How Can a Trip to the Audiologist Reduce Your Risk for Dementia?

Hi, I’m Jim Cuddy and this is Ask the Hearing Doctors, and I’m joined today by Dr. Ana Anzola, doctor of audiology and principal of Hearing Doctors, the Washington D.C. area’s highest rated audiology practice with over 2,500 5-star reviews. Also joining us today, Dr. Keith Darrow, certified dementia practitioner, audiologist, and neuroscientist studying firsthand how the brain ages and what role hearing plays in the process. Anna, Keith, great to see you both. Thank you so much. So, Keith, let’s start. How did you become interested in hearing and brain health?

Oh, that one’s easy. My mother told me to do it. In all seriousness, that is half true. I was looking for a field to help others. I naively went off to college and said I’ll do social work, right? I wanted to be some sort of psychotherapist. Well, long story made short, once I found out that I would probably have to go to graduate school and go to college even longer, I said, “I don’t know if this is for me.” And then my mother said, “Why not take a class and learn about speech pathology and audiology?” Sure. That was it. That first class completely changed the trajectory of my life because I then not only completed my undergrad, I then went on for a few more years to obtain my clinical audiology degree and then went for another six years to obtain a PhD in neuroscience from both Harvard Medical School and MIT. So, it really is true what they say when you find something you love, it’s like you never work another day. And so I stumbled into it. But along the way, I’ve become more obsessed with the concept of how the ear and the brain interact because not only the literature and the research about how hearing loss impacts our ability to think and cognition, but I saw it firsthand. I saw firsthand the demise of my own grandmother and how she lost vision, she lost hearing, and sure enough, the dementia was quick to follow. And so I had this single case study right in front of me wherein my grandmother was dealing with sensory impairment that was absolutely leading to that dementia and just watched her whittle away. And so I feel like it’s now my mission to help educate others on what is dementia? Is it preventable? If so, how can you do it? So on.

Talking about some of the different side effects of hearing loss. Dementia to me seems to be kind of the end game in the whole thing whereas there are a lot of other almost steps towards it if you will.

Yes, so the way I think about it is, if you’re a patient, a person listening to this, I want you to think about these five symptoms, right? So, are you struggling to understand what other people say, did you ever have the sense of, I can hear you, but I don’t understand everything you’re saying? So, a lack of clarity is very common in people with hearing loss. And then I would ask, are you having difficulty in background noise? So, you go to a restaurant, it’s pretty loud, and it’s like you’re struggling to follow the conversation. That’s a sign that there’s a problem. Could it be that you have ringing in your ears? For many patients, that’s actually number one, where the tinnitus or tinnitus comes on first. That is a sign, a side effect of hearing loss. Then you have sensitivity to loud sounds, right? So you go to, like, a concert venue or a wedding, and it’s like it’s just so loud, but everybody else doesn’t seem to have a problem with it. And then finally, issues with memory. So, issues with remembering words, names. What did I do yesterday? Look, I think the average person calls it senior moments. So when you get to a point where you’re like, “I feel like I’m having too many senior moments, so something’s not right here,” well, that could be the hearing loss contributing to potential cognitive decline.

We’ve often talked, Anna, about get in early, get your ears checked regularly. People don’t get their ears checked regularly. You go to the dentist twice a year. You get your eyes checked every year, that kind of thing. People aren’t checking out their hearing.

Right and so that’s our mission here. So, I love the passion that he’s bringing to the conversation because I think that it’s our job as audiologists to be forward thinking about how we can help the person as a whole, right? It’s beyond the ears. I want to know what the brain is doing, how that cortical function of the brain versus what the ears of the hearing is doing, and how we can really help them create a very specific treatment plan for them. Because at the end of the day, that’s where we get the best outcomes.

From personal experience watching my own mother, there’s denial. My ears are fine. You’re not speaking up or you’re turning up the TV louder. Certainly signs that gosh, maybe I need to do something and get my ears checked. But the importance of doing that as soon as you notice, as opposed to putting it off, what do you see, Keith, on a daily basis in that regard?

The best prognosis for treating diabetes is if you catch it early. The best prognosis for cancer is if you catch it early and treat it early. Well, same thing for hearing loss, right? Except most people don’t put hearing loss up on that pedestal. Yet hearing loss is the number one sensory disorder on the planet and it’s listed number three, third most common chronic condition affecting older adults. I think the issue is, is too many people think it’s normal for my age and this is just what’s supposed to happen, not realizing the side effects, right? So, the side effects being the social isolation, the cerebral atrophy, right? Which is a big fancy word for people with hearing loss. They may have loss of the size of their brain. The brain could actually shrink in somebody with hearing loss, which is a very hallmark feature in a brain that has dementia and then there’s this cognitive overload, which is like working really hard to follow a conversation and so those three factors are really what bring together the strong links of hearing loss and cognitive decline.

The research that’s out there and some of this is more than ten years old, which is fascinating to me that we’re still struggling to get people to come in and see an audiologist and get your ears checked because the research is out there. But things like 40% cases of dementia are maybe not preventable, but you could at least curb it, slow it down?

Considered preventable. Those are the words from the landscape, which is the European Dementia Commission, the publisher report in 2017 and then again in 2020. But I want to back up for a second. So, I appreciate that you know that there’s been data around for ten or so years. The very first indication that people with hearing loss have something cognitively happening to them is over 50 years old. Right? There was a paper that came out in the 80s that made a very bold statement that this group of people over here that have hearing loss seem to have higher rates of cognitive decline and dementia. But that paper was kind of ignored. Then fast forward to 2011. John Hopkins, an indisputable leader in healthcare and research, put out the report, and I’m going to summarize it. Hearing loss increases your risk of cognitive decline in dementia by 200% to 500%. Like, let that really sink in. So, people who say, “Oh, I just have a mild hearing loss,” I say, “Okay, so you’re only a 200% increased risk of cognitive decline in dementia.” That’s how serious it is. And I think that’s what gets at the catch it early and treat it early because if we can treat it early, perhaps we could curb your inclination or your disposition to developing decline and dementia.

We often talk about or you hear about, you read about, if you change your diet and your exercise routine and that kind of thing, you can in fact, there are plenty of studies that say you can prevent illnesses or you can get over illnesses more quickly. Is there anything that would suggest diet and exercise would aid in hearing loss and or dementia?

I mean, a healthy diet, healthy exercise, these are really important things, right? But let me summarize, because what I really love that came from the Lancet Commission report again, 2017, updated in 2022, two facts that I think everybody needs to know. 40% of cases of dementia are considered preventable so the way I always try to illustrate that to people is imagine a room filled with 100 people that have dementia. 40 of them didn’t have to be there. Maybe my grandmother, I always say if I knew then what I know now, maybe I could have helped her to prevent it. So, that’s probably one of the most important things for people to realize. Dementia is considered preventable in 40% of cases. Now the follow-up question is what do I got to do to be part of that 40%? I don’t blame you, but if you ask the average person, just stop somebody on the street going by and say, “Hey, what do you think it takes to prevent dementia?” I got to eat better, sleep better, exercise. All true. But what the report put out was twelve modifiable lifestyle factors. So twelve things that have been shown in the literature, if you do them they will significantly reduce your risk of cognitive decline and dementia. Guess what’s number one on the list of twelve modifiable factors that you can do to reduce your risk of cognitive decline and dementia? Tell them.

Treating your hearing loss. That is the number one modifiable risk factor of cognitive decline. So hey, if I can treat it and I can help our patient and their family, it’s huge, I’ve done my job.

Right. And get this one. Sorry, but treating hearing loss is on the list, right? It’s actually number one on the list. Well, I guess what else is on the list? Social integration, which treating hearing loss allows people to reintegrate, to not be socially isolated. We also know that treating hearing loss helps people be more physically active. Guess what else is on the list? Being more physically active. If you’re more physically active, you may be able to reduce your diabetes, cardiovascular disease, all on the list. So, I really come from a holistic standpoint as does the Hearing Doctors of treat the whole person. So yes, we’re going to treat your hearing loss and we’re going to address that issue. But the downstream effects of being able to not only reintegrate but live a healthier and better life. I really believe in my heart that it has a cumulative effect to not only increase quality of life but really help keep dementia at bay.

Like I said in the beginning, all of those things sort of it’s like a step ladder towards dementia. If you take care of all of these things you don’t have to get to that last step, right? Now Anna, you are also a certified dementia practitioner and I know that when folks come in here, it’s not just about checking their hearing. There’s a lot more to what you can offer somebody who’s having hearing loss. There are other things that you are able to do and test here.

Yeah, so it all started with education, everything starts with education, right? But to me I thought I need to empower myself with more education so I can really do the best job that I can for the most optimal outcomes for our patients. And our patients find it quite interesting that I know how to travel through the journey that is going through with empathy. And I think that’s really important and critical. And we take the time to also educate our staff so that they actually know how to talk to them on the phone, how to do it in person and with their family members.

And I want to compliment Dr. Anna because I’ve worked with a lot of hearing healthcare providers, but you’ve really invested in yourself and in your team on really understanding how hearing loss interacts with the brain, how hearing loss can increase the risk of cognitive decline in dementia. And she must be applauded because part of your regular protocol is actually doing cognitive screenings to look at… Is my patient at increased risk? Not only because of their hearing loss, but what about other factors in the way they process, which can help with a referral to a neurologist or a primary care physician and potentially catch it early and treat it early.

Yeah and that’s really key. So, we have a much better relationship with our referring physicians because they really do appreciate that extra information so that they can actually treat it earlier too.

And the families that come in here with their loved one and the loved one themself, once things are moving along and we’re heading in the right direction, I would imagine there’s a great sense of relief there as well.

Sure, absolutely. And we do it with every patient, every patient that comes through our doors. We do it, we measure the improvement which is really great because we know this is where we started without hearing aids or a hearing device or tinnitus for that matter. And then you start showing improvement and that is really critical for us.

This has been eye opening to me especially when you think I’m one of that crowd that would say, “Well you can’t treat dementia. You can’t really do anything. You can’t prevent it.” We’ve learned a whole lot today and it all starts with just getting your ears checked and do it regularly.

Absolutely.

How often should somebody go see an audiologist?

I’ve got a little catchphrase that you should get your first hearing test when you turn 50. And you know how to remember that? Ears and rears because that’s what we do when we’re 50, right? So, you’ve got to check up here, you got to check down there. And so that’s really your first opportunity to get in. Now here, all joking aside, the average, get this one, the average patient who’s diagnosed with dementia sometime in their early 70s, it is fully understood by the scientific community that that dementia has been brewing. Pre-symptomatic is what we call it. Pre-symptomatic dementia has been building for the last 20 years. So, it’s not like it’s just I mean, they may be showing outward signs only for six months or a year, but it’s been building. And so that real critical window is thought to be between about 50 and 70. So, it’s really important to catch your hearing loss early and treat it. And here’s another not so well known statistic. The average age of a patient who starts treating their hearing loss is also in their early 70s. And guess when that hearing loss started. In their 50s.

Wow.

So, I mean, you know, I don’t want to make any, you know, bold assumptions or statements, but those timelines align almost perfectly. And so I feel like our job is to help let people know get your hearing tested early. And the great news is when we catch it early, we can treat it early. You have a better prognosis, and you will have a better quality of life.

It’s just about making an appointment.

That’s it.

It’s not that big a deal. And yet it’s a really, really big deal for what your life can be versus what it shouldn’t be. Anna, Keith, thank you both very much. Appreciate you.
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