There is one thing that might be worse than being diagnosed with Alzheimer's: that would be being diagnosed with it incorrectly. Yet that can happen to someone with a hearing impairment because the symptoms, byproducts, of cognitive and hearing loss are similar. In both cases, the afflicted person may experience anxiety, depression, isolation, denial, distrust, impatience, and memory problems. But the cognitive loss of the dementia patient is not the same as someone who simply does not hear well. After all, you are not going to remember something if you didn't hear it in the first place. And you are not going to do well on cognitive tests if you can't hear the questions. So, if you have not admitted to a hearing problem, if it has not been diagnosed and treated, there is a chance that you may be misdiagnosed, told incorrectly that you have early Alzheimer's, with all the resulting medical and social implications. The opposite can also take place. Through all the years of our marriage, my husband had a severe hearing impairment, partly the result of genetics -- many in his family suffered from various degrees of hearing loss -- and partly the result of shooting, as so many men did in his day, without wearing ear protection. In retrospect, I suspect that there were early signs of Alzheimer's that we dismissed as hearing issues. Had we realized that, the outcome would not have been any different, but I do wonder what it felt like for him. Did he know that there was more than hearing at stake and, if he did, and did not tell any of us, it must have been a very lonely and frightening period for him. Now, studies have shown that there is a link between hearing and cognitive loss, that the hearing impaired are at greater risk for developing Alzheimer's. Without getting into the possible scientific explanations for this, some things are obvious. 1. Hearing loss can lead to isolation with the depression and sedentary lifestyle that can be its companions, all of which are factors in dementia. 2. Like the rest of the body, the brain needs exercise to remain healthy. Untreated hearing loss can get in the way of that by restricting conversation, making going to the theatre, movies, lectures, playing games, very difficult, if not impossible. Clearly, if you are going to do everything you can to prevent Alzheimer's, then making sure wax is removed from the ears, having regular hearing tests, getting aids, and wearing them, is an important step. Again, there are no guarantees but, at the very least, your present life -- and those with whom you interact -- will be improved. While living with my husband, I learned a lot about this handicap. Like many men, he didn't want to admit the problem at first. There were other things he could blame -- hearing aids were expensive; people didn't speak up; they didn't speak clearly; it was the unusual accent. When he finally did accept a hearing aid, he didn't want to wear it. It was uncomfortable; he thought it made him look old. Etc, etc. Everyone who lives with someone who has a hearing impairment will be familiar with all the excuses. I learned to find the quiet corner in the restaurant and seat him where there would be no one talking behind him. To avoid places with a lot of mirrors and bare floors, where sound is exaggerated. To place him in the middle of the table, where his chances of participating in conversation were better than if he sat at the traditional head of the table. Now I, too, have lost some of my hearing. I wear a state of the art hearing aid in one ear. It works very well -- when I wear it. But it doesn't work when I leave it on the dresser which is where a lot of hearing aids seem to end up. Why? Because I forget. Or the battery goes out -- with a beep, beep, beep in the middle of the conversation or the concert or play, and I either have to fake it or do the embarrassing thing: take the aid out of the ear and replace the battery in front of others. If I am in a dark place, forget it. But even when I wear it, there are some situations where I still have difficulty hearing. Like many people who find themselves with this condition, I no longer hear the high notes clearly. I hear alto voices very well, but the soprano notes are lost. My husband experienced the same thing which is why, when I seated a woman beside him, I would tell her, "Speak low, not loud, but low." This very common condition -- hearing some notes and not others -- can create misunderstanding. Family members will say, "He hears when he wants to hear," or "She has very selective hearing." The first statement is not true. What you hear is not always a matter of choice. The second statement is: the ear is a very selective instrument. Talk to me in a high voice, from another room, or talk to my back and, if I hear you at all, it will likely be garbled. Recently someone spoke of needing a wedge in order to sleep -- I thought he said a wife. The result was comic, but in some situations that kind of speech discrimination could be disastrous. In a poor hearing environment, I will "get" some words and not others. This will frustrate the speaker who might well lose patience with me and decide that I am only hearing what I want to hear when, in fact, I do want very much to hear everything but I don't -- I can't. Set me in a noisy restaurant, or a cocktail party where there is a lot of background noise, and it will take tremendous concentration of my part to understand what you are saying. Put your hand over your mouth when you speak and you make it impossible for me to do the lipreading that the hearing impaired automatically rely on to augment sound. The healthy ear is a wonderful instrument -- it can discriminate -- it does not hear all the sounds directed at it at the same time equally. Some hearing aids promise to delete background noise but few actually easily deliver. So being in a crowded place wearing a hearing aid is to be subjected to a cacophony of noise. Given the choice, I entertain at home, where I can control the environment, or find the increasingly rare quiet restaurant. Society does not have much patience with the hearing impaired. Those of us who suffer from it experience hardship, from being shut out of public conversation, to not being able to have a private conversation in a public place because the other person has to speak too loudly, to sometimes speaking too loudly ourselves, to not hearing the intimate words of love whispered in the ear. There is a difference, of course, between hard of hearing and the tuning out that can take place in a long term partnership. When a couple live together for a long time, the relationship takes on the aspects of a comfortable old slipper, very familiar. The routines are established and we tend to assume we just know that the other one is saying or going to say. This can lead to the husband declaring, "You certainly did not tell me that your in-laws were coming to stay with us," or the wife, "I asked you if you wanted to go on a cruise and you said yes, you definitely did." I call that husband's (or wife's) hearing. It is the stuff of jokes and they can be very funny. But there is nothing funny about the real thing -- hearing impairment is definitely not a joke. Especially not when it may be a factor in getting Alzheimer's Disease.\  
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