Hearing loss vs cognition in aging parent?
February 23, 2023 9:41 AM Subscribe
My parent (70 years old, also neurodiverse) went to an audiologist who said that my parent's hearing problems were due to aging and diminished cognitive ability, rather than hearing loss. Have you or people you know experienced this? Should my parent get a second opinion, and what should I expect in coming years?
My parent has complained for a while of not catching what I say on the phone. In the past year, they've spoken more frequently of not catching the beginnings or endings of some sentences when speaking in person to others. A few weeks ago, they went to a musical and said that it seemed like the chorus was "mumbling" their lines when they were singing and speaking, and that she couldn't understand them.
My parent finally went to see an audiologist a month ago, who tested and said my parent's hearing levels were normal, and didn't find signs of hearing loss -- and then administered a test for cognition that showed my parent's memory at the high end of "moderate", and their processing speed at the low end of "good". The audiologist said that my parent's difficulties with following conversations was due to diminished cognitive abilities that often occur with aging people, rather than any hearing loss.
I live across the country from them, and only am able to visit a couple times a year, so I haven't had much opportunity to observe their hearing (or lack of hearing) in person.
As a note, although they haven't been formerly diagnosed, I am certain that my parent has autism. They have always been very sensitive to noise, particularly when stressed. I also wonder if this has some component in the changes they've reported.
Have you or people you know experienced this? Should my parent get a second opinion, and what should I expect in coming years?
My parent has complained for a while of not catching what I say on the phone. In the past year, they've spoken more frequently of not catching the beginnings or endings of some sentences when speaking in person to others. A few weeks ago, they went to a musical and said that it seemed like the chorus was "mumbling" their lines when they were singing and speaking, and that she couldn't understand them.
My parent finally went to see an audiologist a month ago, who tested and said my parent's hearing levels were normal, and didn't find signs of hearing loss -- and then administered a test for cognition that showed my parent's memory at the high end of "moderate", and their processing speed at the low end of "good". The audiologist said that my parent's difficulties with following conversations was due to diminished cognitive abilities that often occur with aging people, rather than any hearing loss.
I live across the country from them, and only am able to visit a couple times a year, so I haven't had much opportunity to observe their hearing (or lack of hearing) in person.
As a note, although they haven't been formerly diagnosed, I am certain that my parent has autism. They have always been very sensitive to noise, particularly when stressed. I also wonder if this has some component in the changes they've reported.
Have you or people you know experienced this? Should my parent get a second opinion, and what should I expect in coming years?
Yeah, if their hearing is normal, this sounds like audio processing / audio processing speed. One thing that tends to be extra hard for autistic people is separating out the "sounds of interest" from the "background sounds", which apparently just happens automatically for neurotypical people. A second thing is literally just "translating" the sounds into meaningful words in our heads -- depending on how tired I am, I'll sometimes not understand something, say "what"?, and then a half-second later the processing finishes and the full meaning is sitting right there in my head.
Both of these things can require more cognitive resources for autistic people than they do for neurotypicals, and therefore a small reduction in available cognitive resources (even if it's just from being tired, or being mildly overwhelmed due to other sensory inputs) can have an outsized effect on comprehension.
Things that may help:
- Accommodate for other sensory sensitivities. Compensating for painful glare, itchy clothes, and muzzy audio presents much higher cognitive demands than just compensating for muzzy audio.
- If your parent uses a cellphone, maybe try noise-cancelling earbuds connected by Bluetooth to the cellphone during phone conversations, for better quality sound and to block out background noise. When you call your parent, make sure you're in a quiet place so your phone isn't picking up a lot of background noise too.
- If your parent can be open to their friends about this, friends can compensate by pointing their faces at your parent while speaking (simultaneous lip-reading can make the audio processing easier) and by enunciating a bit more. (And by getting your parent's attention before they start speaking.)
posted by heatherlogan at 10:20 AM on February 23, 2023 [7 favorites]
Both of these things can require more cognitive resources for autistic people than they do for neurotypicals, and therefore a small reduction in available cognitive resources (even if it's just from being tired, or being mildly overwhelmed due to other sensory inputs) can have an outsized effect on comprehension.
Things that may help:
- Accommodate for other sensory sensitivities. Compensating for painful glare, itchy clothes, and muzzy audio presents much higher cognitive demands than just compensating for muzzy audio.
- If your parent uses a cellphone, maybe try noise-cancelling earbuds connected by Bluetooth to the cellphone during phone conversations, for better quality sound and to block out background noise. When you call your parent, make sure you're in a quiet place so your phone isn't picking up a lot of background noise too.
- If your parent can be open to their friends about this, friends can compensate by pointing their faces at your parent while speaking (simultaneous lip-reading can make the audio processing easier) and by enunciating a bit more. (And by getting your parent's attention before they start speaking.)
posted by heatherlogan at 10:20 AM on February 23, 2023 [7 favorites]
I work in a lab that focuses on hearing loss and cognition, and the short answer is, yes! The two can have similar symptoms (or accentuate symptoms when they co-occur).
One of my coworkers had a concussion and temporary change in cognition with no change in hearing. They felt like they couldn't understand what people were saying, especially in noise. It was something they intellectually knew could happen, but it was still disconcerting.
Other thoughts: you parent may have clinically normal hearing, but it may not be as good as it once was. So they may have experience change in hearing that's made things harder. Without previous tests we couldn't say for certain. But I always like to validate that patients experience and that clinically normal may not have been their normal.
I've had patients with UTIs that experienced it as a change in cognition. Could be worth double checking if they're prone to them.
Along those lines, anything that's causing them fatigue can make auditory processing harder or tax cognitive resources more. So if they have another health issue going on or in going stress, working on that (if they aren't already) may help things.
posted by ghost phoneme at 10:29 AM on February 23, 2023 [12 favorites]
One of my coworkers had a concussion and temporary change in cognition with no change in hearing. They felt like they couldn't understand what people were saying, especially in noise. It was something they intellectually knew could happen, but it was still disconcerting.
Other thoughts: you parent may have clinically normal hearing, but it may not be as good as it once was. So they may have experience change in hearing that's made things harder. Without previous tests we couldn't say for certain. But I always like to validate that patients experience and that clinically normal may not have been their normal.
I've had patients with UTIs that experienced it as a change in cognition. Could be worth double checking if they're prone to them.
Along those lines, anything that's causing them fatigue can make auditory processing harder or tax cognitive resources more. So if they have another health issue going on or in going stress, working on that (if they aren't already) may help things.
posted by ghost phoneme at 10:29 AM on February 23, 2023 [12 favorites]
They could be experiencing more trouble with processing speech as a result of normal age-related cognitive decline, couple with already having those difficulties due to neurodivergence, or this could also be a sign of a more serious progressive condition. Here's some information on how our brain processes language.
I would suggest your parent see their primary care physician or be referred by PCP to a neurologist for a more thorough cognitive screening. If they have Medicare Part B, a cognitive screening is part of their annual wellness visit, and a follow-up care planning visit is also covered. If nothing else, they can be reassured that their level of decline is "normal," even if it is annoying, and move on to focusing on strategies to deal with it, as folks have shared above.
posted by assenav at 10:31 AM on February 23, 2023 [3 favorites]
I would suggest your parent see their primary care physician or be referred by PCP to a neurologist for a more thorough cognitive screening. If they have Medicare Part B, a cognitive screening is part of their annual wellness visit, and a follow-up care planning visit is also covered. If nothing else, they can be reassured that their level of decline is "normal," even if it is annoying, and move on to focusing on strategies to deal with it, as folks have shared above.
posted by assenav at 10:31 AM on February 23, 2023 [3 favorites]
One of my family members has cognition issues unrelated to aging and we've definitely both noticed that when he's struggling under a too-high cognitive load for other reasons, his auditory processing takes a big hit and he needs to ask me to speak slower and louder than I otherwise would, might not be able to watch or listen to something he could handle on a more high-functioning day, etc. (This can be part of a more general sensory processing overload . And yes, he is autistic, although the cognition issues come mostly from a different medical condition.)
All of which is to say that certainly seems plausible, but a second opinion if relatively easy to get would do no harm and might turn up useful support or treatment options.
posted by Stacey at 10:52 AM on February 23, 2023 [2 favorites]
All of which is to say that certainly seems plausible, but a second opinion if relatively easy to get would do no harm and might turn up useful support or treatment options.
posted by Stacey at 10:52 AM on February 23, 2023 [2 favorites]
This might be an option worth checking out:
How to use your Apple AirPods Pro as hearing aids
I've been struggling with impaired hearing for the past few years (I'm 70) but I haven't been able to get to an audiologist because of pandemic and other complications. After reading that article, I decided to give the AirPods a try.
I am very impressed! It's a revelation and a joy to be able to participate in a conversation without every cell of my body straining to hear and understand. I feel much more relaxed with people, and less fatiqued. I'm also hypersensitive to loud noises, and I was concerned that devices like this might not be helpful or tolerable if they just amplified everything. That hasn't been a problem at all so far--conversation is sharp and rich, but other sounds definitely stay in the background. I don't doubt that custom hearing aids fitted and tuned by a professional would be even better, but Damn! these little gadgets have hugely improved my life. Good luck.
posted by Corvid at 3:04 PM on February 23, 2023 [4 favorites]
How to use your Apple AirPods Pro as hearing aids
I've been struggling with impaired hearing for the past few years (I'm 70) but I haven't been able to get to an audiologist because of pandemic and other complications. After reading that article, I decided to give the AirPods a try.
I am very impressed! It's a revelation and a joy to be able to participate in a conversation without every cell of my body straining to hear and understand. I feel much more relaxed with people, and less fatiqued. I'm also hypersensitive to loud noises, and I was concerned that devices like this might not be helpful or tolerable if they just amplified everything. That hasn't been a problem at all so far--conversation is sharp and rich, but other sounds definitely stay in the background. I don't doubt that custom hearing aids fitted and tuned by a professional would be even better, but Damn! these little gadgets have hugely improved my life. Good luck.
posted by Corvid at 3:04 PM on February 23, 2023 [4 favorites]
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Turned out the other health issues were impairing her cognition to a pretty significant level, and once they were addressed and her cognition began to recover, her audio processing did too. At this point she has pretty average hearing loss for a person her age but no longer struggles to follow conversations etc.
posted by We put our faith in Blast Hardcheese at 9:52 AM on February 23, 2023 [7 favorites]