Could you provide the reference for your statement of 92% also suffering from hearing impairment and could you indicate the degree of hearing impairment. Could you also provide references to support your statement that hearing impairment renders an AD diagnosis inconclusive or over-diagnosed? Formalized testing approaches by a trained neuropsychologist can assess when someone is not "hearing" the test stimuli and/or misperceiving it. Auditory perception is often evaluated as a separate issue as well, or the patient is referred to an audiologist if there is a question. Clinicians are trained to take into consideration all sorts of information that may impact someone's performance on testing and to provide differential diagnosis. In my role as a neuropsychologist I have never disregarded someone's auditory abilities in diagnosing dementia. For you to state, quite broadly and without providing specific evidence to that effect that there is a "pervasive oversight" in the mental health field does not in my opinion provide meaningful contribution to the complex topic of Alzheimer's Disease/dementia. I welcome any references you can provide. tlc

Yes, Theresa, I realize it is somewhat of a surprise when broaching this gaping topic. I will provide you some background information below, which will have a good number of references in them. Also, I would refer you to the Johns Hopkins February, 2011 study on the relationship between uncorrected hearing loss and Alzheimer's diagnosis, and a couple of Brandeis studies on memory, brain glucose, and uncorrected hearing loss.

Here are a few links to get you started on your search, and whether you agree or disagree with the conclusions is no problem. The problem is understanding that the vast majority of those diagnsed and currently being "treated" for AD do NOT see a trained professional in such measures, rarely are referred to audiologist first before that diagnosis, and most certainly very few see an expert Neuropyschologist like yourself.

In Behavioral Medicine, my concern are the wider trends of healthcare, the threats imposed by a system that is hurting more than helping because of a lack of training and understanding or utilization of efficacious tools in the larger everyday population. For instance, although I have not seen the figure in some time, I believe that about 85% of those diagnosed with AD saw a PCP, were administered an auditory-only delivered MMSE or similar, no hearing test given, and prescribed one or more of the cholinesterase inhibitors with thier dastardly overlay effects with hypertensive, statins, SSRI/SNRI meds, and often more.

If they are 75 years of age, they nearly always have a hearing loss and rarely, under the scenario described above, wear hearing aids. THIS is the scenario over which I and others are deeply concerned. So that you will not think I just dropped off the turnup truck, I have chaired doctoral research committees on this topic, have worked intimately with thousands of such patients, teach psychoneuroimmunology and psychopharmacology at the doctoral level, and consider this one of the great challenges in today's polypharmacy-dominated healthcare world.

So, please do not take offense in your own practice setting. But I can tell you that you are in the tiny minority, and few AD diagnosis in the US involve a test of audition and subsequent correction before doing the rest that can be done for this population.

Here are the links to get your started on your search, and thank you for commenting:

http://www.audiologyonline.com/articles/undiagnosed-pre-existing-hearing-loss-6831-6831

http://www.audiologyonline.com/articles/exploration-psychological-physiological-causes-for-940

http://www.audiologyonline.com/articles/absence-hearing-healthcare-in-so-1171

Thank you for your response Max, I will check out the links you provided, I certainly appreciate that no turnips are involved! I would agree with you that the MMSE is not a particularly useful assessment measure. I think it is our definitions of "mental health" and "behavioral medicine" that are different, as you are describing that pcp's are mistakenly diagnosing, which I would consider a failure of the medical profession not the behavioral/mental health profession. Thus my sensitivity, which may be due to our different semantics. Of course, in a perfect world all folks with question regarding cognitive dysfunction would have the opportunity to have a thorough neuropsychological assessment!

Absolutely--and many of our former students are biopsychologists today--all the subspecialties that abound in that group are amazing--and I highly respect their work. My larger concern has always been the lack of those careful assessments in the everyday world where we find ourselves having to educate most often. But thank you for your thoughtful response, and please know we are on the same side of the issue (smile).

As a neurotologist I often see patients with hearing loss and dementia. I always recommend amplification and frequently have family state that their family member with dementia has better receptive skills when amplified. I believe the quality of communication b/w the family is greatly increased with amplification in many instances. However this is likely no revelation in the neuropsychiatric community.

Many people currently only think to have their hearing assessed many years after the onset of hearing difficulties. In the United Kingdom even the National Health Service advises that "Hearing tests are carried out… to check the hearing of someone who is experiencing hearing problems or has a hearing impairment" (source: http://www.nhs.uk/conditions/Hearing-tests/Pages/Introduction.aspx)

So the first hearing assessment is many years after others have noticed the person is "missing things", "getting the wrong end of the stick", "drifting off into their own world" and various symptoms that can appear to be cognitive. Yet the two things (cognition and audition) are often regarded as always separate, even by the health profession community where they are dealt with by two separate disciplines. Whenever dementia or Alzheimer's are mentioned by the press or medical practitioners in the UK it is rare that hearing is mentioned. This needs to change.

Carryl L. Baldwin in her book "Auditory Cognition and Human Performance" remarks that many studies assessing the cognitive performance of older adults do not take into consideration hearing thresholds. Why is this, I wonder? Pervasive, as you say, but throughout much of health care and even research. Perhaps it just never "springs to mind" unless you've experienced hearing loss personally or know those who do.

As a hearing healthcare practitioner I think we need to seriously look at the relationship between Hearing Loss and Dementia or Alzheimer's, that appears to be much deeper than symptoms alone.

In a recent study by Rönnberg et al, 2011 hearing loss was found to be negatively related to episodic and semantic memory, problems also found in Alzheimer's: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277836/

Within Psycholinguistics, models of lexical access such as COHORT and TRACE propose that when we hear a word, many possibilities for that word come to mind. For example, if we were to hear the sound CAPT- then CAPTIVE and CAPTAIN will be primed, as will words associated with it (such as ship and guard) will also be activated in memory (Zwisterlood, 1989). But once more of that word is heard the alternative words (and meanings) are suppressed. This has an impact on cognitive load.

When there is a hearing loss, it is often SOME phonemes that become unavailable. Theoretically, then, there would be less suppression in the brain because the word is not resolved so more words and meanings remain "activated". It has to be held in working memory whilst other cues become available disambiguate, meaning less working memory available for other tasks. This would include attention, another problem found in Alzheimer's

Additionally, it has been proposed that the default mode network is linked to Alzheimer's (for a review see Buckner et al, 2008). The default mode network is considered to be associated with internal mental activity and is suppressed when focus is shifted to external tasks. Listening is an external task, so suppresses the default mode network (Greicius & Menon, 2004). Buckner et al, 2005 demonstrated a correlation with the build up of plaque found with Alzheimer's and the default network and asks whether Alzheimer's may be the result of "overuse" in internal mental activity (e.g. daydreaming, worrying etc.)

Now here's the interesting thing: when people don't have as much external stimulus due to a hearing loss, it stands to reason they are more likely to be engaged in more internal mental activity. Leave the hearing loss to develop unchecked and the incidence of mental health problems (stress, anxiety, depression, social isolation, loneliness) have all been found to increase which leads to further internal mental activity. Interestingly loneliness doubles likelihood of having Alzheimer's: Wilson et al, 2007.

The problem we have is that many of our assessments for both hearing and dementia are reactive: it's often only after the problem has become so noticeable that "something has to be done". This is far too late, because it prevents us from seeing whether both Alzheimer's and hearing loss stem from a shared underlying cause, or whether one causes or contributes to the other. It also limits preventative actions. For example, is hearing loss a modifiable factor in Alzheimer's? I don't believe we currently have an answer.

It is only because of longitudinal studies such as the Baltimore Longitudinal Study of Ageing, which uses both types of assessments, that we are starting to see this probable link (27% increase for every 10 decibels of hearing loss), though many hearing healthcare professionals have suspected it for a long time. Yet still it's not widely recognised outside of audiology.

So in answer to your question, the following may help to remedy this oversight:

1. Routine hearing checks like eye checks and dental checks – should be presented as a preventative measure (like servicing a car BEFORE the brakes go wrong).

2. More interaction between audiology and mental health, with "referral protocols" established at national levels. It should be proper pure tone audiology so it can be benchmarked, not simply making sure someone has heard and understood.

3. More work done to investigate the probable link (though not necessarily universal) between hearing loss and dementia where there is uncertainty or ambiguity, and more widely publicised to both the wider health profession and the public.

4. More research into whether hearing aids PRESCRIBED AND WORN much earlier than the current norm (to minimise adverse plasticity in the brain or development of maladaptive behavioural patterns) can modify the risk of Alzheimer's.

The very high prevalence of hearing loss (72% in the 90+ Study; 90% in people aged 80–92 Beaver Dam, Wisconsin) in the very old make evaluations for cognitive impairment difficult that leads to diagnose dementia more often in people with sensory losses.

Some studies have found that the sensory loss itself may be suggestive of neurodegeneration and, thus, related to cognitive decline. A case-control study of AD patients found that hearing loss was associated with the severity of cognitive dysfunction in both the demented patients and normal controls (Uhlmann RF, et al. JAMA. 1989 Apr 7; 261(13):1916–1919)

Wow! This is scary for me. I have been hard of hearing since I was little and have major problems with memory. I was wondering if there is screening for Alzheimer's that is reliable yet? And if one is screened and shown to be high risk, is there interventions around?

Joh,

Have you worn a hearing aid? For those of us that are hard of hearing, the stress factor of wearing a hearing aids is so high, that the trade off is not worth it. It is also very hard on the ear-hurts after a while-like of like glasses, yes you get used to it but it does not mean you like it. How does hearing and AD connect?

Kelly, I am profoundly deaf and wear a cochlear implant. At age three I had a double case of mumps and lost about 80dB of my hearing, later losing all of it due to being given aminoglycoside antibiotics for chronic strep infections in childhood, which brought on Meniere's and total loss of auditory function bilaterally. I wore hearing aids but was too deaf to hear anything--utilizing instead the tactile sensations at the tympanic membrane rather than the sound. I am ever grateful that cochlear implant technology advanced enough that by age 45 in 1993 I was able to get a cochlear implant.

I postulated several decades ago, building on the work of Myklebust etc. that there is a strong link between cognitive and auditory development and as my work pointed to effects at the older adult age groups I was stunned to find that the mental health community almost totally ignored the cognitive effects of untreated presbyacusis. There was no suggestion to "test hearing first and remove the auditory barriers before testing verbally for cognitive status in older adults"...the first study (a meta study, actually) bearing out this point was by my colleagues at the University of Pittsburgh in 1998. I presented that paper to the International hearing society's annual meeting in 2000 and to the American Academy of Audiology (AAA) in 2001, and a broader presentation of many studies and observations to the AAA in 2004. While the presentations were well received by the members of those groups (both in the hearing professions), there was a silence from the mental health field--not even the National Council of Aging's publishing of my chart showing the almost identical symptomtic representations between mild Alzheimer's and uncorrected hearing loss in older adults made a dent in the evaluation protocols for dementias. It was if the mental and medical community was "deaf" on the topic--every screening protocol for Alzheimer's (which is as far as it goes for at least 95% of those evaluated clinically before treatment is given--usually just the meds which produce no positive outcomes) is verbal for a population that is by nature deficient in auditory status. Their assumption is that if a person has hearing loss, someone will make sure they are tested, and if they hearing loss they will likewise be sure to fit them with amplification. Our experience is that only about 8-10% of older adults who have been treated in some way for Alzheimer's have been treated properly for hearing loss.

Making matters worse is that the amyloid plaque theory is shot full of holes, and not a valid one, yet it drives billion-dollar research projects for medications that keep the plaques from forming, presenting new problems for those who still need auditory help and dietary and other changes, not something that scrubs the last vestige of immunology from the neurological structures from the brain. Amyloid is an immune response to other disease. It secondary to anything cognitive and does not diminish cogntive status. A lack of astroglia, on the other hand, diminishes cognitive status. This is another topic that I hope someone will discuss with us here, and then we can develop our conversation to include why the current direction of medicine, while lucrative, is not correct, But the larger topic is what do we do to make sure that no diagnosis or treatment of Alzheimer's is completed before taking care of the ever-present auditory issues? It is not happening, despite what a few people believe. I have chaired and served on research committees for Alzheimer's only to recieve resistance that we need to take care of auitory before cognitive components in older adults.

Are you aware of this dissertation by Lindsey Jorgensen, on THE POTENTIAL IMPACT OF UNDIAGNOSED HEARING LOSS ON THE DIAGNOSIS OF DEMENTIA?

You can find it here:

http://d-scholarship.pitt.edu/13174/1/Jorgensen_Dissertation_Aug2.pdf

Thank you for picking back up on this topic, Curtis. I was so impressed with your earlier thoughts on this and this is another piece of the puzzle. I read her dissertation from top to bottom and noted some evidence I had not seen before--but all concurring with the earlier conclusions talked about above.

Having chaired many doctoral dissertations (in APA) this was a quite a different format and approach from the theretical framework studies to which I am accustomed, but it brought together a quite comprehensive review of the literature. Perhaps this is a clinical AuD dissertation (where they can tackle practical problems not tied to theory per se). I am familiar with some of the faculty there who are outstanding clinicians.

It is still a major oversight in mental health overall that hearing acuity and correction are not required and are rarely done before diagnosis and treatment of AD. At one point, we found physicians in the US prescribing immunological compromising AD meds to more than twice as many seniors as have been diagnosed with it. So, in my mind, this is an over promotion beyond actual prevalence. From several vantages points this is the opposite direction from where it should be heading in real life practice.

What is your work setting and interest in this topic, if I may ask?

My primary role is as a hearing aid audiologist and owner of a modest independent hearing care practice in the United Kingdom. I am also founder of an online think tank for hearing with a particular interest in changing society's attitudes towards hearing.

My interest in the topic of dementia and hearing is multifaceted, and I'm not sure I can do your question justice in a forum response, but I'll try.

1. As I'm sure many hearing care practitioners will attest we come across plenty of anecdotal evidence that a reduction in hearing ability is mistaken for dementia because the symptoms are often very similar. Yet when they are fitted with appropriately adjusted hearing instruments their symptoms of dementia disappear or are mitigated, sometimes dramatically so. Even so, there has been relatively little evidence-based research into the relationship until recently, and even now there is ambiguity in whether hearing aids could help or not. It was a puzzle for me that needed to be solved – partly my natural curiosity, and partly so I could provide my own patients with best advice. It also made logical sense to me that if someone is deprived (partially or wholly) of one of their primary senses it would have an effect on cognitive performance. But again, when I began looking into it there was ambivalence in the literature. So I continued to look, expanding my field of interest into other disciplines that might help fill in the theoretical gaps, even if no one had yet brought the strands together.

2. In my spare time I enjoy studying neuroscience, cognition, psychology and psycholinguistics, though not in any formal context (at this point in my life). I am someone who naturally fuses ideas together, looking for patterns and relationships, and trying to gain an understanding of "how things work". This has provided a basis for approaching audiology from a different perspective than has perhaps been traditional. But it also highlighted for me where the gaps in scientific knowledge are which more often than not stem from several disciplines keeping to their own fields.

3. The final factor of my interest stems from my interest in changing society's attitudes to hearing. Many people in society see hearing as something of an optional extra. They are happy to damage it with excessive noise and believe they can get by without it functioning at its optimum ("I hear enough;" "I get by."), until the reduction in hearing reaches a point where their quality of life reaches a crisis point. Currently hearing care tends to take a reactionary approach. We wait until people get desperate enough to take action and only then do many people have their first ever hearing test, by which time they have negatively adjusted their lifestyles to fit their reduced hearing ability.

Sometimes that can never be fully recovered, and especially if it has led to cognitive decline. It's as if society educates people, trains people, gives them opportunities and gets them to the top of their life potential, then just lets people roll down the hill, attempting to pick up the broken pieces at the bottom; it's surely much better to keep people at the top of the hill by keeping people at their full potential. Common sense tells us that hearing is one of our primary senses – it's one of only a limited number of ways we can get information from the outside world into our brains, and especially speech on which so much of human interactivity is built. If so, it LOGICALLY must have an effect on our brains if it's not working at its optimum. But what is that effect? And how might it be demonstrated? That also has motivated me to look for answers, especially since our profession is so busy looking at deafness that we forget about the importance of hearing in the first place! Ultimately if people knew the importance of their hearing they would look after it better. If they look after it better, we keep people at the top of the hill and keep people from fading away unnecessarily. To do otherwise is a waste of human potential. I think it's wrong that we currently try to close the door after the horse has bolted, to use a cliché.

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I hope that explains a little more about my own interest. For now I find myself "synthesising" the work of others across disciplines and trying to reconstruct a big picture, ideally in a way that is testable and useful in guidance, diagnosis and treatment. Because I am doing this in a non-formal context it is unlikely anything I do carries any weight, but perhaps there will be opportunities in the future for some of the ideas I have for research projects. Meanwhile I enjoy sharing discussion on the subject with others, asking questions that may help the research take essential (though perhaps overlooked) factors into consideration, that perhaps by us all working together we can move things in the right direction. For my own part I am looking to build what I am discovering into developing better protocols within my own practice. I also think it may be time to start reaching out to physicians too.

Excellent, Curits. Thank you for providing such a cogent and clear-minded assessment of the situation. I am ever in hopes of seeing the mental health, and by extension, the larger healthcare field embrace the need for hearing/tinnitus/speech assessments before concluding diagnoses for cognitive function in older adults. Correct these aspects optimally and see how much is actually leftover in the mental health category and I think much less unneeded medicine with be prescribed and more substantive improvements will occur in the health of older adults.

I think it will begin with us formulating a message that healthcare and society can relate to and finds relevant. It is something I plan to work on in the near future.

Dear all: You might interested in this item, which dovetails in a broader sense, some of aspects of this question. https://www.researchgate.net/publication/259367456_Counseling_for_Quality_of_Life_in_Problem_Hearing_Aid_Fitting_Cases?ev=prf_pub

Article Counseling for Quality of Life in Problem Hearing Aid Fitting Cases

Central auditory function is commonly compromised in people with a diagnosis of Alzheimer's disease (AD) and may precede the onset of clinical dementia by several years. Given that screening for AD in its earliest stages might someday be useful for emerging therapies aimed at limiting progression, we inquired whether central auditory testing might be suitable for identifying people at risk for dementia.

To address this question, we performed a battery of behavioral central auditory tests in a cohort of 313 older people enrolled in a dementia surveillance research program. The cohort consisted of three groups: controls without memory loss (N=232), targets with mild memory impairment but without dementia (N=64), and targets with a dementia diagnosis (N=17). The auditory tests were the Synthetic Sentence Identification with Ipsilateral Competing Message (SSI), the Dichotic Sentence Identification test (DSI), the Dichotic Digits Test (DDT), and the Pitch Pattern Sequence (PPS) test. Additional control was provided by electrophysiologic testing to assess the integrity of the primary auditory pathways.

The mean score on each central auditory test worsened significantly across the three memory groups even after adjusting for age and peripheral hearing status, being poorest in the pAD group and moderately reduced in the memory-impaired group compared to the mean scores in the control group. Heterogeneity of results was noted in all three groups. The electrophysiologic tests did not differ across the three groups.

Central auditory function was affected by mild memory impairment. The Dichotic Sentence Identification in the free report mode appears to be the central auditory test most sensitive to the presence of memory impairment. Although central auditory testing requires specialized equipment and training, the objectivity of these tests is appealing. We recommend that comprehensive auditory testing be considered and further evaluated for its potential value as a baseline measure for a) new geriatric patients and b) people being evaluated because of memory impairment. Because central auditory dysfunction may have considerable impact on hearing rehabilitation, we also recommend including a central auditory test, such as the DSI, to the auditory assessment of older people who seek assistance for hearing difficulty.

 Yes, the hearing auditory component is most important, both in diagnosis and in remediation. That has been the position of our work since it began. When the mental health field connects with the audiology field, we will see a vastly improved approach to dementia diagnostics and treatment.

Many of my colleagues and I always have handy a voice amplifier for patients we either know to be hearing impaired or suspect so. Why try to assess someone who can't hear you properly? Recent articles on hearing loss as a cause of dementia I find completely without merit as the authors failed to teat with and without amplification - no, I don't mean hearing aids.

Irene, the research connecting unmitigated hearing loss, shrunken brain, burning of excessive brain glucose, loss of limbic control, higher incidence of memory and cognitive loss--the list is quite astounding--is conclusive. It requires more than simple on-the-spot amplification. Nothing less than 3-6 months of auditory rehabilitation which would of course include appropriately fitted and programmed hearing aids and counseling are necessary in older adults who've been diagnosed with Alzheimer's. In fact, as I state in all of my lectures, no mental health assessment of an older adult is valid until hearing loss has been evaluated and hearing loss corrected, most especially that involving loss in the 4KHz and higher range of frequencies. Having worked in the field for 45 years I can attest that this is indeed the case. Being deaf myself, research chair on such projects, and working with countless hearing impaired older adults I see the crucial need for the mental health field to start recognizing the need for hearing correction as a component of diagnostic verification. A huge topic for which there is tons of data and empirical observation to back up this concern. In every case, we find that it is essential to get to the root causes of dementia and work with our might to address those root causes before going for the pharmaceutical solution. Long-standing hearing loss is grossly under-recognized in the mental health field for both children and older adults.

Of course I have no argument. I must say, however, that after more than 30 years of practice, I have found that persons referred to me for assessment for AD/dementia often immediatelyr become quite normal with appropriate amplification with a voice amplifier. One can consider psychoacoustics forever but as a practicing clinician, if I can determine more exactly what the problem may be I have avoided the massive level of misdiagnosis that exists. Individuals with already established hearing impairment belong to a different group. I am referring to the older person with eithe "simple" (although it never is) presbycusis or the one who comes into your office speaking at a decibel level calculated to rattle windows.

Let's agree on the specific group(s) involved.

Yes, the problem is that less than 20% of seniors with hearing loss have been diagnosed with hearing loss. When I was asked to chair a dementia/Parkinson's study sometime ago, I insisted the lead investigator design an auditory evaluation in the candidacy protocol and take some time in finalizing her subject population. What was found was so few of those with hearing loss were even tested yet all were referred to the study had been diagnosed with the mental health components. A result of this careful approach large numbers of candidates were eliminated from the study--in fact, to have sufficient power of test we had to go back in and change the research questions, hypotheses, and shift the focus of the study. I peer review medical journal articles routinely that assume no hearing loss when no verification that conducted by the investigators. Hence, the need to raise awareness of the high incidence and correlation between cognitive deficits and unmitigated hearing impairments in older adults.

Thank you for your kind engagement on this topic.

It is a pet peeve of mine along with a failure to conduct a complete medical evaluation as step one and failure to find out status of vision. Imagine a person with sound induced hearing loss and catarats/glaucoma/macular degeneration being assessed withe the MMSE or the MOCA (neitherof which is diagnostic) and the being given adx of Alzeimer disease. It really hardly bears thinking about although I've seen it more times tha I want to count.

Both are hearing tests, albeit crude ones (whether the clinician knows it or not)--a hearing loss, which is massively prevalent in those over 65, will comingle with normal aging factors to look just like mild Alzheimer's. Central auditory deficits, recruitment, and cochlear distortions occur in nearly every case of presbyacusis and prevents a conclusive diagnosis of mental health status until that has been addressed. Hearing losses also cause perivascular, immunological, and limbic control problems, as well.

It seems that one important consideration with respect to this question is to determine whether the hearing loss associated with normative brain aging (i.e. in the absence of disease) is equivalent to hearing loss associated with neurodegenerative disease. For example, several genes associated with age-related neurodegenerative diseases, such as the apolipoprotein E (APOE) Ɛ4 allele and variants of Endothelin-1 (EDN1), have been associated with presbycusis (see O’Grady et al., 2007; Uchida et al., 2009) - does the hearing loss in these individuals resemble that of hearing loss observed non-carriers?

My feeling is that genetic influence is not as strong as some tend to believe. For instance, in cases where we find "the deaf gene", we find almost no offspring that are deaf. In combining my clinical (empirical observations in a case history frame) and objective research experience I find genetics influence but do not determine outcome. Environment added to generic influence is a much stronger and more reliable predictor. In fact, as we begin understanding the plasticity of genes, even within individuals, we see a huge range of generic expression over time---from genetic repair to genetic breakdown. The Methuselah Mouse studies bear this out quite well.

But getting back to the core question of hearing loss---no matter what underlying genetic influence we can today conclude that uncorrected hearing does indeed influence both identifiable cognitive behaviors and the underlying physical cascade that brings it on. It is so pervasive that in one (University of Pittsburgh, 1999) meta-study of 32 studies on Alzheimer's and hearing loss, that older adults that were diagnosed with dementia (Alzheimer's), 92% were found to have uncorrected hearing loss.

The research trail before that (Chartrand, 1990; UT-Austin, 1992; University of South Florida, 1996) was better explained and framed in subsequent studies, such as Brandeis University (2006, 2008, 2012) and John Hopkins (2011, 2012, 2014, 2017)--to name but a smattering of the evidence that dementia and uncorrected hearing loss are, for sure, bosom buddies of the first order. But who's paying attention? The entire clinical community of mental health remains, in my opinion, in blissful denial.

For that reason, I started this project to try to 1) alert my colleagues of this massive and critical oversight, and 2) invite more evidence--pro or con--from anyone wishing to shed more light on the subject. To-date, no one has introduced hard data proving the central theme of this project is in error. I appreciate all of your comments--and hope we do the bold thing by getting the word out, thusly: No mental health assessment of an older adult is valid or conclusive until their hearing acuity has been evaluated and any hearing deficiency corrected. Once that has happened, one may have confidence that the diagnosis is reasonably valid, all other factors being equal. But to treat for dementia without first treating the hearing loss represents, at best, professional and clinical negligence.