Medical conditions
Hearing loss and cognitive decline
Research links untreated hearing loss to accelerated cognitive decline, and expert reviews call this one of the largest risk factors people can act on. Here is what is known, what is not, and where a hearing test fits into the picture.
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The research
What the research shows
The Lancet Commission on dementia prevention, an international expert review updated most recently in 2024, lists hearing loss among the leading modifiable risk factors for dementia, alongside factors such as high blood pressure, smoking, physical inactivity and social isolation.
Long-running studies of older adults have found that, compared with people with normal hearing, those with mild, moderate and severe hearing loss had progressively higher rates of dementia over the following years.
Studies that follow people over time have also found that memory and thinking decline faster, on average, in people with untreated hearing loss than in those with normal hearing.
In 2023, a large randomized trial known as the ACHIEVE study tested whether treating hearing loss made a difference to cognition. Across the trial, results were inconclusive over three years. However, among participants who were older and at a higher risk of cognitive decline, those who received hearing aids and counselling showed roughly half the rate of decline of those who did not.
This finding is encouraging, and it emphasizes the importance of treating hearing loss with hearing aids, particularly in higher-risk individuals.
Three explanations
How hearing loss may affect the brain
Researchers have three main explanations, and they are likely all part of the picture.
Listening effort
When sound arrives incomplete, the brain works harder to fill in the gaps. That effort draws on the same mental resources used for memory and attention; this means other parts of the brain experience a reduction in resources. People with hearing loss often describe the exhaustion of a long conversation; that fatigue is the cost of the extra processing.
Less input, less stimulation
The parts of the brain that process sound appear to change when they receive less sound input over years. Brain imaging studies have found faster loss of volume in those regions in people with hearing loss. Whether treating the loss slows that change is still being studied.
Social withdrawal
Conversation is one of the most complex tasks the brain does every day. When conversation becomes difficult, we tend to participate less and gradually withdraw from the interactions that keep us connected. Social isolation and loneliness are themselves risk factors for cognitive decline. Hearing loss may contribute in part by pulling people away from the conversations and social interactions that help keep the mind active.
Signs
Signs to watch for
Hearing loss and early cognitive changes can look remarkably similar from the outside, making it easy for one to mask the other. Someone who appears to have trouble following, forgets what was said, or withdraws from conversation may be struggling to hear, struggling to remember, or both. Watch for:
- Asking for repeats, or answering a different question from the one asked
- The television much louder than it used to be
- Withdrawing from group conversation, family gatherings or the phone
- Tiredness or irritability after social events
- Seeming confused in noisy settings but fine one-to-one
If you or someone close to you shows these signs, a hearing test is a sensible first step. It is quick, it is complimentary at Hear & Co for anyone 55 and over, and it removes hearing from the list of possible explanations. If the test is normal and the concerns continue, the next conversation is with a physician.
Treatment
How treating hearing loss fits in
Hearing loss is considered a modifiable risk factor because, unlike age or family history, hearing loss can be addressed. Hearing aids restore much of the missing sound, which reduces listening effort, keeps the auditory parts of the brain active, and, most importantly, makes conversation and maintaining a social life easier again.
Treating hearing loss is beneficial for your daily life, and it may also be beneficial for your brain over the long term. The first is certain. The second is promising and still being studied. Scheduling a baseline hearing test is the first step in determining whether there is a hearing loss and deciding on next steps.
Good to know
Questions about hearing loss and dementia
Does hearing loss cause dementia?
Hearing loss does not cause dementia. However, long-term studies consistently find that people with untreated hearing loss are more likely to experience cognitive decline and dementia, and expert reviews list hearing loss as one of the largest modifiable risk factors.
Can hearing aids prevent dementia?
Nobody can promise that. One large trial found that hearing aids and counselling slowed cognitive decline over three years in a group of older adults at higher risk, but not across everyone studied. Researchers describe the evidence as promising and continuing.
At what age should I be thinking about this?
The research points to hearing loss in midlife, from age forty to sixty, as the period that matters most for later risk. A baseline hearing test and treatment of any hearing loss found through the use of hearing aids is recommended and encouraged.
My parent has dementia and hearing loss. Is it worth treating the hearing loss?
Yes. Hearing aids can make communication easier and reduce the confusion and frustration that often accompany hearing loss. This matters for quality of life, regardless of disease. They can come in for a test with their caregiver or a family member.
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Start with a free hearing test
Knowing where your hearing stands is the first step, and it is complimentary for anyone 55 and over. Book an appointment online.