Recent studies linking cognition and hearing have made headlines, causing some members of the public to catastrophize the relationship between the two, missing the nuances of the data and what it means. This roundtable discussion addresses the misunderstandings around the connection between hearing loss and cognition and the best ways for hearing care professionals to communicate with their patients (and potential patients) about this important topic.
Participating in this discussion are The Hearing Review advisory board members Douglas L. Beck, PhD, CCC-A, F-AAA; Marshall Chasin, AuD; and hearing health advocate Shari Eberts.
The Hearing Review: It seems that many people are missing the nuances of studies that have come out recently about the connection between hearing loss and declining cognition. Why do you think this is?
Douglas L. Beck: I think it’s a lot of misunderstandings. The core issue (to me) is that I have never heard a licensed healthcare professional say “Hearing loss causes dementia.” That is simply wrong and that is where the negativity comes from, as best I can tell.
I’ve been writing and lecturing and researching this issue for more than a decade and what I say (and what many other audiologists say is), “Untreated hearing loss in people at risk (people with moderate or worse hearing loss, people with less education, people with comorbidities, people with poly-pharm issues, etc.) tends to exacerbate cognitive decline.” That is the wording I use, and it is in accordance with many longitudinal studies, including the ACHIEVE study (Lin et al, 2023), which look for correlations over time.
Of course, one might say “There are no studies showing causation!” And that is correct. These are all correlational studies based on thousands of people over many years, and these are strong correlational studies. Similar to cigarettes; we all know how bad smoking is, but we don’t have causative studies there, either. For example, we cannot say cigarette smoking causes lung cancer, as most smokers simply do not acquire lung cancer. Although the correlation is high, and although reasonable people would realize the obvious association, those are correlations, not causation.
If we waited for causal studies addressing the dangers of cigarette smoking, we’d all be smoking!
Marshall Chasin: If we were in any other field, say, if we were epidemiologists, the correlation between hearing aids and cognition would be way down the list of things to worry about. Diet, smoking, physical exercise, participation in social groups, excessive alcohol consumption, and chronic conditions such as hypertension, diabetes, obesity, depression, and loneliness are all significantly more important to lead a healthy life for a senior citizen than is hearing. Communication is quite important, and hearing is only one element of communication.
Many researchers have grappled with this potential link for decades and are really not that much closer than they were in the early 2000s. Even well-defined randomly controlled studies such as the ACHIEVE study only show a slight fraction of one standard deviation in their data. But people are more than their ears and these nuances are what many of my colleagues may be missing.
Eberts: It is a complex issue, and a confusing one. One key detail missing in this question and many of the writings about the correlation between hearing loss and cognitive issues is the word “untreated.” There is no evidence that hearing loss itself causes cognitive decline. For example, a link between hearing loss and cognition is not found in the Deaf community, probably because Deaf people stay engaged socially within their community using alternative forms of communication.
The correlation that has been repeatedly found is one between untreated hearing loss and cognitive issues in people with hearing loss who remain in the hearing world. Why the link exists is unclear, but there are many possibilities: (1) additional cognitive load from working hard to understand speech, (2) isolation and weakened social networks because communication is harder, so avoided, or (3) a combination of the two.
More research is needed to clarify the relationship.
HR: What would you say to someone claiming that this misunderstanding is being used as a scare tactic to convince people to get their hearing checked?
Beck: I have never heard or seen this in actuality. It seems to me to be like Bigfoot or the Loch Ness Monster. Many people say they have seen him, but nobody has evidence. If any licensed healthcare provider uses scare tactics or misrepresents the situation, they should be reported (with evidence) to the local licensing agency for ethical issues.
Eberts: It is a valid concern that the link between untreated hearing loss and cognitive decline is sometimes misstated and used as a scare tactic, but persuading people to get their hearing checked is one thing. Purposefully mischaracterizing data to convince people to purchase expensive hearing aids is another. Positive messages about the importance of healthy hearing should also be used, but to be fair, these messages have historically not always been enough to drive consumers to care about their hearing health. A careful balance is needed.
HR: Are there positive effects that have come from people thinking hearing loss will lead to dementia?
Beck: As above, nobody says that and nobody should say “hearing loss causes dementia,” and so as I see it, there is no positive or negative benefit to misrepresenting that.
Chasin: There are positive effects because people are now more aware that they should have their hearing assessed by an audiologist who can assist in contributing to healthy aging for that person. The articles in the literature are not easy to read and may not be accessible by the general public. While in the audiology office, issues relating to diet and exercise can also be discussed.
HR: In your opinion, what are the best ways for hearing care professionals to communicate with patients about this important topic to set the record straight?
Beck: To me, the messaging is straightforward and should only be applied to patients who are at risk (people with moderate or worse hearing loss, people with less education, people with comorbidities, people with poly-pharm issues, etc.). Certainly not every patient.
The message which makes the most sense to me is this: Untreated hearing loss in people at risk tends to exacerbate cognitive decline.
Chasin: As a clinical audiologist this is always foremost in my mind: How can we best convey very complicated and sometimes contradictory information to our clients?
I would start our conversation with two pieces of information: (1) No link has been established between cognitive decline and hearing loss. At most, it’s a correlation, and a slim one at that; (2) In addition to improving their communication, they should learn to eat correctly, exercise, and join other social groups. A referral to a dietician or a social worker may be just as important as the recommendation of hearing aids or assistive listening devices.
Eberts: Hearing health is not just about ears. It is about overall health. When ignored and untreated, hearing loss is a risk factor for many health problems, including cognitive ones.
It is important to be clear. Having hearing loss does not mean you will develop cognitive issues, but when left untreated, hearing loss can lead to isolation and depression, known risk factors for many health conditions, including cognitive decline.
Caring for your hearing, just like you do your vision, makes it easier to stay engaged in the activities and relationships that you hold dear, creating a higher quality of life, and leading to better physical and cognitive health.
Featured image: Dreamstime
Are patients asking you questions about the link between hearing loss and cognition? How do you talk to patients about this topic? Sound off in the comments.
