India Ink: Five Questions For: Aminatta Forna

Aminatta Forna’s most recent novel, “The Memory of Love,” won the Commonwealth Writers’ Prize Best Book Award for 2011. 

Her previous novels include the “The Devil that Danced on the Water” and “Ancestor Stones,” which won the 2007 German Liberaturpreis, the Hurston Wright Legacy Award for Debut Fiction in 2007 and the Aidoo-Snyder Book Prize in the United States in 2010. India Ink interviewed her at the Jaipur Literature Festival.  

What are the occupational hazards of being a writer?

I don’t have a pension plan! I love it so much I can’t say that there are any but I think that a lot of people can write – some people write one book and never write another – and the reason that writers continue to write is that we are people who are capable of living in a room on our own with imaginary friends for the rest of our life. If you can do that, then you can be a writer but many people find they can’t do that.

What is your everyday writing ritual?

Most writers I know go for word counts, and I used to be a journalist so I guess that’s ingrained. But if you do something you have to have a goal. Some writers deny it but I think most people feel they have to have some sort of goal. We bought a house about 10 years ago and did up this whole room exactly the way I thought I wanted it as a writer and I discovered I couldn’t write a word in it. I had to go and write the whole book in the British library. Now I do work in that room.

I don’t have very many little fetishes but the one I do have is that I like a particular mug to drink out of. It’s just a small china cup and I get very upset if my husband moves it. He just can’t understand why it matters so much. And of course I’ve got a hoard of displacement activities – all the things you do when you should be writing. I put on the wash, I do the dishes, and I organize things. But they’re part of the ritual so at the beginning of a book the house is always very, very clean. But then once I’ve got past the end of the beginning as it were, once the book has got a certain momentum, then the house gets increasingly untidy because the writing takes over. But I firmly believe that all of those activities are part of the process of thinking. But nobody can talk to you while you do them. Which my husband does understand and the lady who cleans my house also understands.

Why does the Jaipur Literature Fest matter to you?

These festivals are just burgeoning all over the world and that’s really good because books are apparently under threat and we always hear that the publishing industry is dying yet there’s quite obviously a very strong interest in books and the ideas that books contain. But Jaipur in particular matters because it is away from what was once the center – it is the shifting of the center from outside the West and into these emerging cultural and economic powerhouses like India. Kenya’s now got a wonderful book festival, people are talking about maybe locating one in West Africa. The reason I come is because I can talk to audiences who are not the kind of people I find walking down the street in London.

How do you deal with your critics?

Well I understood quite early on that if I was going to accept the good ones I would have to accept the bad ones too so I try and take it on the chin. But when I did your job I went to interview Vikram Seth, and his response to me was, “It’s one person’s opinion.”

Why should we read your latest book, ‘The Memory of Love’?

Increasingly there are those of us who write from outside the center and those are the writers that I’m most interested in because they bring me into worlds that I did not previously know. And that as a writer is what I try to create. To both look at the particular of a world that other people might not know and look at the extremes that people face but also find the universality of that.

It’s also a good story.

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DealBook: Commerzbank to Cut Up to 6,000 Jobs

LONDON – Commerzbank, the second-largest lender in Germany, is planning to cut up to 6,000 jobs in a bid to increase earnings, joining other European banks that have announced restructuring plans in recent months.

The bank said on Thursday that it expected to eliminate 4,000 to 6,000 jobs by 2016, or 7 to 10 percent of its work force.

The layoffs will affect Commerzbank’s global operations, particularly a retail division that had expanded rapidly in recent years, according to a person with direct knowledge of the matter who spoke on condition of anonymity because he was not authorized to speak publicly.

In the wake of tougher capital requirements, sluggish economic growth and growing concerns about risky trading activity, several European banks have announced efforts to reduce their work forces, shed unwanted assets and increase capital reserves.

In October, the Swiss financial giant UBS said it would eliminate 10,000 jobs in its investment bank in a move to reduce exposure to risky trading activity and to focus on its wealth management division.

Barclays, which is to formally announce its own restructuring plan on Feb. 12, also started consulting with staff members in its investment banking unit this week over potential layoffs.

The expected job cuts at Barclays could result in up to a 10 percent reduction, or around 2,000 jobs, in the division, according to two people with direct knowledge of the matter who spoke on condition of anonymity because they were not authorized to speak publicly. On Thursday, Barclays started to reduce the size of its investment banking staff in Asia by 15 percent, or 70 jobs, according to one of the people.

On Jan. 17, the firm’s new chief executive, Antony P. Jenkins, told staff members they should leave the bank if they did not want to help rebuild its reputation. Barclays agreed last year to a $450 million settlement with American and British authorities over the manipulation of the London interbank offered rate, or Libor, a crucial benchmark rate.

The layoffs at Commerzbank come after efforts by the bank’s chief executive, Martin Blessing, to sell some of the firm’s 160 billion euros ($213 billion) of noncore assets, including shipping and real estate investments. The bank is also trying to reduce its exposure to European sovereign debt because of continuing volatility in countries like Spain and Greece.

Commerzbank said it would start negotiations with employee unions in early February to decide on the final number of layoffs. The announcement comes a day after Mr. Blessing was spotted at a party on Wednesday night at the luxury Belvedere hotel in Davos, whose attendees also included Deutsche Bank’s co-chief executive Anshu Jain. The Commerzbank chief is attending the World Economic Forum in the Swiss town.

Commerzbank received an 18.2 billion euro bailout from the German government in 2008 after its mistimed acquisition of a rival German bank, Dresdner, for 5.5 billion euros at the height of the financial crisis. As part of the deal, the German government still owns a 24 percent stake in Commerzbank.

Shares in Commerzbank bank rose less than 1 percent in morning trading in Frankfurt on Thursday.

European banks have been struggling through a series of recent financial scandals, mounting demands to increase capital reserves and growing political pressure to increase lending to stimulate local economies.

The Continent’s major financial institutions will begin reporting earnings next week, and analysts will be waiting to see if they will follow UBS’s lead in announcing major changes in response to these pressures.

“We believe that UBS has kicked off the much-awaited industry restructuring, even if each bank takes a different path,” Citigroup banking analysts told investors in a research note.

Neil Gough reported from Hong Kong. Jack Ewing contributed reporting from Davos.

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The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Francis, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

The New Old Age Blog: Grief Over New Depression Diagnosis

When the American Psychiatric Association unveils a proposed new version of its Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnoses, it expects controversy. Illnesses get added or deleted, acquire new definitions or lists of symptoms. Everyone from advocacy groups to insurance companies to litigators — all have an interest in what’s defined as mental illness — pays close attention. Invariably, complaints ensue.

“We asked for commentary,” said David Kupfer, the University of Pittsburgh psychiatrist who has spent six years as chairman of the task force that is updating the handbook. He sounded unruffled. “We asked for it and we got it. This was not going to be done in a dark room somewhere.”

But the D.S.M. 5, to be published in May, has generated an unusual amount of heat. Two changes, in particular, could have considerable impact on older people and their families.

First, the new volume revises some of the criteria for major depressive disorder. The D.S.M. IV (among other changes, the new manual swaps Roman numerals for Arabic ones) set out a list of symptoms that over a two-week period would trigger a diagnosis of major depression: either feelings of sadness or emptiness, or a loss of interest or pleasure in most daily activities, plus sleep disturbances, weight loss, fatigue, distraction or other problems, to the extent that they impair someone’s functioning.

Traditionally, depression has been underdiagnosed in older adults. When people’s health suffers and they lose friends and loved ones, the sentiment went, why wouldn’t they be depressed? A few decades back, Dr. Kupfer said, “what was striking to me was the lack of anyone getting a depression diagnosis, because that was ‘normal aging.’” We don’t find depression in old age normal any longer.

But critics of the D.S.M. 5 now argue that depression may become overdiagnosed, because this version removes the so-called “bereavement exclusion.” That was a paragraph that cautioned against diagnosing depression in someone for at least two months after loss of a loved one, unless that patient had severe symptoms like suicidal thoughts.

Without that exception, you could be diagnosed with this disorder if you are feeling empty, listless or distracted, a month after your parent or spouse dies.

“D.S.M. 5 is medicalizing the expected and probably necessary process of mourning that people go through,” said Allen Francis, a professor emeritus at Duke who chaired the D.S.M. IV task force and has denounced several of the changes in the new edition. “Most people get better with time and natural healing and resilience.”

If they are diagnosed with major depression before that can happen, he fears, they will be given antidepressants they may not need. “It gives the drug companies the right to peddle pills for grief,” he said.

An advisory committee to the Association for Death Education and Counseling also argued that bereaved people “will receive antidepressant medication because it is cheaper and ‘easier’ to medicate than to be involved therapeutically,” and noted that antidepressants, like all medications, have side effects.

“I can’t help but see this as a broad overreach by the APA,” Eric Widera, a geriatrician at the University of California, San Francisco, wrote on the GeriPal blog. “Grief is not a disorder and should be considered normal even if it is accompanied by some of the same symptoms seen in depression.”

But Dr. Kupfer said the panel worried that with the exclusion, too many cases of depression could be overlooked and go untreated. “If these things go on and get worse over time and begin to impair someone’s day to day function, we don’t want to use the excuse, ‘It’s bereavement — they’ll get over it,’” he said.

The new entry for major depressive disorder will include a note — the wording isn’t final — pointing out that while grief may be “understandable or appropriate” after a loss, professionals should also consider the possibility of a major depressive episode. Making that distinction, Dr. Kupfer said, will require “good solid clinical judgment.”

Initial field trials testing the reliability of D.S.M. 5 diagnoses, recently published in The American Journal of Psychiatry, don’t bolster confidence, however. An editorial remarked that “the end results are mixed, with both positive and disappointing findings.” Major depressive disorder, for instance, showed “questionable reliability.”

In an upcoming post, I’ll talk more about how patients might respond to the D.S.M. 5, and to a new diagnosis that might also affect a lot of older people — mild neurocognitive disorder.

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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Bits Blog: Keeping the Internet Safe From Governments

Even before the World Conference on International Telecommunications took place last month in Dubai, Internet activists anticipated trouble. So did Congress, which issued a resolution calling it “essential” that the Internet remain “stable, secure and free from governmental control.”

The worries proved prescient. The conference, which supposedly was going to modernize some ancient regulations, instead offered a treaty that in the eyes of some critics would have given repressive states permission to crack down on dissent. The United States delegate refused to sign it. Fifty-four other countries, including Canada, Peru, Japan and most of Western Europe, voted no as well.

The OpenNet Initiative estimates that about a third of Internet users live in countries that engage in “substantive” or “pervasive” blocking of Internet content. They tended to be among the 89 countries that signed the treaty, including Russia, Cambodia, Iran, China, Cuba, Egypt and Angola.

Those in favor of a free and open Internet have long had a problem with the International Telecommunication Union, the affiliate of the United Nations that ran the conference. They see the I.T.U., which dates back to 1865, as longing for the pre-Internet era, when its influence and fortunes were greater. As a result, activists think, the I.T.U. has become aligned with, and a tool of, countries that desire more governmental control over public speech.

In the wake of the Dubai meeting, there are renewed calls to scale back United States financing of the I.T.U. drastically. The logic is, why are taxpayers supporting an organization whose motives they oppose?

“Paying for both sides of a conflict is unsustainable and illogical, and should simply be corrected,” says the De-Fund the I.T.U. Web site, which has posted a petition on the White House Web site.

The De-Fund site notes that the petition is not asking the United States government to take an unprecedented first step. “Many of our free-market democratic allies, led by Germany, France, Spain and Finland, have already de-funded the I.T.U. Likewise, right-thinking American companies like I.B.M., Cingular, Microsoft, Fox, Agilent, Sprint, Harris, Loral and Xerox, and others, have already withdrawn their private-sector contributions from the I.T.U.”

The petition was the brainchild of Bill Woodcock, the Berkeley-based research director of Packet Clearing House, a nonprofit institute. “This is really about whether people should be allowed to say what they think,” Mr. Woodcock said. “The Internet enables free speech, and that makes it very dangerous to countries that try to control public discourse.”

The United States government contributes about 8 percent of the I.T.U.’s budget. The 55 countries that voted against the treaty contribute about three-quarters of it. If the White House receives 25,000 signatures by Feb. 10, it will review and quite possibly act on the petition. As of Tuesday, it had about 600 signatures with minimal publicity.

A spokesman for the I.T.U., which is based in Switzerland, did not respond to an e-mail seeking comment.

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India Ink: India Rape Trial Starts With Renewed Ban on Media Coverage

The trial of five men accused in the gang rape of a 23-year-old woman in a moving bus in New Delhi is being watched closely as a symbol of India’s commitment to justice for women, but information about the ongoing court proceedings may be scarce.

As court proceedings began Thursday, the presiding judge said  there would be a blanket ban on reporting on the trial. The judge, Yogesh Khanna,  also warned defense lawyers, who have been openly speaking about the case, not to provide information about the proceedings to the press.

The five men accused in the Dec. 16 rape and murder of a physiotherapy student were ushered into the special fast-track court in South Delhi on Thursday at noon, flanked by policemen, with their faces were covered with gray woolen caps. During the two-hour court proceedings, the prosecution used the opening arguments to lay out charges against the men, which include gang rape, murder, robbery and destruction of evidence.

The police allege that the five accused men and a sixth teenager, who is being tried as a juvenile, committed a premeditated, vicious crime that included plans to kill their victim. The woman died nearly two weeks after the rape from injuries suffered during the attack, which included an assault with an iron rod. Her companion, a 29-year-old man, was also beaten, and is expected to testify  at the trial.

The court proceedings took place in room 305 of the Saket District Court complex, a small wood-paneled chamber. The next hearing will be on Monday, when the defendants’ lawyers will respond to the charges the prosecution has laid out.

The new fast-track court will try only cases related to crimes against women, and once trials have started, they will not adjourn for weeks or months, as is common in other courts. Several fast-track courts have already  been set up in Delhi to hear crimes against women in the wake of the Delhi gang rape, which brought thousands of protesters to the streets demanding justice for the victim and other victims of sexual assault.

Judge Khanna ordered  Monday that all court proceedings in ths current case would take place “in camera,” allowing only those directly connected with the case to be present in the courtroom, reiterating an earlier magistrate’s order on the case. He also renewed a blanket ban Monday on the printing or publishing of any information relating to the case’s proceedings.

Defense lawyers were instructed by the court during the proceedings to “honor the spirit” of the gag order, they said, after the special public prosecutor Dayan Krishnan said he would file a petition of contempt of court if lawyers for the defendants continued to brief the media on developments.

V. K. Anand, the lawyer for Ram Singh, one of the accused, confirmed Thursday that he would now also represent Mr. Singh’s brother Mukesh. Mr. Anand and Vivek Sharma, a second lawyer for accused, told the media after Thursday’s court proceedings that they could not answer any further questions.

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McDonald's December Sales Help Fourth-Quarter Profit

(Reuters) - McDonald's Corp reported an unexpected rise in sales in December at established U.S. restaurants, helping to lift its fourth-quarter profit above analysts estimates.

The world's largest restaurant chain on Wednesday said sales at U.S. eateries open at least 13 months rose 0.9 percent in December, compared with an average estimate compiled by Consensus Metrix calling for a 1.78 percent drop in the month.

A push by the company to have more of its restaurants open on Christmas and a shift of the limited-time offering of its popular McRib sandwich to December, both helped boost U.S. sales during the month.

But analysts said the early part of 2013 will be tough for the chain as it runs short of quick fixes for boosting U.S. sales that have been hurt by stiffer competition for customers who are pinching pennies in a weak economic recovery.

Net income at the world's biggest restaurant chain rose to $1.40 billion, or $1.38 per share, from $1.38 billion, or $1.33 per share, a year earlier.

Analysts on average forecast $1.33 a share, according to Thomson Reuters I/B/E/S.

Total sales rose 1.5 percent to $4.59 billion.

McDonald's fourth-quarter global sales at restaurants open at least 13 months rose 0.1 percent. Analysts on average had forecast a 0.3 percent decline, according to Consensus Metrix.

(Reporting By Lisa Baertlein in Los Angeles and Brad Dorfman in Chicago; Editing by Maureen Bavdek)

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The New Old Age Blog: Study Links Cognitive Deficits, Hearing Loss

There’s another reason to be concerned about hearing loss — one of the most common health conditions in older adults and one of the most widely undertreated. A new study by researchers at Johns Hopkins Medicine suggests that elderly people with compromised hearing are at risk of developing cognitive deficits — problems with memory and thinking — sooner than those whose hearing is intact.

The study in JAMA Internal Medicine was led by Dr. Frank Lin, a hearing specialist and epidemiologist who over the past several years has documented the extent of hearing problems in older people and their association with falls and the onset of dementia.

The physician’s work is bringing fresh, and some would say much-needed, attention to the link between hearing difficulties and seniors’ health.

In his new report, Dr. Lin looked at 1,984 older adults who participated over many years in the Health ABC Study, a long-term study of older adults conducted in Pittsburgh and Memphis. Participants’ mean age was 77; none had evidence of cognitive impairment when the period covered by this research began. In 2001 and 2002, they received hearing tests and cognitive tests; cognitive tests alone were repeated three, five and six years later.

The tests included the Modified Mini-Mental State exam, which is administered through an interview and yields an overall picture of cognitive status, and the Digit Symbol Substitution Test, a paper-only exercise that asks people to match symbols and numbers, which can reveal deficits in someone’s working memory and executive functioning.

Dr. Lin found that annual rates of cognitive decline were 41 percent greater in older adults with hearing problems than in those without, based on results from the Modified Mini-Mental State Exam. A five-point decline on that test is considered a “clinically significant” indicator of a change in cognition.

Using this information, Dr. Lin found that elderly people with hearing problems experienced a five-point decline on the exam in 7.7 years, compared with 10.9 years for those with normal hearing.

Results from the Digit Symbol Substitution Test showed the same downward trend, though not quite as steep: older people with hearing loss recorded a yearly rate of cognitive decline 32 percent greater on it than those with intact hearing. In both cases, the results showed an association only, with no proof of causality.

Still, given the fact that nearly two-thirds of adults age 70 and older have hearing problems, it is an important finding.

For caregivers and older adults, the bottom line is “pay attention to hearing loss,” said Kathleen Pichora-Fuller, a professor of psychology at the University of Toronto who was not involved in the study.

Most people seek medical attention for hearing difficulties 10 to 20 years after they first notice a problem, she said, because “there’s a stigma about hearing loss and people really don’t want to wear a hearing aid.” That means years of struggling with the consequences of impairment, without interventions that can make a difference.

One consequence that may help explain Dr. Lin’s findings is social isolation. When people have a hard time distinguishing what someone is saying to them, as is common in older age, they often stop accepting invitations to dinners or parties, attending concerts or classes, or going to family events. Over time, this social withdrawal can become a self-fulfilling prophecy, leading to the loss of meaningful relationships and activities that keep older people feeling engaged with others.

A substantial body of research by cognitive scientists has established that seniors’ cognitive health depends on exercising both body and brain and remaining socially engaged, and “now we have this intersection of hearing research and cognitive research lining up and showing us that hearing health is part of cognitive health,” said Dr. Pichora-Fuller, who originally trained as an audiologist.

Family physicians and internists, too, often dismiss older patients’ complaints about hearing, and should pay close attention to Dr. Lin’s research, she said.

“I hope this study will be a wake-up call to clinicians that auditory tests need to be part of the battery of tests they employ to look at an older person’s health,” agreed Patricia Tun, an adjunct associate professor of psychology at Brandeis University.

Although the tests are effective and cause no known harm, a panel of experts recently failed to recommend them for older adults because of a lack of supporting evidence, as I wrote last August.

Another potential explanation for Dr. Lin’s new finding lies in a concept known as “cognitive load” that Dr. Tun has explored through her research. Basically, this assumes that “we only have a certain amount of cognitive resources, and if we spend a lot of those resources of processing sensory input coming in — in this case, sound — it’s going to be processed more slowly and understand and remembered less well,” she explained.

In other words, when your brain has to work hard to hear and identify meaningful speech from a jumble of sounds, “you’ll have less mental energy for higher cognitive processing,” Dr. Tun said.

Even seniors who hear sounds relatively well often report that words sound garbled or mumbled, she noted, indicating a deterioration in hearing mechanisms that process complex speech.

Also, as yet unidentified biological or neurological pathways may affect both speech and cognition. Or hearing loss may exacerbate frailty and other medical conditions that older people oftentimes have in ways that are as yet poorly understood, Dr. Lin’s paper notes.

A limitation to his study is its reliance, in part, on the Modified Mini-Mental State exam, which asks older adults to respond to questions posed by an interviewer, according to Barbara Weinstein, a professor and head of the audiology program at CUNY’s Graduate Center.

Her research has shown that hearing-compromised seniors may not understand questions and answer incorrectly, confounding results. Another limitation arises from the failure to test participants’ hearing over time, as happened with cognitive tests, making associations more difficult to tease out.

Dr. Lin hopes to address this through another research project that would follow older adults over time and test whether interventions such as hearing aides help prevent the onset or slow the progression of cognitive decline. In the meantime, older people and caregivers should arrange for hearing tests if they have concerns, and consider getting a hearing aid if problems are confirmed.

Getting sound to the brain is the “first and most important step” in preventing sensory deprivation that can contribute to cognitive dysfunction, said Kelly Tremblay, a professor of speech and hearing science at the University of Washington.

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The New Old Age Blog: Study Links Cognitive Deficits, Hearing Loss

There’s another reason to be concerned about hearing loss — one of the most common health conditions in older adults and one of the most widely undertreated. A new study by researchers at Johns Hopkins Medicine suggests that elderly people with compromised hearing are at risk of developing cognitive deficits — problems with memory and thinking — sooner than those whose hearing is intact.

The study in JAMA Internal Medicine was led by Dr. Frank Lin, a hearing specialist and epidemiologist who over the past several years has documented the extent of hearing problems in older people and their association with falls and the onset of dementia.

The physician’s work is bringing fresh, and some would say much-needed, attention to the link between hearing difficulties and seniors’ health.

In his new report, Dr. Lin looked at 1,984 older adults who participated over many years in the Health ABC Study, a long-term study of older adults conducted in Pittsburgh and Memphis. Participants’ mean age was 77; none had evidence of cognitive impairment when the period covered by this research began. In 2001 and 2002, they received hearing tests and cognitive tests; cognitive tests alone were repeated three, five and six years later.

The tests included the Modified Mini-Mental State exam, which is administered through an interview and yields an overall picture of cognitive status, and the Digit Symbol Substitution Test, a paper-only exercise that asks people to match symbols and numbers, which can reveal deficits in someone’s working memory and executive functioning.

Dr. Lin found that annual rates of cognitive decline were 41 percent greater in older adults with hearing problems than in those without, based on results from the Modified Mini-Mental State Exam. A five-point decline on that test is considered a “clinically significant” indicator of a change in cognition.

Using this information, Dr. Lin found that elderly people with hearing problems experienced a five-point decline on the exam in 7.7 years, compared with 10.9 years for those with normal hearing.

Results from the Digit Symbol Substitution Test showed the same downward trend, though not quite as steep: older people with hearing loss recorded a yearly rate of cognitive decline 32 percent greater on it than those with intact hearing. In both cases, the results showed an association only, with no proof of causality.

Still, given the fact that nearly two-thirds of adults age 70 and older have hearing problems, it is an important finding.

For caregivers and older adults, the bottom line is “pay attention to hearing loss,” said Kathleen Pichora-Fuller, a professor of psychology at the University of Toronto who was not involved in the study.

Most people seek medical attention for hearing difficulties 10 to 20 years after they first notice a problem, she said, because “there’s a stigma about hearing loss and people really don’t want to wear a hearing aid.” That means years of struggling with the consequences of impairment, without interventions that can make a difference.

One consequence that may help explain Dr. Lin’s findings is social isolation. When people have a hard time distinguishing what someone is saying to them, as is common in older age, they often stop accepting invitations to dinners or parties, attending concerts or classes, or going to family events. Over time, this social withdrawal can become a self-fulfilling prophecy, leading to the loss of meaningful relationships and activities that keep older people feeling engaged with others.

A substantial body of research by cognitive scientists has established that seniors’ cognitive health depends on exercising both body and brain and remaining socially engaged, and “now we have this intersection of hearing research and cognitive research lining up and showing us that hearing health is part of cognitive health,” said Dr. Pichora-Fuller, who originally trained as an audiologist.

Family physicians and internists, too, often dismiss older patients’ complaints about hearing, and should pay close attention to Dr. Lin’s research, she said.

“I hope this study will be a wake-up call to clinicians that auditory tests need to be part of the battery of tests they employ to look at an older person’s health,” agreed Patricia Tun, an adjunct associate professor of psychology at Brandeis University.

Although the tests are effective and cause no known harm, a panel of experts recently failed to recommend them for older adults because of a lack of supporting evidence, as I wrote last August.

Another potential explanation for Dr. Lin’s new finding lies in a concept known as “cognitive load” that Dr. Tun has explored through her research. Basically, this assumes that “we only have a certain amount of cognitive resources, and if we spend a lot of those resources of processing sensory input coming in — in this case, sound — it’s going to be processed more slowly and understand and remembered less well,” she explained.

In other words, when your brain has to work hard to hear and identify meaningful speech from a jumble of sounds, “you’ll have less mental energy for higher cognitive processing,” Dr. Tun said.

Even seniors who hear sounds relatively well often report that words sound garbled or mumbled, she noted, indicating a deterioration in hearing mechanisms that process complex speech.

Also, as yet unidentified biological or neurological pathways may affect both speech and cognition. Or hearing loss may exacerbate frailty and other medical conditions that older people oftentimes have in ways that are as yet poorly understood, Dr. Lin’s paper notes.

A limitation to his study is its reliance, in part, on the Modified Mini-Mental State exam, which asks older adults to respond to questions posed by an interviewer, according to Barbara Weinstein, a professor and head of the audiology program at CUNY’s Graduate Center.

Her research has shown that hearing-compromised seniors may not understand questions and answer incorrectly, confounding results. Another limitation arises from the failure to test participants’ hearing over time, as happened with cognitive tests, making associations more difficult to tease out.

Dr. Lin hopes to address this through another research project that would follow older adults over time and test whether interventions such as hearing aides help prevent the onset or slow the progression of cognitive decline. In the meantime, older people and caregivers should arrange for hearing tests if they have concerns, and consider getting a hearing aid if problems are confirmed.

Getting sound to the brain is the “first and most important step” in preventing sensory deprivation that can contribute to cognitive dysfunction, said Kelly Tremblay, a professor of speech and hearing science at the University of Washington.

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DealBook: Microsoft May Back Dell Buyout

The effort to take Dell private has gained a prominent, if unusual, backer: Microsoft.

The software giant is in talks to help finance a takeover bid for Dell that would exceed $20 billion, a person briefed on the matter said on Tuesday. Microsoft is expected to contribute up to several billion dollars.

An investment by Microsoft — if it comes to pass — could be enough to push a leveraged buyout of the struggling computer maker over the goal line. Silver Lake, the private equity firm spearheading the takeover talks, has been seeking a deep-pocketed investor to join the effort. And Microsoft, which has not yet made a commitment, has more than $66 billion in cash on hand.

Microsoft and Silver Lake, a prominent investor in technology companies, are no strangers. The private equity firm was part of a consortium that sold Skype, the online video-chatting pioneer, to Microsoft for $8.5 billion nearly two years ago. And the two companies had discussed teaming up to make an investment in Yahoo in late 2011, before Yahoo decided against selling a minority stake in itself.

A vibrant Dell is an important part of Microsoft’s plans to make Windows more relevant for the tablet era, when more and more devices come with touch screens. Dell has been one of the most visible supporters of Windows 8 in its products.

That has been crucial at a time when Microsoft’s relationships with many PC makers have grown strained because of the company’s move into making computer hardware with its Surface family of tablets.

Frank Shaw, a spokesman for Microsoft, declined to comment.

If completed, a buyout of Dell would be the largest leveraged buyout since the financial crisis, reaching levels unseen since the takeovers of Hilton Hotels and the Texas energy giant TXU. Such a deal is taking advantage of Dell’s still-low stock price and the abundance of investors willing to buy up the debt issued as part of a transaction to take the company private. And Silver Lake has been working with Dell’s founder, Michael S. Dell, who is expected to contribute his nearly 16 percent stake in the company to a takeover bid.

Yet while many aspects of the potential deal have fallen into place, including a potential price of up to around $14 a share, talks between Dell and its potential buyers may still fall apart.

Shares of Dell closed up 2.2 percent on Tuesday, at $13.12. They began rising after CNBC reported Microsoft’s potential involvement in a leveraged buyout. Microsoft shares slipped 0.4 percent, to $27.15.

Microsoft’s lending a hand to Dell could make sense at a time when the PC industry is facing some of the biggest challenges in its history. Dell is one of Microsoft’s most significant, longest-lasting partners in the PC business and among the most committed to creating machines that run Windows, the operating system that is the foundation of much of Microsoft’s profits.

But PC sales were in a slump for most of last year, as consumers diverted their spending to other types of devices like tablets and smartphones. Dell, the third-biggest maker of PCs in the world, recorded a 21 percent decline in shipments of PCs during the fourth quarter of last year from the same period in 2011, according to IDC.

In a joint interview in November, Mr. Dell and Steven A. Ballmer, Microsoft’s chief executive, exchanged friendly banter, as one would expect of two men who have been in business together for decades.

Mr. Dell said Mr. Ballmer had gone out of his way to reassure him that Microsoft’s Surface computers would not hurt Dell sales.

“We’ve never sold all the PCs in the world,” said Mr. Dell, sitting in a New York hotel room brimming with new Windows 8 computers made by his company. “As I’ve understood Steve’s plans here, if Surface helps Windows 8 succeed, that’s going to be good for Windows, good for Dell and good for our customers. We’re just fine with all that.”

Microsoft has been willing to open its purse strings in the past to help close partners. Last April, Microsoft committed to invest more than $600 million in Barnes & Noble’s electronic books subsidiary, in a deal that ensures a source of electronic books for Windows devices. Microsoft also agreed in 2011 to provide the Finnish cellphone maker Nokia billions of dollars’ worth of various forms of support, including marketing and research and development assistance, in exchange for Nokia’s adopting Microsoft’s Windows Phone operating system.

A version of this article appeared in print on 01/23/2013, on page B1 of the NewYork edition with the headline: Microsoft May Back Dell Buyout.

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