Cognitive Risks of Hearing Loss

It is well known that many individuals experience hearing loss with increasing age. Age-related hearing loss (presbycusis) is commonly caused by changes to the inner ear over time and is characterized as difficulty understanding speech and detecting sounds. Signs of hearing loss may include difficulty hearing conversations, particularly in crowded environments, turning up the volume on the television, and asking others to repeat themselves. Hearing loss can be frustrating for those who experience it and their loved ones. It has also been linked with wide-ranging effects on well-being, such as isolation, mood symptoms, poorer quality of life, falls, delirium, and even cognitive impairment or memory loss.

Hearing loss has recently been identified as one of the leading, potentially modifiable risk factors for dementia. Several studies have connected hearing loss with increased rates of memory loss, with the likelihood increasing with the severity of hearing loss. For example, a recent study in the journal, Alzheimer’s & Dementia: Translational Research & Clinical Interventions, examined data of over 4,300 participants from a large database, the National Alzheimer’s Coordinating Center (NACC). They found that hearing loss was associated with an increased risk of developing mild cognitive impairment (MCI) and a faster rate of cognitive decline. Further, there was a reduced risk of developing MCI in those individuals who wore their hearing aids.

It is important to remember though that it is has not been proven that memory loss is caused by hearing impairment or that memory loss causes hearing decline. The reasons for the association between hearing loss and cognitive decline are unclear still. Several possibilities for this have been suggested:

-Increased cognitive load. With hearing loss, the brain can become overworked with the increased straining to make sense of and understand sounds. This increased effort drains mental energy, leaving fewer resources available for other cognitive and memory skills. Improving hearing can “take some of the load off” of your brain!

-Changes in brain structure and function. Brain regions may atrophy or shrink from lack of input due to decreased hearing, including the parts of the brain that receive and process sounds. In other words, “use it or lose it.”

-Social isolation. Individuals with hearing loss may often avoid or withdraw from social gatherings and conversations, especially in settings which have high levels of background noise. They may become isolated and lonely, develop mood symptoms such as depression, and experience a smaller social network and reduced activities. Social isolation is also a well-known risk factor for memory loss.

-Common cause. There may be other common, underlying risk factors to hearing loss and cognitive decline.

Below are some recommendations if you are experiencing hearing loss:

• Discuss your concerns about hearing loss with your doctor and make an appointment with an audiologist or ENT (ear, nose, and throat) specialist for a hearing check and evaluation of other risk factors. They can make recommendations of options for improving hearing to achieve your goals. This may include hearing aids, implantable devices, other assistive devices, and communication strategies. They can also evaluate for conductive problems, such as excessive ear wax buildup, inflammation, and structural changes of the ear, as well as effects of endocrine disorders, medications, and other risk factors.
• Talk with your doctor or audiologist if you are considering purchasing a hearing aid online. While many hearing aid ads on television and the internet are reputable, some are not.
• Many people are reluctant to try or consistently use hearing aids and other hearing devices. Discuss with your doctor and audiologist if there are any barriers to obtaining or benefitting from hearing aids or other devices.
• Consider using assistive listening devices and assistive listening systems. These can be used with or without hearing aids and implants. They make the sounds you want to hear louder (amplify) and improve the signal-to-background noise ratio.
  • A “PockeTalker” is a relatively inexpensive, wired, example of this type of device.
  • There are speech-recognition software to turn spoken messages into words that you can read on your telephone or computer.
  • Alerting devices use other methods to make you aware of sounds.
• If you are going to a cognitive or memory assessment, be sure to tell your doctor about your hearing loss. Let them know if the room is too noisy or if you need to use a hearing aid or other technology to make sure that you are hearing well
• Considering seeking help for hearing loss early rather than when it is advanced to stay active and reduce the potential risk for cognitive decline.
• Discuss with your friends and family that you are experiencing hearing loss, and let them know how to help you. They may appreciate knowing this, and it gives them “permission” to try additional strategies.  They could try to use the following communication strategies:
  • Speaking face-to-face
  • Turning off competing background noise, such as the television, if possible
  • Speaking at a normal level if speaking too loudly is distorting the words
  • Coming into the same room if they are speaking to you
  • Providing the topic or key words during conversation, especially if the topic has changed
• Share with your friends and family if you are experiencing negative emotions related to hearing loss, such as frustration, resentment, and loss of companionship.
• Consider joining a support group for individuals with hearing loss. They may have additional strategies. Mayo Clinic Connects offers support groups: https://connect.mayoclinic.org/group/hearing-loss/