Q: You said in a column last month that hearing loss is linked to the risk of dementia. Could you please explain why this should be so?
Howard Ashton Blackwood, South Wales.
Dr. Martin Scurr replies: Thank you for asking this valuable question, which will be interesting and concerning to many.
Dementia is a brain disorder that affects memory and other key functions, such as the way people use language and communicate, spatial awareness (for example, the ability to estimate distances) and the processes that allow us to plan, carry out tasks pay attention and juggle with each other. .
About 40 percent of dementia cases could be prevented or delayed by addressing twelve key risk factors, including: high blood pressure; obesity; diabetes mellitus; depression; physical inactivity; smoking; social isolation – and hearing (according to a 2020 report on dementia prevention from the Lancet Commission).
The link between hearing loss and dementia has been confirmed by several large studies. One involved almost 2,000 people who started with no signs of cognitive impairment: they were then followed for 11 years – and those who had hearing loss at the start of the study had increased levels of cognitive impairment by the end.
Some experts believe that the social isolation caused by hearing loss contributes to a person developing dementia, but we don’t currently know enough about the mechanisms involved to be sure. There are other possible mechanisms, including a dysfunction of central auditory processing – where people find it difficult to understand speech in noisy environments, a problem that becomes more common with age. The person knows he or she is being spoken to, but cannot understand what is being said. This may be an early sign of Alzheimer’s disease.
Dementia is a disease of the brain that affects memory and other key functions, such as the way people use language and communicate, spatial awareness and the processes that allow us to plan, pay attention and juggle tasks.
The question is which comes first: the hearing problems that affect the brain or brain changes that affect hearing.
It’s also not clear whether wearing a hearing aid can slow the rate of cognitive decline. There is limited evidence – for example, a study published last year in the journal Lancet Public Health suggested this might be the case, but this has since been retracted. So the jury is still out.
It seems likely that working on the known risk factors from midlife onwards, if committed to with determination, could go a long way towards preventing the decline in brain function known as dementia.
But to answer your exact question, the answer, I’m afraid, is: more research is needed.
The 12 steps that can help you prevent this…
- Get at least seven hours of sleep per night
- Challenge the brain regularly
- Ensuring mental well-being
- Stay socially active
- Take care of your hearing
- Eat a balanced diet
- Stay physically active
- Quit smoking
- Drink responsibly
- Maintain healthy cholesterol levels
- Maintaining healthy blood pressure
- Control diabetes as best as possible
Q: I play badminton two or three times a week. During a recent game, I felt and heard a pop in the upper back muscle of my left leg, just below my buttock. It can be painful, especially at night. Will it fix itself quickly so I can play again?
Tim Fuller, by email.
Dr. Martin Scurr replies: What you’ve described is a hamstring injury, a tear involving the tendons or large muscles in the back of the thigh. The hamstrings are actually a group of three muscles – they essentially allow you to bend your knee – while the tendons connect these muscles to the bones of the knee and the top of the thigh.
A sudden movement can cause a tear, which is acutely painful. The popping sensation you noticed could be a sign that this is a fairly serious injury: the ‘popping’ is caused by the sudden snapping of a tendon (rather than the muscle pulling apart). If the tendon is completely torn, it will be difficult to walk or fully straighten your knee and may take some time to heal. It may take several months before you can resume active exercises such as badminton. In the meantime, gentle exercise such as walking is wise, but you should let the pain be your guide in how much you do.
However, the increase in pain at night raises a question. Could it be that you have actually torn one of the three muscles that make up the hamstrings, from where it connects the bones in the pelvis? Night pain is a sign of this and you may need an ultrasound or MRI to confirm this. I strongly recommend that you discuss this with your doctor.
In my eyes… there is awedire lack of anesthetists
My father was an anesthetist (at one point to King George VI, when he underwent surgery at Buckingham Palace to save him from lung cancer). That also applies to my brother and my son.
Sometimes I wonder if I could have been one, even though realistically I don’t have the requisite nerves of steel. Keeping a patient alive but anesthetized during surgery is a complex operation that requires utmost skill, expert judgment and an in-depth knowledge of medications and dosage.
So it is deeply worrying to hear that the Royal College of Anesthetists is now warning that the shortage of anesthetists has become so severe that it is putting some patients off having surgery, while the NHS waiting list is over 9 million.
Yet, remarkably, there is no shortage. What is missing is good government financing. Currently there is only funding for around 400 places per year in the higher education required to become an anesthesia consultant, for around 650 candidates per year.
The 250 who lose out must retrain for another medical specialty – or emigrate, or leave medicine altogether. Without money for more training places, this crisis will only get worse.