Hearing Loss and Cognitive Decline
Becky Wiacek
Vanderbilt University
Bill Wilkerson Center
Department of Hearing and Speech Sciences
Outline
Patient JL
Background
Recommendations
Future
Patient JL
87 year old female
Former teacher and principal, still employed
2010: first signs of memory decline and anxiety
2013: concerns from daughter, first hearing evaluation
2015: doctors concerned, MMSE abnormal
2016: formal diagnosis: mild cognitive impairment, attention and concentration deficit, dementia
September and October 2016
Interested in pursuing amplification
Dementia
Alzheimer’s Association, 2016
Defined |
Decline in memory, cognitive skills |
Symptoms |
Core Mental Functions |
Prevalence |
Double every 20 years |
Cause |
Permanent and Progressive Brain Changes or Symptoms of Dementia |
Dementia
Mayo Foundation for Medical Education and Research, 2016
Intervention |
Delay onset by 1 year would lead to more than 10% decrease in global prevalence in 2050 |
Treatment |
No Cure Therapies and Medications |
Diagnosis |
No One Test Combination of Evaluations |
Hearing Loss and Incident Dementia (Lin et al, 2011)
Hearing Loss and the Brain
Baltimore Longitudinal Study of Aging
MRIs for up to 10 years
Accelerated rates of brain atrophy
Sound, speech, memory, sensory integration
Hearing Loss Linked to Accelerated Brain Tissue Loss (Johns Hopkins Medicine, 2014)
Treat hearing loss before these brain structural changes occur |
Hearing Loss and Cognitive Decline
Baltimore Longitudinal Study of Aging
More at risk for cognitive decline and dementia
24% increased risk for cognitive impairment
Cognitive and psycho-social declines
If you fit subjects with hearing aids, will it stop this decline of cognitive function? |
Hearing Loss and Incident Dementia (Lin et al, 2011)
Now that we have these connections, how do we, as audiologists, adjust to patients with dementia?
GOALS
|
Use of Hearing Aids
Simply wearing hearing aids |
Improving the quality of the auditory signal reaching the cognitive system |
One vs. Two hearing aids |
Significant improvement in listening effort by adding spatial cues |
Listening effort and acclimatization to hearing aids (Dawes, et al., 2011)
Starkey Research (Xia and Kalluri)
Fitting
Interactions between cognition, compression, and listening conditions: effects on speech-in-noise performance in a two-channel hearing aid.
(Lunner and Sundewall-Thoren, 2007)
Best option: Slow-acting compression |
Directional Microphones/ �Noise Reduction
Objective measures of listening effort: effects of background noise and noise reduction (Sarampalis, et al., 2009)
Low SNR, better word-memory, quicker visual reaction times |
Accessories
Counseling
Purchasing
Medications
Zinc-air battery
ZPower's technology offers rechargeable hearing aids (Healthy Hearing, 2016)
Z Power Rechargeable Battery System |
Aural Rehabilitation
The Need for and Development of an Adaptive Listening and Communication Enhancement (LACETM) Program (Sweetow and Sabes, 2006)
Listening and Communication Enhancement (LACE) |
Speech, Spatial and Qualities
of Hearing Scale (SSQ)
Outcome Measures
Analysis of counted behaviors in a single-subject design: modeling of hearing-aid intervention in hearing-impaired patients with Alzheimer’s disease
(Durrant, 2005)
Involving Significant Others
There is a need for more and better outcome measures |
Cognitive Screening
Mini Mental State Examination (MMSE)
The Effect of Decreased Audibility on MMSE Performance: A Measure Commonly Used for Diagnosing Dementia (Jorgenson et al., 2016)
Highly influenced by changes in audibility and could change diagnosis of dementia. |
Treat hearing loss before dementia evaluation. |
Future of Hearing Aids and Dementia
Oticon Opn
Low Battery
GPS tracking
Daily activity summaries
Set house alarm
Schedule events
https://www.oticon.com/support/downloads/
Reduce listening effort |
Remember more of conversations |
Looking Forward
Future Goals |
Improve cognitive function and daily life |
Past Goals |
Improve audibility Speech understanding |
Questions/Discussion
Thank You
Dr. Angley
Dr. Kist
Sarampalis, A., Kalluri, S., Edwards, B., & Hafter, E. (2009). Objective measures of listening effort: effects of background noise and noise reduction. Journal of Speech, Language and Hearing Research, 52, 1230-1240.
Lunner, T., & Sundewall-Thorén, E. (2007). Interactions between cognition, compression, and listening conditions: effects on speech-in-noise performance in a two-channel hearing aid. Journal of the American Academy of Audiology, 18(7), 604-617.
Lin, F. R., Metter, E. J., O’Brien, R. J., Resnick, S. M., Zonderman, A. B., & Ferrucci, L. (2011). Hearing loss and incident dementia. Archives of Neurology, 68(2), 214-220. doi: 10.1001/archneurol.2010.362.
Dawes, P., Munro, K., Kalluri, S., & Edwards, B. (2011, June). Listening effort and acclimatization to hearing aids. Paper presented at the International Conference on Cognition and Hearing, Linkoping, Sweden.
Beck DL and Edwards B, Humes LE, Lemke U, Lunner T, Lin FR, Pichora-Fuller MK. Expert Roundtable: Issues in Audition, Cognition, and Amplification Hearing Review. 2012;19(09):16-26.
Johns Hopkins Medicine. "Hearing loss linked to accelerated brain tissue loss." ScienceDaily. ScienceDaily, 22 January 2014. <www.sciencedaily.com/releases/2014/01/140122133423.htm>.
Sweetow, R.W. & Sabes, J.H. (2006). The Need for and Development of an Adaptive Listening and Communication Enhancement (LACETM) Program. J Am Acad Audiol, 17, 538-558.
Durrant, J.D., Palmer, C.V. & Lunner, T. (2005). Analysis of counted behaviors in a single-subject design: modeling of hearing-aid intervention in hearing-impaired patients with Alzheimer’s disease. International Journal of Audiology, 44, 31-38.
Jorgensen, L.E., Palmer, C.V., Pratt, S., Erickson, K.I. & Moncrieff, D. (2016). The Effect of Decreased Audibility on MMSE Performance: A Measure Commonly Used for Diagnosing Dementia. J Am Acad Audiol, 27, 311-323.
References