Exploring the Link Between Hearing Loss and Cognitive Decline with Dr. Julia Sarant

Embark on a profound exploration of the mind's auditory avenues with Dr. Douglas Beck and the distinguished Dr. Julia Sarant, as we unravel the intricate web connecting hearing health and cognitive vitality. Our conversation lifts the veil on how untreated hearing loss might fast-track cognitive decline, particularly in the older population, while considering the additional strains imposed by socioeconomic disparities and other health conditions.

As your guide through this critical discourse, we shine a light on the pivotal role of hearing care professionals and the revolutionary potential of hearing aids to possibly turn the tide against the risks of dementia. We wrap up with a powerful message that could redefine the future of cognitive care: the use of hearing aids might not just slow cognitive decline, but may actually halt it. This episode is a treasure trove of insights, filled with thought-provoking findings on how auditory assistance can have far-reaching implications beyond just improved hearing. Dr. Sarant's expertise helps us appreciate the sweeping enhancements to quality of life hearing aid technology can foster, painting a hopeful picture for the marriage of better hearing and better thinking. 

Join us for a journey that could change the way we perceive the interplay between our ears and our minds.

Transcript

Blaise M. Delfino, M.S. - HIS: 0:19

Thank you. Before we kick this episode off, a special thank you to our partners Cycle, built for the entire hearing care practice. Redux faster, drier, smarter, verified. Otoset, the modern ear cleaning device. Faderplugs the world's first custom adjustable earplug. This episode is going to be hosted by none other than Dr Douglas Beck himself. Get ready for expert insights and invaluable discussions coming your way.

Dr. Douglas L. Beck: 0:53

This is Dr Douglas Beck and you are listening to the Hearing Matters podcast. Today's guest is Dr Julia Sarant, and Dr Sarant is with the University of Melbourne Department of Audiology and Speech Pathology. Julia, welcome, glad to have you here today.

Dr. Julia Sarant: 1:08

Thanks for having me, Doug.

Dr. Douglas L. Beck: 1:09

My pleasure and what I'd like to do. We'll start with the general emerging relationship foundation of cognition and audition and then we'll go more particularly into the enhanced study, which was just published in January, of 24. So, julia, is it fair to say that for people with untreated hearing loss who are at higher risk for cognitive decline that might be, people who are older, people with greater hearing loss, people who are from lower socioeconomic groups, people with comorbidities those people with untreated hearing loss are at higher risk to exacerbate cognitive decline? Is that a fair place to start?

Dr. Julia Sarant: 1:47

I think that's a reasonable place to start, doug, and I think that there is certainly a growing body of evidence to suggest that the risk is higher, because what seems to actually happen is that the rate of cognitive decline is accelerated in these people in direct well related to their degree of hearing loss. So it seems to be suggested in the literature that people with greater hearing loss decline more quickly.

Dr. Douglas L. Beck: 2:15

So, Julia, the numbers that I'm most familiar with come out of the USA and some of the numbers that I'm going to speak about come from our literature. And please correct me because I want to also, of course, discuss Australia and pull your research in the rate of mild cognitive impairment that the JAMA, the Journal of the American Medical Association, has used in the last year. As they say, up to 22% of Americans by the time they're age 65 or older have mild cognitive impairments, so that would be one out of five. And then for people when we're speaking specifically about Alzheimer's, which is one of 200 types of dementia, but Alzheimer's is 65% of all dementias and people with Alzheimer's by the time you're age 85 in the US, your chance of having Alzheimer's is about one out of three. I think those are the American statistics that I've been reading and quoting, but I'd like your insight. Are those numbers sort of kind of correct or way off?

Dr. Julia Sarant: 3:15

Yeah, sure. No, I don't think they're way off at all. There are different dementia prevalences in different countries around the world and I think part of that is due to the healthcare system, the access to healthcare and the access to control of systemic disease that people have. In Australia the dementia prevalence is quite a lot lower than it is in the US, but I would agree that in general, about a third of people over the age of 80, that statistic is correct, Okay.

Dr. Douglas L. Beck: 3:41

And just to fill in for people who aren't as familiar as you are, when we say Alzheimer's and dementia, alzheimer's is one of, as I said, 200 types of dementia, but most of those dementias, two-thirds of them, are Alzheimer's. And then you have things like Lewy body disorders, you have vascular dementia, frontotemporal dementia, you have Parkinson's with dementia. That's probably the vast majority. That probably covers 98% of all people with dementia. Would be those four or five categories. What about people who have Alzheimer's? Are you familiar with the discussions on tau proteins and amyloid and the prevalence of that in the Alzheimer's population?

Dr. Julia Sarant: 4:23

I have some familiarity with that and in fact I wrote a paper a couple of years ago looking at the relationship between amyloid in the brain and hearing loss, to see what was going on there.

Dr. Douglas L. Beck: 4:36

What did you find?

Dr. Julia Sarant: 4:37

We found no relationship.

Dr. Douglas L. Beck: 4:39

Yeah.

Dr. Julia Sarant: 4:40

And that might have been because we only had about 600 or so people in the sample. It might have been simply because so about 600 or so people in the sample. It might have been simply because so we could see the relationship until we controlled for age. Once we controlled for age, obviously, because with age amyloid increases.

Dr. Douglas L. Beck: 4:55

With age dementia increases.

Dr. Julia Sarant: 4:57

So once we took that out of the equation we didn't see a relationship. There were only about three papers at that time. Another couple have come out.

Dr. Douglas L. Beck: 5:11

So the jury's still out on what's going on there. And I think it's kind of fascinating now because we do have some drugs that are very, very good at reducing and slowing amyloid but that hasn't really had a substantial effect on Alzheimer's disease, In other words no, it hasn't. Yeah Well, and I think that to a large degree. You know, Alzheimer's takes 20 or 30 years to develop from the time you first get microcellular changes and I think amyloid builds up over time as well, perhaps as a result of that. But I don't think that necessarily taking the amyloid out of the picture changes the course of Alzheimer's, because I wonder if amyloid is the result of that process and not the cause of that process.

Dr. Julia Sarant: 5:50

I think that's something that people are coming to terms with. Just recently, there are some papers in the literature talking about the fact that there is a synergistic relationship between amyloid and tau protein.

Dr. Douglas L. Beck: 6:02

Right.

Dr. Julia Sarant: 6:04

And that without the tau people can live with the amyloid and tau protein and that without the tau people can live with the amyloid load and not necessarily develop cognitive impairment. But it's a really fascinating and tricky area to work in. Dementia in many ways to me is like cancer it's not one disease, it's many, and it has multiple causes and multiple risk factors and these interact with each other. So I don't believe it's, and I don't believe the literature suggests it's only about amyloid. It's about all sorts of things and the process of aging.

Dr. Julia Sarant: 6:38

The reason that the risk for dementia and cognitive decline increases with age is we have all these other things going on in our bodies, so the term inflammation is often used about older adults. So we have increasing levels of inflammation and inflammation drives cardiovascular disease and metabolic disease and all these other things that are really significant risk factors for dementia. We also have things like the breakdown of the brain barrier that allows things to go into the brain that can cause changes that may predispose or help this process along. So it's a really complicated and fascinating thing to study and we still don't really have very many answers about what is causal. It's likely to be, as with cancer, a whole range of factors and a whole range of processes, and that's illustrated particularly in the studies where people have done autopsies on the brains of people.

Dr. Douglas L. Beck: 7:38

Sure absolutely.

Dr. Julia Sarant: 7:39

And you see people with massive amyloid load who were completely cognitively, functionally normal.

Dr. Douglas L. Beck: 7:47

Absolutely, and yeah, we know it's sort of startling, yeah.

Dr. Julia Sarant: 7:53

It is fascinating, and so that illustrates on its own. It is not just one thing Right, it is a whole range of things.

Dr. Douglas L. Beck: 8:00

This is a point that I think is so important. No-transcript, oh, remind me so. It was a study really about yeah, well, it was about cognitive reserve and the idea, uh, this fellow I can't remember where I want to say massachusetts, I may have that wrong he was studying a bunch of nuns who were in their 80s and 90s and what he found is that because, yes, yeah, yeah, so because the nuns, uh, when they had had died, they had given permission to do autopsies and to look at their brains. And what he found is that the nuns, when they had died, they had given permission to do autopsies and to look at their brains. And what he found is that the nuns who were in their 80s and 90s had developed all sorts of Alzheimer's, like tissues, right, their brain was decaying or changing, you know, in a way consistent with what you might expect from Alzheimer's, but they showed no outward signs and symptoms.

Dr. Douglas L. Beck: 9:08

And his, if I get this right, and I hope I do he said that because the nuns work every day, they work in groups. Every day they socialize, they teach, they read in groups, they're doing constructive things, they're doing projects, they're working with children, they're working with other adults, and you see that in the blue zones as well. Right, the people in Okinawa who live to be 90 and 100, they're very, very involved in their community, and so his theory is that the more active you are, the more you are learning, the more you are maintaining and growing brain cells. You know you may have these other problems, but your brain is able to work around them because you're still exercising neuroplasticity. And so that's the idea of cognitive reserve is that the more you learn, the better educated you are across. Whatever it is, the healthier it is for your brain over the long term.

Dr. Julia Sarant: 10:00

Exactly, and that explains why you can have two people with the same amount of amyloid in their brain. One has full-on dementia and the other one is completely normally functioning, and the issue of cognitive reserve is really important for everybody. Are really frightened of the risk of developing dementia themselves and pretty much equally frightened of having to care for someone they love with that disease.

Dr. Douglas L. Beck: 10:32

In fact, I think that's the number one fear. It's not cancer, it's not cardiovascular disease, it's dementia.

Dr. Julia Sarant: 10:38

Yes, and so the fact that we have cognitive reserve is a really powerful and really positive thing to be aware of, because we have control. We have quite a lot of control about how we live our lives. We can be aware of the potentially modifiable risk factors for this disease and we can work on improving our own situation with relation to those. So we can exercise, we can be socially connected, we can educate ourselves, we can do puzzles, we can do all sorts of things that are known to build cognitive reserve, and we're not just sitting waiting to see what happens to us. We actually have control over a lot of what happens to us.

Dr. Douglas L. Beck: 11:23

That's so refreshing to hear. I think that's brilliant. I totally agree with you and I think that it's so important and I think this is a point you made in your paper that hearing care professionals whether they be otolaryngologists, whether they be audiologists, hearing aid dispensers they have to know and recognize warning signs and symptoms of cognitive impairment, because if we catch it early and we pay attention to the 12 modifiable risk factors according to the Lancet 2020, dr Gil Livingston and his colleagues, if we do that, we may reduce the opportunity for dementia by perhaps 40% and there's no guarantees you could do everything right and still have dementia. There's certainly some people who that happens, but I think what the Lancet 2020 and the previous version of the Lancet on the same topic of dementia said is that if you attend to these potentially modifiable risk factors, that you may change the trajectory and reduce your opportunity for dementia by potentially some 40% opportunity for dementia by potentially some 40%.

Dr. Julia Sarant: 12:27

Yes, I think the potentially more probable risk factors taken together contribute to about 40% of the risk, so that's an enormously powerful statistic.

Dr. Douglas L. Beck: 12:33

Yeah, it sure is Okay. Well, with that as background, what I'd like to do, let me see if I I had some notes here from your early paper and you know one of the things that comes up a lot people say well, what's, what is it about hearing and listening that would impact your brain? And in one of the papers I wrote a few years ago, we had four hypotheses on that and I noticed I know I'm catching you a little bit off guard, but what you and your colleague said. So this is the paper that was September 2023 in the International Journal of Audiology. We talk about well, why would hearing or listening have anything to do with cognition and stuff like that? And you mentioned a few different potential hypotheses. The first one and I'll give you the hypotheses and perhaps you can just give us a sentence or two on it One was the common cause or the common neuropathic pathology for hearing loss and dementia.

Dr. Julia Sarant: 13:30

Yeah, so that's the theory that there is the same neuropathic pathology driving both the onset of hearing loss and the development of hearing loss, and also that of dementia, and that this affects the cochlear and the ascending auditory pathway, causing hearing loss, and the cortex, causing dementia. I think it's really yep.

Dr. Douglas L. Beck: 13:50

Well, so that's a neuronal phenomena, if that is indeed the one that we're talking about, right, but then there's also a vascular version of that, where we talk about the labyrinthine artery, which is one of the smallest arteries in the body which feeds the inner ear and we talk about if you have atherosclerosis, you have hardening of the arteries, you have a lot of goo in your arteries, maybe cholesterol, triglycerides, whatever, and as time goes on, so the blood flow to the cochlea may be diminished, reduced, and also the blood flow through the middle cerebral artery and the posterior arteries, anterior arteries, is also reduced by the same atherosclerosis or deposits. So you have that common cause theory that prevails, I think, in neuronal disease, which is what you started with, and I think also in vascular disease. If the labyrinthine artery is not well supplied with blood and nutrients within the blood and oxygen and red blood cells and iron and everything we need with glucose, then the same phenomena could occur throughout the brain as well. Then the same phenomena could occur throughout the brain as well.

Dr. Julia Sarant: 15:05

Yes, and so those are theories that are not reversible, not addressable by hearing intervention. Right, and this is where we go back to this my sense that dementia is like cancer, it has multiple risk factors.

Dr. Douglas L. Beck: 15:21

I'm so glad you said that Because you know Agay Moller wrote about this with tinnitus. He said tinnitus is not one thing, tinnitus is many things and in each person it could be different.

Dr. Julia Sarant: 15:30

Yeah, yeah. But you know, in addition to those hypotheses, there are other hypotheses that could be potentially modifiable. Do you want to start off on that, or would you like me to.

Dr. Douglas L. Beck: 15:41

So the one I think you're talking about is the information degradation theory.

Dr. Julia Sarant: 16:34

Yes, so if you have a degraded auditory signal, there is greater cognitive effort required by the brain to process that signal, and often the theory is that other cognitive resources are recruited from other potential tasks, such as memory and executive function, to speech perception, for example, and that means that those other functions are not performed so well because they've essentially been robbed of resources for those tasks. So that's, yeah, that's I would. I would call that more the. The cognitive load theory, I think, is the, but yeah, both of those terms have been used.

Dr. Douglas L. Beck: 17:10

And, and the final one you guys mentioned is the altered cortical brain activity due to hearing loss causes irreversible molecular degenerative damage.

Dr. Julia Sarant: 17:19

And that's a newer theory. That's a newer theory.

Dr. Douglas L. Beck: 17:23

Yes.

Dr. Julia Sarant: 17:24

There's only been one paper on that. I think the other two potential mechanisms are that we haven't directly addressed are decreased auditory stimulation, the lose it or lose it theory. If you don't stimulate an area of the brain then you can have degeneration and we see that in shrinkage of the cerebellum and the auditory cortex and also the other flow-on effects. If you have reduced environmental stimulation and your communication ability is lower, that can lead to social participation withdrawal, which may contribute to loneliness, social isolation, depression and these things are also risk factors for dementia.

Dr. Julia Sarant: 18:06

Absolutely so there are flow-on mechanisms from these biological ones.

Dr. Douglas L. Beck: 18:11

And most of those came out in the Lancet study, the 2020. They identified depression and social isolation and hearing loss, and of course these things are. They don't act in and of themselves. If you have hearing loss, that can promote social isolation because you can't converse as easily or readily, so perhaps you tend to stay away from other people and stay by yourself. Same with depression, of course. If you're not able to interact and communicate easily, effortlessly, it's a little bit depressing, can make you anxious, can make you, you know, socially isolated, and so these things all can work together.

Dr. Douglas L. Beck: 18:50

I think I did an analysis back in 2020, so four years ago, looking at those 12 potentially modifiable risk factors, and I think I had six of the 12 related back to hearing loss. You know could be secondary impact from hearing loss Anyway. So that's a great orientation and, if you don't mind, what I'd like to do in our last 15 or 20 minutes is I really want to underscore the January 2024 Frontiers in Aging in Neuroscience, your enhanced study, because I think most people in hearing healthcare are familiar a little bit, you know, with the studies that came out of Baltimore, frank Lennon colleagues, you know the ACHIEVE study, but I think that the ENHANCE study is just as important to understand and I know you were one of the primary authors, so if you would outline that and we'll talk a little bit about what you did and what you found, Sure.

Dr. Julia Sarant: 19:46

So the ENHANCE and the ACHIEVE studies have actually run in parallel. So, unlike the ACHIEieve study, the Enhance study is an observational study, non-intervention observational study, and we had two groups of people. We had a control group who were more representative of the normal population. They were derived from an existing study of ageing and it's particularly a study of cognitive aging and of dementia called the ABLE study, which is quite a famous study that's been running in Australia since 2006. So we recruited our control group from that study and that group consisted of only about a bit less than half of the people in that study had hearing loss Right, and on average that hearing loss was incredibly mild. It was something like 21 dB average hearing loss and the other people had normal hearing. And so we had that group of people as our control group. They did not have hearing aids or cochlear implants or anything. They had no devices, no intervention.

Dr. Julia Sarant: 20:49

And then we recruited from clinics in Melbourne people who did have hearing loss. On average that was a mild hearing loss as well 31 dB average hearing loss. The two groups were around the same age, about 74, a year's mean age, and we intervened with the hearing aid. The hearing loss group that we recruited from our audiology clinics and we followed. We started off assessing at baseline and we followed them up at 18 months and 36 months and we're continuing to follow up both groups of people ongoing, which is really important. And one of the limitations of a lot of the studies that have been done trying to tease out the effects of hearing intervention on cognition is that they don't follow up for long enough and, as you said, the process of developing cognitive decline and dementia is decades long. So why would we expect to see any effect of hearing intervention after six months or 12 months? We really wouldn't.

Dr. Douglas L. Beck: 21:49

So that's why I want to frame this. Everything you said is fine and I'm so glad you did, but I have the numbers from your study, so let me apply those. So you had 160 people who had hearing loss, who were treated with hearing aids and, as you said, they were pretty much mild hearing losses. And then there were, I believe, 102 people in the untreated hearing loss and normal. So group two, the control group. Some of them had a mild loss, some had absolutely normal thresholds. So we're comparing mild losses that are treated and mild losses that are untreated, right, and you had them at time zero when they entered the study, 18 months and 36 months. And you're looking specifically at the MMSE, the mini mental state exam, and then you used I forget what the second, the cog state right To follow up.

Dr. Julia Sarant: 22:39

Yep. So we use the mini mental to screen for dementia, for pre-existing dementia, because we didn't want to confound, muddy the waters Because, as you know, particularly if you have something like mild cognitive impairment, people about a third of people progress to dementia, a third of people stay stable and a third of people can actually revert back to normal and we don't know why. So you need enormous sample sizes to be able to control for all of that variance in outcomes, none of which you can explain and which may or may not be related likely not related to hearing loss. So, yeah, so we did that. Another strength of the study was that we used the cog state battery and that is visually presented on a computer. It's computer-based card games, which takes away any language issues. It takes away cultural issues, most people around the world.

Dr. Julia Sarant: 23:32

The guy who designed that test, paul Maroff, had the brainwave of this is how we could test cognition internationally and take away the cultural influences and disadvantages for various peoples. He was in Asia and he was in a village in the middle of nowhere and they were playing essentially a card game and he thought, wow, this can really be useful. And he came home and he devised this test. The most important thing about that test, apart from its sensitivity to small changes over periods of time, is the fact that it is not auditorily administered. So we completely take out the hearing element and again that's been a big problem, I think, with a lot of the studies that have been done.

Dr. Douglas L. Beck: 24:15

So glad you said that. So this has been something. I first wrote about this, I think in 2009 or 2011, with Carol Flexer, and we were talking about cognitive screenings back then. So that was 100 years ago. Well, actually about 15 years ago, and this occurred to us as we were writing the paper that many people who were getting cognitive screenings 15 years ago they were older folks in their 60s, 70s, 80s You'd expect they would have hearing loss.

Dr. Douglas L. Beck: 24:40

So they're getting an oral or a verbal spoken cognitive screening from a psychologist or a social worker or somebody who has no idea what their hearing is like. So they don't know that. They no idea what their hearing is like, so they don't know that they're even understanding or hearing the questions, yet their responses to that are what's saying whether or not they had cognitive issues. So this is very, very important to use a test. That number one could be universal. That would be great. Number two does not rely on audition, because we know that many of the signs and symptoms of hearing loss language delays, language problems, super threshold listening disorders, auditory processing, subclinical hearing loss many of these problems will interfere and mask and parade, just like cognitive problems, and if you're not doing a comprehensive audiometric evaluation to really understand that the patient is able to not just hear but make sense of. So hear and listen to the questions that are being asked so that they can respond appropriately. If we're not making sure that we've done that, we really don't know what the answers mean. And this is one of the beautiful things with the cog state.

Dr. Douglas L. Beck: 25:48

The other one that is non-auditory is the Cognivue Thrive and there's probably two or three others. I think there's a new Mocha version that's HI hearing impaired. I haven't seen that one myself. I read about it when the German version came out, probably a year or two years ago. I don't know if it's available in English, but it's for older and hearing impaired people, because the vast majority of older people have hearing impairment. By the time you're 65, one out of three people in the US has hearing loss. By the time you're 75, two out of three people in the US have hearing loss. By the time you're 90, it's about 98% of all people in the US have hearing loss.

Dr. Julia Sarant: 26:38

So this is very important what you're saying, that you have to be sure the patient can hear and listen to the stimuli, whatever it is, in order to get a valid answer. Sure, and another thing I think that's important to think about is that not only do we have to know that they're understanding the instructions, the other thing that happens when you are struggling with hearing loss to listen to instructions is you have increased cognitive load in doing the task, and that can also impact on your performance, on the cognitive assessment. You are actually doing a harder task than somebody who has normal hearing and is not having trouble understanding what it is they're supposed to be doing. So that's a further reason for not using auditorily administered tests, and so that's a big difference between the ACHIEVE and the ENHANCE study. But anyway, achieve used auditorily administered tests, enhance was truly visual Right.

Dr. Douglas L. Beck: 27:26

And you know, some clinicians I mean to this day, 2024, we're in April will say oh, I can tell if they have hearing loss. And I have news for you I've been an audiologist 40 years you cannot tell if somebody has hearing loss If you don't do a comprehensive audiometric evaluation. You're guessing and guessing. There's really no place for that in science. We either do things correctly or we do things less than correctly. And you know, I don't want to say anything negative about the ACHIEVE study, because it was brilliant. You know, from execution to publication, everything about it I liked. But I think you're right, it's a potential pitfall, another potential pitfall, one that I wrote up almost a year ago, just before, well, just when it came out, so just under a year ago.

Dr. Douglas L. Beck: 28:08

You know, there's really not a control group. I mean, this is this is something that in my mind, maybe, maybe there is a control group. I'm not a statistician, but what they did is they gave brilliant counseling to one group and they gave hearing aids to another, and so these two groups changed together and what they said is that over time, you didn't see any difference in the group that got hearing aids. But there was no control group. You had a control group. You had people who were untreated. What the ACHIEVE study had is two groups who were treated, one who was treated with hearing aids Right.

Dr. Douglas L. Beck: 28:38

So if they had changed together you're not going to see any changes. And then in their other group, in the secondary group that they reported these are the people who were at much higher risk. Again, they had multiple comorbidities, they had lower socioeconomic, they had less education, they were older, they had more hearing loss, lots of things going on and they found that in those people over the three years the people who wore hearing aids got about a 48% lesser cognitive decline. Did I say that correctly?

Dr. Julia Sarant: 29:08

Yeah, the rate of cognitive decline decreased by 48%.

Dr. Douglas L. Beck: 29:13

Yeah, the rate of cognitive decline decreased. So that was important. And again, I don't mean to criticise that study at all. It was brilliant. I wish I had been a part of it. But there's a couple of flaws, and there's always flaws. Every study I've published has at least one or 75. So I'm not, you know, I don't want anybody to think I'm disrespecting that. I think it's brilliant work. So I'm not, you know, I don't want anybody to think I'm disrespecting that.

Dr. Julia Sarant: 29:35

I think it's brilliant work. No, I think it's really important. When you consider the evidence, the chief study has made a massive contribution to the body of evidence. It's the first large-scale randomized clinical trial and we've learned a lot and we're going to continue to learn a lot as they publish more of the data. But, as with considering any evidence, we have to look at the flaws, the strengths, the weaknesses, and we have to take those into account when we interpret the results, so that we learn from them Absolutely, and we know where to go from next.

Dr. Douglas L. Beck: 30:05

Yeah, and they've said they're going to keep following these people and they're going to publish more brilliant work as time goes on. But I think the lesson is that we have to take it in context and say, okay, these are the strengths, these are the weaknesses, which they readily admit. There's nothing shocking in anything that we just said. But this does fall under a different situation now with the enhanced study, because you had an untreated group that received no treatment whatsoever and you compared that to the group that was treated with hearing aids, and I believe that your essential core outcome was that hearing aid use may delay cognitive decline. Is that fair? Did I say that right?

Dr. Julia Sarant: 30:45

Yeah, that's the conclusion we came to, because we didn't actually see any significant cognitive decline in our hearing aid group, whereas we did see decline in the control group. And that was quite surprising to me, firstly because it was only three years and I still consider that to be a relatively short period of time. Secondly, because there is a process that's going on for all of us that we call cognitive aging, and that process starts in our 20s and involves ongoing cognitive decline at about a rate of approximately 1% per year. So we didn't see what we would expect to see in terms of normal cognitive aging and then, when you consider the fact that these people had hearing loss and you would expect that rate to increase, yes.

Dr. Julia Sarant: 31:34

We didn't see it, and so I'm very, very excited about that.

Dr. Douglas L. Beck: 31:38

For those reasons, yeah, and so the hearing aid may have offered some sort of protection. It certainly didn't reverse cognitive decline, but it may have slowed it down. And you guys looked also not just at hearing and not just at cognition, but I'm looking at your paper. Object of speech.

Dr. Julia Sarant: 31:55

Doug, can I just interrupt just for one minute? Just to clarify we didn't see so, whereas the ACHIEVE study saw a slowing of the rate of cognitive decline.

Dr. Julia Sarant: 32:06

We saw none. Oh, that, yes, no cognitive decline, and that's really important. We may see it in the future and I'm waiting to see what happens, because people can't stay the same for the rest of their lives. But we didn't see. When we compared the two groups, we didn't see, overall, any cognitive decline in the treated group, whereas we did in the untreated control group and that is brilliant and that's why, when I read this, I started sending you email.

Dr. Douglas L. Beck: 32:30

I said we need to talk about this. So you did a little bit more than just looking at cognitive screenings with the two tools and hearing tests. You did speech and noise tests, you did medical health history, genetic screening, anxiety and depression, health and lifestyle education and all of that was taken into the statistical analysis when you said that we did not see cognitive decline in the people who were hearing aids over that period of time.

Dr. Julia Sarant: 32:58

And the other thing that's really important about this study also is objective data. So we didn't ask people to report whether they had a hearing loss. We audiometrically objectively assessed it and we continue to assess it at every assessment point. We also it's really important in a drug trial when you give people medication, you need to know that they're swallowing that medication. In the same regard, we use data logging to see how much are people using their hearing aids, under what circumstances are they using their hearing aids, how many hours a day are they using their hearing aids, and we also measured so is the treatment being complied with in terms of objective use of the hearing aids? And also are the hearing aids working? Because how are we going to interpret the results if we don't know that we're getting a significant benefit to speech perception, either in quiet or in noise? So that's something again that was really important to have objective data on in interpreting these results.

Dr. Douglas L. Beck: 33:55

And it was so refreshing to read your study.

Dr. Douglas L. Beck: 33:59

There are quite a few studies now that have found similar findings where and I have a brand new paper that's coming out, I want to say, june or July it's sort of an update on cognition, audition, amplification and it's a screen, a pilot test that some of my colleagues in New Jersey did, and I can't talk about the results because that hasn't been published yet.

Dr. Douglas L. Beck: 34:22

But we see in the literature quite a few papers now, quite a few peer-reviewed articles that have said the group that got the treatment of hearing aids, generally speaking, didn't decline or did better than the untreated group, and there's quite a few of those. I'll talk about them in my paper, which is in June or July, and I know that in your work you've come across those as well. So what is the take-home lesson that you would like the listeners to get from the enhanced study? Because I think it was brilliant. I think it's just about the best research study on cognition and audition that I've read to date, and I'm very proud of you for participating in creating this. This is absolutely huge. And so, in your words, what should the listeners know about audition, cognition and amplification?

Dr. Julia Sarant: 35:16

I'd like to actually borrow somebody else's words in the take-home message, and those are the words of Jan Bluestine, josh Chodosh and Barbara Weinstein. I think something that's really easy and simple as a take-home message is hearing better can help you think better. I love it. I think, though, it's really important not to just focus on cognitive health, because, as you are well aware, having good hearing enables and prevents, or at least decreases, so many of the comorbidities of hearing loss, and those are impacts on physical health, social connectedness, mental health, function, maintenance of function, and I think that audiologists are in a really prime position to help older adults to maintain their function, their quality of life and their wellbeing through to older age, and using hearing aids is, for me, a no-brainer, and it appears now that we may be able to add looking after our cognitive health as a further benefit to hearing aid use, but we mustn't forget all of these other enormous benefits that hearing aid use give us.

Dr. Douglas L. Beck: 36:32

Absolutely. I am so delighted to meet you and to work with you and Julie. I want to thank you for your time. This has been a wonderful session. I learned so much listening to you and I'm so happy that you had the time to record with us for the Hearing Matters podcast and looking forward to working with you again.

Dr. Julia Sarant: 36:52

Thank you very much, doug, it was a pleasure.

Dr. Douglas L. Beck: 36:54

Thank you.