Dr. Douglas L. Beck - The Latest Studies on Cognition and Hearing

Dr. Douglas L. Beck – The Latest Studies on Cognition and Hearing

Posted June 8, 2023

Dr. Douglas L. Beck is a well-known figure in audiology and the Vice President of Clinical Sciences for Cognivue, a company that manufactures adaptive hearing solutions for the modern age. Dr. Beck is a prolific author on the subject, having 185 different publications to date through Oticon, where he worked as Vice President of Academic Sciences from 2005-22. He also serves as an Adjunct Professor at State University of New York at Buffalo and the Senior Editor of Clinical Research at Hearing Review.

Here’s a glimpse of what you’ll learn:

What current literature is saying about hearing loss and cognition
The largest risk factor for dementia
Differences between hearing and comprehending
The cascading effects of health problems on hearing
Best practices from leading audiology organizations
How Cognivue can be properly utilized
The long history of correlating sensory impairment with cognitive decline

In this episode…

With modern medicine and science, research is rapidly accelerating. Particularly for burgeoning or underexplored fields, the pace of research can make it difficult for the public to catch up — making it even more important for experts to inform everyday people on the key takeaways from recent studies.

Dr. Douglas Beck is an established figure in audiological research. His current role at Cognivue sits at the intersection between cognition and hearing loss. The overlap between the two has only grown with further research, and now, you can learn even more about the connection.

In this episode of the ListenUp! Podcast, Dr. Mark Syms talks once again with Dr. Douglas Beck, the Vice President of Clinical Sciences at Cognivue, to explore the cutting edge research on hearing loss and cognitive decline. They discuss some of the new studies, the history of the research, and the risk factors for dementia. The two also go through Cognivue’s test and how it works.

Resources mentioned in this episode

Sponsor for this episode…

This episode is brought to you by the Arizona Hearing Center.

The Arizona Hearing Center is a cutting-edge hearing care facility providing comprehensive, family-focused care. Approximately 36 million Americans suffer from some sort of hearing loss, more than half of whom are younger than the age of 65. That’s why the team at the Arizona Hearing Center is focused on providing the highest-quality care using innovative technologies and inclusive treatment plans.

As the Founder of the Arizona Hearing Center, Dr. Mark Syms is passionate about helping patients effectively treat their hearing loss so that they can stay connected with their family and friends and remain independent. He knows first-hand how hearing loss can impact social connection and effective communication. By relying on three core values—empathy, education, and excellence—Dr. Syms and his team of hearing loss experts are transforming the lives of patients.

So what are you waiting for? Stop missing out on the conversation and start improving your quality of life today!

To learn more about the Arizona Hearing Center, visit https://www.azhear.com/ or call us at 602-307-9919. We don’t sell hearing aids—we treat your hearing loss.

Episode Transcript

Intro 0:04

Welcome to the ListenUp! Podcast where we explore hearing loss communication, connections and health.

Dr. Mark Syms 0:17

Hey everybody, Dr. Mark Syms here, I’m the host of the ListenUp! Podcast where I feature top leaders in hearing healthcare. This episode is brought to you by Listen Up! Hearing Centers, I help patients to effectively treat their hearing loss so that they can connect better with their friends and family remain independent. The reason I’m so passionate about hearing loss is because I had a brother Robbie who lost I lost him twice, first to hearing loss from radiation to his brain tumor. And then again, when he passed away, I am the E N T. I only care for years, I performed over 10,000 ear surgeries over my 20 plus year career and take care of many more with hearing loss. I’m also the founder of Listen Up Hearing Center, and I wrote a book of the same name Listen Up!: A Physician’s Guide to Effectively Treating Your Hearing Loss. If you want to learn more about that go to listenuphearing.com. That’s listenuphearing.com. Today, I have a great and very generous guest. It’s Dr. Douglas Beck. He’s been on before, he has operated in almost every space. He’s been a master clinician, and academician. He’s worked in industry. He’s an educator, he’s an advocate, he’s really been everywhere in audiology. Right now he’s working in the hearing loss and cognitive space for Cognivue. But we want to we had him on before, but we want to see where he is and give us some updates on hearing loss and cognition. Doug, I want to confess to the listeners. This is version 2.0. We did a great episode yesterday. And one person who would be me did not hit the record button. So we’re doing this again. And so he is I’m doubly appreciative of his time, because he’s doing this for the second time. So giving me more time. Thank you so much that I really entirely

Dr. Douglas Beck 1:50

Welcome in and I wouldn’t do it for anybody else.

Dr. Mark Syms 1:55

Well, especially when you get to talk to you and experienced the Northern Lights, it’s really pretty amazing. He is coming in. I’m kidding. He’s not I don’t think he’s coming in from Iceland. But it would be San Antonio. But it is. It’s the Northern Lights of San Antonio, although I’m not sure that’s north enough, but we’ll leave it at that. And the humidity might be a little higher at this point. But anyway, Doug, it’s thank you so much for coming, you know, what we were taught, what I’d like to talk about is kind of update where things are. And I know, you know, one of the things you know, I know you keep on top of the literature. So like, can you tell us about some of the things that have emerged over the past year in terms of the literature, hearing loss and cognition? What’s kind of happened?

Dr. Douglas Beck 2:38

Yeah, so it’s pretty fascinating. You know, when you go back to 1949, there was one article on cognition and audition, meeting hearing and listening tours. And that was by Dr. Michael bust in the ashram literature, and very interesting paper, because what he said in 1949, so 70 years ago, how do you know that when your patient is complaining about speech and noise, or hearing difficulty, how do you know there’s not anything else going on. And so that’s that in literature for awhile, not much attention, people didn’t do much about it. But then it came back a couple of times over in 2011, I wrote a paper called listening is where hearing meat spray. Now, that wasn’t the first modern paper on this. But it certainly got a lot of people thinking about listening is we’re hearing meets great. And what that means is you have to have sounds that are audible, they have to be that you can hear them. But you also need a good brain to process them. And it gets back in Gosh, 62 or 65. My one of my mentors, I have three mentors, but one of them was Dr. Jack Katz and Jack used to talk about auditory processing disorders, which he defined like this, he said APD is what you do with what you hear. In other words, hearing isn’t the whole thing. Gearing is step one, listening, applying meanings down, that’s the end result. Turns out, there been a lot of papers in these last four or five years that have really globbed onto this and started looking more and more at the relationship between cognitive decline, things like mild cognitive impairment, and hearing loss. And one of the most important studies that come out of this was in 1920 22, Dr. Stevenson and colleagues were reading about the UK Biobank study from the United Kingdom. They had 82,000 people in their study. And they found that the people who had the worst speech and noise ability over a 10 or 12 year period of time were 61% more likely than the others to develop signs and symptoms of dementia. So that doesn’t mean that if you have difficulty with speech noise of dimension, nobody’s saying that what it is is a hazard ratio based on 82,000 people so it means if you have that 61% of the population but but it’s it’s not instantaneous. It’s over the 10 to 12 years that they studied him, the nest off the first one that looked at that back in 2015, Dr. Miva, from Bordeaux, France and his AMI e va amoeba, she and her colleagues followed people for 25 years. And they used a screening test called the mini mental state exam MMSE, which is very common physicians go on about that when they use it all the time. And the thing is that she found that people who self admitted they have hearing loss, if they self admitted they had hearing loss, and they treated it with hearing aids after 25 years, they look just like people who said they didn’t have pimples. However, the people who had hearing loss and didn’t wear hearing aids, they degraded much more rapidly and much more significantly. So we have a lot of these huge kind of epic studies in the literature. And I think they’re coming more and more to the forefront. And I think it’s very important to my dear friend, Dr. Patricia CRICOS. Unfortunately, she died about five years ago, six years ago, Patty was at the University of Florida, Gainesville. And in 2006, she published a peer reviewed paper where she said, you know, the thing is, symptoms of hearing loss. And symptoms of cognitive decline can be the same. They are similar, that might overlap. Neither is a silo. In other words, having hearing loss doesn’t mean you don’t have cognitive, and vice versa. And she said, hearing loss, listening disorders, cognitive decline, they can all occur together in isolation in tandem. And this really, you know, that was 2006. So there’s a lot of us who’ve been really writing and exploring and studying this. And I think that right now, we’re probably at the point where it’s safe to say, people who have untreated hearing loss are untreated, hearing loss, exacerbates, you know, makes worse, the ability to have cognitive decline. So I feel very comfortable saying that, during the loss exacerbates cognitive decline in many people is having a request doesn’t mean you’re going to have cognitive decline, but many people do.

Dr. Mark Syms 6:55

But I mean, you know, they’re a couple of things, you know, medically, you know, there’s always that person where you, you say, you know, you need to quit smoking. And then they say, Well, my grandfather smoked two packs a day till they were 97 years old, and it didn’t affect them. I mean, it’s great, the outliers are but even with that outlier, you still should be smoking. And even if it’s not going to cause dementia, it’s good to treat your hearing loss nonetheless. So I think there’s a lot of upside. The other comment I make is, it really resonated with me is, you know, when I try to explain to patients, I’ll say stuff like, well, you know, you can detect sound, it doesn’t mean you can understand or listen to it. And so the example I give is foreign language, right? If somebody speaks to you, you’re hearing it, but you’re actually not able to listen to it because you don’t have the cognitive ability or the tracks laid down for you to actually understand.

Dr. Douglas Beck 7:45

Absolutely. And, you know, it’s funny, you mentioned smoking, because in 2020, in The Lancet, which is the world’s premier medical journal, Dr. Livingston and colleagues published his enormous study, and it was on dementia risk, really about hearing or hearing loss. And what they found is 60% of your risk for dementia is based on two things, you can affect your age, and your deoxyribonucleic acid, your DNA, your genetic change, right. But then they said, the other 40% is potentially due to 12 modifiable risk factors, and of those 12. The single largest was, of course, hearing loss, which is, you know, pretty staggering. So the implication there is, of course, if you have untreated hearing loss, that is the largest risk factor that you can control. Now, the other factors are very important to right. One of them was less education, people who have less brain development, you know, more or less, they’re more subject to problems with dementia, mild cognitive impairment, things like that. Hypertension untreated, so that’s high blood pressure and treated. Certainly hearing impairment. Now hearing impairment just so you know, at an 8.2% pF, that means population attributable factor, and what that means is that, you know, 8% of your risk for dementia is due potentially to untreated hearing loss. Then they went into smoking, which you mentioned, obesity, and I’ll show you something interesting about obesity, depression, physical inactivity, diabetes, low, you know, untreated diabetes, low social contact, air pollution, alcohol consumption and traumatic brain injury now, so that was in 2020. And the whole during an industry was very excited to find. Now hearing loss is the number one treatable, but potentially treatable, modifiable risk factors. That sounds really good for people who produce hearing aids. But then in 2022, in the Journal of the American Medical Association, there was a newer paper that came out on a much larger sample three elements. Yeah, by neon ago, Rosenwall and Yaffe in 2022. And they actually said the most significant risk factor for dementia was midlife obesity, you know, after age and after DNA.

Dr. Mark Syms 9:59

Yeah, I guess the question Does that actually represent a bunch of other things? In other words, does that represent physical activity in activity? Does that represent social isolation? High blood pressure, diabetes? I mean, it actually could be a marker for four or five of those modifiable risk?

Dr. Douglas Beck 10:14

Absolutely, absolutely. And I think that, you know, this is, of course, out of control in the US, I mean, we are the most obese country in the world. And that’s a real problem, not just because it sacrifices people’s health as they age. But you know, it’s very costly for the medical error for the healthcare system, it’s very costly for the patient. You know, when you think about, and I’m not the surgeon, here you are. But you know, when you think about, you know, knee replacements, and things like that, often not always, but often that can be related to, you know, your knees are carrying an awful lot of weight up those stairs. And you know, the normal body weight, you could, you could say, well, your bodies, okay, if you’re if you’re there, but if you’re carrying an extra 50, or 100, or 200 pounds, that stress and strain is on those ligaments and muscles, and, you know, bone on bone. And so there’s a lot to it. And of course, you know, obesity is responsible for an awful lot of diabetes type two. And, you know, if we could only eat healthier foods, it’s an easy thing to do. It’s really easy and washed proportions, we’d be in a much better situation. And Mark, you and I’ve talked about this before, but the World Health Organization last year rated the United States of America, number 37. In

Dr. Mark Syms 11:32

healthcare. Yeah, no, I know, I, you know, the one thing I will say the The nice part about that discussion, which you just presented is, is it’s not really the Battle of the risk factors, right? It’s treat your hearing loss and lose weight, you know, and so it’s not one or the other. And so the, you know, if if it’s one or the other is the bigger thing, it’s not have a huge impact to the extent that you should treat your hearing loss well, and you should have your weight, right and exercise and do all of those things. And so there’s plenty of room for both right? Losing weight.

Dr. Douglas Beck 12:08

Oh my gosh, yeah. And to be really clear, when you and I talked about hearing loss, generally, it’s a little different than what most people talk about. When people think about hearing loss, they think about, you know, the entire Gestalt, the whole picture, that’s not it hearing is just perceiving or detecting. So, hearing is a low, a low level central nervous system function. It’s like, you know, touching your skin, you know, tactile sensation is very, very low level. When you hear that means you’re perceiving or detecting But listening is where we’re assigning meaning to sound listening is where we’re comprehending. So that means it has to be audible, it has to be heard, but it also by I have to have a brain that can decode that information to make sense of it. And that goes back to your example about if supposing that the listener to this podcast doesn’t speak French, right, and we’re at a restaurant in Montreal or in Paris, you can hear just fine, but you can’t understand what anybody’s saying. That’s the difference between hearing disorder and eliciting disorder. Now, the numbers on this are also very impressive. When you think about the USA, you got 335 million people, right? You think about how many of them have hearing loss on an audiogram, which is what most of them think, right? You do a hearing test and have hearing loss there? Well, that’s 37 million. So that’s a lot. That’s a lot. But how many have no hearing loss whatsoever, yet, they can’t understand speech and noise, they can’t understand what was just said to them, they complained of hearing difficulty with normal during test. That’s another 26 million. And that’s huge. And basically, you know, unfortunately, hearing care providers, you may be hearing a dispensers, audiologists and $11. We tend to dismiss these things. And we say, well, they’re having difficulty understanding in cocktail party or noise, gee, I have to get used to it. Everybody has stroke. Everybody doesn’t have trouble there. And as a matter of fact, if you were to treat your listening disorder or your hearing loss, there’s amazing technology, things called Remote microphones, FM systems, pocket talkers, there are things that make listening to the phone easier. telecoils, tele loops, all these things improve the signal to noise ratio, which makes it much easier for your brain to process. So again, the numbers are 37 million people with hearing loss 26 million, no hearing loss, but they complain that they can’t understand speech noise, and generally, we tend to dismiss them in American medicine, we say, Well, the good news is your hearing is normal. We haven’t solved the problem. And this gets to an even more clinical issue, which is that when somebody complains about speech noise, the number one go to in hearing care provision, is we test them under headphones, in quiet, and we give him a very, very loud signal, say the word went easy, you know, there’s nothing to it. But that doesn’t reflect there’s virtually no relationship between speech and quiet and your speech and noise are totally unrelated.

Dr. Mark Syms 14:59

No. And that’s actually I mean, that speaks to a lot of different things. You know, I spent a decent amount of time explaining to patients who are further along the hearing spectrum that, you know, the screening audiogram is not a functional test. And so cochlear implantation candidacy, there’s some predictive stuff, but ultimately, it’s functional. I mean, you know, one of the other things I share with you is, you know, I think there are some things like, some of my happiest patients are patients who have had their, they’ve like at the bottom part of normal, but they have difficulty and noise. And they have high demand lifestyle, right. So they’re typically, you know, in the upper echelon of management and have very high listening demands. And those patients tend to be really, really, really happy. It’s kind of interesting.

Dr. Douglas Beck 15:46

Absolutely, I mean, you change the quality of people’s lives through these modifications, and through these treatments. And it’s very important because people don’t think of hearing loss as particularly important. But here’s the thing. And you and I talked about this recently, that when you have hearing loss that’s untreated, what’s actually going on is your brain is getting less and less and less stimulation, as your hearing loss gets worse and worse and worse. Over the years, your brain is getting less sensory information than sensory information is or things like you know, vision and smell and taste and touch and hearing, those are sensory situations. And as we proceed less or fewer sensory sensations our brain can operate on, it can’t make sense of it, it can’t figure it out, because it didn’t get the complete signal. And so there are four hypotheses on the relationship between that degradation of hearing and the opportunity to have more significant and earlier mild cognitive impairment or dementia. And, you know, one is that it could be a common cause. In other words, and this is an extreme example, but I’ll just say so people know what we’re talking about. We could say that people with high cholesterol, high triglycerides, you know, when their arteries are being occluded, you get less blood flow. Now that less blood flow becomes important when you think about the labyrinthine artery, that’s the one that feeds your inner ear. Because it’s tiny, it’s a couple of hairs thick. So if that gets clogged or attenuates the flow of blood to your inner ear, your cochlea, you can say, well, that might be the cause of the hearing loss. And likewise, that same patient might have other arterioles, depression, vascular anomalies throughout the brain that could also be responsible for dementia or mild cognitive impairment. So that’s the common cause hypothesis, that hearing loss and cognitive decline may both be caused by a common cause such as arterial blockage. And, you know, that’s, that’s not unusual. I mean, we certainly know

Dr. Mark Syms 17:48

that it seems calm, but it’s not at all. That’s the thing. That’s right. That’s right.

Dr. Douglas Beck 17:53

And you know, when you think about carotid endarterectomy is these are procedures that we used to do pretty often on people’s carotid arteries, to open them up to give them better blood flow to the brain. I don’t think that’s done very much anymore. But maybe it is, you would know the answer to that. I don’t know. But you know, it’s, it’s, it’s, it’s an idea. And I think it’s an idea that it makes sense is that people’s carotid arteries, as they get smaller and smaller and smaller, because it’d be more and more occluded over the years. That’s why blood pressure rises, that’s one of the reasons is because you still have to transmit blood to all of these neural structures, and the arteries are getting smaller and smaller and smaller. So blood pressure has to increase to keep up with the demand. Anyway, so that’s the common cause, then you have cascade via social effects. And that’s the one hypothesis as to where people disengage, because you were talking about people with severe and profound loss a few minutes ago. And, you know, it is incredibly difficult to be in a conversation, and just nodding your head and hoping we can get by it’s but it produces anxiety and depression. And it’s very, very difficult, particularly as the patient you’re talking about, you know, a high profile patient. You know, that’s, that’s just a mess. And so that person tends to withdraw, and they get lonely, get depressed, and they feel frustrated, because they, they remember that they could do these things a few years ago, but they can’t do now. So that’s the hypothesis to have the cascade cascade three, or hypothesis three, this cascade of auditory deprivation. Now, this one to me makes tremendous sense. We have studies back in the neck 1999. From the National Council of aging, they looked at about 2000 people with hearing loss that were treated with hearing aids and another 2000 people that did not treat aids. And what happened is that people did not treat their hearing loss at higher rates, suicidal ideation, anxiety, depression, frustration, more isolation, the people who treated their ears did not so that we refer to that as auditory deprivation because as the hearing loss is increasingly increasing, as the brain is getting Less and less stimulation, the brain has less information to operate. So it is auditory deprivation has deprived the auditory signal. And the final hypothesis for is cognitive load. So that to me, that to me is my favorite. I don’t know that you could prove this. But you know, your brain can do a couple of things at one time, do a lot of things that went on depending on the situation and who you are and how your brain is working. But when you have more and more hearing loss, and you have put more and more cognitive resources into what somebody just said, there’s less leftover to remember, there’s less leftover to apply meaning to what you’re trying so hard to figure out.

Dr. Mark Syms 20:36

You know, it makes the most sense to me. Because the reason I talk about like a computer, and there’s only so much CPU power, and so you’re diverting your CPU power to make up for your hearing loss which diverts it from other normal thoughts and memories. That’s the one to me that kind of I can make. And it makes the most sense, I think, to patients, because a lot of them, as you know, are in denial about their social isolation. Oh,

Dr. Douglas Beck 20:57

absolutely. Yeah. And you know, there are a lot of studies. Now, when you look in the literature, if you just go to Google, and you put Google Scholar, or PubMed and you put in cognition, comma, audition, AUD it, when you pull up 1000s of articles in only 10 or 15 years ago, there were two dozen. But you know, this is a really interesting phenomenon. Now, when you have people like Johns Hopkins publishing, just to January 10 2023, they look to people with severe profound loss folks that you were talking about earlier. And they found that they had one, if they were untreated, they had a 1/3 greater likelihood of having cognitive decline than the people who were treated. And that was based on, I want to say 2000 people in that study? Yeah. Yeah, you know, and so you see this more and more. And it sort of gets us back to good clinical audiology and group clinical protocols. Because the American Academy of Audiology, the American Speech, Language, and Hearing Association, the International Hearing Society, all three of these national boards, all three of them say that you should be doing speech. And this gets us back to where we started. You know, most hearing care providers don’t do it only about 15%. And that’s really unfortunate, because that 26 million that we talked about, aren’t going to be feasible. They’re invisible, you can’t see them, you’re not seeing their difficulty, right. They’re telling you their difficulty, but you’re not quantifying it, you’re not testing it. And so they’re not likely to get treated, they’re not likely to get a cognitive screening, they’re not likely to find to go to the right provider who might change the course of their life. This gets to the 2020 Lancet study, right? The 40% of your risk for dementia modifiable risk factor. So if we catch it early, when it’s a modifiable risk factor, we might change their their trajectory, we might not, there’s no guarantees, but we do know that untreated hearing loss is a disaster. And not just the person. But

Dr. Mark Syms 22:56

yeah, but also ties into you know, the hearing noise ties it to the Stevenson article, right, where they talk a little bit about that. I mean, because it really is about that their target or their impact, what they’re talking about is not just hearing loss, but it’s hearing in noise, correct? Yeah. And that’s

Dr. Douglas Beck 23:12

a very common complaint. I mean, you and I hear that every day from patients, though, you know, what brings you in? Well, you know, I can’t understand the noise. But I think it’s people don’t speak clearly they don’t enunciate my significant other speaks to me from across the house. A million reasons why they don’t get voted. But we can quantify that in about two minutes. It’s really easy to get speech noise. And,

Dr. Mark Syms 23:34

and we study fine, though, in terms of the correlations, right?

Dr. Douglas Beck 23:37

Yeah, so what Stevenson said in the looking at 82,000 reports, with bad speech and noise, they were much more likely to have cognitive decline more significantly more rapidly, over a 10 to 12 year period of time get people who didn’t have speech. So I think we have to really step up our game, I think we need to go back to really basic best practices, best practices by ASHA, AAA by IHS, all say the same thing. You do your diagnostic tests, and I will bore the audience with what those are, but there’s a series of diagnostic tests, then you have to do a listening and communication assessment is that those who need hearing it or who needs other amplification, right? We’re telling audiometry doesn’t do that you can have, you know, two thirds of all people with mild to moderate loss. They have no idea they have here, they have no idea and then they wouldn’t because they become accustomed to it. They’re used to it’s not causing tremendous problems in their life or is meeting their expectations. So they don’t look for a solution to a problem they don’t identify. And speech to noise is absolutely and you know, for your patients, my patients, most people think that the reason people come to see you come to see me is because of hearing loss. And actually the biggest reason that they come to see us is because they can’t understand speech. And so now we have all these very clever cognitive screeners, which help us to identify is the patient Performing within normative values? Or might they be aggressive, because if they’re at risk, we got to get them to their GP to their PCP to their primary care doctor as soon as possible now across the nation, a lot of GPS and PCPs hammerless, because there aren’t very many neurologists, I think there’s 10 or 12,000, neurologists in America, and again, 325 million people. So a lot of the diagnosis of mild cognitive impairment, a lot of the diagnosis of dementia are done by GPS, and that’s fine, you know, but that’s why I always say, you know, if we’re going to test somebody, we should include a cognitive screen, particularly if they’re over age 55, I’m not really worried about people in their 20s 30s 40s. If they have cognitive issues, they need to see a specialist for that group. You know, we have different expectations and different realities in that group. And certainly, they could have a cognitive issue. Absolutely. But it’s just not like, you know, it’s probably something else. And in this situation, when we have cognitive screeners that, that are so fast and so efficient. So you know, the mini mental state exam, I don’t know, it’s been around for 30 years for the mini cog, which is the clock drawing, test and a couple other little things. You have the mini cog, the MMSE, you have, which is the Montreal cognitive assessment. Now, the funny thing about the Mocha, the Mocha is pretty good. But here’s the thing, supposing that I came in to see you. And supposing you were gonna do the Mocha, you would read me these series of questions or statements, and I would respond. But here’s the thing that audiologists are very well aware of is that, how do you know if they hear that they can hear and listen to what you’re saying? Right?

Dr. Mark Syms 26:34

That’s true, what I will say is there is a hearing impairment version, but you have to have an audiogram, to know which one to do. And so by, and you also need to be certified. We were certified and do that. But I think having an automated system, like Cognivue makes much more sense. It’s not as big a lift, and people are already doing a lot of testing and using a lot of time. So you have to do it in a, we have the luxury of a practitioner who can do it. But the most

Dr. Douglas Beck 27:06

beautiful thing for the patient, right is their hearing loss doesn’t go into the factor at all. When you’re doing a Cognivue thrive, which is the most typical electronic screening test. It doesn’t matter what your hearing loss is, it’s all visual and motoric. So you have to have corrected vision. And you have to have good mobility of your hands. But the test is done with shapes and designs and figures that you’re running kind of a joystick and, you know, it takes five minutes, and then it spits out a report now that the report covers the most important domain. So you have executive function, you have memory, and you have visual spatial relationships. And, you know, that is enough to say, I’m not worried about you, or let’s dig a little deeper, because none of these cognitive screeners are diagnostic, none of them.

Dr. Mark Syms 27:54

They’re strings. The word they’re exactly. Do you need more workup? Or don’t you need more of a cup? And that’s what the goal, but you’ve got to figure that out on people in a time effective and efficient manner? And it sounds like this isn’t a great answer.

Dr. Douglas Beck 28:08

Yeah. And it’s important that we look at it early. Because again, if we can catch it early, because patients coming in with signs and symptoms of hearing loss or listening disorders, the best thing I can ever say to a patient is this look strictly auditory, I don’t see any problems, I’m gonna, I’m gonna let you try some hearing aids to try an FM system, or whatever is appropriate for that patient. And I think you’re going to do fine. But here’s a couple of things. Number one, I don’t rescreen patients when a patient gets a screening, the purpose of that is to find out are they a candidate for a deeper test? Or are they okay, so if you believe in the screening you did, that’s your answer, then re screening them a month or two months later, that that’s just not realistic. Because when you’re looking at something like Alzheimer’s, it doesn’t change Exactly. No, it takes 20 to 25 years from the time you have the first cellular changes in your brain until even manifest. So to think that a hearing is going to change that 30 days now what happens in 30 days, you have a better sensory perception. And so you might be doing well, because we’ve changed your auditory deprivation, array and more information. I think if

Dr. Mark Syms 29:13

people are doing it, it’s a nice indicator that they’re doing better. But it really isn’t true assessment. It’s just you did better on the screen or the screen becomes negative, right or less positive or something. But it’s really the screen. It’s binary, should you be sent on for more, or shouldn’t you and changing that doesn’t mean I think if you probably had a cognitive minimum or indications that you needed a cognitive workup before you got your hearing loss treated, you probably should still go get a cognitive workup because your primary care might find vascular issues hyperlipidemia or other things that are addressable. So you would use that as a an interest to do that. That would be my take.

Dr. Douglas Beck 29:51

And you know, when you go back historically, right, the average age that people develop mild cognitive impairment is you know, in their 50s 70 So, the JAMA, Journal of the American Medical Association neurology said in 2022. When you’re age 65 or older in the USA, your chance of having mild cognitive impairment is 22%. That’s pretty substantial one out of five people. And if you go to the American Alzheimer’s Association, and you look at your risk for Alzheimer’s, by the time you’re 85, in the USA, it’s one out of three, it’s strikingly high. And so these are little easy to do screeners that might change your life over the next 510 20 3040 years. And they make good sense now for audiologist. The American Speech Language Hearing Association has been saying for since 2018, cognitive screening is within scope of practice. The American Academy of Audiology just said the exact same thing in April of 23. So you know, it’s important and when you think about your audiologist, you may say, Well, what does he or she know about cognition? Well, probably 98% of those audiologists have undergraduate or bachelor’s degrees in Communicative Disorders and Sciences. Yeah, and, you know, I am still a professor at State University in New York at Buffalo, and I am an adjunct. But I am a full professor and I, I teach about Communicative Disorders, that sciences to the undergraduates and to the doctoral students. So they have a good background in this, but it hasn’t been until recently that we’ve really, you know, start to lean into it and say, oh, you know, I don’t, I don’t think that this is a problem for you. But let’s do a cognitive screening I when I do cognitive screening, I frame it as an audiologist by which is, you know, I’m checking to see how you remember things, how you prioritize things, how you make sense of things, I don’t talk about their brain, I don’t talk about you know, I talk about information processing, because that’s more comfortable to me, and it doesn’t, you know, get the patient on red alert, because, you know, you say to a patient while you failed a cognitive screening, what they heard is I have dementia, right? And you can’t do that you shouldn’t do that. I don’t recommend ever doing that. So your audiologist or otolaryngology hearing aid dispensers. I think we have to stay in our lane. And let’s talk about you know, communication, listening and things like that. We’re not hiding that it’s a cognitive screening. That’s not it at all. What we’re doing is we’re focusing in our professional we’re focusing, focusing discussion on our areas of expertise, which means listening is where hearing meets brain, you have to be able to perceive sounds when your brain has to process them. And that’s, you know, auditory processing disorders. That’s auditory neuropathy spectrum disorders. It’s that whole line that I gave you earlier on the 26 million. So, you know, we’re in a very exciting time. There’s lots of great papers being written. I just did a neuroscience bootcamp with my dear friend, Dr. Keith Darrow, in Keith Keith is an audiologist. They also have a PhD in neuroscience from MIT and Harvard. We just have in Dallas this past weekend, it was standing a moment, I think we had 110 people. Great. Yeah. And we’re doing it again in Toronto a few weeks. And that’s Dr. Ashley Brogan who’s coordinating that. And you know, nobody is saying, jump in and just start doing this. What we’re saying is this has always been a part of Communicative Disorders since 1949. Since Dr. Michaelmas outlined in the national publication and what he said, How do you know how much of a communicative problem is due to hearing loss? Listening disorders are might be something else. And if it is something else, you want to catch up as soon as possible, just like you’re

Dr. Mark Syms 33:24

sure, no, I mean, it’s great. And hopefully those resources from those meetings will start to get out into the public, pervasive, more than 110 people can enjoy my I think it’s great. I mean, I think it’s, that’s why you’re here, again, is to talk about this topic, because I think it’s, it’s evolving, but I think it’s it’s very important to me, you know, one of the things you did touch on is that, you know, only 15% of people are practitioners are doing a hearing and noise. And so, I hope it’s also an impetus for people to really follow best practices and actually do the stuff that needs to be done. And I’ll

Dr. Douglas Beck 33:55

tell you something a little bit political. I don’t like to get political, but I will I, I was asked to write an op ed for ASHA. Now ASHA has a quarter of a million members, the American Speech. I’m curious. So I did in November, December of 22. And I argued, the only screening that I’m in favor of would be newborn infant hearing screenings are something which, and but I think for adults, whenever there was a concern about hearing, hearing loss listening, you need a comprehensive audiometric evaluation. Press the button when you hear the beat, you’re never going to catch those 26 million people.

Dr. Mark Syms 34:29

Right. In other words, you’re saying not a screening? audiogram but more comprehensive. I agree.

Dr. Douglas Beck 34:34

Yeah. I mean, if I came in to see you because I had a little bump right here, you know, my parotid gland, right? You’re not gonna just palpate and say, you know, 20% of them are malignant but 80% are benign. So it’s probably not, you know, we’re gonna get a fine needle aspiration, we’re probably gonna get a CT or an MRI. We’re gonna get a complete, you know, blood workup because it’s important that we diagnose first B Tech, and what happens with a lot of people across the globe As you know, it’s Russian treatment of hearing loss, we’re not going to dig much deeper, we’re just gonna treat the hearing loss. To me that’s a mistake. And now that we have OTC you know, once we have a diagnosis, it’s relatively inexpensive for people pre hearing loss through OTC. And that’s not going to be for everybody, probably not even half. But there are less expensive alternatives 2023 that we want to pet?

Dr. Mark Syms 35:21

Yeah, I don’t disagree with you. I mean, the only caveat I would say is as long as it’s effective, and that’s a big if, right? In other words, it actually has to treat your hearing loss not make your hearing less bad. We need to actually make your hearing loss rehabilitated. And that’s a big topic,

Dr. Douglas Beck 35:36

right? And I’m going to tell you that the number one thing, and you and I’ve mentioned it two or three times already is a speech and noise test, I want the patient to come in unaided, just their ears, and where they’re OTC. And we should see their speech and noise score get better. If it doesn’t get better, they’re not helping you. They’re just making stuff louder. But that also means you’re making the noise louder, so it’s more irritating to the person wearing an inappropriate. So I always urge all clinicians start with a speech noise test aided and unaided. And that tells you what’s going on with the patient’s functional ability. That is how they find.

Dr. Mark Syms 36:07

Yeah, this has been great, Doug, I really appreciate that, you know, your insights and your knowledge of the literature. And, you know, I know, well, hopefully you’ll be continuing working in the space. I’m not saying you are aren’t but I really enjoy your your contributions. And you coming on the podcast and sharing your passion for hearing loss. I think it’s always a joy and listening problem. So both.

Dr. Douglas Beck 36:30

Absolutely. And you know, I totally enjoy and share your passion for these people as well because they’re our brothers, sisters, mothers, fathers, children, they’re our patients, there are other professionals, and we need to take care of people.

Dr. Mark Syms 36:41

So and they’re everywhere. They’re everywhere. They’re everywhere. So so this is great. Thank you for coming on and redoing the episode. I really appreciate it. Thank you so much.

Dr. Douglas Beck 36:50

My pleasure. Mark, thank you so much.

Outro 36:55

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Arizona Hearing Center, Cognivue, Dr. Douglas L. Beck, Dr. Mark Syms, ListenUp! Podcast