New studies on the relationship between hearing loss and dementia

The most recent scientific evidence reinforces that age-related hearing loss is not only a sensory problem: it is consistently associated with a higher risk of cognitive decline and dementia. In 2024, the standing Commission of The Lancet updated its report and concluded that the evidence supporting the treatment of hearing loss as a strategy to reduce the risk of dementia is now stronger than in previous reports, and that almost half of the cases could be prevented or delayed if modifiable factors throughout life are addressed, including hearing loss. (2)

Key points for audiological practice

1. Hearing loss is associated with a higher risk of dementia in large population cohorts; risks tend to be higher with more severe losses and when hearing aids are not used. (3)

2. Intervention with hearing aids, within comprehensive auditory rehabilitation programs, can attenuate cognitive decline in older adults at high risk of deterioration, as shown by the ACHIEVE trial. (1,2,4)

3. Not all studies find the same effect size; the magnitude depends on age, severity, baseline risk, and adherence to hearing aid use. (1,3)

What do the most recent studies say?

ACHIEVE clinical trial (Lancet, 2023): in 977 adults aged 70–84 with untreated hearing loss, the comprehensive audiological intervention (counseling + hearing aid fitting) did not reduce global cognitive change at 3 years in the primary analysis of the combined cohort. However, in a prespecified subgroup analysis, the benefit was significant in the group with higher baseline risk of deterioration (participants from the ARIC study), suggesting that treating hearing loss could slow cognitive decline in those who already accumulate risk factors. (1)

Danish cohort (JAMA Otolaryngology, 2024): in 573,088 adults followed for an average of 8.6 years, hearing loss was associated with a 7% higher risk of dementia (adjusted HR 1.07; 95% CI 1.04–1.11), with higher risks for severe losses. Among people with hearing loss, those who did not use hearing aids showed a notably higher risk than those who did. (3)

Update of The Lancet Commission (2024): the report reaffirms hearing loss as a relevant modifiable factor throughout the life course and highlights that the use of hearing aids appears particularly effective in people with hearing loss and additional risk of dementia. It also summarizes new evidence of dose–response association (for example, worse performance on speech-in-noise tests associated with higher risk of dementia). (2)

How might hearing loss contribute to cognitive decline?

The proposed neurobiological models are not mutually exclusive and likely coexist:
(a) increasing cognitive load due to degraded auditory signals that force reallocation of attentional and memory resources;
(b) sensory deprivation and reduced stimulation that lessen cognitive reserve and promote cortical atrophy;
(c) social isolation, depression, and reduced cognitive activity; and
(d) shared pathology affecting ascending auditory pathways and multimodal cortex. (5)

Magnitude of risk and heterogeneity among studies

In recent years, meta-analyses and large cohorts have confirmed the association between hearing loss and cognitive decline/dementia, with estimates varying according to the population, audiological definition, and statistical adjustments. The Danish cohort reports modest risks at the population level but clinically relevant ones in severe losses and in non-users of hearing aids. (3) For its part, the 2024 Lancet Commission summarizes evidence of a dose–response relationship, including a higher probability of dementia as speech-in-noise thresholds worsen. (2) These findings underscore the need to stratify by severity, baseline risk, and adherence to treatment when interpreting results.

Do hearing aids prevent dementia?

The nuanced answer from current evidence is: they may help, especially in people with high baseline risk and when integrated into an auditory rehabilitation program. ACHIEVE suggests benefit in those with higher initial risk; additionally, several observational cohorts show lower risk among hearing aid users compared to non-users with hearing loss, although causal inference must be approached with caution. (1–3,4) The 2024 Commission considers that the evidence in favor of treating hearing loss to reduce dementia risk is stronger than before. (2)

Clinical implications for audiologists and hearing-health teams

1. Early detection: incorporate systematic audiological screening in adults from middle age, especially if they report difficulty following conversations in noise, since speech-in-noise performance is linked to increased risk of dementia. (2)

2. Comprehensive rehabilitation: combine hearing aid fitting with counseling, communication training, strategies for the acoustic environment, and psychosocial referrals when appropriate. Adherence and daily usage time determine the impact. (1,2)

3. Management of comorbidities and risk factors: control hypertension, diabetes, dyslipidemia, depression, and promote physical, cognitive, and social activity, since multimodal prevention likely enhances the benefits of auditory rehabilitation. (2)

4. Communication with patients and families: explain that treating hearing loss improves communication and quality of life today, and could contribute to long-term brain health, especially in people with greater cognitive vulnerability. (1,2,3)

Conclusions

The relationship between hearing loss and dementia is now supported by robust evidence from population studies and clinical trials that, although showing effects of variable magnitude, point in the same direction: identifying and treating hearing loss —especially in people at higher risk— is a concrete public health and clinical opportunity to improve communication, quality of life, and possibly reduce the rate of cognitive decline. (1–3)

References (recent selection)

1. Lin FR, Pike JR, Albert MS, et al. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): multicentre randomized controlled trial. The Lancet. 2023;402(10404):786–797. doi:10.1016/S0140-6736(23)01406-X.

2. Livingston G, Fox NC, Ferri CP, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet. 2024; Published online Jul 31, 2024. doi:10.1016/S0140-6736(24)01296-0.

3. Cantuaria ML, Pedersen ER, Waldorff FB, et al. Hearing Loss, Hearing Aid Use, and Risk of Dementia in Older Adults. JAMA Otolaryngol Head Neck Surg. 2024;150(2):157–164. doi:10.1001/jamaoto.2023.3509.

4. Francis L, et al. Self-Reported Hearing Aid Use and Risk of Incident Dementia. JAMA Neurol. 2025; Online ahead of print Aug 18, 2025. doi:10.1001/jamaneurol.2025.2713.

5. Griffiths TD, Lad M, Kumar S, et al. How Can Hearing Loss Cause Dementia? Neuron. 2020;108(3):401–412. doi:10.1016/j.neuron.2020.08.003.