Untreated Hearing Loss, Hearing Aids, and Cognition: Correlational Outcomes 2025

By Douglas L. Beck, AuD; Keith N. Darrow, PhD; Bopanna Ballachanda, PhD; Nashlea Brogan, AuD; Mark Campbell-Foster, AuD; Jackie L. Clark, PhD; Blaise M. Del!no, MS; Robert M. DiSogra Au.D; Kathryn Dowd, AuD; Kris English, PhD; Dave Fabry, PhD; Raúl García-Medina PGDip (Aud), MBA; Jedidiah J. Grisel, MD; Tami Harel-Arbeli, PhD; Michael A. Harvey, PhD; Kara Ho”man, AuD; Christophe E. Jackson PhD; Douglas A Lewis, JD, PhD, AuD, MBA; Gerda Maissel, MD; Cli”ord R. Olson, AuD; Natalie Phillips, AuD; Rhee Nesson, AuD; Jacqueline R. Scholl, AuD; Dung Trinh, MD, and Albert F. Turri, AuD

Multiple correlational, meta-analysis, and longitudinal peer-reviewed reports have demonstrated that untreated hearing loss tends to exacerbate cognitive decline in people “at risk.” Likewise, professionally ftted prescription hearing aids have been shown to delay or attenuate the adverse efects of hearing loss on cognitive decline for many people. This article reviews key points from the ever-increasing correlational and longitudinal compendium of knowledge regarding these issues. “Hearing loss” and “dementia” are umbrella terms with wide and varied de!nitions. “is results in di#ering, sometimes contradictory, interpretations of the growing evidence-base relating hearing loss to dementia. “e purpose of this article is not to resolve these discrepancies but to draw attention to the very signi!cant evidence “as is” and let it speak for itself. Likewise, “causation” is a difficult standard to establish, and causation is rarely demonstrated. For example, we cannot say cigarette smoking causes lung cancer, as most smokers simply do not acquire lung cancer. “e correlation between smoking and lung cancer (and other adverse e#ects) is high, and although reasonable people would realize the obvious correlation, the health risks from smoking are also not based on causation. Villeneuve & Mao (1994)1 stated that the rate of smokers who eventually develop lung cancer is about 12% in females, 17% in males, and for never-smokers (male and female) the estimate is under 2%. More recent evidence shows shockingly that the lung cancer incidence rate for 40-79 year olds who have never smoked ranges from about 14-21% for women and from 5-14% for men (Minkove, 2018).2 “e primary takeaways are correlational: 1) Smoking is clearly very dangerous and a substantial health risk, and 2) Lung cancer only occurs in only about 15% of smokers. Regarding hearing loss and dementia, the correlations are also signi!cant. No responsible professional would make a blanket statement saying “hearing loss causes dementia.” However, it does appear clear that “untreated hearing loss in at-risk patients tends to exacerbate dementia.” (“e term “at-risk” refers to individuals from lower socio-economic backgrounds, those experiencing signi!cant hearing loss [moderate, severe, or profound], people with limited education, individuals on multiple medications, and those with co-morbidities.) Hearing loss may contribute to an increased risk of dementia without being the primary cause. Again, in epidemiological research, causation is rarely demonstrated, as multifactorial conditions such as neurodegenerative diseases do not arise from a single, isolated source. Instead, these conditions result from complex interactions between genetic, environmental, and physiological variables.

Patients Need Information

As our understanding of dementia risk evolves, clinicians must be trained to communicate risk factors in a meaningful and actionable way to appropriate patients. In fact, it is our duty as healthcare professionals to inform patients about their individual risk factors—such as hearing loss—without inducing undue fear or distress. “is requires a balanced approach, ensuring that discussions remain patient-centered, evidence-based, and free from concerns about professional repercussions. Failing to address potentially modi!able risk factors for cognitive decline deprives patients of the opportunity to make informed decisions regarding potential opportunities to change their long-term cognitive health trajectory. Failing to address potentially modi!able risk factors for cognitive decline deprives patients of the opportunity to make informed decisions regarding potential opportunities to change their long-term cognitive health trajectory. We believe it is our professional responsibility to discuss and address factors and issues with patients who are at-risk for harm. Indeed, when a professional has a concern about a potential harm for a speci!c patient, they should address it in a professional manner. Doing less appears problematic, unethical, and wrong. According to Scope of Practice (SOP) statements from the American Academy of Audiology (AAA)3 and American Speech-Language and Hearing Association (ASHA),4 audiologists are authorized to perform cognitive screenings when appropriate. “ese SOP statements include audiologists who train, learn, and work in these areas. While not every audiologist performs these assessments, those with specialized training in cognitive health have a duty to communicate their !ndings to patients, family members, and allied healthcare providers. “is interdisciplinary approach ensures that at-risk individuals receive comprehensive care, ultimately serving the best interests of patients and the broader healthcare system. This challenge is not unique to hearing loss and dementia. In numerous other domains of medicine, including cardiovascular disease and cancer, extensive research has identified robust correlations between risk factors and disease incidence without definitively proving causation. Similarly, while no responsible clinician would claim that hearing loss directly causes dementia, extensive epidemiological evidence demonstrates that untreated hearing loss is a significant risk factor for cognitive decline. Longitudinal studies have consistently shown that individuals with moderate-to-severe hearing loss and other risk factors face a substantially higher likelihood of developing dementia compared to those with normal auditory function.

Highlighted Research

While there are studies that show hearing loss treated with hearing aids does not impact cognitive status, the sample of research cited below demonstrates why a balanced discussion with patients should include acknowledgement about the links between untreated hearing loss and dementia. ■ Kricos (2000)5 reported age-related changes in cognition impact speech perception and simply testing the peripheral nervous system (i.e., via pure tones) is not enough. Older people’s performance on auditory processing was more related to differences in cognition rather than auditory function. ■ Moore et al (2014)6 reported that for middle-aged people, a poor speech-in-noise (SIN) score may represent an early warning of the need for intervention. ■ Amieva et al (2015)7 reported 3,670 people followed for 25 years and concluded “Self-reported hearing loss is associated with accelerated cognitive decline in older adults; hearing aid use attenuates such decline.” ■ Stevenson et al (2021)8 reported on 82,039 dementia-free participants aged 60+ years to investigate whether speech-in-noise (SiN) hearing impairment is associated with an increased risk of incident dementia. After 11 years, they noted insufficient and poor SiN was associated with a 61% increased risk of developing dementia. ■ Huang et al (2023)9 reported on 2413 participants, of which 1285 were aged 80+ years or older. The authors found moderate to severe hearing loss was associated with a higher prevalence of dementia compared to those with normal hearing, and hearing aid use was associated with lower dementia prevalence. ■ Conceição et al (2023)10 reported on 19,551 individuals. Their systematic review showed the existence of a significant relationship between hearing loss and cognitive decline in the elderly. ■ The ACHIEVE study (Lin et al, 2023),11 as noted on www.achievestudy.org, showed that in older adults at increased risk for cognitive decline, hearing intervention slowed down loss of thinking and memory abilities by 48% over 3 years. ■ Yeo et al (2023)12 queried whether hearing aids and cochlear implants decrease the risk of subsequent cog- nitive decline in individuals with hearing loss. In their meta-analysis involving 137,484 participants, they stated “the use of hearing restorative devices was associat- ed with a 19% decrease in hazards of long-term cognitive decline such as incident dementia over a duration ranging from 2 to 25 years. The use of hearing aids and cochlear implants is associated with a decreased risk of subsequent cognitive decline and physicians should strongly encourage their patients with hearing loss to adopt such devices.” ■ Cantauria et al (2024)13 reported on their 5-year study of people 50+ years which included 573,088 people. The authors reported that having hearing loss was associated with an increased risk of dementia, and severe hearing loss was associated with a higher dementia risk. They noted dementia risk was higher among people with hearing loss who were not using hearing aids than those using hearing aids. The authors stated that hearing loss was associated with increased dementia risk, especially among those not using hearing aids, suggesting that hearing aids might prevent or delay the onset and progression of dementia. ■ Yu, Proctor, et al (2024)14 summarized the cohort evidence to date on adult-onset hearing loss as a risk factor for incident cognitive impairment and dementia, and examined the evidence for dose-response, the risk for various dementia subtypes, and other moderators. They identified 50 studies of 1.5 million people. They report each 10-decibel worsening of hearing was associated with a 16% increase in dementia risk. They concluded cohort studies consistently support that adult-onset hearing loss increases the risk of incident cognitive decline, dementia, MCI, and ADD. ■ Wei et al (2024)15 reported using target trial emulation to leverage an existing longitudinal cohort study to estimate the association between hearing aids initiation and risk of dementia. Participants were 50+ years with self-reported hearing loss and without dementia at baseline, and without use of hearing aids in the previous 2 years. Among 2314 participants (328 in the intervention group and 1,986 in the control group; average age: 72.3 ± 9.7 years) after 8 years of follow-up, the risk of dementia was significantly lower among individuals who initiated hearing aid use. The authors report hearing aid use was associated with a significant reduction of incident dementia. ■ Sarant et. al. (2024)16 reported a 3-year study of 160 audiology clinic patients (49% female patient; mean age 73.5 years) with mild-to-severe hearing loss, fitted with hearing aids at baseline and 102 participant controls. Hearing aid users demonstrated significantly better cognitive performance as measured up to 3 years post-fitting, suggesting that hearing intervention may delay cognitive decline/dementia onset in older adults. ■ Myrstad et. al (2025)17 reported hearing impairment is associated with dementia. The authors used the Norwegian population-based longitudinal cohort study (The Trøndelag Health Study or HUNT). At baseline, they invited all residents 20+ years for an audiometric hearing assessment, and at 20+ years follow-up. The authors cognitively assessed all persons 70+ years including the MoCA adjusted for hearing impairment. The authors included 6,879 people (mean 56.1 years) and reported a long-term association between hearing impairment and dose related reduced cognitive performance, particularly in those aged <85 years (for every 10 dB of increased hearing loss, MOCA scores worsened.) ■ Jang, Lee, et al (2025)18 reported 511,953 subjects from the Korean National Health Insurance Service-Senior Cohort (2002-2008). The authors report subjects with hearing loss had a 1.245 times higher risk of all-cause dementia compared to those without hearing loss (adjusted hazard ratio over 3 years, 95% CI = 1.201-1.290), adjusting for gender, age, residence, and income. They concluded hearing loss consistently increased the risk of all-cause dementia and Alzheimer’s disease across timespans, suggesting a complex link between hearing loss and neurodegenerative diseases. These findings highlight the importance of early intervention and cognitive monitoring for individuals with hearing loss.

Patient-centric Care Should Include a Balanced Explanation of the Scientific Literature

Given the strength of these associations, it is the ethical responsibility of healthcare professionals to address hear- ing loss as a potentially modifiable risk factor for cognitive decline. Just as physicians counsel patients on the dangers of smoking, excessive alcohol consumption, or uncontrolled hypertension—none of which are singularly causal but all of which contribute to disease risk—so too should audiologists and hearing healthcare providers educate patients about the potential neurocognitive consequences of untreated hearing loss. Ignoring this well-documented relationship would be both unethical and clinically negligent. As cognitive screening is within the Scope of Practice by audiologists via AAA and ASHA,3,4 it is important for hearing care providers to understand the vast and significant correlations between untreated hearing loss and cognitive decline. Of note, the potential for professional hearing aid fittings to change the trajectory in at-risk people has been demonstrated many times, as shown above. The scientific consensus is clear: untreated hearing loss in at-risk people is strongly correlated with cognitive decline and increased dementia risk. While definitive causation remains elusive—much like in other multifactorial diseases such as heart disease and cancer—the weight of epidemiological and clinical evidence supports hearing loss as a major modifiable risk factor. Longitudinal studies and meta-analyses consistently demonstrate that untreated hearing impairment in many at-risk patients accelerates cognitive decline, while hearing aids o%en slow or potentially mitigate cognitive decline in many similar patients. These findings underscore the critical need for proactive hearing health- care as part of a broader dementia prevention strategy. Scaring people or “weaponizing” research with the goal of driving more consumers into hearing healthcare offices remains inappropriate and unethical and is not consistent with professional standards. A patient-centric approach addressing an individual’s needs, concerns, and questions— or “meeting people where they are”—is always warranted. However, going too far in the direction of protecting patients’ feelings at the expense of a balanced explanation of the science also threatens to be a disservice; it underestimates consumers’ intelligence and potentially undermines their ability to be proactive in their self-care. In summary, there exists a correlation between untreated hearing loss in “at-risk” people and an increased risk of cognitive decline. Hearing aid amplification has been shown across multiple studies to reduce the risk of cognitive decline over the long-term in many individuals. The views and opinions expressed in this article are those of the authors and do not necessarily re&ect the official policy or position of their workplaces and/or affiliated institutions, nor does it necessarily reflect the official policies or positions of HearingTracker or its advertisers and affiliates. This article is intended for informational purposes only and should not be construed as professional, medical, or legal advice.

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EN- HANCE: A comparative prospective longitudinal study of cogni- tive outcomes a%er 3 years of hearing aid use in older adults. Front Aging Neurosci. 2024;15:1302185. Available at: https://pubmed. ncbi.nlm.nih.gov/38356856 doi:10.3389/fnagi.2023.1302185 17. Myrstad C, Engdahl BL, Costafreda SG, et al. Hearing and cog- nitive scores measured with the Montreal Cognitive Assessment Scale in The HUNT Study, Norway. Alzheimers Dement. Published online January 23, 2025. Available at: https://pubmed.ncbi.nlm. nih.gov/39846386/ doi:10.1002/alz.14514 18. Jang JW, Lee SH, Kim T, Lee E, Park SW, Yeo NY, Kim YJ. Hearing loss and the risk of dementia: A longitudinal anal- ysis of the Korean National Health Insurance Service Senior Cohort. J Alzheimers Dis. 2025 [Feb 9];13872877251316805. Available at: https://pubmed.ncbi.nlm.nih.gov/39924913 doi: 10.1177/13872877251316805 About the authors Douglas L. Beck, AuD, is Adjunct Clinical Professor Communication Disorders & Sciences at State University of New York at Buffalo, the host of Hearing Matters Pod- cast, and Senior Director of Audiology Professional Affairs at EssilorLuxottica; Keith N. Darrow, PhD, is Professor of Speech-Language-Hearing Sciences at Worcester State University, Worcester, Mass; Bopanna Ballachanda, PhD, is a consultant at the School Hearing Care Project in India, and Past President and current member of the Board of Directors at the American Academy of Audiology (AAA); Nashlea Brogan, AuD, is an audiologist at Bluewater Hearing, Sarnia, Ontario, Canada; Mark Campbell-Foster, AuD, is Director of Marketing at Redux, Boston, Mass; Jackie L. Clark, PhD, is a Clinical Professor of Behavioral & Brain Sciences in the AuD Program at UT Dallas/Calli- er Center, Managing Editor of the International Journal of Audiology and Past President of AAA and the Texas Acad- emy of Audiology; Blaise M. Delfino, MS, is Director of Professional Relations at Starkey and Founder of Hearing Matters Podcast, Summerville, SC; Robert M. DiSogra, AuD, is an author and retired clinical audiologist who lives in Millstone Township, NJ; Kathryn Dowd, AuD, is Ex- ecutive Director of The Audiology Project, Charlotte NC; Kris English, PhD, is Professor Emeritus of Audiology at the University of Akron and a Past President of AAA; Dave Fabry, PhD, is Chief Hearing Health Officer, at Starkey, Eden Prairie, Minn, and a Past President of AAA; Raúl García-Medina, PGDip (Aud), MSHA, MBA, is Clinical Director of The Audiology Clinic in the UK, Past President of the British Society of Hearing Aid Audiologists (BSHAA) and Past Company Secretary of Asociación Nacional de Audioprotesistas (ANA) in Spain; Jedidiah J. Grisel, MD, is an otolaryngologist and managing partner at Texoma ENT & Allergy, Managing Partner, ENT Specialty Partners, and Chief Medical Officer at Amptify Hearing USA, Wichita Falls, Tex; Tami Harel-Arbeli, PhD, is Chief of Audiology at Nuance Audio/EssilorLuxottica, Tel-Aviv, Israel; Michael A. Harvey, PhD, ABPP, is a clinical psychologist who spe- cializes in hearing healthcare issues in Framingham, Mass; Kara Hoffman, AuD, is Director of Hoffman Audiology, Inc, Durban, KwaZulu Natal, South Africa; Christophe E. Jackson PhD, DMA, PA-C, is Executive Director of Mu- sician’s Clinic Without Borders, Adjunct at Shenandoah University, and Associate Research Professor of Music, Medicine and Neuroscience, Atlanta; Douglas A Lewis, JD, PhD, AuD , MBA, is the owner of Excalibur Business Con- sultants/Excalibur Hearing and Audiology, Patriot Health Systems/Patriot Health Holdings in Columbus, Ohio; Ger- da Maissel, MD, BCPA, is a private patient advocate at My MD Advisor; Clifford R. Olson, AuD, is creator of the Dr. CliffAuD YouTube channel and owner of Applied Hearing Solutions, Phoenix; Natalie Phillips, AuD, is owner of Audiology Center of Northern Colorado, Fort Collins, Colo, and host of the All Things AuD Live Show; Rhee Nesson, AuD, is Founder of Hearing Doctors of New Jersey, Living- ston, NJ; Jacqueline R. Scholl, AuD, CCC-A, CSP/A is a former audiology clinic owner and executive director of the non-profit SoundWrx Inc, Tulsa, Okla; Dung Trinh, MD, is Chief Medical Officer-Healthy Brain Clinic, and a member of the Board of Directors at Alzheimer’s Los Angeles and Alzheimer’s Orange County, and Albert F. Turri, AuD, is Audiology Director at the The Villages Health System, The Villages, Fla.