[HN Gopher] Hearing aids slow cognitive decline in people at hig...
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Hearing aids slow cognitive decline in people at high risk
Author : gardenfelder
Score : 120 points
Date : 2024-01-31 17:47 UTC (5 hours ago)
(HTM) web link (www.nih.gov)
(TXT) w3m dump (www.nih.gov)
| gardenfelder wrote:
| > Hearing aids reduced the rate of cognitive decline in older
| adults at high risk of dementia by almost 50% over a three-year
| period.
| m3kw9 wrote:
| Sounds like if you stimulate your brain more your brian is less
| likely to "atrophy"
| Night_Thastus wrote:
| This seems to be backed up by a lot of other things. Social
| activity especially seems to be useful for preventing decline.
| magicalhippo wrote:
| Which to me shouldn't be that surprising given that we know
| neurons seek to connect with other neurons based on activation
| patterns, and that the brain stays plastic into old age.
|
| I've seen similar with movement. Once they break a hip or
| something which severely reduces their physical activity level,
| cognitive abilities usually go downhill fast. Part of that is
| probably cardio-related, but I've long thought it was related
| to lack of stimulus.
|
| Just doing the dishes or feeling the wind creates a ton of
| sensations, and may trigger memories, that sitting in a chair
| watching daytime TV just won't.
| jeltz wrote:
| I wonder if some of that could be solved via VR or even just
| video games. Not as good as the real thing but should be more
| mentally stimulating than passively watching.
| austinjp wrote:
| There's a ton of research into this idea, have a search on
| PubMed.
|
| Unfortunately it suffers from at least two problems.
|
| First, generalisable effects from specific interventions
| often fail to replicate, so for example subjects tend to
| get better at a specific task but it doesn't necessarily
| carry over to real-world contexts. There are a few
| promising potential directions, although even those results
| are modest and uncertain.
|
| Second, people with even mild/early signs of dementia are
| extremely unlikely to continue with an intervention. Even
| if they do they often modify it, e.g. unplugging a smart
| device to save energy, or taping over buttons to prevent
| accidentally pressing them.
|
| I would hunt out references but I'm on mobile, they
| shouldn't be hard to find.
| FrustratedMonky wrote:
| Seems like this is saying something different.
|
| If it was purely lack of hearing leads to atrophy and neural
| decay, then why are deaf not all just in steady decline and
| dying off?
|
| There must be more to it, why can't people that loose hearing
| later, learn sign language, and thus stay active, just like
| the deaf.
| Jensson wrote:
| > why can't people that loose hearing later, learn sign
| language, and thus stay active, just like the deaf.
|
| Did their friends and family learn sign language as well?
| People who are deaf young tend to get a social circle who
| can communicate with deaf people, while old people are
| unlikely to rebuild all of that.
| bluGill wrote:
| Very few adults learn a new language to a high level. It
| can be done, but most get to the level of ordering a beer
| and call it good if they get alcohol.
|
| If you don't need to use the language except for a one week
| tour (where you are still mostly with people who speak your
| language) this is good enough. However if you are suddenly
| without ability to communicate you probably can't suddenly
| learn fast enough to combat decline.
| magicalhippo wrote:
| Seems rather unsurprising, given what we already know of the
| brain. Though I guess specific studies like this is more
| actionable.
|
| Good thing hearing aids have become more affordable lately, from
| over-the-counter models to DIY style using cheap microcontrollers
| for developing countries.
| dblohm7 wrote:
| My spouse is an audiologist, and yes, she has told me (and of
| course her patients) this is very much a "use it or lose it" type
| of deal.
| loco5niner wrote:
| Would you be willing to clarify that? Is she talking about
| losing cognitive abilities when someone fails to get hearing
| aids when they should? I'm starting to deal with some hearing
| issues and would like to make sure to stay on top of this
| issue.
| TedDoesntTalk wrote:
| Use what or lose it? Hearing? Cognition?
| chaostheory wrote:
| Most likely hearing, but that's strongly related to
| cognition.
| sp332 wrote:
| Interesting that another Lancet paper on this topic was recently
| retracted. https://news.ycombinator.com/item?id=38894636
| AlexErrant wrote:
| The retracted paper discusses an _association_ since it was
| _observational_ :
|
| > We used Cox proportional hazards models to estimate hazard
| ratios... between self-reported hearing aid use status (hearing
| loss with or without hearing aids) at baseline and risk of
| dementia
|
| The top-level article discusses a _randomized controlled study_
| and therefore can make a much stronger claim of _causality_ :
|
| > The researchers randomly assigned participants to one of two
| interventions. About half received hearing aids and instruction
| in how to use them. The other half were assigned to a health
| education program focused on promoting healthy aging. Both
| groups received follow-up visits every six months to reinforce
| the training.
| augustk wrote:
| What about people who are completely deaf since birth?
| robg wrote:
| Different mechanisms, you're born with ~100x the amount of
| neurons you'll have as an adult, those normally used for
| hearing get adapted and trained on other stimuli.
| jauntywundrkind wrote:
| Make sure their glasses prescriptions are up to date & that
| they are engaged with the world (and not slipping away) too.
| wirrbel wrote:
| I would assume they compensate with other senses and so if they
| get blind at high age they are at equal risk.
| thomastjeffery wrote:
| There is no pre-existing neutral training in a newborn's brain.
|
| Adults who become deaf lose a stimulus that their brains are
| already trained to use.
| wirrbel wrote:
| Isn't that common knowledge? Or let me rephrase this: this can be
| observed by laypeople in their communities.
|
| I am glad that it's also scientifically studied if the body of
| evidence hasn't been large enough so far
| ben_w wrote:
| I suspect most people think that both are caused by old age,
| rather than that deafness causes (or accelerates) dementia.
| It's not like there's a well known group of congenitally deaf
| people who get dementia young to inspire a causal connection.
|
| My mum started noticeably losing her hearing _after_ her
| dementia symptoms got quite bad. She may well have lost her
| hearing sooner and we just didn 't notice, just as in
| retrospect there were huge warning signs of dementia well
| before the diagnosis and we just didn't realise what we were
| observing.
| joombaga wrote:
| May I ask what the huge warning signs were?
| ben_w wrote:
| Thinking I was born 3 years earlier than I was. Forgetting
| how to read maps. Higher anxiety causing her to ask me to
| drive dangerously _slowly_ , and in so doing revealing she
| didn't know the speed limit on that category of road.
| Forgetting to renew her road tax (I have no idea how she
| wasn't fined for that, given the rest of the family noticed
| this six months after it was due).
| jdietrich wrote:
| _> It's not like there's a well known group of congenitally
| deaf people who get dementia young to inspire a causal
| connection._
|
| Hearing ability and cognitive ability are significantly
| correlated, independent of age.
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8581793/
| ben_w wrote:
| The important point was "well known", in this context by
| the general population rather than to subject experts.
| bilsbie wrote:
| Alternate headline: people who take actions to be more social
| slow cognitive decline.
| jeltz wrote:
| Yes, but this is also a very concrete solution to encourage
| people to take more actions.
| rqtwteye wrote:
| It's not that simple. If you have hearing problems it can be
| quite difficult to be social no matter how hard you try.
| waterhouse wrote:
| A randomized intervention! Huzzah!
|
| > The researchers randomly assigned participants to one of two
| interventions. About half received hearing aids and instruction
| in how to use them. The other half were assigned to a health
| education program focused on promoting healthy aging.
| olliecornelia wrote:
| What are you advocating
| waterhouse wrote:
| I'm advocating that people do studies with randomized
| interventions--an approach that is capable of proving
| causation--and not being satisfied with purely observational
| studies that look at correlations, which are often hopelessly
| confounded and can't distinguish between "X causes Y" and "Z
| causes both X and Y". I was pleasantly surprised to find that
| this study was of the first type rather than the second.
| hombre_fatal wrote:
| While this take seems popular, this isn't a good way of
| looking at it because, in my experience, it seems to lead
| to the dismissal of good evidence or it suggests that we
| can't build confident causal inferences without a certain
| study. For example, RCTs are also observational, and it's
| incorrect to say they can uniquely detect causation.
|
| I think a more helpful way to look at research is to look
| for a convergence of outcomes across the evidence, like a
| bunch of needles of various sizes pointing in the same
| direction (or not) on a gauge. And where there are
| divergences, and there always will be, which differences in
| methodology can explain them.
| waterhouse wrote:
| > RCTs are also observational
|
| The key phrase is "purely observational". Now,
| occasionally you end up with a "natural experiment" in
| which some accident has effectively done the
| randomization for you--specifically, where the mechanism
| that puts people in the treatment group vs the control
| group is something you can be very confident has no other
| causal interactions. This was a good example: https://twi
| tter.com/PGeldsetzer1/status/1661776663074738176
|
| "Causal evidence that herpes zoster vaccination prevents
| a proportion of dementia cases [...] To provide causal as
| opposed to merely correlational evidence on this
| question, we take advantage of the fact that in Wales
| eligibility for the herpes zoster vaccine (Zostavax) for
| shingles prevention was determined based on an
| individual's exact date of birth. Those born before
| September 2 1933 were ineligible and remained ineligible
| for life, while those born on or after September 2 1933
| were eligible to receive the vaccine."
|
| But any time you're looking at a scenario where treatment
| vs non-treatment was the result of individual human
| choices, that opens up a potentially very wide range of
| ways for something you didn't know about (and potentially
| something difficult to accurately control for even if you
| do know about it) to cause treatment and cause the
| outcome, instead of the treatment causing the outcome.
|
| > it suggests that we can't build confident causal
| inferences without a certain study
|
| I do think there's an upper limit to the confidence you
| can justifiably hold, and that it's often not very high.
| Consider the studies that observe "A bit of alcohol
| correlates with better health than zero alcohol". You
| control for wealth, education, and maybe other things,
| and the apparent effect remains. How high confidence
| should you have in the result? Then someone realizes:
| Some fraction of people who consume zero alcohol do so
| under doctor's orders because they have health problems,
| and if you exclude those people then the effect
| disappears.
|
| No matter how many causal pathways you think you've
| controlled for, how confident can you really be that
| there isn't a new one you haven't thought of? (And
| controlling has its own perils: if your measurements are
| noisy, or if you end up controlling for the outcome.)
|
| > it's incorrect to say they can uniquely detect
| causation
|
| Oh, correlational studies can "detect" causation, but the
| hard part is being certain that the thing detected isn't
| a false positive.
| TylerE wrote:
| And it'll also include some number of alcoholics in
| recovery who are currently consuming no alcohol, but
| who's bodies have hard years on them, and you'd expect to
| do worse than overall population average in outcomes.
| LeifCarrotson wrote:
| I completely agree that randomized intervention studies
| have enormous value when compared to observational studies.
|
| In this example, it would be particularly hard to establish
| a causative relationship that said "hearing aids inhibit
| dementia" or "hearing loss causes dementia" if instead all
| you had was a population, some of whom used hearing aids,
| and some of whom had varying levels of hearing abilities,
| and some of whom developed dementia. In all the noise,
| you'd be very fortunate to find that a control group of
| people with undiagnosed (how would you ever measure that!)
| hearing loss who failed to get hearing aids had cognitive
| decline in excess of that experienced by those who did get
| hearing aids. Here, instead, the intervention is "the coin
| flip said you're in the hearing aid group/you're in the
| health education group."
|
| Of course, the murky ethical issue here is that this
| randomized intervention resulted in some people having
| poorer hearing, perhaps permanently (use it or lose it!)
| and some people having more rapid cognitive decline. This
| randomized intervention directly caused real suffering.
| Nearly 125 people in the heart-health group with increased
| risk of dementia onset were assigned to a study that just
| received health education. For at least three years, they
| had reduced hearing and a reduced ability to communicate,
| and after three years, they had significantly greater
| cognitive decline.
|
| Caution is good, but in general I have no problem
| personally with the 'shut up and multiply' application of
| ethics in this case. There are 8 billion people all getting
| old, and more being born every day who will eventually get
| older. It's very important as a species to know that
| hearing aids slow cognitive decline, and if that meant that
| 119 people were placed at a slightly increased medical
| risk, 119 divided by 8 billion is a pretty small number,
| and 7.999999881 billion who are now more likely to get
| hearing aids and have slower cognitive decline is a lot of
| positive utility. But it wasn't me or my mom who can no
| longer hear and who is suffering from dementia, and some
| will draw a hard line and say that you can't perform
| studies that will put even a small number of people at
| increased risk.
|
| We should be careful to evaluate merit and limit harm, but
| we should perform more randomized intervention studies.
| bluGill wrote:
| there needs to be at least 3 groups, with the third assigned to
| both. Otherwise you know one is better than the other, but not
| if both are good/better
|
| Ideally we would have a 4th: control that we do nothing with -
| but this is not ethical so we can't. Where you can do this
| ethically you should do it.
| aksss wrote:
| Wait, isn't the retraction of this old news by now?
|
| "We should have followed up': Lancet journal retracts article on
| hearing aids and dementia after prodding"
|
| https://retractionwatch.com/2024/01/04/we-should-have-follow...
|
| "When the paper first appeared, it seemed to confirm a widely
| held belief - that hearing loss is associated with developing
| dementia, and using hearing aids can help to reduce risk - about
| which the scientific evidence has been mixed, Blustein, the
| hearing loss researcher, told Retraction Watch. In her view,
| public health messaging and media coverage of the question has
| been "misleading."
|
| The findings were picked up quickly and disseminated among the
| community of people following the question of hearing loss and
| dementia, she said. "I don't think people are necessarily aware
| of retractions."
|
| Another pull quote:
|
| "Most notably, he found that hearing aid use did not correspond
| to a lower rate of dementia for people with hearing loss, as the
| authors reported. He found the opposite: among people with
| hearing loss, the dementia rate was higher for those using
| hearing aids."
| sp332 wrote:
| That one was from UK BioBank data and published in April. This
| one is from John Hopkins in the USA and was published in July.
| aksss wrote:
| In context, I would be careful taking this conclusion at face
| value quite yet, though it does seem intuitive, just as the
| other one was.
|
| "About 250 healthy older adults came from a long-term study
| of heart health ... 739 people were newly recruited. . . .
| Participants recruited from the heart-health study had more
| risk factors for developing dementia, including being older
| and having faster rates of cognitive decline than those from
| the general community.
|
| In the main analysis of all study participants, the
| researchers saw no difference in the rate of change in
| cognitive functioning between people who received the hearing
| aids and those who didn't.
|
| However, when the analysis focused on people from the heart-
| health study, who had a higher risk of dementia, the benefit
| of the hearing aids was substantial. Those who received
| hearing aids had an almost 50% reduction in the rate of
| cognitive decline."
| Vicinity9635 wrote:
| Fun fact: auditory signals are the fastest path to human
| reflexes, way faster than vision. I forget the exact numbers, but
| visual reactions are on the order of 300ms whereas auditory
| reactions are sub 100 IIRC. Feel free to correct me if anyone can
| find numbers.
|
| So all those blind fights in the matrix cartoons or daredevil are
| sill, but not quite as silly as you might have expected. There is
| actually a significant reaction time advantage. But good look
| hearing a sword swing at your face vs your leg lol
| gpt5 wrote:
| There is a difference, but not that dramatic. You can try it on
| yourself here - https://playback.fm/audio-reaction-time
| Vicinity9635 wrote:
| There's a lot more between the actions there image to
| display, mouse to computer that have nothing to do with
| internal meatbag reactions. Especially when we're already
| measuring in milliseconds.
| gpt5 wrote:
| I'm referring to the paper cited in the linked site, which
| quotes about 50ms of difference in reaction time between
| auditory and visual, not 200ms like stated in the comment
| above.
| nyrikki wrote:
| As social isolation was associated with about a 50% increased
| risk of dementia this isn't surprising.
|
| https://nap.nationalacademies.org/catalog/25663/social-isola...
| Overtonwindow wrote:
| Makes you wonder if social isolation is a cause of dementia,
| thinking less means less brain stimulation.
| mrangle wrote:
| Deaf-infant cochlear implants can make a significant difference
| in IQ (less language audio input affects IQ if not mitigated
| ASAP: a principle that extends from deaf to normal hearing
| children). With this principle in mind, it isn't surprising that
| hearing aids slow cognitive decline later in life. Though, I'm
| not implying that it may be a 1:1 mechanism.
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