ROBERT FIRPO-CAPPIELLO wrote . . . . . . . . .
For people whose hearing is impaired, hearing aids may lower the risk of cognitive decline. Still, many resist getting them. Advice from specialists may help overcome that reluctance.
About 10 years ago, Susan Edelman began to notice changes in her hearing that made loud restaurants, crowded rooms, and large groups of people almost unbearable. She tried avoiding such situations, but for a company CEO with an active social life, that was problematic both professionally and personally.
Eventually she saw an audiologist (a specialist in hearing and balance disorders), who did an audiogram—which tracks the softest sounds a person can hear at a range of frequencies from low to high—and recommended hearing aids. Edelman, now 62, was initially resistant but changed her mind after learning that hearing loss can negatively affect cognitive function. “That information struck a nerve with me because both of my parents have dementia. I ran to the audiologist to get fitted with hearing aids,” she says. “I’ve been wearing them for five years, and it has been life-altering. I’m better able to focus, connect with others, and retain complex thoughts and conversations.”
Recent evidence of the cognitive benefits of treating hearing loss includes a National Institutes of Health–funded study, published in August 2023 in The Lancet, involving 1,000 adults between the ages of 70 and 84. The primary results of the study showed that participants who wore hearing aids did not see improved cognition, but a secondary analysis of data, focused on a sub-group of participants at increased risk of cognitive decline, found that wearing hearing aids was linked to a slowing of cognitive decline over the course of three years.
“Hearing loss, among all known potentially modifiable risk factors for dementia, was estimated by the 2020 Lancet Commission on Dementia to be the greatest risk factor, possibly accounting for 8 percent of all cases worldwide,” says Frank Lin, MD, PhD, director of the Johns Hopkins Cochlear Center for Hearing and Public Health in Baltimore and one of the authors of the Lancet study.
A related study, in which participants underwent MRI brain scans at the start and after three years, showed that hearing aids reduced damage (known as “thinning”) to parts of the brain involved in social and cognitive processing. Wearing hearing aids may mitigate three factors implicated in raising the risk of dementia—social isolation, cognitive fatigue, and sensory deprivation—says Dr. Lin, who is also professor of otolaryngology and head and neck surgery at Johns Hopkins.
Research into the efficacy of hearing aids in preventing cognitive decline is ongoing. For example, a 25-year study of 3,777 people age 65 or older published in the Journals of Gerontology in October 2018 found an increased risk of dementia in people with self-reported hearing loss—except in study participants who used hearing aids.
Poor hearing does not cause cognitive decline, but untreated, it can trigger behavior that may have a negative impact on cognitive health. “Hearing loss often results in reduced social interaction, less verbal stimulation and communication, loneliness, and depression,” says neuro-otologist Terry D. Fife, MD, FAAN, professor of neurology at the University of Arizona College of Medicine in Phoenix. “In people who are already experiencing cognitive decline, the effects of social isolation may accelerate that.” A study published in the Journal of the American Geriatrics Society in January 2023 suggested that the risk of dementia was 28 percent higher when older adults were socially isolated.
A study published in Neurology in March 2022 found that older adults experiencing loneliness were at an increased risk of developing dementia in the subsequent 10 years. “We observed up to a three-fold increase in risk in those who otherwise wouldn’t be at elevated risk due to genetic and other traditional risk factors,” says Joel Salinas, MD, FAAN, one of the study authors. “It’s possible that increasing a person’s ability to engage in social interactions by treating hearing loss may also address loneliness and thus also reduce risk of cognitive decline,” adds Dr. Salinas, who is clinical assistant professor of neurology at NYU Langone Health and chief medical officer at Isaac Health.
When Roy Feldman, an 83-year-old retired researcher and consultant in New York City, began losing his hearing in his sixties, he remembered that his father had resisted wearing hearing aids and had subsequently experienced social isolation and cognitive decline. That motivated Feldman, for whom conversations were getting more difficult, to “get a hearing aid right away,” he says.
“I regularly hear from my patients and their family members how they enjoy socializing again because they can understand and participate in conversations,” says Dr. Lin. “They feel connected because they can speak to loved ones on the telephone with more ease, and they report less exhaustion because they aren’t constantly straining to understand.”
The diminishment of social interaction is a compelling explanation for the cognitive consequences of untreated hearing loss, says David S. Knopman, MD, FAAN, professor of neurology at Mayo Clinic in Rochester, MN.
Nearly a third of people 65 and older experience hearing loss, according to the National Council on Aging, and two out of five people 75 and older do. It typically starts between the ages of 52 and 64, says Dr. Fife. Causes vary and can include a lifetime exposure to loud noises, ear or head trauma, viral infection, and certain medications. Hearing loss also is associated with certain rare neurologic disorders, including Fabry disease, Waardenburg syndrome, and superficial siderosis, Dr. Fife says. A 2022 review in Open Medicine found a connection between hearing loss and Alzheimer’s disease, autism, Parkinson’s disease, and stroke.
In addition to social isolation and an elevated risk for cognitive decline and dementia, hearing loss is associated with a higher risk of falls and hospitalization and greater health care costs, says Dr. Lin. By depriving the brain of normal sensory input, hearing loss can lead to changes in brain structure and function, he adds. “Hearing loss results in reduced stimulation of regions in the brain responsible for processing speech and sound, potentially causing atrophy.”
Overcoming Resistance
Many people with hearing loss are reluctant to get hearing aids, despite evidence that wearing them can improve quality of life and reduce the risk of dementia—and prevent what physicians call cognitive fatigue. “Untreated hearing loss can distort speech and sound signals by the time they reach the brain, demanding additional effort from the brain to process them,” Dr. Lin says. “Consequently, fewer cognitive resources are available for tasks like thinking and memory, as well as for mitigating the impact of conditions like Alzheimer’s disease, diabetes, and heart disease, which can further exacerbate the risk of cognitive decline and dementia.”
Since the U.S. Food and Drug Administration released regulations for over-the-counter (OTC) hearing aids in 2022, they have become more readily available, at significantly lower cost than prescription models. The more moderate price could change minds about wearing hearing aids, although people may need prescription-strength models if their hearing loss is severe. “Some people balk at spending thousands of dollars on audiologist-fitted, customized hearing aids when OTC hearing aids—which may not be effective for advanced hearing loss—are only a few hundred dollars,” notes Dr. Fife.
The cost of a pair of prescription hearing aids ranges from $1,000 to $8,000, according to the National Council on Aging, but prices can vary even for the same brand and model because audiologists often purchase them wholesale and set their own prices. OTC hearing aids, which range in price from $189 per pair to more than $1,500, can offer many of the same benefits as prescription hearing aids for people with mild to moderate hearing loss.
Many private insurance plans, some Medicare Advantage plans, and some Medicaid plans offer coverage for hearing aids, but the benefits vary widely by type of plan and state of residence. Medicare Parts A and B do not cover hearing aids. A study published in Innovation in Aging in June 2021 found that only 27 percent of Medicare patients use hearing aids.
“Most people with hearing loss don’t think it’s bad enough to warrant a hearing aid,” says Andrew Budson, MD, professor of neurology at Boston University. “I tell family members to say to the parent with hearing loss, ‘Don’t wear it for you, Dad, wear it for me, so I don’t need to shout.’ That’s often the most effective way to motivate people to get the intervention they need.”
Newer products and services can address certain objections to getting tested for or wearing hearing aids. Some people have cosmetic concerns, but many hearing aids these days are far less visible than previous models. Those reluctant to see an audiologist or otolaryngologist can assess their own hearing through a free-to-download app such as SonicCloud, Jacoti, Mimi, or Hearing Number and get an evaluation on HearingNumber.org. “The hearing number indicates how loud a sound must be [measured in decibels] for you to hear it,” says Dr. Lin. This sort of evaluation is part of a public health campaign to raise awareness about hearing loss and is not intended as a substitute for seeing a professional, he says.
By regularly monitoring their hearing numbers, people have a sense of how their hearing is changing over time and how they can adapt. “For example, I’m 47 years old, and my hearing number is about 10 dB in both ears,” says Dr. Lin. “This technically puts me in the normal range, but it’s a lot worse than my 18-year-old daughter’s hearing, which is a 3. That information helps me understand why I no longer hear as well as she does when we’re in a busy restaurant.”
While hearing aids are vital for those with hearing loss, their families, friends, and colleagues can take measures to improve communication with them. Dr. Lin recommends moving closer and speaking face-to-face, repeating or rewording a sentence when needed, and choosing the right environment—lower ceilings, plenty of soft surfaces that keep sound from bouncing around—for important conversations.
For those with hearing loss, early intervention can have long-term benefits. Roy Feldman began wearing hearing aids in his sixties, and in his late seventies, he sustained a serious infection in both ears, which resulted in significant deterioration in his hearing. His audiologist was able to adjust his hearing aids to compensate for the damage. “Roy now has some short-term memory loss, but he functions well in social situations and has maintained his quality of life,” says Feldman’s wife, Carol.
Source: Brain&Life
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