What does new drug for Alzheimer’s have to do with hearing loss?

What does last week’s approval of a new drug for Alzheimer’s have to do with hearing loss? Nothing, according to the articles and commentary that I read about the drug. Hearing loss was not mentioned in a single news story or commentary.

The drug, brand-name Aduhelm, is the first new treatment for Alzheimer’s in 18 years. The FDA’s decision to approve the drug was made despite opposition from the agency’s independent advisory committee, which said that the evidence raised significant doubts about whether the drug is effective, and noted the risk of serious side effects, including swelling and bleeding in the brain.

Biogen set a list price of $56,000 a year per patient. Very few patients will end up paying that amount, but their insurance companies might. Medicare has not yet said whether it will cover the drug. The insurer Cigna said that beyond the cost of the medicine itself, diagnostic care and safety monitoring will cost another $30,000 a year.

Medicare won’t pay for your $3000 hearing aids, but should you develop signs of Alzheimer’s, it seems likely that it will kick in the $56,000 to treat you with Aduhelm.

The new drug was approved without evidence that it slows symptoms of Alzheimer’s. But it does reduce levels of amyloid, which forms a plaque in the brain, and which is thought to cause symptoms. For a fuller discussion of the new drug and the controversies around it, this New York Times article is excellent. F.D.A. Approves Alzheimer’s Drug Despite Fierce Debate Over Whether It Works.

So what does this have to do with hearing loss? In 2011 an epidemiological study by Frank Lin of Johns Hopkins School of Medicine and others found a strong association between hearing loss and dementia, including Alzheimer’s. The greater the degree of hearing loss, the earlier the onset and severity of the dementia. These findings do not suggest that hearing loss causes dementia, although that could turn out to be the case.

Lin and others are conducting a long-term study to see whether the use of hearing aids or other devices mitigate the risk. If their study shows that hearing aids do help delay the onset of dementia, or lessen its severity, many people with hearing loss will be relieved. But that has not yet been definitively proved.

A smaller study, published in 2015, did find some evidence that hearing aids could help, but not why. The researchers suggested that because hearing loss can cause depression and social isolation, which then affect brain health, the use of hearing devices helps offset those other conditions, and thus slows dementia. You can read more about this study in an article I wrote for AARP online. 

The FDA’s approval of a controversial and expensive drug for Alzheimer’s struck some with hearing loss as sadly ironic. Medicare famously does not cover hearing aids, which are expensive and out of range for many users. A typical brand-name hearing aid costs about $3000, and most people need two. But $6000 sounds cheap compared to the cost of Aduhelm.

In 2020, a study by Columbia researcher Justin Golub and others found that even subclinical hearing loss is associated with cognitive decline. Normal adult hearing is defined as the ability to hear at 25 decibels or less. Golub’s paper found that hearing levels below 25 dB were also associated with cognitive decline. The authors wrote that the findings “suggest that the association between hearing loss and impaired cognition may be present at earlier levels of hearing loss than previously recognized; the current 25-dB threshold for defining adult hearing loss may be too high.”

We may find in the next few years that treating hearing loss can help offset dementia. That would be welcome news. But without affordable hearing aids and hearing care, widespread treatment is unlikely to happen. Medicare won’t pay for your $3000 hearing aids, but should you develop signs of Alzheimer’s, it seems likely that it will kick in the $56,000 to treat you with Aduhelm.


For more about living with hearing loss, read my books “Smart Hearing: Strategies, Skills and Resources for Living Better With Hearing Loss” and “Shouting Won’t Help: Why I and 50 Million Other Americans Can’t Hear You.” Both are available as ebook and paperback on Amazon.com.

How Fit is Your Hearing?

Recently, a prominent researcher in the field of hearing loss suggested a simple change in the way we talk about hearing loss. Rather than frame it as a disability, said Dr. Justin Golub of Columbia University Irving Medical Center, “I like the idea of hearing fitness.”

images“Hearing loss” is a negative term. For people who don’t want to admit they have hearing trouble, it invites the dismissive response: “I’m fine.”  But who wouldn’t want to be as fit as possible, especially if it takes little to no work on their part?

Dr. Golub is the lead author on a November 2019 paper in JAMA Otolaryngology-Head Neck Surgery, which found an association between cognitive impairment and what is generally considered “normal” hearing. In 2011, Johns Hopkins’ researchers led by Frank Lin, published the result of a longitudinal study on a large cohort of older adults showing that those with moderate or more severe hearing loss were at a greater risk of dementia. The greater the hearing deficit, that study found, the greater the risk of developing dementia. What Golub and his colleagues have now found is that even minor loss, within the so-called normal range  of 25 dB or less, is associated with lower cognition.

Using two major national databases as their source, the Golub team studied data on hearing and cognitive performance in 6451 people age 50 and over. This study, unlike previous studies of hearing loss and cognition, focused on people with hearing loss in the range usually considered normal. They considered all levels of hearing in that category, down to what would be considered “perfect” hearing, the ability to hear at zero decibels. (Dogs can hear at -5 to -15 decibels.)

After adjusting for demographics and cardiovascular disease, the study found that decreased hearing was independently associated with decreased cognition. The study did not look at whether hearing loss causes cognitive decline. Nor did it look at whether correcting hearing loss with hearing aids offsets the correlation.

“Can Hearing Aids Help Prevent Dementia?” That question was the title of the article in The New York Times Magazine where Golub’s hearing fitness quote appeared. We don’t have an answer yet but Frank Lin and colleagues will conclude what is expected to be the definitive study on hearing aids and their deterrent effect on cognitive decline in 2022. (For those who are interested in learning more about the study, Aging and Cognitive Health Evaluation in Elders (ACHIEVE), funded by the National Institute on Aging, here’s a link to an interview in AudiologyOnline on the study and other hearing-related public-health issues.)

Speaking to the Times Magazine, Golub mused, “We always frame [hearing loss] as a disability.” Telling college students that blasting their ears with loud noise is going to make them more susceptible to dementia 50 years later, he said, isn’t going to be much of a deterrent. “But if you say, ‘Hey, hearing is good for your brain, the more hearing you have the better,” that has immediate implications.”

“Hearing Fitness” is good for people at any age. Whatever it is about hearing loss that aligns it with an increased risk of dementia is of course of paramount interest. But poor hearing has a host of other physical and psychological ramifications, some of which themselves are a risk factor for cognitive decline.

Hearing fitness means taking care of the hearing that you have, whatever your age. And if it begins to decline, as it often does with age, correcting it. Cost has been a prohibitive factor for many up till now, but this year the FDA will announce guidelines for an over-the-counter hearing aid that will cost a fraction of existing FDA-approved hearing aids. Hearing aid companies and the consumer electronics industry are already offering products that are as good as some hearing aids at even cheaper prices. Costco is reportedly the nation’s largest hearing aid dealer (except for the VA), with volume permitting lower prices. Having hearing professionals on staff insures responsible service. Insurance companies are increasingly covering hearing aids, finally understanding their role in healthy aging. In some states, Medicaid covers hearing aids. Even that dinosaur Medicare may soon revise its hearing aid policies.

Tuesday March 3 is World Hearing Day. Although hearing fitness may be a distant goal for the half a billion people worldwide with disabling hearing loss, those of us in prosperous countries can make a start by taking care of our hearing, and by treating it promptly when problems develop. Hearing help comes in all price ranges. Keep your hearing fit!


For more about living with hearing loss, read my books, available at Amazon.com and maybe at your favorite bookstore or library. If it’s not there, ask for it!




Answers to Questions About Hearing Health

black and white business career close up
Photo by Pixabay on Pexels.com

We all have questions about our hearing, our hearing aids, and our life with hearing loss. How can we enhance our hearing experience? How do we deal with hearing related issues like tinnitus and vertigo? How does hearing loss affect cognitive health?

Sometimes these issues may be addressed at HLAA chapter meetings, or through informal contacts made at HLAA’s annual convention (to be held this year in Rochester, June 20-23). Books like mine also offer information, as does the HLAA website. But now the Mayo Clinic is offering a new service where people with hearing loss, at every stage of their life, can get and share information with others.

The Mayo Clinic, in collaboration with the Hearing Loss Association of America (#HLAA) and the Ida Institute, an independent non-profit organization that promotes hearing health, has established an online forum where you can find support, answers to specific questions, share experiences and even gripe if you feel like it.

The forum is monitored by Mayo Clinic staff as well as volunteer mentors, and this oversight should help keep the discussions civil and the information credible.

To join the group go to https://connect.mayoclinic.org/group/hearing-loss/. Click on the “Join” button at the top, create a user name (you can use a nickname or a first name plus @ — for instance Katherine@), enter your email address and follow the prompts.

Anyone can read the discussions, whether or not you join, but if you want to initiate a topic or comment on an existing discussion, you’ll need to fill in information in the section titled “Introduce Yourself.”

Existing discussions address hyperacusis, how to improve hearing clarity, tips for speaking to someone with hearing loss, acoustic neuroma, trouble with TV captions, Meniere’s disease, dealing with tinnitus and much more.

An online forum is not a substitute for an in-person support group. Whether you are new to hearing loss or a veteran of hearing loss, you might benefit from joining an HLAA or ALDA (Association of Late Deafened Adults) chapter near you. But I also recommend joining this forum. You can learn from the discussions and also contribute to others’ knowledge.


For more about hearing health, my book “Smart Hearing.” (2018) will tell you everything I know about hearing loss, hearing aids, and hearing health. “Shouting Won’t Help,” (2013) will tell you how I coped with unexpected hearing loss 

You can get them online at Amazon or Barnes & Noble, in paperback or ebook for Kindle or Nook. You can also ask your library or favorite independent bookstore to order it.