Sutton's Place

There is one thing that might be worse than being diagnosed with Alzheimer’s: Being diagnosed with it incorrectly,

Yet, because the symptoms of early dementia are similar to those of hearing loss — anxiety, depression, isolation denial, distrust, impatience, what seem to be memory problems – that can happen.

But the cognitive loss of the dementia patient is not the same as someone who simply does not hear well. After all, you are not going to remember something if you didn’t hear it in the first place. And you are not going to do well on cognitive tests if you can’t hear, or understand, the questions.  So, if you have not admitted to a hearing problem, if it has not been diagnosed and treated, there is a chance that you may be misdiagnosed, told incorrectly that you have early Alzheimer’s, with all the resulting medical and social implications.

The opposite can also take place.  Through all the years of our marriage, my husband had a severe hearing impairment, partly the result of genetics – many in his family suffered from various degrees of hearing loss — and partly the result of shooting, as so many men did in his day, without wearing ear protection. In retrospect, I suspect that there were early signs of Alzheimer’s that we dismissed as hearing issues.  Had we realized that, the outcome would not have been any different, but I do wonder what it felt like for him. Did he know that there was more than hearing at stake and, if he did, and did not tell any of us, it must have been a very lonely and frightening time for him.

Now, studies have shown that there is a link between hearing and cognitive loss, that the hearing-mpaired are at greater risk for developing Alzheimer’s.  Without getting into the possible scientific explanations for this, some things are obvious.

• Hearing loss can lead to isolation with the depression and sedentary lifestyle that are factors in developing dementia.
• Like the rest of the body, the brain needs exercise to remain healthy.  Untreated hearing loss can get in the way of that by restricting conversation. making going to the theater, movies, lectures, playing games, very difficult, if not impossible.

Clearly, if you are going to do everything you can to prevent Alzheimer’s, then making sure wax is removed from the ears, having regular hearing tests, getting aids -and wearing them! – is an important step.  Again, there are no guarantees but, at the very least, your present life – and those with whom you interact – will improve.

Living with my husband. I learned a lot about this handicap. Like many men, at first he didn’t want to admit that he had a problem.  There were other things he could blame –people didn’t speak up; they didn’t speak clearly; it was the unusual accent.  When he finally did accept a hearing aid, he didn’t want to wear it.  It was uncomfortable; he thought it made him look old. Etcetera, etcetera.  Everyone who lives with someone with a hearing problem will be familiar with all the excuses.

I learned to find the quiet corner in the restaurant and seat him where there would be no one talking behind him. To avoid places with a lot of mirrors and bare floors, where sound is amplified. To ask that the background music be turned to a lower volume. To place him at the middle of the table, where his chances of participating in conversation were better than if he sat at the traditional head.

Ironically, now I too have lost some of my hearing. I wear  state of the art hearing aids.  They work very well — when I wear them. But they don’t  work when I leave them on the dresser which is where a lot of hearing aids seem to end up. Why? because I forget to put them in. Or the battery goes out – with a beep, beep, beep in the middle of the conversation or the concert or play. Then, I either have to fake it or do the embarrassing thing – take the aid out of the ear and replace the battery in front of others. If am in a dark place, forget it. I fumble around and the battery ends up on the floor.

But even when I wear it, there are some situations where I still have difficulty hearing. Like many people who find themselves with this condition, I no longer hear the high notes clearly. I hear alto voices very well, but the soprano notes are lost.My husband experienced the same thing which is why, when I seated a woman beside him, I would tell her, “Speak <strong>low</strong>, not loud, but <strong>low</strong>”. (The last thing someone wearing a hearing aid wants is someone shouting into their ear). Hearing some notes and not others often leads to misunderstanding. Family members will say, “He hears when he wants to hear”, or “She has very selective hearing.’ The first statement is not true. What you hear is not always a matter of choice. The second statement is: the ear is a very selective instrument.

Part of hearing loss flows from something called speech discrimination. Someone may say one thing, but the hearing impaired will hear something entirely different. Recently a friend told me he needed  a wedge for sleep – I thought he said a wife. The result was comic, but in some situations that kind of speech discrimination could be disastrous. In a poor hearing environment, without a hearing aid,  I will “get”  some words and not others. I hear vowels, but the consonants are often missing. This will frustrate the speaker who might well lose patience with me and decide that I am only hearing what I want to hear when, in fact, I do want, very much. to hear everything but, without assistance, I don’t, I can’t.

Sit me in a noisy restaurant, or a cocktail party where there is a lot of background noise, talk to my back, or call from another room, and it will take tremendous concentration on my part to understand what you are saying. Put your hand over your mouth when you speak and you make it impossible for me to do the lip-reading that the hard of hearing automatically rely on to augment sound. The healthy ear is a wonderful instrument – it can discriminate – it does not hear all the sounds directed at it at the same time equally.  Some hearing aids promise to diminish  background noise and the more expensive ones have pushbutton controls that help with that, but they can be difficult for the older person who isn’t technologically adept (me!) to manage.  So being in a crowded place wearing a hearing aid may mean being  subjected to a cacophony of noise. As a  quiet restaurant seems to be a very rare thing today, given the choice, I prefer to entertain at home, where I can control the environment.

Society does not have much patience with the hearing-impaired. A private conversation in public is difficult  because the speaker may have to speak so loudly that everyone else can hear and sometimes, the afflicted partners speak too loudly for comfort.  As to the intimate words of love whispered in the ear, well, I wonder how many I have missed.

There is a difference, of course, between true hearing problems and what I call husband’s hearing (or wife’s), the tuning out that can take place in a long-term partnership.  When a couple live together, the relationship can take on the aspects of a comfortable old slipper.  The routines are established and we tend to assume we just know that the other one is saying or going to say. This can lead to the husband declaring, “You certainly did not tell me that your parents were coming to stay with us”, or the wife. “I asked you if you wanted to go on a cruise and you said “yes”, you definitely did.” This kind of marital back and forth   is the stuff of jokes and they can be very funny.

But there is nothing funny about the real thing — hearing impairment is definitely not a joke. Especially not when it may be a factor in getting Alzheimer’s Disease.