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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