By ANDY WAITS
ContributingWriter

Problem behavior and hearing handicaps in patients with Alzheimer's disease and hearing loss were significantly reduced after they began wearing properly fitted hearing aids as part of a unique in-home study conducted by audiologists at the Center for Audiology of the UPMC Eye and Ear Institute and in the Communication Science and Disorders Program at the University of Pittsburgh, in Pittsburgh, Pa.

The research, published in the Journal of Speech, Language and Hearing Research (April 1999), further showed that hearing aid treatment for the patient with Alzheimer's disease living at home with a care giver actually may benefit the care giver as much as the patient.

“This is the first on-site study of patients with Alzheimer's disease who have hearing loss and are living at home with a care giver,” said principal investigator Catherine V. Palmer, Ph.D., assistant professor of communication science and disorders at the university and director of the Center of Audiology.

“We were able to show the positive impact of managing hearing loss with hearing aids by measuring treatment compliance and reduction of problem behaviors as reported by care givers,” she said. “We hope that our research may encourage primary care physicians and audiologists to become more willing to provide accessible hearing assistive care to this patient population and care givers to become more motivated to seek hearing assistive care.”

She added, “Studies and clinical procedures related to Alzheimer's disease largely have ignored the hearing ability of either the patient or care giver, yet the majority of Alzheimer's disease treatment and investigation depends on communication-based issues.”

Although previous studies showed more than 0 percent of aging individuals with organic mental syndromes such as Alzheimer's also have impaired hearing, hearing deficits may be the most frequently unrecognized condition in patients with Alzheimer's.

The impairment is often masked by other behavioral symptoms of the disease, and patients may communicate adequately in ideal quiet conditions.

In addition, patients with Alzheimer's traditionally have been considered difficult to test for hearing loss and difficult to manage because of anticipated patient noncompliance.

“Disease can interact to make a pair of diseases much more disabling than either one alone, and this may be the relationship between Alzheimer's disease and hearing impairment associated with aging,” said Palmer. “Besides its effect on communication, hearing loss has been [blamed for] feelings of helplessness, depression, passivity and negativism and has been associated with an accelerated and rapid cognitive decline in subjects with dementia and Alzheimer's disease.”

For the study her team of audiologists conducted research entirely in the homes of eight patients with Alzheimer's disease who were hearing impaired and had not been using hearing aids. Five spouses, two daughters and a son who handled care giving duties also participated in the study.

During the first home visit, the researchers administered hearing tests to the patients similar to those conducted in a clinical setting.

Patients were fitted with the most technologically advanced hearing aids to wear in both ears.

Before the devices were given to the patients, the care givers were trained to identify and document certain hearing related problem behaviors of patients on a daily basis for one and a half to two and a half months.

The researchers made weekly visits to the homes to collect the data. Documented problem behaviors included the following: hearing things that are not there, being unable to hear, talking nonstop, playing the TV or radio too loud, repeating questions, making negative statements, presenting with searching behaviors and forgetting the responses to questions.

After this period the patients began wearing the hearing aids. Care givers continued to collect daily data on the problem behaviors as well as hearing aid wearing compliance for approximately two months post treatment.

“We were pleased to find that in each case the care giver reported one to four problem behaviors, such as hearing things that aren't there, were significantly reduced,” said Palmer.

In three of the patients, all of the identified problem behaviors were reduced significantly after hearing aid treatment. All but one of the behaviors were reduced in another three, and one behavior was reduced in the remaining two.

When the care givers were asked if the hearing aid treatment improved the ability of the patients to communicate, six out of eight reported a significant improvement, said Palmer. The remaining two said they were less sure.

Regarding patient compliance, each patient wore the hearing aids between five and 15 hours per day. All but one patient wore them at least seven hours a day by the end of the study.

The work of Palmer's research team was supported by a grant from the National Association for Alzheimer's disease.

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