The need for the assessment of hearing loss as part of the dementia diagnosis Jenna Littlejohn jllittlejohn1@sheffield.ac.uk Department of Neuroscience

Links between HL and CI Cognitive decline natural process Cognitive decline is accelerated in people with HL Risk of dementia is proportional to the severity of HL Dementia associated with language alterations or disorders ARHL effortful listening 24% accelerated rate of cog decline in people with HL over 12 years Hearing is a complex entity that involves cognitive processes but similarly methodology questioned, are people being disadvantaged by testing procedure Effortful processing- natural cognitive impairment with ageing and have to attribute resources to comprehend sounds rather than in depth processing necessary for memory recall 09/11/2018 © The University of Sheffield

Alzheimer’s disease Most common form of dementia Currently affects 850,000 in UK (637,500) Progressive memory decline One of leading causes of disability in later life Prognosis between 3 and 10 years Lack of disease modifying treatments- most effective in early stages Prime ministers challenge – raising public awareness & improving diagnosis rates Earliest and most prominent feature is memory loss and impairment in new learning, which can then have a knock on effect to planning, judging, organising etc and as disease progresses so do behavioural symptoms and other cognitive symptoms- language and then widespread where insight into condition is lost and most basic of motor functions are lost. 09/11/2018 © The University of Sheffield

Early diagnosis Treatments most effective Access to clinical trials/research Planning for families Pressure on medical professionals diagnosis rates Treatment harms (side effects) Detrimental effects on QoL Diagnosis of life altering disorder or disease Piers early slides: overlapping symptoms No definitive test for AD or other dementias and so relies on clinicians judgement 09/11/2018 © The University of Sheffield

The challenge HL under recognised and underdiagnosed in ageing population Distraction, lack of concentration, confusion, appear forgetful Frustration: social isolation, poor self esteem Awareness= people shifted towards dementia assessment Overlapping symptoms Verbal administration on cognitive tests Overlaps with social isolation  people with HL may be ‘over’ diagnosed with CI 09/11/2018 © The University of Sheffield

Case study First assessment September 2015 76 year old male 11 years formal education Profound HL and AD (Dx 2013) History of depression, apathy, excessive sleeping Personal description: Current mood: bad Memory: average Reported periods of absentmindedness and lack of initiative and motivation Neuropsychological profile- normal performance

Second assessment November 2015 Extensive neuropsychological testing and in-depth imaging protocol Compared with 9 male, age (M=73.89, SD=6.60) and education (M=14, SD=2.79) matched controls Hearing assessment- PTAv of 64dbHL SEAH questionnaire- 64% (severe handicap) 09/11/2018 © The University of Sheffield

https://ahearingloss.com/reading-your-audiogram Example of moderately severe HL.. *Relies heavily on amplification for speech (w/out miss 50-75%), *difficulty hearing the high frequency consonants *may be able to discriminate the vowels *difficulty communicating in a group *or noise *or at a distance (lip read) *identify only loud environmental sounds https://ahearingloss.com/reading-your-audiogram 09/11/2018 © The University of Sheffield

Neuropsychological assessment Healthy age matched controls should out perform patient with AD on almost all tasks of cognitive function with biggest deficits in global cognition, episodic memory, language comprehension and semantic association.. Earliest indiciator semantics.. 09/11/2018

Neuroradiological assessment 09/11/2018 © The University of Sheffield

Neuroradiological assessment 09/11/2018 © The University of Sheffield

Clinicians report September 2013 74 year old male ST memory decline over last 12 months Recent lack of understanding of finances No problems driving, personal care or navigation Appropriate behaviour Insight into memory impairment 09/11/2018 © The University of Sheffield

Formal testing MMSE (30/30) MRI scan: slight atrophy of mesial temporal lobes No mention of HL or mood DIAGNOSIS of early AD Started on medication 09/11/2018 © The University of Sheffield

Only subjective memory complaints and case report Neuropsychological and neuroradiological profiles not in keeping with early AD Only subjective memory complaints and case report Highlights standard diagnostic criteria not always applied in clinical practice  over estimation of AD cases 09/11/2018 © The University of Sheffield

To conclude HL (& psychosocial associations) contributed to subjective memory complaints (supports Lopes et al., 2007) HL may masquerade as functional memory disorder and therefore should be excluded as part of the dementia diagnosis 09/11/2018 © The University of Sheffield

Further work Increase awareness of sensory impairment in memory clinics (advise) Identification of barriers to sensory impairment in memory clinics Identification of appropriate sensory screening test(s) Evaluation of sensory assessment protocol in clinical setting Refer to Piers slide 09/11/2018 © The University of Sheffield

Acknowledgements TNG Group Deafness Support Network Prof. Annalena Venneri Dr. Dan Blackburn Deafness Support Network Case and all participants 09/11/2018 © The University of Sheffield