288 Hearing Loss as a Potentially Modifiable Risk Factor in People with Mild Cognitive Symptoms Attending a Specialist Memory Service

Abstract

Background People with mild hearing loss at age 50 are twice as likely to develop dementia increasing to a five times greater risk for those with severe hearing loss. The prevalence of dementia and hearing impairment increase with age. Intact hearing enables cognition, facilitates social interaction and enhances communication. Hearing loss, social isolation and dementia are commonly interwoven. We recently commenced routine audiology screening in our memory service. Methods Consecutive patients with mild cognitive impairment attending a tertiary memory assessment and support service were referred for full audiology screening. People were routinely referred on basis of cognitive diagnosis, and not on the basis of perceived hearing loss. Assessment included ENT history, otoscopy, tympanometry, pure tone audiometry and speech audiometry to determine the presence, type and amount of any hearing loss present. This included speech discrimination testing – a functional test to determine processing of 10 phonetically balanced words with 100% being an optimal response. Results 20 people (12 women), mean age 72.3 (range 57-87) were assessed. The majority had amnestic MCI 18/20 (90%). 9/20 (45%) patients subjectively complained of hearing loss. 7/20 (35%) had history of occupational noise exposure. 12/20 (60%) had occlusion due to ear wax. Hearing loss identified: Mild 8/20 (40%); Moderate to severe 7/20 (35%); with Normal hearing in 5/20 (25%). High frequency hearing loss was noted in 19/20 (95%). Speech discrimination score was impaired in those with hearing loss: mean 89.4% (range 66-100). 6/20 (30%) received referral for hearing aids. Conclusion This study highlights the importance of incorporating an assessment of auditory acuity as part of memory assessment and post-diagnostic care-pathway for people with mild cognitive complaints given the established impact hearing loss has on the future risk for cognitive decline. Hearing loss is frequently unidentified and is a clear modifiable risk factor to promote brain health.

New horizons in hearing conditions

“…A 5th mechanism (the auditory brain) suggests that healthy ageing affects multiple stages of auditory processing, and that compensatory mechanisms in peripheral and central (executive control) systems may compensate until compromised by neurodegenerative pathology [ 32 ]. Hearing loss is ‘frequently unidentified and is a clear modifiable risk factor to promote brain health’ [p.iii17, 33 ]. Using data from five waves of the English Longitudinal Study of England and the Health and Retirement Study, Matthews et al.…”

Embedding audiological screening within memory clinic care pathway for individuals at risk of cognitive decline—patient perspectives

“…This highlights the importance of screening for hearing deficits in high-risk populations to identify patients most likely to benefit from intervention. In memory clinics where there is a blanket referral pathway for audiology assessment based on cognitive diagnosis, a significant amount of hearing impairment is identified [ 9 ], allowing intervention for an otherwise unidentified, key risk factor for cognitive impairment. With sensory interventions potentially improving not only cognition, but also quality of life and behavioral disturbance [ 10 ], auditory screening has the potential to meet a clearly unmet need.…”