MGordon_MD
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May 16, 2011, 7:53 AM
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By Dr. Michael Gordon
It was one of many geriatric meetings that I have attended as part of my academic professional activities. The speakers and the audience were all health-care professionals committed to the care of the elderly.
The session focused primarily on issues of driving and aging, but the question of hearing and cognitive impairment came up. An audience member, a speech-language pathologist, asked one of the speakers about the importance of confirming a patient’s hearing capacity before a decision was made about his or her cognitive abilities.
A well-respected geriatrician, contrary to what I would have thought to be a reasonably suitable answer, discounted hearing as playing an important role in the symptomatology and evaluation of people with cognitive impairment. The questioner reiterated her concern that it was an issue, expressing some degree of incredulousness at the physician’s answer, and from the murmuring in the audience, it seemed that she was not alone in her connecting compromised hearing with compromised cognition.
After the session, I went up to the therapist and expressed my surprise at the answer and told her of our practice at Baycrest in which we try, whenever possible, to evaluate hearing as part of an assessment, at least initially, of a person with symptoms of cognitive impairment.
I was, therefore, elated to read recently of a research study that implicated hearing impairment in the development of dementia and suggested that hearing loss is perhaps linked as one component to be considered in its causation.
To quote Dr. Frank R. Lin of the Center on Aging and Health, Johns Hopkins Medical Institutions, the first author of the study published in the February 2011 issue of Archives of Neurology, “Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.”
From an article by Megan Brooks, published in Medscape Medical News on Feb. 16, Lin is quoted as saying, “A number of mechanisms may be theoretically implicated in the observed association between hearing loss and incident dementia. Dementia may be over-diagnosed in people with hearing loss; alternatively, people with cognitive impairment may be over-diagnosed as having hearing loss. It’s also possible that the two conditions share an underlying neuro-pathologic process.”
He goes on to say, “Another option is that hearing loss may be causally related to dementia, possibly through exhaustion of cognitive reserve, social isolation, environmental deafferentation or a combination of these pathways.” Environmental deafferentation is a complex medical term that means the freeing of a motor (movement) nerve from sensory components.
How do we translate this into our ordinary clinical activities and how should individuals experiencing cognitive decline and their families address the issue? One important step in the assessment and evaluation of cognitive impairment is to ascertain a person’s level of hearing, and if there is any doubt whatsoever, a proper audiology evaluation should be done. A rough test of hearing is not enough because sound as well the ability to discriminate sounds into words and meanings must be evaluated.
If there is any question of hearing impairment, it’s always worth addressing it, even with a Pocket Talker, a relatively low-cost amplification device that can usually help determine if some degree of amplification will enhance hearing and, at the same time, cognitive capacity. Don’t hesitate, just get it done.
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Dr. Michael Gordon is Medical Program Director, Palliative Care Baycrest Geriatric Health Care System in Toronto, Canada and Professor of Medicine, at the University of Toronto.
Dr. Gordon is the author of the engaging memoir Brooklyn Beginnings: A Geriatrician's Odyssey, published by I-Universe.
Brooklyn Beginnings is available in bookstores and online at: Indigo-Chapters, Amazon.ca, Amazon.com, Barnes and Noble and I-Universe
Moments That Matter: Cases in Ethical Eldercare: A Guide for Family Members, is available online at Amazon.ca.
His latest release is Late-Stage Dementia: providing comfort, compassion and care. It is available at Amazon and Indigo.
Visit Dr. Michael Gordon's website.
(This post was edited by MGordon_MD on May 16, 2011, 8:02 AM)
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