More on Hearing Loss and Dementia

I posted recently about hearing loss and mental decline.  Today I discovered author Katherine Bouton whose book, Shouting Won't Help, will be published on February 17th.  While reading a little more about her, I came across the following article which goes a long way to validate what many of us with hearing loss, and Meniere's disease specifically, affectionately call brain fog.  Though it is what I imagine dementia might feel like.

Could Hearing Loss and Dementia Be Connected?
Interview by PAM BELLUCK
Published: February 11, 2013

This interview has been edited and condensed for space.


PAM BELLUCK: I’m Pam Belluck, I’m a health and science writer for The New York Times. And this week, I am interviewing Katherine Bouton, who has been a long time editor for The New York Times and it now a contributing writer to our science section. And she has written a book called, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You.” And it’s a look into her own personal journey with hearing loss and a look into the research behind hearing loss. Katherine has written a piece that looks at a very interesting and surprising connection that some scientists have found between hearing loss and dementia. Katherine, first of all, welcome to the podcast, thank you for joining us.

KATHERINE BOUTON: Thank you very much.

MS. BELLUCK: And why don’t you tell us a little bit about what the scientists have found here.

MS. BOUTON: In studies over about the past…beginning in 2011 and continuing now—a new study was just published last month—is that there seems to be a strong association between hearing loss and both the earlier onset and more serious degree of dementia even with milder hearing loss, but especially with very severe hearing loss. For somebody like me who has a hearing aid and a cochlear implant but I still don’t hear very , this is alarming news.

MS. BELLUCK: All they have found at the moment is what’s called an association. So we don’t have any kind of causal connection—either that dementia either causing hearing loss or vice versa. But they do have three interesting theories about what could be happening. Could you lay those out for us?

MS. BOUTON: Okay, I should mention that the primary researcher on this is Frank Lin, who is at Hopkins and his database are two or three different long-term epidemiological studies. The first was based on the Baltimore Longitudinal Study of Aging. I went to see him after that first study was published and he had three things to offer.

The first made a lot of sense. It was that people with hearing loss tend to isolate themselves and isolation is a risk factor for dementia whether you’re hearing or hearing-impaired.

The second is something that he calls cognitive load — and which I call cognitive overload. What happens is that when you aren’t hearing very well, even with corrected hearing you’re trying so hard to hear the person that it makes it very hard to actually listen to what the person is saying. It’s very hard to absorb the information. When I did my interviews for this book – and I did a lot — I taped all of my interviews and I had someone else transcribe them because I couldn’t hear the tapes. I went and I got my transcriptions back I was constantly surprised by what I had asked, what I had heard, what they had answered. Every interview was like doing the whole thing fresh twice over.

The third possible explanation is the one that is most alarming and it’s the one that scientists like Dr. Lin and others are beginning to look at, and that’s that there’s an underlying pathological mechanism that has an influence on both hearing loss and dementia. It could be something environmental. It could be something genetic. They just don’t know.

These studies so far have relied on self-reported use of hearing aids. The next study that Dr. Lin is doing — he’s submitted a grant application now — is to specifically study how hearings aids are used, how often they are used, how carefully they were fitted, how much continual contact with the audiologist there is, whether the hearing-impaired person uses any assistive technology in addition to the hearing aids or the cochlear implant.

MS. BELLUCK: I’m interested in what you’re saying about corrected hearing. You are somebody wearing a hearing aid and a cochlear implant and according to the research that would not necessarily make a difference here. According to his research so far, people who are wearing hearing aids — it didn’t protect them from getting dementia. So does that tend to suggest some support for this idea that there being this underlying biological mechanism that might cause both?

MS. BOUTON: First they have to determine what the real relationship is between correcting hearing and the development of early or serious dementia. So far, the questions about the uses of hearing aids have been answered anecdotally by the participants in the study. What Frank Lin and his colleagues are going to do now is a serious prospective study about how people use their hearing aids, how often they use them, how well they were fitted, how often they go back and have them reprogrammed, where or not they use assistive devices like FM systems and looping, which in effect augment the use of hearing aids and implants — until they can really determine the role of hearing aids and the development of dementia the underlying causative factor remains a sort of outlying explanation.

MS. BELLUCK: An unanswered question. You open your piece with a kind of anecdote about your own sense of cognitive overload, as you call it.

MS. BOUTON: What happens is that you can’t really hear what the other person is saying and so you’re grasping for straws and basically trying to direct conversation in a way where you’ll be able to predict the answers.

I was at a party with my husband who is a literary editor and he was talking to a writer who I recognized and who I’ve met before, but who I figured didn’t remember me. And suddenly I found the two of us standing side by side. And this writer has had best-selling books and he’s very highly regarded and I have read his books and I wanted to talk to him about them. And I had a question about the second book — how it referred back to the first book.

And as I started the sentence I realized that I couldn’t remember the name of the second book and as I got half way through the sentence I realized I couldn’t remember the name of the first book either. So I stumbled through the sentence and said, ‘your first book, umm, umm, ummm…’ and he said — he gave me two choices. One of them I’d never heard of and of them was the book I was actually thinking of.

Last year, even, I would not have put myself in that situation. I would have just stayed home. I wouldn’t have gone to the party and that’s where isolation comes into this association with dementia as well because it’s very typical behavior just to say, this is too hard, it’s too embarrassing, I’d rather stay home and read a book.

MS. BELLUCK: Now, did you explain to him upfront that you have hearing loss and wouldn’t be able to hear him?

MS. BOUTON: I did, but I don’t have any visible signs of hearing loss and I tell people but I think they simply can’t comprehend what I’m saying. And this is one reason I wrote the book. It’s because I think people do not understand what so many people in the United States, and around the world for that matter, what their life is like on a daily basis. Serious hearing loss — it’s something you can’t just try it out for yourself. You can’t put earmuffs on and go outside and see what it’s like because it’s not just that you can’t hear, it’s that what you do hear is distorted. You hear every single thing that’s going on in the room, in addition to whatever you can grasp of the speaker’s voice. You hear some kinds of sounds louder than other sounds. In my case I mostly hear the things — like a glass being put down on the table is like an assault. So, going out is difficult.

Even now, I have a dog that I walk in the park a lot and somebody will say to me, ‘What’s your dog’s name?’ and I’ll say, ‘He’s three years old.’ [Laughter.] It’s windy in the park. It’s hard to hear when it’s windy because it makes noise on your hearing aid. But, I usually just guess what it is: ‘What’s your dog’s name?’ ‘How old is your dog?’ ‘What kind of dog is that?’ They all sound about the same to me. And I take a chance on getting it right — one out of three times.

MS. BELLUCK: Well, you’re doing a great job with this interview, which we are doing across a table probably separated by about four feet.

MS. BOUTON: Well, I’m looking directly at you. And being able to read lips and hear at the same time is the optimal way to hear. There’s a term for it, it’s called the McGurk-MacDonald effect. It means that you hear bi-modally, so that if you can hear, and see and even better, hear and see and read, as you would do in captions on a TV, your hearing is optimized.

MS. BELLUCK: So, just to circle back to the subject of this piece, which is dementia, I would imagine that that’s something of great concern to you, you’re 65 now. What are your thoughts about whether you have increased risk for yourself?

MS. BOUTON: Yes, I do worry about it. My mother, who has perfect hearing at 88, has very severe dementia. So I would worry about dementia anyway from a genetic perspective, but these studies have given me additional reason to worry about it.

MS. BELLUCK: Is there anything else you would like to add?

MS. BOUTON: First of all, the number of people with hearing loss in this country is astonishing. Approximately 48 million people in this country have hearing loss. Of these 48 million people in this country with hearing loss, from mild to profound, by far the majority have sensorineural hearing loss, which is the hair cells are damaged in your inner ear. And that causes eventual deafness. By far the majority of this kind of hearing loss can be avoided. It’s all noise-related hearing loss.

And one of the things I do in the book is talk about how noisy our society is. We have a real love affair with noise. If you’ve gone into any restaurant recently you’ll know how loud it is. If you were at the Super Bowl and you weren’t wearing earmuffs, you were probably deafened. Stadiums deliberately amp up the noise. Restaurants deliberately amp up the noise. It’s a very dangerous environment and unless we do something to control the amount of noise we’re exposed to on a daily basis, this rate of hearing loss is going to go on. And if these studies between hearing loss and dementia turn out to be accurate, as we get older that means a really considerable number of people having earlier and more serious dementia, which is — it’s bad for them, but it’s a huge cost factor in terms of public health.

MS. BELLUCK: Absolutely. Well, Katherine Bouton, thank you so much for joining us, for writing this article, which is fascinating and worrisome. Katherine Bouton is a former New York Times editor and currently a contributing writer to the science section. She’s author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You.” Thanks so much.

MS. BOUTON: Thank you.