Alzheimer’s|Dementia, Poor Hearing and Language Confusion

hearin-aidAlzheimer’s/Dementia, Hearing and Language

Several years before my Mom was diagnosed with Alzheimer’s, my brother contacted me about Mom’s behavior at a family gathering (which I did not attend.)

He stated that he’d tried several times to have a conversation with our mother to no avail. She would either talk in circles, having no idea what my brother was saying despite his repeated attempts to make a simple point clear. Her answers were inappropriate and her comments didn’t match the conversation in progress.

My mom had worn a hearing aid for many years and both my brother and I agreed that it probably needed testing and perhaps an upgrade. I hadn’t seen any signs of confusion in my own conversations with her, but our topics of interest were pretty much the same all the time, so Mom could easily talk to me with her ears closed.

However, as I thought about it, she had been more intent on facing me as we spoke as of late, yet I assumed most people who wore hearing aids did their fair share of lip-reading and dismissed any thought that mom needed anything more than a new battery for her hearing aid.

Later in the week, I made a point of checking the batteries in Mom’s hearing-aid only to find that they were properly charged.

That very week, I scheduled an appointment with a specialist for a complete check of Mom’s hearing and her hearing-aid. Her protests to such testing were a little puzzling as Mom never had an issue with doctor’s appointments which always meant lunch at her favorite restaurant afterward.

During the hearing test that day, I gained quite an insight into Mom’s hesitancy to have her hearing tested at all.

  • I was shocked to learn that Mom was totally deaf and when her old hearing-aid was tested it was totally dead as well. The battery was fine, but the hear aid itself was no longer working.  Not a single sound could be heard from that antiquated hearing-aid even with brand new batteries.

When I stood directly behind Mom, where she was unable to read my lips, there was no reaction to my voice at all. She could not hear a word said.

  • I was stunned, remembering that Mom had worn her hearing-aid religiously and touted the benefits of that hearing-aid on a daily basis.

Yet, it had all been a ruse, Mom had to know she was totally deaf, yet she resisted a doctor’s appointment or new hearing aid to bring her back into the “hearing world”. It seemed a complex and confusing proposition to me.

With the assistance of a temporary hearing-aid, Mom was given another test. The hearing specialist spoke 100 words, one at a time, while Mom repeated each word that she actually heard. Mom failed to repeat a single word correctly. Not one word repeated correctly out of 100! And Mom was wearing a hearing-aid that did work!

I later learned that such hearing problems often show up as an inability to understand speech against a background of other conversations, sometimes called the “cocktail party effect.” Amplification with hearing aids does not help this form of auditory defect.

The specialist who worked with Mom said Mom no longer recognized the sounds of consonants at all. As hearing loss progresses, the comprehension to hear and understand consonants and their sounds is the first to be lost. So when a word was repeated, Mom could only guess which “consonant” sound might be used, thus guessing wrongly on all 100 words.

The technician reassured me that a good electronic hearing-aid worn at a recommended sequence, might assist Mom in a return to hearing and the recognition of consonants. But the affirmative message was offered with a warning–some patient’s are deeply opposed to a return to hearing when they’ve learned to adjust in their silent world so well.

I found that hard to believe and never considered that my mother would choose a silent world over her cheerful friendships with other people.

Unfortunately, Mom was one of those in opposition to returning to a “hearing world.”

On the way home the very first day with her brand new all electronic hearing-aid, Mom removed it in the car because my auto air-conditioner’s buzz was deafening to her. A buzz, I might add,  that I had never heard and strained to hear after Mom grudgingly  acknowledged its existence.

Her prescribed schedule was to wear the new hearing-aid 4 hours a day for 3 days a week. And only 2 hours on weekends. Once they became accustom to hearing again, the technician said, they would gradually begin to wear the hearing-aid all the time.

Mom wore it if family was present, because we insisted, but she never wore it when she was alone. She read lips so well that I hadn’t known she was deaf and she continued to function well enough without the hearing-aid that she never wore it in the “Group Home,” where she finally resided.

Though Mom had not been diagnosed at the time of that hearing test, I wonder if the confusion in her answers of the 100 words was from dementia, rather than a lack of hearing consonants as the technician projected.

In a study of 313 patients at least 71 years old, several measures of central auditory processing were impaired in those diagnosed with Alzheimer’s disease and, to a lesser extent, those with memory impairment but not meeting criteria for Alzheimer’s, reported George A. Gates, M.D., of the University of Washington, and colleagues in a recent issue of Archives of Otolaryngology and Head and Neck state that: Central auditory processing is the brain function involved in interpreting complex sounds such as speech “Hearing speech involves detection, recognition, and comprehension, the latter being clearly a cognitive task,” said Dr. Gates.

Another paper from the same group has been accepted by Ear and Hearing for publication this fall, Dr. Gates said. “This leads me to believe that it is the brain effect on hearing that is the major problem in the elderly and wearing a hearing aid does not help,” he said. The study was supported by the National Institute of Deafness and Other Communication Disorders and the National Institute on aging.

So for me, the question still exists.

Does Dementia appear first and impair cognitive thinking, or does hearing loss appear first and impair cognitive thinking by the elimination of consonants and thus, cause Dementia. As with the chicken and the egg, we don’t know which comes first.

My brother and I have both discussed this issue and he has determined to have his hearing checked and get a hearing aid since he is having minimal hearing issues. So far, I don’t have hearing issues, but if I do, I believe I will follow his lead and seek hearing aids right away.

Even if Alzheimer’s or Dementia weren’t involved, it broke my heart to see Mom try so hard to wear the new hearing aid. She just couldn’t do it. She’d adjusted to a silent world. If a good hearing aid is sought at the first sign of hearing loss, that can be avoided.

And, I know from my own mother that it was gradual,  many years of ignoring a continuing loss of hearing until she finally existed in a silent world. I’m certain she never realized she would one day be completely deaf.

If you’ve had any experience with hearing loss and symptoms of Dementia, I’d surely like to hear what you think on this issue. Feel free to leave Feedback or Comment!

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Comments

  1. Merry says

    My mother is 81 and has been diagnosed with Alzheimer’s. before that official diagnosis by a Neurologist, she was diagnosed with hearing loss and started wearing a hearing aid. She has not worn that aid in at least a year or longer. I am saddened to really learn how vital it is to consistently wear the aids. It is difficult to know what is hearing loss related, dementia, and drug side effects.

    • ~ Sandy says

      Hello Merry,
      Oh, I hear you on this one. My Mom did the exact same thing. When she lost the desire to wear her hearing aid, her dementia escalated exponentially. On one of her appointments with the hearing specialist, they showed me a graph of how quickly they lose their ability to follow a conversation after they stop wearing their hearing aid. Eventually, Mom would hide hers and absolutely refuse to wear it.

      I was so sad for her because a few family members stopped visiting because she could no longer converse well without her hearing aid.

      The longer they wear their hearing aid, the better off they are– I believe.

      Thank you for commenting and I do understand your sadness in this situation–

      ~Sandy

  2. Tricia says

    My father, 74, has worn hearing aids since he was 60. Within the past year, he was diagnosed with Alzheimers. While his hearing aids were certainly never perfect, they allowed my dad to engage in conversation and understand what was going on around him. This summer, his hearing seems noticeably worse. He is confused and it is difficult for him to engage with others. (For instance, yesterday I went with him to negotiate a car lease. I am very glad I went because it seemed he really could not hear anything! ) After trials with 8 different hearing aids, nothing has worked to improve it. The audiologist infromed him that his hearing is the same according to the hearing test as it has been for several years. The problem seems to be the connection of the hearing to his brain. Does this sound familiar? Everything I read online talks of hearing loss in Alzheimers patients, hearing aids etc. But I do not see much about this “hearing loss” being more associated with the connectivity to the brain etc. I am somewhat new to this so any insight you can provide is very much appreciated!
    Tricia

    • ~ Sandy says

      Tricia,
      The experience with your father sounds so similar to mine with my mother.
      Eventually, Mom refused to wear her hearing aid even when they programmed a new one specifically to her recommendations.

      She did many antics with that hearing aid (stomped on it, flushed it down the toilet, etc.) before I finally gave in to the fact that she preferred deafness.

      It was almost like no language at all was better than the confusing gibberish she heard from everyone around her. She simply refused to deal with it. She didn’t associate it with her hearing but that everyone else talked too fast or talked nonsense. She would say.

      Occasionally she’d put the hearing aid in when I visited, but she was very good at reading my lips. Still–our conversations were very disjointed.

      Eventually, my brother’s visits with my Mom became further and further apart and mostly because she could no longer have a sensible conversation. And this was before her diagnosis with Alzheimer’s. Very very sad. We felt like she was just giving up on language.

      Best,
      Sandy
      By the way, I did mention this to every doctor she visited, but none seemed to think there was a correlation.

  3. says

    I think you are right on target with you thoughts on hearing loss. In my own family, we had a similar experience with sight issues. My grandfather who had Alzheimer’s disease would complain that he couldn’t see, and a few minutes later, pick up a straight pin that had fallen unnoticed on the floor. Sometimes, his brain functioned properly and interpreted the things his eyes saw correctly. Sometimes, what he saw did not register with his brain. It’s such a tragic disease.

    Ellen Potts
    Co-author, A Pocket Guide for the Alzheimer’s Caregiver

    • ~ Sandy says

      Hello Ellen,
      That does sound familiar. Your grandfather with sight issues. All the senses are affected, I suppose. You know, it’s so very sad to think of all the experiences that our loved ones may have had and we weren’t even aware. They had to feel totally confused.

      Sandy

  4. says

    Thanks for this post. My mother was diagnosed with vascular dementia (early stage, but moving quickly to middle stage). She started out with mild hearing loss a few years ago — she is now 81 — and it’s gotten worse right along with her dementia and other health issues. We took her to buy state-of-the-art hearing aids to replace the outdated ones. But she refuses to wear the new ones, and only wears the old ones when she is with guests.

    The audiologist told us that people with hearing loss MUST wear their aids around the house — even when they are alone. This is especially important for dementia patients, she advised. Apparently the brain needs the information and stimulation from sounds in the daily environment. This helps the brain process information and keeps it more active. When dementia patients live in their silent world, they are missing all of these important sounds and cues. And things get worse from there.

    Another problem: the new hearing aids we got for my mom — $6,000 !! — require some getting used to. They self-modulate the sound, but my mom just doesn’t like them. She refuses to take the time to get used to them, and keeps going back to the old pair — and doesn’t wear those regularly. We have tried to explain that the aids will HELP her dementia but she denies the dementia diagnosis and blames it all on her meds. My heart goes out to other caregivers who must live with this horrific frustration. It’s to the point where I (and many of Mom’s friends) don’t even want to spend time with her — saddest of all.

    • ~ Sandy says

      Hello Cindy,
      Your situation sounds so much like what I went through with my Mom. My mom hadn’t been diagnosed with Alzheimer’s yet, but I do believe she had dementia while we blamed her issues on poor hearing. Yes, we purchased the best hearing aids we could find–yet she refused to wear them. They told Mom she would adjust to them gradually, if she’d only wear them a couple hours a day. But she would not.

      The audiologist explained the same thing to me; without hearing, the brain would lose it’s ability to understand language. And–that’s exactly what happened. My brother would get so discouraged because Mom could no longer carry on a simple conversation and his visits eventually slowed. Her friends, too, could not make sense of conversations with her. Very sad situation. I certainly understand how you feel.

      I felt like I could add “quality years” to her life with the hearing aids– but totally helpless to make her wear them, or even understand how important they were.

      It is so sad. I know. I certainly understand. When you’ve fought this disease, you have so much sympathy for others struggling with their loved ones. It’s baffling and heartbreaking in so many ways.

      My thoughts and prayers are with you. I hope you are able to help your Mom understand about wearing those hearing aids. They are vital.

      Sandy

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