Understanding The Link Between Dementia And Hearing Loss

Dementia isn't a disorder on its own, but a group of symptoms characterized by memory loss, confusion, cognitive and language impairment, and changes in mood and personality. It is often caused by changes in brain structure and functioning resulting from a number of conditions, including:

• Alzheimer's disease
• Lewy body dementia
• Vascular dementia
• Multiple sclerosis
• Brain injury/infection
• Alcohol use disorder
• Tumors

Alzheimer's Disease International (ADI) estimates approximately 55 million people live with dementia worldwide. Symptoms typically emerge in older adults over 65, but individuals with early-onset dementia may begin presenting symptoms in their thirties or forties.

There are several factors associated with a greater risk of dementia, such as genetics, certain medical conditions like hypertension and diabetes, and some psychosocial factors, such as stress and social isolation. 

Impact of hearing loss on cognitive functioning

Age-related hearing loss (presbycusis) is prevalent in older adults, affecting roughly one in three people between the ages of 65 and 74 in the U.S. Presbycusis can significantly impact several areas of an individual's life. For example, when individuals experience severe hearing loss, they may experience difficulty processing auditory information, which can lead to difficulties in communication, social interaction, and overall cognitive functioning.

Research shows that the ability to hear plays a critical role in cognitive processes such as attention, memory, and language comprehension. Untreated hearing loss is associated with an increased risk of cognitive decline, dementia, and other impairments as one ages. This may be due to the brain working harder to compensate for the lack of auditory input, leading to neural degradation and reduced functioning. 

Social isolation and cognitive decline

Hearing loss may be a risk factor for several conditions, including stroke, heart disease, anxiety, and depression. Also, cognitive stimulation and engagement can decrease when individuals with hearing problems withdraw from social activities and avoid conversations. Studies indicate that social isolation may contribute to a 50% increased risk of dementia. 

Signs and symptoms of dementia 

The signs and symptoms of dementia typically emerge slowly and become more severe with time. Primary symptoms tend to be associated with cognitive functioning, but dementia often presents in other ways, as well. 

Cognitive symptoms of dementia

Symptoms associated with cognition are often the most recognized in people with dementia and can cause significant disruption in daily life. These include:

• Memory loss. One of the most common symptoms of dementia is trouble remembering recently learned or basic information, such as names, dates, and important details. Someone with dementia may forget such information but remember it later on. 
• Concentration difficulties. Individuals with dementia might become easily distracted and have trouble completing familiar tasks due to a lack of focus. 
  
• Confusion and disorientation. People with dementia may become confused about time, place, or familiar surroundings. For example, they might get lost at the grocery store or forget how they got there.
• Changes in visual-spatial abilities. Dementia can affect how a person perceives space and depth, leading to difficulties with tasks such as driving or navigating familiar environments. 
• Trouble with planning or problem-solving. People with dementia might have problems making decisions, solving problems, or completing complex tasks. They may also experience challenges with organization. 
• Language challenges. Dementia can affect an individual's ability to express themselves and communicate. It might be challenging to find the right words or structure sentences coherently. People with dementia may repeat themselves often during conversations. Hearing loss may make communication even more challenging. 

Behavioral and psychological symptoms

Behavioral and psychological symptoms of dementia (BPSD) are common. However, they can be unpredictable, and presentation often varies between people. BPSD can significantly impact an individual's quality of life and, in some cases, that of their caregivers. BPSD symptoms include:

• Agitation/aberrant motor behavior: Restlessness, pacing, wandering, and repetitive movements.
• Aggression: Physical or verbal aggression toward others.
  
• Anxiety: Feelings of worry, fear, or unease.
• Depression: Persistent feelings of hopelessness and sadness, diminished self-esteem, and loss of interest in activities the person once enjoyed. 
• Elation/euphoria: Feelings of extreme or "manic" elation without an apparent cause.
  
• Disinhibition: Behaviors that are socially inappropriate or out of character. 
• Delusions: Strongly held (typically paranoid) false beliefs that aren't reality-based. 
  
• Hallucinations: Sensory experiences that aren't based on reality, such as seeing or hearing things that aren't there. 
• Changes in appetite/sleep: Changes in sleeping or eating patterns, such as insomnia, daytime sleepiness, and loss of appetite. 

Physical symptoms

Individuals with dementia and their caregivers may also expect to see some physical symptoms, including:

• Motor impairment: Dementia may cause coordination, balance, and movement difficulties. Individuals with dementia might experience problems with fine motor skills,  walking, or other physical tasks. 
• Muscle weakness: Individuals with dementia might experience muscle weakness or loss of muscle tone.
• Fatigue: Dementia can lead to increased fatigue and decreased energy levels. 
• Incontinence: Individuals with more advanced dementia might have difficulty controlling their bladder or bowels.
• Weight loss: Changes in appetite, difficulty swallowing, or forgetting to eat can result in weight loss in some people with dementia. 
• Changes in gait: Individuals who develop dementia may have difficulty walking steadily, which may lead to changes in gait, such as shuffling or dragging. 
• Trouble swallowing: As dementia progresses, some people may have difficulty swallowing food or liquids.
• Sensory impairments: Changes in vision or hearing can occur in individuals with dementia.
• Immune system complications: People with dementia might experience diminished immunity to infections and illnesses as the condition progresses. 

Seeking treatment

While there is currently no cure for dementia, there are treatments that can help manage symptoms and improve the quality of life of those affected. Dementia treatment is often holistic, involving a combination of medication, therapy, and lifestyle adjustments to provide the best outcomes. 

Hearing loss treatment may also require hearing aids and other active listening devices (ALDs). Research indicates that hearing aids reduce cognitive decline in some patients, making it essential for physicians to address both conditions in a treatment plan. 

Medications

Acetylcholinesterase inhibitors and memantine are commonly prescribed to help manage cognitive symptoms, improve memory, and boost attention/problem-solving abilities. 

Antidepressants or antipsychotic medications might be prescribed in the later stages of dementia to help patients manage symptoms associated with BPSD, such as aggression, agitation, wandering, delusions, and hallucinations. 

As part of a comprehensive treatment plan, some people may require medications for other health conditions that impact their dementia symptoms, including:

• Heart problems
• Stroke
• High blood pressure
• Diabetes
• High cholesterol

Some people choose to use alternative remedies such as curcumin and ginkgo biloba in combination with or in place of prescription medications for treating dementia. More research is required to determine if such products are effective for reducing dementia symptoms, and some of them may interact negatively with prescribed medications. Individuals considering such remedies should always consult with their physician first. 

Therapy

While medications are often a key part of treating dementia, therapeutic interventions can also be important for helping individuals improve communication skills, cognitive abilities, and overall quality of life. These might include:

• Cognitive behavioral therapy (CBT): This type of therapy focuses on changing negative or unhealthy thought patterns and behaviors to help an individual develop coping strategies for managing symptoms like anxiety or depression. 
• Cognitive stimulation therapy (CST): In CST, individuals with dementia often participate in group activities and exercises with other dementia patients to improve memory, language, and problem-solving skills. 
  
• Occupational therapy: This method focuses on helping individuals with dementia maintain their independence and ability to perform daily activities. Trained occupational therapists can provide strategies and tools for managing everyday tasks, such as personal hygiene, dressing, cooking, and other household responsibilities.
• Speech therapy: Speech therapists can provide techniques and exercises to improve speech, language, and swallowing abilities as the condition progresses. This can help individuals with dementia communicate more effectively and maintain their ability to eat and drink safely.
• Reminiscence therapy: This type of therapy involves asking dementia patients to recall life memories and experiences to better connect with their personal history. Reminiscence therapy can help boost mood, self-esteem, and overall well-being in people with dementia. 

Lifestyle factors

Several lifestyle factors might help reduce the risk of developing dementia or slow its progression in people who already have it. These include:

• Regular physical activity: Regular exercise is a proven strategy for helping individuals reduce the risk of dementia or slow its progression, in addition to improving mood. 
• Proper nutrition: Eating nutritious foods can help support brain health and reduce the risk of dementia. Although nutritional needs vary between people, research suggests that a Mediterranean-style diet, including whole foods and healthy fats like nuts and olive oil, can help lower dementia risk.
• Quality sleep: Poor sleep has been linked to an increased risk of cognitive decline and dementia. Getting enough quality sleep is necessary for overall brain health and cognitive function.  
• Mental stimulation: Keeping the brain active and engaged can help improve cognitive function and reduce the risk of dementia by building and maintaining neural connections. Activities like reading, doing puzzles, playing music, and learning new skills are all examples of ways to cultivate better cognitive health. 
• Social engagement: Individuals with even mild hearing loss may experience challenges navigating social situations. However, maintaining relationships and staying socially connected can help reduce feelings of loneliness and isolation, which are documented risk factors for dementia. In addition to supporting cognitive functioning, social engagement can help improve mood and boost self-esteem. 
• Management of other health conditions: High blood pressure and cholesterol, diabetes, anxiety, and depression are all examples of conditions that can increase the risk of cognitive decline and dementia. Managing such conditions can be critical for cognitive health, mental health, and overall well-being.

Dementia and hearing loss present unique challenges.

Therapy can support the caregivers who navigate them.

Challenges of caring for a loved one with dementia and hearing loss

As dementia progresses, an individual may face challenges requiring higher levels of involvement. 

For example, some people with dementia lose the ability to do basic, everyday things like dressing, bathing, and completing household responsibilities as the disease progresses. They may have difficulty chewing and swallowing food, which can raise the risk of choking. Some people with dementia forget to eat or drink, which can increase the risk of malnourishment or dehydration. 

Difficulties with communication are a common characteristic of dementia, particularly for those with impaired hearing. Miscommunication can create significant complications and can potentially contribute to social isolation. 

Help for caregivers of those with dementia and/or hearing loss

Challenges like these can sometimes leave caregivers feeling overwhelmed and drained. Research is plentiful on the impacts of caring for a loved one with dementia. It may help for caregivers to take care of their own mental health by speaking with a therapist. Those who don’t have time for in-person therapy due to caregiving responsibilities may benefit from online therapy, With BetterHelp, caregivers speak to a licensed therapist via audio, video, or live chat. 

Research shows that online therapy can be effective for caregivers.  A study published in Clinical Interventions in Aging found that online cognitive behavioral therapy helped reduce distress in caregivers of individuals with dementia, in addition to reducing the behavioral and psychological symptoms of dementia in individuals they cared for.