression, and dementia.
The anxiety of not understanding what others are saying can lead to self-imposed isolation. Rather than struggling to have a conversation with other people, it’s easier to avoid conversations altogether. Social isolation can be a risk factor for both depression and dementia. In fact, social isolation has been associated with about a 50% percent increased risk of dementia.
The negative effects on brain health caused by depression can mimic those of dementia. As such, distinguishing between depression and dementia can be a challenge since they exhibit some of the same symptoms: impaired concentration, apathy, and loss of appetite, among others.
Further complications arise from the fact that the cognitive struggles produced by hearing loss mimic the struggles of both depression and dementia. Comprehension difficulties are a byproduct of cognitive decline as well as hearing loss.
As Geriatric Nurse Practitioner, it is my job to help identify what is going on with a patient in order to connect them with the appropriate course of treatment.
Auditory Testing: the First Line of Investigation
When a patient comes to me, they are being evaluated for their cognition and memory loss. Testing hearing is the first priority. Of course, I ask the patient directly about their hearing. However, self-diagnosing hearing loss can be a challenge.
Sometimes patients will report that they hear fine, but when I ask other family members they say that they need to talk louder or that the TV is always up very loud. That is an indication that there is some hearing loss so it’s time for me to investigate further.
I might list out letters and ask them to tap when they hear the letter A. If they are tapping all the time, or missing letters, that could be a sign of hearing loss. If a patient can’t hear a question I asked, they might guess at a response resulting in something off-topic, or nod along to try and make it look like they understand. I can also have a patient try to repeat a word that was whispered in their ear.
A simple cause of hearing problems is the buildup of cerumen (ear wax), so I use a scope to see in the ear canal. Once that is eliminated as a possibility, the next step is to refer the patient to one of the audiologists at Hebrew Rehabilitation Center's outpatient clinic to make sure that there isn’t any loss of hearing function. If so, then the next step might be hearing aids.
This is where there can be some resistance. In fact, many adults wait over 10 years to get hearing aids. While there are valid concerns around getting hearing aids—especially in regards to cost—an audiologist can help you come up with a solution that meets your needs.
It is important to find a solution because of the crucial role hearing can play in combating dementia. Hearing aids have been shown to reduce the risk of being diagnosed with dementia by 18%. It is also believed that addressing hearing loss reactivates the nerve cells responsible for auditory processing and could recover some of what was lost.
Some people are self-conscious about looking old. Luckily, hearing devices are getting smaller and less noticeable. Hearing aids can also be forgotten, lost, run out of batteries, or be uncomfortable to wear.
Another concern is that hearing aids are usually not covered by insurance. Some plans offer optional coverage for hearing aids, but those options are not widely available. Fortunately, they are becoming cheaper, with over-the-counter devices available.
One of the most effective techniques for getting a patient to accept hearing aids can be encouragement from their family. Emphasizing that they are coming from a place of love and support, family members can gently remind their loved one how poor hearing affects the entire family unit. Improved hearing will allow that person to be more independent and participate in their own life; listening to cheering crowds at an event or the laughter of their grandchildren.
Of course, family members need to remember that their loved one cannot be forced into using hearing aids. Otherwise, there will be pushback. With the proper support, hopefully the person in need of hearing aids will accept that they need them in order to live a productive life.
Once we’ve ruled out hearing as the issue, we can then move on to different diagnostic testing to assess if a patient has dementia and if so, the exact cause. This can include the Montreal Cognitive Assessment verbal exam (MOCA), a brain MRI, and/or a spinal tap.
That said, cognitive decline and memory loss don’t automatically mean you have dementia. Other factors that affect memory can include vitamin deficiencies, an underactive thyroid, head trauma, emotional disorders, medication side effects, and more. A dementia diagnosis will only come when the patient is having difficulties with their ability to do everyday tasks, take their medication, or navigate their environment. Read more about early signs of Alzheimer’s disease.
Addressing Memory Loss
If you're concerned about memory loss, the Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife can help you identify the cause - whether it's hearing loss or something more complicated. If a diagnosis is made, we can also work with you and your family to create a treatment plan based on your own individual needs and goals. Call us at 617-363-8600 or contact us today.
The Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife provides outpatient memory care services, in person and virtually, for people living with cognitive symptoms — and for their families and caregivers.
From our Wolk Center for Memory Health to our Adult Day Health program to Assisted Living to Memory Care Assisted Living, we offer a wide range of memory care services and support.