Silencing Tinnitus: A Sound Strategy for Dementia Prevention

In 2017, the European Dementia Commission put forth the first in its series of ‘the holy grail’ on the state of dementia. This report, published in the Lancet (FYI – the Lancet is among the oldest, most respected, and most widely read medical journals in the world) and recently updated in 2020, lays out the ‘How To’ of preventing dementia.

To summarize, the 2020 Lancet report (Dementia Prevention, Intervention and Care) has two major findings:

  • 40% of all cases of dementia are considered preventable.
  • 12 (simple) modifiable factors can help prevent dementia.

Each of the 12 modifiable lifestyle factors is scientifically backed and can dramatically reduce your risk of developing cognitive decline and dementia.

Not surprising to us, but surprising to most in both the medical and non-medical fields, is that the early treatment of hearing loss and tinnitus is #1 on the list of modifiable factors! Below is a list of all 12 modifiable factors – with most of the attention focused on the links of tinnitus, hearing loss and dementia.

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NOTE – the 12 items below are listed IN ORDER of percentage chance of avoiding dementia if this risk is eliminated:

  1. Treat Your Tinnitus & Hearing Loss – The early medical treatment of hearing loss and tinnitus is the #1 modifiable lifestyle factor for reducing the risk of dementia. Several studies have shown a correlation between untreated hearing loss and cognitive decline, including dementia. While the exact mechanisms behind this link are not fully understood, the correlation between increased risk of cognitive decline and dementia is undeniable.
    • There are three strong theories on why untreated tinnitus and hearing loss can increase your chances of cognitive decline and dementia.
    • Tinnitus and hearing loss impacts over 48 million people in the U.S. (nearly 1.5 billion people worldwide) and is listed by the Department of Health and Human Services as the 3rd most common chronic disorder affecting today’s older adults.
    • Unfortunately, for most of us, age-related hearing loss is inevitable, impacting nearly 50% of seniors between the ages of 60-70, almost 2/3 of people between the ages of 70-80, and nearly 80% of individuals over the age of 80. Age-related hearing loss is characterized as a progressive degenerative disorder that impacts neural connections and functions throughout the brain. 
    • This chronic medical condition can have a significant impact on several key brain areas, including memory, emotion, hearing, decision-making, speech, and language portions. Several key research studies have pointed to the potential links between hearing loss and dementia, including the groundbreaking work from Dr. Lin and his colleagues at Johns Hopkins Medical Center that indicates hearing loss can increase the risk of dementia by 200-500%.
    • The links between tinnitus, hearing loss and cognitive decline are detailed below:
      • Social Isolation: The impact of reduced social and physical activity. Withdrawal from social situations is common in individuals with hearing loss. Many studies cite feelings of embarrassment, fear of making mistakes in conversations, and feeling like you are not part of the conversation as the common rationale for individuals with hearing impairment to separate themselves from family, friends, and community. This retreat from social activity has even been found in individuals with a mild degree of hearing loss. In addition, individuals with hearing loss are less likely to engage in physical activity. Both increased social isolation and reduced physical activity are strong risk factors for the development of dementia.
        • Note – Both social isolation and the ensuing depression are major risk factors for the development of dementia, and both increase as we age. Being a lifelong learner and staying active is important to maintain a healthy, active brain and can also reduce your risk of cognitive decline and dementia. Some studies have shown that social activities, larger social networks, and a history of social contact are associated with better cognitive function and reduced risk for cognitive decline.
      • Cerebral Atrophy (aka Brain Shrinkage): The association of a shrinking brain, resulting from the loss of neurons, with dementia, has been long documented. Even people with MCI (Mild Cognitive Impairment) show signs of cerebral atrophy. In recent years, scientific studies using advanced brain imaging techniques (including fMRI - Functional Magnetic Resonance Imaging) have demonstrated that hearing impairment is associated with accelerated brain atrophy throughout the entire brain.
      • Cognitive Overload (i.e., Working Your Brain Too Hard to Hear): Tinnitus and hearing loss are not normal, and neither is the excess strain that it puts on your brain. While hearing loss may be more common as we age, tinnitus and hearing loss must be treated. With hearing loss, the brain is constantly on ‘overload,’ trying to fill in the missing pieces and follow the conversation. Increased cognitive load is considered a risk factor for developing dementia. Cognitive load, as measured by pupillometry, is a measurement of how hard your brain is working to follow a conversation. Recent research has found that individuals who treat their hearing loss do not work as hard to listen (i.e., have a reduced cognitive load) and have as much as a 20% increase in memory recall when following a conversation.
  2. Increased Education: Your mother was right – stay in school and never stop learning. Education level has been found to have a significant impact on the risk of developing dementia. Research has consistently shown that individuals with higher levels of education tend to have a reduced risk of developing dementia compared to those with lower levels of education. Here's how education level is related to dementia:
    • Cognitive Reserve: One of the leading theories explaining the relationship between education and dementia is the concept of cognitive reserve. Cognitive reserve refers to the brain's ability to withstand damage and function effectively despite neurological changes. Higher education is thought to contribute to cognitive reserve in several ways:
    • Education typically involves mental stimulation and learning, which can enhance cognitive abilities and create a reserve of brainpower.
    • Educated individuals often engage in complex mental tasks throughout their lives, which may help their brains adapt to challenges and function efficiently, even in the presence of brain changes associated with dementia.
  3. Stop Smoking: If the threats of lung cancer and emphysema are not enough to get you to stop smoking, perhaps ending up without dementia will. Smoking has been identified as a significant risk factor for the development of dementia, particularly Alzheimer's disease and vascular dementia. Research has consistently shown a link between smoking and an increased risk of cognitive decline and dementia. Several factors contribute to smoking and cognitive impairment, including:
    • Vascular Damage: Smoking is a major contributor to vascular diseases, including atherosclerosis (hardening and narrowing of the arteries) and hypertension (high blood pressure). These conditions can lead to reduced blood flow to the brain, depriving it of essential oxygen and nutrients. Such vascular damage is a known risk factor for vascular dementia, which is caused by impaired blood flow to the brain.
    • Inflammation: Smoking promotes inflammation throughout the body, including in the brain. Chronic inflammation is believed to play a role in the development of Alzheimer's disease and other neurodegenerative conditions.
    • Oxidative Stress: Smoking generates oxidative stress in the body, which can damage cells, including brain cells. This oxidative damage is associated with the development and progression of dementia.
    • Amyloid Plaque Accumulation: Smoking may contribute to the accumulation of beta-amyloid plaques in the brain. These protein deposits are a hallmark of Alzheimer's disease.
    • Interaction with Other Risk Factors: Smoking can interact with other risk factors for dementia, such as high cholesterol and diabetes, further increasing the risk of cognitive decline.
    • Accelerated Brain Aging: Smoking has been linked to accelerated brain aging, which is associated with cognitive decline and an increased risk of dementia.
  4. Depression: Addressing depression in older age is critically important for cognitive health, and living a life with less ringing and healthy hearing goes a long way to reducing depression. Depression and dementia are two distinct but interconnected health conditions, and they can often co-occur or influence each other in complex ways. Here are some important points to understand about the relationship between depression and dementia:
    • Coexistence of Depression and Dementia: Depression and dementia can coexist in the same individual. In some cases, depression may be a symptom of dementia, especially in the early stages when individuals may be aware of their cognitive decline. This is known as "depressive pseudodementia." Conversely, individuals with a history of depression may be at a higher risk of developing dementia later in life.
    • Depression as a Risk Factor for Dementia: Several studies have suggested that late-life depression may be a risk factor for the development of dementia, particularly Alzheimer's disease. The exact mechanisms linking depression and dementia are not fully understood, but chronic inflammation, vascular changes, and stress-related changes in the brain are some of the proposed pathways.
    • Symptoms and Overlapping Features: Depression and dementia can share certain symptoms, such as memory problems, difficulty concentrating, and changes in mood and behavior. This overlap in symptoms can make it challenging to differentiate between the two conditions, especially in older adults. Healthcare professionals must conduct thorough assessments to determine whether symptoms are due to depression, dementia, or a combination of both.
  5. Social Isolation: Tinnitus and hearing loss often lead to profound isolation among many patients. Social isolation and loneliness have been associated with an increased risk of developing dementia and can also exacerbate cognitive decline in individuals already living with dementia. The links of social isolation and dementia include:
    • Reduced Cognitive Stimulation: Social interactions provide cognitive stimulation through conversations, problem-solving, and engagement with others. When individuals are socially isolated, they may experience a lack of mental stimulation, which can contribute to cognitive decline.
    • Mental Health Impact: Loneliness and social isolation are linked to depression and anxiety, both of which can negatively affect cognitive function. Chronic stress associated with loneliness may also contribute to cognitive decline.
    • Physical Health Impact: Social isolation can lead to a sedentary lifestyle and poor health behaviors, such as a lack of exercise and unhealthy eating habits. These factors can increase the risk of conditions like obesity, diabetes, and hypertension, which are known risk factors for dementia.
    • Neurobiological Effects: Loneliness and social isolation have been associated with changes in the brain, including increased inflammation and alterations in stress-related hormone levels. These changes may contribute to cognitive impairment and increase the risk of dementia.
    • Medication Adherence: Social isolation can make it challenging for individuals to manage their healthcare, including taking medications as prescribed. Poor medication adherence can lead to the progression of underlying health conditions that increase dementia risk.
    • Lack of Social Support: A solid social support system can provide emotional and practical support, which can reduce stress and help individuals cope with life's challenges. Social isolation can result in a lack of this support, potentially leading to increased stress and anxiety.
  6. Traumatic Brain Injury (TBI): While most TBIs are the result of an accident, preventative measures should always be taken to reduce the incidence of TBI, as it can be a significant risk factor for the development of various cognitive impairments, including dementia. While not everyone who experiences TBI will develop dementia, there is evidence to suggest that TBIs, particularly moderate to severe ones, can increase the risk of dementia in the future. Several factors contribute to the connections between head injury and dementia, including:
    • Types of TBIs: TBIs can range from mild (e.g., concussions) to severe, with varying degrees of cognitive and physical impairment. Moderate to severe TBIs, which involve more significant damage to the brain, are more strongly associated with an increased risk of dementia.
    • Increased Risk: Many research studies have indicated a link between moderate to severe traumatic brain injuries (TBIs) and an increased likelihood of developing dementia, specifically Alzheimer's disease and various types of neurodegenerative dementia. The risk appears to be highest in the years immediately following the TBI.
    • Mechanisms: The exact mechanisms by which TBIs increase the risk of dementia are not fully understood, but several factors may contribute:
      • Neuroinflammation: TBI can trigger an inflammatory response in the brain, which may lead to chronic inflammation and neurodegenerative processes.
      • Tau Protein Accumulation: TBIs can result in the abnormal accumulation of tau protein in the brain, a hallmark of Alzheimer's disease.
      • Axonal Injury: Damage to axons (nerve fibers) in the brain can disrupt communication between brain regions, potentially contributing to cognitive impairment.
      • Vascular Changes: TBIs can also lead to changes in blood vessels in the brain, increasing the risk of vascular dementia.
      • Cumulative Effect: Multiple TBIs, even if they are mild, can have a cumulative effect on the brain and may further increase the risk of cognitive impairment and dementia.
  7. Physical Inactivity: People with tinnitus and hearing loss do less physical activity. This has been shown time and time again in research and is likely the result of increased social isolation in older adults with hearing loss. Physical inactivity is a well-established risk factor for the development of dementia. Regular physical activity is associated with various health benefits, including improved cardiovascular health, reduced inflammation, better blood flow to the brain, and enhanced brain plasticity. Here's how physical inactivity is related to dementia:
    • Cardiovascular Health: Physical inactivity can lead to conditions such as hypertension (high blood pressure), obesity, and diabetes, all of which are risk factors for vascular dementia. Vascular dementia is caused by reduced blood flow to the brain due to vascular problems, and physical activity can help maintain a healthy cardiovascular system.
    • Brain Health: Exercise has a positive impact on brain health. It can stimulate the release of neurotrophic factors, which support the growth and maintenance of neurons (brain cells). Regular physical activity can also enhance cognitive function and improve memory.
    • Reduction of Alzheimer's Risk: Alzheimer's disease, the most common form of dementia, is characterized by the accumulation of beta-amyloid plaques and tau tangles in the brain. Physical activity has been linked to a lower risk of developing Alzheimer's disease and a reduced rate of cognitive decline.
    • Stress Reduction: Physical activity is known to reduce stress and improve mood. Chronic stress and depression are associated with an increased risk of cognitive decline and dementia. Exercise can help mitigate these risk factors.
    • Blood Flow to the Brain: What’s good for the heart is good for the mind! Exercise promotes better blood flow to the brain, ensuring that it receives the oxygen and nutrients it needs to function optimally. Reduced blood flow can contribute to cognitive impairment.
    • Neuroplasticity: Physical activity can enhance neuroplasticity, the brain's ability to reorganize and adapt by forming new neural connections. This can be particularly important in protecting against age-related cognitive decline.
    • Social Engagement: Some forms of physical activity, such as group sports or classes, also involve social engagement. Maintaining an active social life can have a protective effect against dementia.
    • Healthy Lifestyle: Regular physical activity is often part of a healthy lifestyle that includes a balanced diet, not smoking, and moderate alcohol consumption, all of which can contribute to a lower risk of dementia.
  8. Hypertension: If it’s good for the heart, it’s good for the mind!  Cardiac conditions compromise blood flow to nearly all major organs, including the brain and the ear. Love yourself and take care of your heart.
    • Hypertension, or high blood pressure, is a known risk factor for the development of dementia, particularly vascular dementia, and Alzheimer's disease. There is a strong association between hypertension and cognitive decline, and here's how hypertension is related to dementia:
      • Vascular Damage: Hypertension can cause damage to blood vessels throughout the body, including those in the brain. Over time, high blood pressure can lead to atherosclerosis (narrowing and hardening of the arteries), which reduces blood flow to the brain. This reduced blood flow can result in small strokes or micro-infarctions that damage brain tissue, increasing the risk of vascular dementia.
      • Impact on Brain Structure: Long-term high blood pressure has been associated with structural changes in the brain, such as white matter lesions and brain atrophy. These changes are often seen in individuals with dementia.
      • Amyloid Accumulation: Hypertension may also contribute to the accumulation of beta-amyloid plaques in the brain, a hallmark of Alzheimer's disease.
      • Midlife Hypertension: Hypertension in midlife (around ages 40-64) appears to be particularly relevant to dementia risk. Controlling blood pressure during midlife may have a protective effect on cognitive function later in life.
      • Interaction with Other Risk Factors: Hypertension often coexists with other risk factors for dementia, such as diabetes, high cholesterol, and obesity. The combination of these factors can increase the risk of cognitive decline.
  9. Air Pollution: This was recently added to the list as air pollution might act via vascular and/or respiratory mechanisms and reduce proper blood and oxygen flow to the brain. There is growing evidence to suggest that air pollution, especially fine particulate matter, and other pollutants, may be associated with an increased risk of dementia. While more research is needed to establish a definitive causal link, several studies have found significant correlations between exposure to air pollution and cognitive decline, including the development of dementia. Here's how air pollution is related to dementia:
    • Inflammation and Oxidative Stress: Air pollution, especially fine particulate matter and toxic chemicals can enter the bloodstream and reach the brain. Once in the brain, these pollutants can cause inflammation and oxidative stress, which are processes implicated in the development of neurodegenerative diseases, including dementia.
    • Blood-Brain Barrier Disruption: Air pollution can impair the integrity of the blood-brain barrier, a protective barrier that regulates the passage of substances between the bloodstream and the brain. This disruption may allow harmful substances to enter the brain more easily.
    • Vascular Effects: Air pollution is a well-known risk factor for cardiovascular diseases, including hypertension and atherosclerosis. These conditions can reduce blood flow to the brain, increasing the risk of vascular dementia, which is caused by reduced blood flow to brain tissue.
    • Brain Structure and Function: Some studies have shown that long-term exposure to air pollution is associated with structural changes in the brain, such as smaller brain volume and white matter damage. These changes are often seen in individuals with dementia.
  10. Diabetes: While diabetes and dementia are two distinct health conditions, insulin levels play a vital role in how the brain operates. Some even theorize that dementia is a ‘type 3 diabetes’. Several studies suggest that the brains of people with Alzheimer’s disease are in a ‘diabetic state’, partly due to the decrease and insensitivity to insulin. People with diabetes are at least twice as likely to experience dementia. Several mechanisms contribute to the correlation between diabetes and dementia, including:
    • Increased Risk: Several studies have shown that individuals with diabetes, especially type 2 diabetes, have an increased risk of developing dementia, including Alzheimer's disease, vascular dementia, and other types of cognitive impairment.
    • Vascular Factors: Diabetes can lead to various vascular changes and complications, including atherosclerosis (narrowing and hardening of the arteries) and hypertension (high blood pressure). These vascular problems can reduce blood flow to the brain, increasing the risk of vascular dementia.
    • Insulin Resistance: Insulin resistance is a hallmark of type 2 diabetes, and it can also affect the brain. Some research suggests that insulin resistance in the brain may contribute to Alzheimer's disease by impairing brain cell function and the clearance of toxic beta-amyloid proteins.
    • Blood Sugar Control: Poorly controlled diabetes can result in high blood sugar levels, which may have a negative impact on brain health. High blood sugar can cause inflammation and oxidative stress in the brain, both of which are associated with cognitive decline.
    • Hypoglycemia: Episodes of hypoglycemia (low blood sugar) can occur in individuals with diabetes, especially if they are using medications like insulin or sulfonylureas. Severe hypoglycemia can lead to cognitive deficits and, in some cases, may increase the risk of dementia.
    • Interaction with Other Risk Factors: Diabetes often coexists with other risk factors for dementia, such as hypertension, obesity, and high cholesterol. The combination of these risk factors can increase the risk of cognitive impairment.
  11. Obesity: Being overweight is an emerging concern when it comes to dementia. The rates of increased BMI in older adults are growing and may be contributing to cognitive decline.  Obesity is a significant risk factor for the development of dementia, including Alzheimer's disease. The relationship between obesity and dementia is complex, but several mechanisms and factors contribute to this association, including:
    • Inflammation: Obesity is characterized by chronic inflammation in the body, including the brain. Inflammation is believed to play a role in the development and progression of neurodegenerative diseases, such as Alzheimer's disease.
    • Insulin Resistance: Obesity is often accompanied by insulin resistance, a condition where the body's cells do not respond properly to insulin. Insulin resistance has been linked to impaired brain function and an increased risk of cognitive decline.
    • Vascular Changes: Obesity is a risk factor for cardiovascular diseases, including hypertension (high blood pressure) and atherosclerosis (hardening and narrowing of the arteries). These conditions can reduce blood flow to the brain, potentially leading to vascular dementia.
    • Metabolic Factors: Obesity is associated with metabolic disturbances, such as abnormal lipid profiles and elevated levels of triglycerides and cholesterol. These metabolic factors can contribute to cognitive impairment.
    • Hormonal Changes: Obesity can lead to hormonal imbalances, including elevated levels of certain hormones like leptin and insulin, which may affect brain health.\
    • Sleep Apnea: Obesity is a risk factor for sleep apnea, a condition characterized by interrupted breathing during sleep. Sleep apnea has been associated with cognitive deficits and an increased risk of dementia.
    • Amyloid Plaque Accumulation: Some studies suggest that obesity may be associated with increased production and accumulation of beta-amyloid plaques in the brain, which are a hallmark of Alzheimer's disease.
    • Physical Inactivity: Obesity often coincides with physical inactivity, which is also an independent risk factor for dementia. Regular physical activity is essential for maintaining cognitive health.
    • Psychosocial Factors: Obesity can lead to psychosocial factors such as depression and low self-esteem, which can contribute to cognitive decline and dementia.
  12. Alcohol Intake: Like most things we enjoy in life, moderation is key. Consuming less than 21 units of alcohol per week (the equivalent of 2 bottles of wine per week) can help to reduce the risk of cognitive decline and dementia as we age. The relationship between alcohol consumption and dementia is complex and varies depending on the amount and pattern of alcohol use. Below offers some insight into how alcohol can impact the brain and increase the risk of cognitive decline and dementia:
    • Excessive Alcohol Consumption: Chronic heavy alcohol use is a well-established risk factor for dementia. Excessive alcohol intake can lead to a range of neurological and cognitive problems, including alcohol-related dementia (often referred to as alcohol use disorder-related dementia or alcohol-induced neurocognitive disorder). Impairments in memory, executive function, and overall cognitive ability characterize this type of dementia.
    • Brain Damage: Prolonged heavy drinking can result in structural and functional brain damage, including the shrinkage of brain regions crucial for memory and cognition. This brain damage can lead to cognitive deficits and contribute to the development of dementia.
    • Wernicke-Korsakoff Syndrome: Chronic alcohol use can lead to Wernicke-Korsakoff syndrome, a condition characterized by severe memory problems, confusion, and hallucinations. This syndrome can significantly impact cognitive function.
    • Alcohol-Related Neurotoxicity: Alcohol has neurotoxic effects on the brain and can lead to the death of brain cells, particularly in regions critical for memory and cognitive function.
    • Interaction with Other Risk Factors: Excessive alcohol consumption often coexists with other risk factors for dementia, such as hypertension, liver disease, and nutritional deficiencies. These comorbid conditions can further increase the risk of cognitive impairment.

                    While we certainly cannot guarantee that if you do everything on this list, you will not get dementia, we do guarantee that you are doing everything you possibly can to reduce your risk of getting dementia. For more information regarding tinnitus and dementia, please visit us at www.excellenceinaudiology.org.

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