A Voice Disorder May be an Early Sign of Dementia, Drexel Study Suggests

Those experiencing worsening voice quality – in pitch, clarity, volume, reduced vocal range or other voice disorders – and no hearing loss may be at 58% greater risk of cognitive impairment or dementia than those who are not experiencing a voice disorder, according to the first large-scale study on diagnosed voice disorders and cognitive decline. The findings, which suggest that voice disorders may be a more accurate early sign of cognitive decline than hearing loss alone, were recently published in the Journal of Voice from researchers at Drexel University’s College of Medicine.

Roughly 17.9 million U.S. adults report having had a voice problem within the past 12 months, and 9.4 million of them have had an issue that lasted for a week or longer, according to the National Institutes of Health. The findings from the Drexel study are particularly important for the four in ten adults who experienced a voice disorder and did not pursue medical care (and may be at higher risk of cognitive decline).

More than six million Americans have Alzheimer’s or another form of dementia, a number that is expected to more than double by 2060, according to the National Institutes of Health.

The findings from the Drexel research are also relevant to the more than four in 10 Americans over 55 who will receive a dementia diagnosis in their lifetime. Early diagnosis empowers a patient to develop more robust plans for taking care of finances and prepare for future health issues to ensure the best possible quality of life.

“If you have a voice disorder that impacts how your voice sounds or if it’s painful when you attempt to talk or sing, it’s only natural to participate less often in brain-supporting social or other engaging activities,” said senior author Robert Sataloff, MD, a professor and chair in Drexel’s College of Medicine. “We already see this in patients with Parkinson’s disease, in which voice disorders often precede other physical signs of the disease.”

The research team tracked data on 833,417 patients at primary care doctor well visits, beginning at least a full year following a diagnosis of a voice or hearing loss disorder. The team compared patients with diagnosed voice disorders and a patient control group that did not experience voice or hearing problems to see who went on to develop dementia or cognitive impairment.

The team found a greater association between cognitive decline and voice disorders than among those with hearing loss and no voice disorders.

The findings challenge hearing loss as the prevailing area of focus for diagnosis of cognitive decline. At the same time, the data in the study did not contradict earlier studies linking hearing loss and dementia. Hearing loss is considered the largest modifiable risk factor for dementia, and the team’s data supported this, reporting that hearing loss was associated with a 27% increased risk of cognitive decline compared to matched controls. The link between hearing loss and cognitive decline is well-documented, including a study in The Lancet which found that counseling and hearing aid use reduced a three-year cognitive change in older adults who were at increased risk for cognitive decline.

“Our work shows that voice disorders may be an earlier and stronger sign of cognitive decline than hearing loss alone,” said Sataloff. “We found the strongest link with dementia among patients experiencing a voice disorder and hearing loss; but importantly, we found that those with a voice disorder and no hearing loss were at greater risk than patients who experience hearing loss only. It may be valuable for many of these patients to talk with an otolaryngologist who can arrange a cognitive assessment to help patients develop an appropriate care plan.”

The team found that those with a voice disorder and hard of hearing were also older and experienced higher rates of health issues like high blood pressure, heart disease and Type 2 diabetes.

The field would benefit from future studies into whether particular voice disorders have a stronger link to future cognitive decline, the authors say, as well as whether treatment of voice disorders will slow cognitive decline as it occurs with treatment of hearing disorders.

In addition to Sataloff, other authors on this paper include lead author Anthony G. Russo and Mary J. Hawkshaw from Drexel’s College of Medicine.