Effects of hearing loss on health① | Senile deafness is the main cause of dementia

[헬스코리아뉴스 / 임도이] As we approach the age of 100, the importance of ear health is increasing day by day. In particular, Korea is about to enter a super-aging society (20% of the population) beyond the aged society, in which the population aged 65 and over accounts for 14% of the total population. The elderly population is also increasing the most rapidly among OECD countries. In that sense, hearing loss, which is known as a direct cause of senile dementia, is one of the most core diseases that our society must overcome. Based on the data presented at the 64th symposium held by the Korean Academy of Sciences (Chairman Koo Ja-won) on the 2nd and 3rd, the effect of hearing loss on health was focused on four times. [편집자 글]

1. Senile deafness is the main cause of dementia

2. Hearing loss, young people are no exception

3. If left unattended, it causes greater social and psychological loss

4. Reasons to be interested in hearing loss in newborns and infants

Prevalence of age-related hearing loss and dementia

Korea is rapidly entering an aging society. After entering the aged society (14% of the population aged 65 and over) in 2018, it is expected to enter the super-aged society (20% of the population aged 65 and over) in 2026. As the average life expectancy increases, the absolute number of the elderly and the proportion of the elderly in the total population are increasing. According to the results of the 5th (2010-2012) National Health and Nutrition Examination Survey conducted jointly by the Korea Centers for Disease Control and Prevention and the Korean Academy of Otolaryngology in 2009, 68.9% of people over 70 years of age have mild or more deafness. Among them, 31% said they needed hearing aids with moderate hearing loss.

Dementia also increases in frequency every year, and according to the 2009 Ministry of Health and Welfare data, 420,000 people, or 8.4% of those aged 65 and over, suffer from dementia. According to data from the National Statistical Office, the number of patients in their 60s and older who received treatment for geriatric hearing loss increased by an average of 5.5% per year from 2008 to 2013.

As of 2013, 280,000 patients and total medical expenses were reported to be KRW 31.9 billion. According to the National Health Insurance Corporation’s ‘conductive and sensorineural hearing loss (diagnosis code: H90)’ health insurance payment data, the number of people treated increased by an annual average of 4.8% from 222,000 in 2008 to 282,000 in 2013. did. The number of males increased from 106,000 (2008) to 132,000 (2013), 24.1% (annual average increase of 4.4%), and for females, from 116,000 (2008) to 150,000 (2013), 29.1% (annual average increase rate of 5.2%), respectively. From 2008 to 2013, the average annual growth rate of the total medical expenses for health insurance was 6.7%, and the average annual growth rate of the salaries paid by the Corporation (insurers) was 6.3%.

Occurrence of age-related hearing loss and dementia … “Hearing loss is an independent factor of cognitive decline”

According to a report in ‘Age-related Hearing Loss and the Occurrence of Dementia in 2018 JAMA’, it was predicted that hearing loss due to aging could be used as a biomarker to predict cognitive decline, cognitive impairment and dementia. This paper meta-analyzed about 30 papers related to hearing loss and cognitive decline from 12 districts and derived the result that hearing loss increases the risk of cognitive function. The association between senile hearing loss and dementia was reported by the Johns Hopkins School of Medicine and the National Institute on Aging.

Hearing and cognitive function tests were conducted on 639 people, and the results of observations for an average of 12 years showed that the dementia incidence rate was 1.89 times higher for mild hearing loss (26-40 dB) compared to those with normal hearing, and moderate hearing loss (41~40 dB). 70dB) was 3 times higher, and in the case of severe hearing loss of 71dB or higher, 4.94 times higher. The incidence of dementia increased with severe hearing loss.

Cognitive ability declines with age, and it is important to provide continuous external stimuli to the brain to overcome this. Cognitive function and judgment are maintained only when appropriate external auditory stimuli and information are transmitted and integrated to the central nervous system. If accurate and appropriate auditory information is not received at this time, there is a high possibility of cognitive decline, which is suggested as a strong hypothesis that hearing loss leads to dementia.

According to the results of many studies on hearing loss and depression, the depression score increased as the degree of hearing loss increased, and the degree of subjective impairment experienced by the elderly with hearing loss in daily life due to hearing loss was found to be related to depression. In addition, recent studies have revealed that wearing a hearing aid affects depression in people with hearing loss.

Elderly Hearing Test

Evidence data related to hearing loss and dementia are being reported in more recent studies. In a study on the prevalence of hearing loss and dementia, which was reported by Professor Lin of Johns Hopkins University in the ‘Archives of Neurology’ of JAMA in 2011, the risk of dementia was found in mild, moderate and severe hearing loss, respectively. There is also a shocking study result that it increases by 2, 3, or 5 times.

Afterwards, the research team reported that hearing loss was an independent risk factor for cognitive decline through a follow-up study related to hearing loss and cognitive decline in 1984 people.

Professor Lin’s research team also reported in the international academic journal Neuroimage in 2015 that the brain volume of patients with hearing loss significantly decreased in the right temporal lobe, the center of hearing, compared to controls with normal hearing.

In the meantime, interesting research results have emerged. That’s the only way to overcome hearing loss. According to the research results reported by Dr. Cuoco S. et al. in the scientific journal ‘Scientific Report’ in 2021, hearing rehabilitation through hearing aids in patients with hearing loss can induce a delay in cognitive decline.

This study demonstrated that hearing rehabilitation through hearing aids contributes to cognitive decline by verifying that the long-term spatial memory ability of the patient group who wore a hearing aid for 6 months was higher than that of the group without a hearing aid.

It has been reported that auditory rehabilitation through cochlear implant can also prevent cognitive decline in patients with hearing loss and even restore cognitive function to normal in patients with mild cognitive impairment. This is the result of a 2018 study by Mosnier et al. JAGS 2018:66:1553-61. As a result of follow-up of 70 patients with severe hearing loss for about 7 years after cochlear implantation, 10 out of 38 patients with mild cognitive impairment among patients 65 years of age or older recovered their normal cognitive function.

Professor Hyunjin Lee, an otolaryngology specialist at Catholic University of Korea Incheon St. Mary’s Hospital, said, “Combining these research results, hearing loss is recognized as an independent factor in cognitive decline and dementia. “It is being shown that the rate of decline can be reduced or improved.”

Overcoming hearing loss, the country should pay attention

Unfortunately, however, Korea’s policy on hearing loss is still being evaluated as not being realistic or meeting the needs of the people. According to the Welfare Act for the Disabled in Korea, one or both hearing aids are provided depending on the hearing level of the visually impaired. The number of people with hearing impairment grades 1, 2, and 3 was 5,604 people, and those with hearing impairment grades 4,5 and 6 were 108,503. there is. As such, even if the elderly over the age of 65 have hearing loss, there is currently no policy to support hearing aids unless they are deaf enough to be judged as deaf.

According to the ‘2020 Dementia Policy Project Guide’ presented by the Ministry of Health and Welfare, direct hearing-related education is not included in the domestic dementia-related professional training course. It is pointed out that education and testing should be added to check whether hearing is deteriorated in the future as only education on performing dementia screening tests and training on neuropsychological testing tools are included in the education of the responsible task.

On the other hand, 7 countries in the European Union supported a research fund of about 8.45 billion won for 5 years at the national level through the large project ‘The SENSE-Cog Residential Aged Care Facility Study’ in which 21 researchers participate, resulting in hearing and visual impairment. Evidence-based research has been conducted to support appropriate medical policies and services for patients with dementia.

The personnel standard of France’s national dementia-related policy also includes clinical psychologists, occupational therapists, psychomotor therapists, gerontology specialists, social workers, and non-drug program-related specialists (eg, speech therapists, music therapists, etc.) to practice multi-faceted care. are doing

The most common treatment for age-related hearing loss is the use of hearing aids.

Experts say that the most representative rehabilitation treatment for geriatric hearing loss is the use of a hearing aid. This is because wearing hearing aids can improve hearing and prevent dementia by increasing cognitive function.

Many studies have already reported that cognitive function scores were higher after using hearing aids. According to a domestic study published in 2011, 18 patients with hearing loss in their 60s and 70s who wore hearing aids for 6 months compared with 11 who did not.

According to a research paper reported in the 2020 international scientific journal ‘Journal of Clinical Medicine (JCM)’, participants (ages 62-82) in the study were able to improve their hearing, cognitive function, and language skills before and 18 months after wearing a hearing aid. Perception, quality of life, physical activity, and loneliness were assessed. As a result, speech perception and quality of life were significantly improved after 18 months of wearing hearing aids. Cognitive function assessment scores did not show a significant decrease. 97.3% of subjects and women showed clinically significant improvement or safety in working memory, visual attention, and visual learning. This suggests that cognitive decline can be delayed if hearing rehabilitation is actively performed through wearing a hearing aid.

Professor Lee Hyun-jin said, “The increase in aging-related hearing loss, cognitive dysfunction and depression due to the increase in the elderly population is an important health problem that lowers the quality of life of the elderly. It can even increase the incidence of dementia, so active diagnosis, treatment, and management of hearing loss is necessary.”

Professor Lee continued, “If communication is difficult even with hearing aids due to severe hearing loss, if it is possible to hear through a cochlear implant, it will be possible to prevent the decline in cognitive function even in old age. We need a social device that can induce people to do so and prevent depression and cognitive decline as much as possible,” he emphasized.

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