The subtle voice changes that could be an early sign of dementia… it’s not just forgetting words

Subtle changes in your voice could be an early warning sign of dementia, a major study has found.

Researchers in Pennsylvania analyzed the medical records of 830,000 patients in their 60s – including 400,000 who had voice changes. 

Patients were tracked from their diagnosis with a voice disorder or routine medical visit until their diagnosis with dementia, cognitive impairment or their final visit to the doctors. 

Those who had a voice disorder – such as talking less clearly, quietly or suffering from pain while speaking – and no hearing loss had a 58 percent higher risk of being diagnosed with dementia or cognitive decline, the researchers found, compared to those who had no voice problems. 

The scientists said this may be because the voice is controlled by the same complex network of neurons that are also involved in cognition, which also decline with dementia.

They suggested that means that when cognition starts to decline, changes may show up first in the voice – making it a potential early warning sign of cognitive decline. 

They also warned that voice problems could raise someone’s risk of cognitive decline by causing them to withdraw from social activities, which some studies say raises the risk of suffering from cognitive decline.

Dr Robert Sataloff, a throat specialist at Drexel University and senior study author, said: ‘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.’ 

‘When these networks start to break down, subtle vocal changes like reduced volume, a flatter or more monotone pitch, or a strained, breathy quality can show up years before more obvious symptoms like memory loss appear,’ Dr Chandril Chugh, a neurologist who was not involved in the research, told Newsweek.

‘The voice is really a real-time readout of very complex neural coordination, so when that coordination starts slipping, the voice often shows it early.’

He added: ‘In practice, I’d treat a voice change as a flag that prompts a proper cognitive workup, not as a diagnosis by itself.’ 

About 9.4 million Americans suffer from a voice problem that lasts for a week or more every year. 

It occurs when there’s a problem with the structure, muscles or nerves in someone’s voice box. These can be caused by trauma to the neck or chest, tumors or changes in nerves linked to multiple diseases.

Anyone can suffer from a voice disorder, but those who are female, over 60 years old or have other neurological disorders are at higher risk, potentially because of hormone fluctuations during menopause.

Approximately seven million Americans have dementia, although this number is expected to more than double by 2060.

In the study, published in the Journal of Voice, researchers at Drexel University defined voice disorders into six categories.

These were changes in pitch, reduced speech clarity, altered volume, reduced vocal range, pain when speaking or singing and other medically diagnosed voice conditions. 

As part of the study, they also analyzed medical records to detect a link between hearing loss and cognitive decline.

Overall, they found those who had hearing loss had a 27 percent higher risk of dementia or cognitive decline compared to those who did not have the condition.

Previous studies have linked hearing loss to a higher risk of cognitive decline, which is said to be because the brain is receiving fewer sensory inputs. 

Adults who had both a voice disorder and hearing loss were at double the risk of suffering from dementia or cognitive impairment. 

It was not clear why this was the case, but researchers said struggles with both hearing and speaking could signal neuron decline or lead people to become more socially isolated, a known risk factor for the disease. 

The paper did not say exactly how many participants were diagnosed with dementia or cognitive decline.

‘Our work shows that voice disorders may be an earlier and stronger sign of cognitive decline than hearing loss alone,’ Sataloff said. ‘We found the strongest link with dementia among patients experiencing a voice disorder and hearing loss. 

‘But, importantly, we found 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 [ear, nose and throat doctor] who can arrange a cognitive assessment to help patients develop an appropriate care plan.’

The study was observational and did not prove that a voice disorder raises the risk of cognitive decline, it only detected an association.  

Results were adjusted for factors including age, sex and high blood pressure.

Limitations included that the study included all voice disorders and used a group that was not representative of the general population.

Researchers said future research should investigate links between particular types of speech disorder and cognitive impairment.