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Opinion | Are Your Patients Aware That Hearing Loss May Affect the Brain?

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There was a recent long term study from John’s Hopkins, and there definitely seems to be a correlation, however, there’s still a big lack of understanding of whether, or how, there is causation. They did talk about some possibilities, such as with more hearing loss there is more isolation and potentially less brain use. Still a guess though. I’m on the younger side of age related loss (since it wasn’t :wink: and honestly I could care less what others think. I prefer to hear :grin:

I would hate to have it used as a scare tactic - they seem to backfire for things like this imho. Trying to make aids more acceptable might be a better way to go. But it’s a hard sell. Take minivans - they are far better than suvs for many, if not most, conditions and yet they are reviled pretty often. :man_shrugging:

It seems to be leaning heavily on the Lancet article which presented hearing loss as the number one potentially modifiable risk factor for dementia. We do not have sufficient evidence at this point that hearing loss causes dementia rather than, say, whatever causes dementia also causes auditory processing deficits and/or hearing loss. We do not have sufficient evidence that hearing aids can actually slow or prevent dementia. Given this lack of evidence I would certainly say that it is unethical for a hearing health care professional to use dementia as a scare tactic to sell hearing aids. There’s been heavy marketting everywhere that hearing loss comes out as ‘number one’ in the Lancet review, but note that a couple of the other risk factors for dementia are ALSO risk factors for hearing loss.

That said, I would be shocked if it were inevitably discovered that untreated hearing loss has no effect on cognition. I would expect that vision loss also has an effect. Stress has an effect. We simply do not have infinite cognitive resources and when you need to use extra resources to make up for a deficit, it reduces what you have to use for other things. But is this a static change influenced by a degree of disability along with a whole host of other components, or does it contribute to a faster decline? There is still a lot of unweaving to do.

What I absolutely do agree with in this article, dementia aside, is that primary healthcare practitioners need to develop a better understanding of the functional impact of hearing loss and not dismiss it when they notice symptoms or when a patient raises concerns. Hearing loss is worth treating in its own right, not just because of a possible link to dementia. I’ve seen (ENTs!) dismiss a “mild” hearing loss and tell patients that there’s nothing that will help them. Deeply inserted foam ear plugs create a “mild” hearing loss.

As for taking steps to reduce the risk of dementia–stop smoking, exercise, eat a healthy diet. All the same old boring stuff that I don’t want to do. :upside_down_face:

Thanks. I really don’t doubt that hearing loss increases risk of dementia. It was this quote that seemed overstated and unlike the careful statements that most PhDs make: “This means that a staggering 800,000 new cases of dementia each year are attributable to hearing impairment.”
I’m quibbling I guess, but it seemed a bit overly confident.
Yes, no smoking, being physically (and socially) active and eating a healthy diet really do prevent a lot of problems. Thanks again.

I suppose if there are 10 million new cases worldwide annually and the Lancet article suggests that by getting rid of hearing loss you could get rid of 8% of that, that does translate to 800,000 people.

Not doubting the math. Lack of couching is what struck me as unusual. Sounds like they’re claiming direct causation.

I expect it happens most to elderly people who have great difficulty communicating with those nearest and dearest to them.

I would think some types of physiological issues could be associated with both risk of dementia and also of hearing loss. We also already know social isolation and depression are hard on cognition. And hearing loss can greatly increase the chances of having both isolation and depression in some cases. What I have not seen is a study linking Deaf peoples’ risk and dementia in the same way. I think figuring out associative vs casual relationships must be really challenging. And it likely varies because there are so many different types of hearing loss and dementia. Not to mention that hearing loss affect some folks’ social lives far more than others.

Was thinking about this a bit further. Seems like a question is whether hearing loss leads to dementia or social isolation, as a consequence of hearing loss leads to dementia. If it’s hearing loss per se, one would think there would be a higher incidence of dementia among the deaf community. I don’t think it’s been studied well, but the little I saw suggests that is not the case. I’m guessing that being a member of a tight knit deaf community might actually be protective against dementia.

If the mechanism is hearing loss–>social isolation–>dementia, you wouldn’t expect it in the deaf community because their language is manual/visual. If it’s just a reduced sensory input thing, you might. If it’s that something else causes both dementia and hearing loss, you would expect the same prevalence in the deaf community because their congenital (or whichever) deafness would come from a different source but presumably they’d still be suceptible to whatever it is causing dementia.

Semi-related, but I thought interesting:

Linking Cerebrovascular Dysfunction to Age-Related Hearing Loss and...

Alzheimer’s disease (AD), the most common cause of dementia in the elderly, is a neurodegenerative disorder associated with neurovascular dysfunction, cognitive decline, and the accumulation of amyloid β peptide (Aβ) in the brain and tau-related ...

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