Cognitive Decline and Aging
Pichora-Fuller et al (2013) report a strong and well established connection between hearing loss and cognitive impairment in old age. Hearing loss is the third most common chronic health condition in the United States and it is experienced by half the population by age 65 years and 90 percent of the population by age 80 years. The authors report audiologists need to consider cognitive health due to the ever increasing population of older people in the United States.
Cognitive Impairment appears to be present in 5 percent of people between the ages of 71 and 79 years yet is found in 37 percent of those aged 90 years and older. Mild cognitive impairment (MCI) appears to be present in approximately 16 percent of those over age 70 years. Importantly, MCI is not considered to be dementia, yet some 80 percent of people with MCI convert to dementia over approximately 6 years. Alzheimer’s Disease (AD) is the most common dementia, representing some two-thirds (or more) of all dementia diagnoses. AD is progressive and degenerative and is typically fatal within 7 to 10 years of diagnosis for people diagnosed in their 60s and early 70s. In the United States, there are currently 4.7 million people with dementia. By 2050, the quantity of people with dementia is expected to double. Hearing loss has been reported in 9 of 10 people with dementia and hearing loss is more prevalent in those with dementia than those without dementia.
Pichora-Fuller et al note cognition is a multidimensional concept which includes memory, attention, language and reasoning abilities and they state "the time is right" for audiologists to help older people with hearing loss and cognitive loss to communicate. The authors report a study which found that for every 5 dB increase in hearing loss above 30 dB, clients lost (on average) 3 points on the Mini Mental State Exam (MMSE). Of note, following hearing aid fittings, significantly improved MMSE scores were determined. The authors also report on the Montreal Cognitive Assessment (MoCA) screening test and its usefulness with regard to identifying MCI. The test takes ten minutes to administer and is used by many health care professionals. Based on 300 people ages 50 to 90 years, people with hearing loss scored poorer on the MoCA than those with normal hearing.
Pichora-Fuller et al report cognitive rehabilitation works well for many older patients and cognitive neuroscience has demonstrated older brains are plastic and learning can continue into old age. Psychosocial and behavioral interventions may keep brains active longer and may slow cognitive decline and may delay the transition to dementia. The authors state it is reasonable that treating visual and/or auditory impairment may offer multiple cognitive advantages and benefits.
For More Information, References, and Recommendations
Beck DL. (2009) Cognition Friendly Amplification. British Society of Audiology Newsletter 57(August):22-25.
Beck DL, Sockalingham R. (2009) Audition, Cognition, Ageing and Listening Success. ENT & Audiology News 18(4):101-103.
Beck DL, Edwards B, Pichora-Fuller MK. (2011) Exploring the maze of the cognition-audition connection. Hearing Journal.
Beck, DL., Edwards, B., Humes, LE., Lemke, U., Lunner, T., Lin, FR., Pichora-Fuller, MK. (2012): Expert Roundtable: Issues in Audition, Cognition, and Amplification