Hearing Loss Linked to Cognitive Decline, Impairment

Medscape News
Jan 23, 2013

written by Pauline Anderson

Older adults with hearing loss have a rate of cognitive decline that is up to 40% faster than the rate in those with normal hearing, according to results of a new study. Those with hearing loss also appear to have a greater risk for cognitive impairment.

“I would argue going forward for next 30 or 40 years that from a public health perspective, there’s nothing more important than cognitive decline and dementia as the population ages,” said lead author Frank R. Lin, MD, PhD, assistant professor, otolaryngology, geriatrics, and epidemiology, Johns Hopkins University, Baltimore, Maryland.

“So from a big picture point of view, identifying factors that are associated with cognitive decline and dementia are important, in particular those factors that are potentially modifiable.”

Although the study did not find a significant association between hearing aid use and rate of cognitive decline, Dr. Lin is convinced that addressing hearing loss could have an impact greater than just improving quality of life.

The study was published online January 21 in JAMA Internal Medicine, formerly known as Archives of Internal Medicine.


A Review of Vitamin C. — Are you taking enough?

Vitamin C, also known as ascorbic acid, is a water-soluble vitamin. Unlike most mammals and other animals, humans do not have the ability to make their own vitamin C. Therefore, we must obtain vitamin C through our diet. Since it is water soluble and quickly secreted through the urine, vitamin C supplements are more effective if divided into a minimum of twice daily. Dividing the dosages into 4-6 hour increments is even better.

Vitamin C is required for the synthesis of collagen, an important structural component of blood vessels, tendons, ligaments, and bone. Vitamin C also plays an important role in the synthesis of the neurotransmitter, norepinephrine. Neurotransmitters are critical to brain function and are known to affect mood. Research also suggests that vitamin C is involved in the metabolism of cholesterol to bile acids (components of bile, which are formed by the metabolism of cholesterol, and aid in the digestion of fats), which may have implications for blood cholesterol levels and the incidence of gallstones.

Severe vitamin C deficiency has been known for many centuries as the potentially fatal disease, scurvy. Symptoms of scurvy include bleeding and bruising easily, hair and tooth loss, and joint pain and swelling. Such symptoms appear to be related to the weakening of blood vessels, connective tissue, and bone, which all contain collagen.

Disease Prevention

  • Vitamin C is useful in wound healing of all types. From cuts and broken bones to burns and recovery from surgical wounds, vitamin C taken orally helps wounds to heal faster and better. Applied topically, vitamin C may protect the skin from free radical damage after exposure to ultraviolet (UV) rays.
  • Common cold
  • Allergies
  • Role in Immunity
  • Cataracts
  • Coronary Heart Disease
  • Stroke
  • Hypertension
  • Cancer
  • Gout
  • Lead toxicity
  • Diabetes Mellitus

As shown in the table below, different fruits and vegetables vary in their vitamin C content, but five servings (2½ cups) of fruits and vegetables should average out to about 200 mg of vitamin C.



Vitamin C (mg)

Orange juice

¾ cup (6 ounces)


Grapefruit juice

¾ cup (6 ounces)



1 medium



½ medium



1 cup, whole



1 medium


Sweet red pepper

½ cup, raw chopped



½ cup, cooked



1 medium, baked



Vitamin C (L-ascorbic acid) is available in many forms, but there is little scientific evidence that any one form is better absorbed or more effective than another. Most experimental and clinical research uses ascorbic acid or sodium ascorbate.

Natural vs. synthetic vitamin C

Natural and synthetic L-ascorbic acid are chemically identical and there are no known differences in their biological activities.

Mineral ascorbates

Mineral salts of ascorbic acid are buffered and, therefore, less acidic than ascorbic acid. Some people find them less irritating to the gastrointestinal tract than ascorbic acid. Sodium ascorbate and calcium ascorbate are the most common forms, although a number of other mineral ascorbates are available. Sodium ascorbate generally provides 131 mg of sodium per 1,000 mg of ascorbic acid, and pure calcium ascorbate provides 114 mg of calcium per 1,000 mg of ascorbic acid.

Vitamin C with bioflavonoids

Bioflavonoids are a class of water-soluble plant pigments that are often found in vitamin C-rich fruits and vegetables, especially citrus fruits. There is little evidence that the bioflavonoids in most commercial preparations increase the bioavailability or efficacy of vitamin C.

Ascorbate and vitamin C metabolites

One supplement, Ester-C® contains mainly calcium ascorbate, but also contains small amounts of the vitamin C metabolites dehydroascorbate (oxidized ascorbic acid), calcium threonate, and trace levels of xylonate and lyxonate). Don’t try to remember these. Although the metabolites are supposed to increase the bioavailability of vitamin C, the only published study in humans addressing this issue found no difference between Ester-C® and commercially available ascorbic acid tablets with respect to the absorption and urinary excretion of vitamin C. Ester-C® should not be confused with ascorbyl palmitate, which is also marketed as "vitamin C ester."

Ascorbyl palmitate

Ascorbyl palmitate is actually a vitamin C ester (i.e., vitamin C that has been esterified to a fatty acid). In this case, vitamin C is esterified to the saturated fatty acid, palmitic acid, resulting in a fat-soluble form of vitamin C. Ascorbyl palmitate has been added to a number of skin creams due to interest in its antioxidant properties as well as its importance in collagen synthesis. Although ascorbyl palmitate is also available as an oral supplement, it is likely that most of it is hydrolyzed (broken apart) to ascorbic acid and palmitic acid in the digestive tract before it is absorbed. Ascorbyl palmitate is also marketed as "vitamin C ester," which should not be confused with Ester-C® (see above).

Tolerable Upper Intake Level (UL) for Vitamin C

Age Group

UL (mg/day)

Infants 0-12 months

Not possible to establish*

Children 1-3 years


Children 4-8 years


Children 9-13 years


Adolescents 14-18 years


Adults 19 years and older


*Source of intake should be from foods or formula only.


Linus Pauling Institute Recommendations

For healthy men and women, the Linus Pauling Institute recommends a vitamin C intake of at least 400 mg daily—the amount that has been found to fully saturate plasma and circulating cells with vitamin C in young, healthy nonsmokers. Consuming at least five servings (2½ cups) of fruits and vegetables daily provides about 200 mg of vitamin C. Most multivitamin supplements provide 60 mg of vitamin C. To make sure you meet the Institute’s recommendation, supplemental vitamin C in two separate 250-mg doses taken in the morning and evening is recommended.

Older adults (65 years and older)

It is not yet known with certainty whether older adults have higher requirements for vitamin C than younger people. A vitamin C intake of at least 400 mg daily may be particularly important for older adults who are at higher risk for chronic diseases. Because maximizing blood levels of vitamin C may be important in protection against oxidative damage to cells and biological molecules, a vitamin C intake of at least 400 mg daily is particularly important for older adults who are at higher risk for chronic diseases caused, in part, by oxidative damage, such as heart disease, stroke, certain cancers, and cataracts.


Sister Mary Joseph nodule

Pam and I learned something new today. A Sister Mary Joseph node or nodule.

We had our 6 month dental check. While there, one of the dental hygienists (Monica) told us that her mother-in-law was just diagnosed today with stage 4 pancreatic cancer. It went diagnosed since last April. She went to her family Dr. for a ‘mild’ infection around her belly button. He said it was just a staph infection and not to worry. She said her mother-in-law always alluded to her not having good hygiene. Allegedly, he never examined her on the table for it from the very beginning. Evidently he simply looked at it while she was sitting in the chair. During her most recent visit, an accompanying family member insisted that he properly examine her and to do an entire physical exam on her. Monica said that he felt something and sent her for an abdominal ultrasound which ultimately led to having a biopsy.

As a non-surgeon, I have never encountered or read anything about this kind of nodule and I imagine that this patient’s physician hadn’t either. But what isn’t acceptable to me is his/her failure to actually examine her during a physical exam. Perhaps she could have been spared the inevitable despicable agony and pain which she will probably have to endure.

Imagine feeling like you don’t keep yourself clean every time you leave your Dr. only to find out later that you have advanced cancer!

Sister Mary Joseph Nodule

Sister Mary Joseph Nodule slide

Got thirst?

I got thirsty today from working outside (not good). We trimmed, pruned, cut grass and mulched some leaves. Wow! What a great byline for the national nightly news! Applause But it was a lot of fun. Yea, Pam and I are both aching now…………where’s that aspirin??

The last week or so has been much better. In fact, it feels like I did all summer long. I’ve never been able to achieve my baseline since becoming ill but nonetheless I’m OK with that. This LBD truly is cunning, baffling and powerful! One day they will have an answer to all the mysteriousness of the symptomatic fluctuations of Lewy Body Dementia.

So back to being thirsty. I remembered blogging about dehydration last fall. Particularly with regard to the elderly. And in the winter……not just summer (whenever we think of dehydration the most). So I thought I’d cheat and repost it again since winter is right around the corner. Hope it is helpful to someone.

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Signs and Symptoms of Winter Dehydration in the Elderly and 8 Ways to Avoid Them

It’s Winter! Dehydrated? How could I be? Dehydration can occur anytime of the year. We think of summer time as being a time to avoid the sun as well as heat stroke and heat exhaustion. Here are some tips to keep you and your elderly loved ones well hydrated this winter. And to better health!

Dehydration can kill. It is crucial for anyone to stay properly hydrated but it is even more important for seniors who have other comorbidities as well as dementia like diseases. One of the reasons that the dehydration threat is higher for seniors is because of thinner skin that comes with aging. The thinner skin makes a person more prone to losing fluid. Another issue that makes seniors more open to fluid loss is their medications, some medicines can cause you to become easily dehydrated.

A wide array of medical issues can lead to dehydration. Considering that our bodies are made up of 50% to 65% water, this element is critical to virtually all our physical functions. Every organ and system of the body depends on water, so a shortage of fluid can naturally lead to serious health consequences. Dehydration is one of the most frequent causes of hospitalization among people over the age of 65. Worse, at least one study has found that about one-half of those hospitalized for dehydration died within a year of admission. Older people are at greatest risk for dehydration because the mechanism that normally triggers thirst becomes less sensitive with age. In addition, as we age, a lower percentage of our body weight is water, so dehydration can occur more rapidly. Those elderly individuals most vulnerable to dehydration live alone, especially when they are ill. In addition to fluid lost from fever from flu, or diarrhea from a stomach virus, sickness usually interferes with normal eating and drinking patterns.   We lose water in many ways.

  1. Breathing results in humidified air leaving the body
  2. Diarrhea is the most common reason a person loses excess water. A significant amount of water can be lost with each bowel movement. Worldwide, dehydration from diarrhea accounts for many of the deaths in children.
  3. Vomiting can also be a cause of fluid loss; as well, it makes it difficult to replace water by drinking it.
  4. The body can lose significant amounts of water when it tries to cool itself by sweating. Whether the body is hot because of the environment (for example, working in a warm environment), intense exercising in a hot environment, or because a fever is present due to an infection, the body loses a significant amount of water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk will generate up to 16 ounces of sweat (a pound of water).
  5. In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine and water then follows. Significant dehydration can occur. For this reason, frequent urination and excessive thirst are among the symptoms of diabetes.
  6. Burn victims become dehydrated because water seeps into the damaged skin. Other inflammatory diseases of the skin are also associated with fluid loss.
  7. The inability to drink adequately is the other potential cause of dehydration. Whether it is the lack of availability of water or the lack of strength to drink adequate amounts, this, coupled with routine or extraordinary water losses, can compound the degree of dehydration.
  8. One common side effect of many medicines is increased frequency of urination. You need to compensate for these additional lost fluids by drinking more than usual. Medications that often cause this problem are diuretics, blood pressure drugs, antihistamines and psychiatric drugs.
  9. The aging process can diminish our natural sense of thirst, but if you also suffer from incontinence, you may be reluctant to drink fluids throughout the day. Sipping often in small amounts is essential to avoid becoming dehydrated.

The body’s initial signs and symptoms of dehydration are:

  • Thirst
  • Decreased urine output. The urine will become concentrated and more yellow in color.
  • Fatigue
  • Headache
  • Dry nasal passages
  • Dry, cracked lips dry mouth the eyes stop making tears sweating may stop muscle cramps nausea and vomiting lightheadedness (especially when standing). weakness will occur as the brain and other body organs receive less blood.
  • Coma and organ failure will occur if the dehydration remains untreated.
  • Irritability & confusion in the elderly should also be heeded immediately.

Here are some easy remedies and ways to prevent dehydration:

  1. As is often the case in medicine, prevention is the important first step in the treatment of dehydration.
  2. Fluid replacement is the treatment for dehydration. This can include: water, juice, soups and clear broths, Popsicles, Jell-O, ice cream, milk, puddings, decaffeinated beverages, Kool-Aid, nutritional drink supplements (Ensure, Boost, Sustacal, Resource and instant breakfast drinks), and replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)
  3. Reduce or eliminate dehydrating beverages such as coffee, tea and soft drinks (unless decaffeinated). But even decaffeinated drinks can contribute to dehydration. Beware of alcohol intake too. Alcoholic beverages increase risk of dehydration because the body requires additional water to metabolize alcohol and it also acts as a diuretic.
  4. If you drink the unhealthy beverages, you need to add even more water to you daily total. The dehydration caused by those drinks must be compensated for by increasing the water.
  5. Eat lots of fruits and vegetables. Most have a high water content.
  6. Drink water all day long in small amounts. It is not good to suddenly gulp down 64 ounces of water. You can fill a 24-32 ounce tumbler in the morning, refill it by late morning and refill again for the afternoon. Consume that by 5 PM. Most people need to start limiting fluids 1-3 hours before bedtime.
  7. Individuals with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss. Acetaminophen or ibuprofen may be used to control fever.
  8. If an individual becomes confused or lethargic; if there is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed. Call 911 for any patient with altered mental status – confusion, lethargy, or coma.

Remember that the lack of a sense of thirst is not a reliable indicator of the need for water. You need water long before you feel thirsty.


Sex and Dementia: Shrouded by Taboo

A man with Alzheimer’s and his wife of many years finish lovemaking when he rolls over and tells her, “You’d better hurry up and get your things because my wife will be home soon." ……….

This comes from a thought provoking article here. I believe this is a subject which needs to be addressed on many levels. Life doesn’t stop when someone becomes demented. All of our physiological needs persist throughout the course of our lives..

We all follow Maslow’s hierarchy of needs. Click on the picture to open it up. Notice that the red portion of the triangle is the foundation of our being.


Physiological needs include:


Tell me what you think…………..David

Sunburst Throw and Peaceful Pastels Afghan

A few pictures of some crochet projects I’ve completed. 


 Sunburst Throw

 Sunburst Throw

I finally finished this throw over this past summer. I started it last summer but I had too many problems with shaking to finish it.

Peaceful Pastels Afghan

Peaceful Pastels Afghan

 This one was from a kit which I made several years ago while I was still working.

So far, all of my neurologists have encouraged me to do as many hand made crafts as possible. All types….knitting, crochet and others. Counted cross stitch is a little hard on the eyes.

Louise Morse made this comment:

Submitted on 2009/08/17 at 4:08am

Hello David,

This is such a helpful blog. You’re probably helping more people with this than you would be if you were back in work!
I love your warmth…

I haven’t come across testosterone replacement therapy before, certainly not here in the UK, as part of treatment for LBD.

Is it common there, in the States?

Hospitalization for evaluation doesn’t happen here. Is it standard in the States? When was that – perhaps things have changed?

Hope you have a lovely day, today. I’m plowing on with my follow up book. There have been so many changes for the better in the two years since I wrote the first one! Positive changes. God is good.


Louise……………..to the best of my knowledge, testosterone replacement therapy (TRT) is not a standard treatment for LBD. I believe it is given on a case by case basis. During my evaluation at UCSF, they did a testosterone blood level and found it to be almost negligible. So I now take the Androderm patch daily. For me, I feel an increased sense of well being, increased energy, better mood and an overall cognitive improvement.

I’ve often wondered if many males with dementia would benefit from TRT since it does enhance cognitive functions, lift the depression which they didn’t know they have, and to make them feel alive again. We all know that testosterone levels are very low in the majority of men in the age range with dementia.

Warmly David………………………


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