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      Hearing and dementia

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          Hearing deficits associated with cognitive impairment have attracted much recent interest, motivated by emerging evidence that impaired hearing is a risk factor for cognitive decline. However, dementia and hearing impairment present immense challenges in their own right, and their intersection in the auditory brain remains poorly understood and difficult to assess. Here, we outline a clinically oriented, symptom-based approach to the assessment of hearing in dementias, informed by recent progress in the clinical auditory neuroscience of these diseases. We consider the significance and interpretation of hearing loss and symptoms that point to a disorder of auditory cognition in patients with dementia. We identify key auditory characteristics of some important dementias and conclude with a bedside approach to assessing and managing auditory dysfunction in dementia.

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          Most cited references 127

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          Hearing loss and incident dementia.

          To determine whether hearing loss is associated with incident all-cause dementia and Alzheimer disease (AD). Prospective study of 639 individuals who underwent audiometric testing and were dementia free in 1990 to 1994. Hearing loss was defined by a pure-tone average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear (normal, 70 dB [n = 6]). Diagnosis of incident dementia was made by consensus diagnostic conference. Cox proportional hazards models were used to model time to incident dementia according to severity of hearing loss and were adjusted for age, sex, race, education, diabetes mellitus, smoking, and hypertension. Baltimore Longitudinal Study of Aging. Six hundred thirty-nine individuals aged 36 to 90 years. Incident cases of all-cause dementia and AD until May 31, 2008. During a median follow-up of 11.9 years, 58 cases of incident all-cause dementia were diagnosed, of which 37 cases were AD. The risk of incident all-cause dementia increased log linearly with the severity of baseline hearing loss (1.27 per 10-dB loss; 95% confidence interval, 1.06-1.50). Compared with normal hearing, the hazard ratio (95% confidence interval) for incident all-cause dementia was 1.89 (1.00-3.58) for mild hearing loss, 3.00 (1.43-6.30) for moderate hearing loss, and 4.94 (1.09-22.40) for severe hearing loss. The risk of incident AD also increased with baseline hearing loss (1.20 per 10 dB of hearing loss) but with a wider confidence interval (0.94-1.53). Hearing loss is independently associated with incident all-cause dementia. Whether hearing loss is a marker for early-stage dementia or is actually a modifiable risk factor for dementia deserves further study.
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            The inevitable deterioration in hearing ability that occurs with age--presbycusis--is a multifactorial process that can vary in severity from mild to substantial. Left untreated, presbycusis of a moderate or greater degree affects communication and can contribute to isolation, depression, and, possibly, dementia. These psychological effects are largely reversible with rehabilitative treatment. Comprehensive rehabilitation is widely available but underused because, in part, of social attitudes that undervalue hearing, in addition to the cost and stigma of hearing aids. Remediation of presbycusis is an important contributor to quality of life in geriatric medicine and can include education about communication effectiveness, hearing aids, assistive listening devices, and cochlear implants for severe hearing loss. Primary care physicians should screen and refer their elderly patients for assessment and remediation. Where hearing aids no longer provide benefit, cochlear implantation is the treatment of choice with excellent results even in octogenarians.
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              Varieties of musical disorders. The Montreal Battery of Evaluation of Amusia.

              Multiple disorders of musical abilities can occur after brain damage. Conversely, early brain anomalies or vast brain injuries may sometimes spare ordinary musical skills in individuals who experience severe cognitive losses. To document these incidences, comprehensive behavioral testing is required. We propose to use the Montreal Battery of Evaluation of Amusia (MBEA) because it is arguably the best tool currently available. Over the last decade, this battery was developed and validated in populations with brain damage of various etiologies. Furthermore, the MBEA is theoretically motivated and satisfies important psychometric properties. It is sensitive, normally distributed, reliable on test-retest, and correlates with Gordon's Musical Aptitude Profile, another more widely used battery of tests. To promote its wide usage, the MBEA is now available upon request. In addition, individual MBEA data of 160 normal participants of variable age and education have been made available to all via the internet.

                Author and article information

                44 207 829 8773 ,
                J Neurol
                J. Neurol
                Journal of Neurology
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2 July 2016
                2 July 2016
                : 263
                : 11
                : 2339-2354
                [1 ]Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, University College London, Queen Square, London, WC1N 3BG UK
                [2 ]Department of Neuro-otology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
                [3 ]UCL Ear Institute, University College London, London, UK
                [4 ]Cognitive Disorders Clinic for the Deaf, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
                [5 ]Auditory Group, Institute of Neuroscience, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, UK
                [6 ]Central Auditory Disorders Clinic, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
                © The Author(s) 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funded by: FundRef, Wellcome Trust;
                Award ID: 091673/Z/10/Z
                Award Recipient :
                Neurological Update
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                © Springer-Verlag Berlin Heidelberg 2016


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