“There is nothing wrong with my memory.” This is often where we start with a new patient. Judy, a silver-haired, pleasant but tentative new patient, who appears younger than her 76 years, comes into the office for evaluation at the request of her husband, Tom. She is not happy with him- or with us. Tom explains that Judy’s memory is “not too bad but she seems different, more distant, not as aware of everything going on.” During large family meals, she will become quiet, “zone out” and often retreat to the living room while everyone still having conversation around the dinner table.
As the interview continued, it became apparent that Judy has no major risk factors for dementia aside from advanced age. However, during the visit she asks repeated questions. When we hit the topic of possible hearing difficulties, she becomes upset: “I can hear just fine. Tom calls to me from the next room, how does anyone hear that? He mumbles all the time, I tell him to speak up.” The evaluation, including physical examination of her ear canals, proceeds and it is highly suspicious for significant hearing loss, rather than memory loss. We even note that she seems to be reading lips during the evaluation. I make a deal with her. If we admit that her memory is close to normal, will she have her hearing checked? She is gracious, relieved and agrees to a hearing test.
Judy has second thoughts on the car ride home, “My hearing is fine. I don’t need testing.” We have prepared her husband for this change of heart and he points out she has “made a deal”. They schedule the hearing evaluation, although Judy is understandably skeptical. She returns to clinic two weeks later with subtle hearing aids in both ears. She says, “These hearing aids have changed my life and my perspective on life. I put them in as soon as I get up, and take them out to sleep. I was so worried about my memory and took it out on Tom for putting me through a memory evaluation and you for suggesting I couldn’t hear well. I’m just so relieved to know that it was all related to my hearing. Now I have to tell Tom to turn down the TV, I think he might need a hearing check! I owe you an apology.”
Hearing problems are very common as we age and can present similarly to memory loss. Folks become less engaged in conversation and withdraw when they are not able to keep up. Repeated questions relate to the fact that they didn’t hear you the first time, not that they didn’t remember. It is important to note, however, hearing loss is a marker for memory loss and cognitive decline. In our patients with dementia, well over 50% have significant hearing impairment. We are aggressive in recommending hearing evaluations in patients with early memory loss and are convinced it will lessen the decline. Social connection is vital to maintain cognition. Hearing loss reduces our ability to connect, therefore patients withdraw and become reluctant to participate in activities with family and friends. This can eventually lead to isolation. In patients with moderate to severe memory loss, hearing aids often get lost and it is more difficult to support the purchase of new hearing aids.
We introduced you to Judy to make you aware of how important hearing is in evaluating of memory loss and dementia. This was a great outcome for all involved. A deal is a deal!