Hearing loss, aphasia and dementia

Over the last ten years or so, I have noticed increasing trouble understanding what people are saying to me, especially if there are several people speaking at the same time, like at a family dinner, or worse, at a big party. It may be the main reason I find social occasions increasingly difficult and intimidating.  When my wife speaks to me, I often have to ask her to repeat what she said.  She has learned to say things twice if she wants me to get it.  I know that is irritating for her.  Often I just nod or grunt, pretending I understand what she is saying.  I have attributed this increasing problem to my Alzheimer’s disease interfering with my ability to understand language, particularly if I don’t hear every word clearly. Aphasias affecting language production (poor word finding) or reception (impaired understanding) are common in the mid-to-late stages of Alzheimer’s, but naming troubles in particular are often one of the earliest symptoms of Alzheimer’s.In the last few months, I have noticed that my wife and I have markedly different choices for the volume when watching TV.  She finds it is too loud when I set it and I have to cup my hands to my ears too hear at her chosen level. It finally dawned on me that maybe it isn’t just the Alzheimer’s disease.  Maybe I have a hearing problem. At my annual checkup last month, I asked my internist to refer me for an audiogram. It showed severe hearing loss on the left in the higher frequencies and moderate loss in the lower frequencies.  The right ear wasn’t quite as bad with severe hearing loss only in the higher frequencies and normal hearing in the lower and midrange frequencies.

Almost everyone experiences hearing loss with age, particularly in the high frequencies. This especially effects our ability to hear and understand speech.  By age 80, most people have significant impairment.  I’m just about ten years ahead of that normal decline, especially in the left ear. The audiologist recommended that I get fitted for hearing aids. This audiology lab does not sell hearing aids, so there is no conflict in that recommendation.  I am put off a bit by the extra hassle of using these devices, but I plan to look into it more soon.

An increasing number of studies have shown that hearing loss may be a modifiable risk factor for all-cause dementia. There has been agreement that people with significant hearing loss are more likely to develop dementia than those with normal hearing, but there has been uncertainty about whether treatment of hearing loss would reduce the risk of developing dementia.  Several recent studies appear to show that use of hearing aids can indeed reduce the risk of dementia in hearing-impaired subjects. In a 2021 study published in Alzheimer’s & Dementia, hearing-impaired subjects with mild cognitive impairment (MCI) who wore hearing aids were 27% less likely to progress to dementia compared to those who did not wear hearing aids. A much larger meta-analysis of eight studies including 126,903 subjects with hearing loss showed a significant 19% lower chance of developing dementia in those who used hearing aids [3]. 

I was slow to come around, but I am now convinced that there is a very good chance that hearing aids will not only improve my hearing and my ability to understand speech, but possibly also slow the progression of my Alzheimer’s disease.