1. The need for the assessment of hearing loss as part of the dementia diagnosis
Jenna Littlejohn
Department of Neuroscience

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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
09/11/2018
© The University of Sheffield

9. 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

10. Neuroradiological assessment
09/11/2018
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11. Neuroradiological assessment
09/11/2018
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12. 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

13. 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

14. 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

15. 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

16. 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

17. 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