Wellness Corner: Understanding the Relationship Between Hearing Loss and Cognitive Decline
By Christine Jones, Au.D., Phonak Audiology Vice President
June is Alzheimer’s Awareness month, making it a perfect opportunity to reflect on what we know — and don’t know — about the link between cognition and hearing. Here’s what we do know:
- Around 50% of people age 65 and older have hearing loss.1
- 24% of people above 65 have dementia or some mild cognitive impairment.2
Since both hearing loss and cognitive loss increase is prevalence with age, it is reasonable to assume that many older adults are dealing with both conditions and the consequences of each, which can be difficult to differentiate. This means many aspects of hearing care may be impacted when our patients are also dealing with cognitive decline.
Considerations in Hearing Care
Evidence suggests that speech understanding can be impacted in individuals with cognitive impairment. Specifically, deficits in working memory and cognitive capacity may limit one’s ability to recall sentences in challenging acoustic environments.
Evidence suggests that speech understanding can be impacted in individuals with cognitive impairment.
Additionally, cognitive impairment may limit one’s ability to effectively use auditory closure skills or contextual cues to fill gaps in the signal caused by the perceptual deficits associated with hearing loss. When hearing aids are applied, there is evidence that some signal processing schemes, such as fast-acting compression and frequency lowering, can also be cognitively demanding. For patients with cognitive loss, less modification of the signal can be less taxing and therefore, more beneficial. A recent chart review conducted in a geriatric hospital in Canada revealed that 42% of audiology patients would need some daily help to successfully use hearing aids.3
This could include anything from a caregiver changing batteries to a caregiver providing overall management of the devices. All of these considerations need to be thoughtfully factored into the diagnosis, treatment, counseling and functional outcomes of patients.
Partner for Healthy Aging
Acknowledging and understanding the relationship between hearing and cognition allows hearing care professionals to provide an increasingly personalized form of support for our patients. It also helps audiology to integrate our services into a broader healthcare landscape that supports the healthy aging of our patients.
In order to gauge the cognitive status of your patients, you may consider administering a cognitive screener.
In order to gauge the cognitive status of your patients, you may consider administering a cognitive screener. This will help you look after your patients’ overall wellness, make appropriate referrals when necessary, and be on the lookout for the 30% acceleration of cognitive impairment that has been associated with hearing loss.4
Johnson, Solodar and MacMillan5 showed that a cognitive screening could be implemented in a busy audiology/ENT clinic in as little as 1.2 mins. These results showed the clinical feasibility of incorporating such a measure that could both inform hearing care and more global health management through appropriate referrals.
The future of hearing care requires that our professional services purvey a broader value than the hearing device itself. Taking a holistic look at the challenges and goals of patients and their loved ones in order to support them in achieving those objectives is the right place to start.
The intertwined nature of the effects of hearing loss and cognitive decline inhibits hearing care professionals from looking at either of these conditions in isolation, and for the well-being of the patient, it is essential that we use the tools at our disposal to support wellness.
1Pichora-Fuller, M. K., Dupuis, K., Reed, M., & Lemke, U. (2013). Seminars in Hearing Paper
2https://www.alz.org/downloads/facts_figures_2014.pdf : p.18, 66: 11% http://www.alz.org/documents_custom/2017-facts-and-figures.pdf; retrieved on 14.03.2017
3Dupuis, K., Lemke, U., Reed, M. & Pichora-Fuller, M. K. (2016). Audiologic care for clients with multiple medical comorbidities: Modifications to clinical practice and inclusion of family members and caregivers. Proceedings of the Acoustics Week in Canada. Canadian acoustics, 44 (3).
4Lin, F. R., Yaffe, K., Xia, J., Xue, Q. L., Harris, T. B., Purchase-Helzner, E., … & Health ABC Study Group, F. (2013). Hearing loss and cognitive decline in older adults. JAAudMA internal medicine, 173(4), 293-299.
5 Johnson, J., Solodar, H., Macmillan, G. (2018, April) Integrating cognitive and medical screens into a busy clinical practice. Presented at the American Academy of Audiology Conference, Nashville, TN
Christine Jones is the Vice President of Audiology at Phonak U.S. Prior to this role, she was responsible for Phonak U.S. Pediatrics and ran pediatric clinical research in Phonak Audiology Research Center (PARC). Christine received her Master’s degree from Vanderbilt University and Doctoral degree from Central Michigan University.