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Does Hearing Loss Cause Dementia?

ACHIEVE found no overall slowing of cognitive decline with hearing treatment, but a higher-risk group declined more slowly. Hearing loss is linked to dementia.

6 min read · Longevity365 Editorial

Two women sit facing each other and smile beside a lake.
Illustrative ordinary conversation; neither person is identified as having hearing loss or dementia, using hearing aids, or experiencing a treatment or cognitive benefit. Photo by Mental Health America (MHA) on Pexels.

A hearing problem may first become noticeable in a busy room: the conversation is there, but the words keep disappearing. Now hearing loss also appears in dementia research. For this Humanic Blue guide, the question is what that connection means—and what it doesn’t tell us about one person.

Long-term studies link hearing loss with a higher risk of dementia, but the link doesn’t prove that one causes the other. The ACHIEVE trial found no overall slowing of cognitive decline with hearing treatment, while a higher-risk group did benefit. For living longer and better, communication and participation matter in their own right. Whether hearing treatment prevents dementia or extends life remains unestablished.

In This Article

Key Takeaways

  • The National Institute on Aging (NIA) reports a link between hearing loss and dementia; it isn’t a diagnosis or proof of cause.
  • Hearing treatment didn’t slow cognitive decline across the whole ACHIEVE trial.
  • Its higher-risk group benefited, but that doesn’t establish prevention for everyone.
  • Hearing care also addresses communication, social participation and everyday safety.

The National Institute on Aging reports that older adults with hearing loss have greater dementia risk on average. The Lancet Commission also includes hearing loss among potentially changeable risk factors.

That tells us there is a relationship worth investigating. It can’t tell someone with hearing loss that dementia is coming, or someone with good hearing that it won’t. A hearing test measures hearing—not a person’s future brain health.

What about people who use hearing aids?

Researchers at the National University of Singapore and Monash University found less cognitive decline or fewer dementia diagnoses among hearing-aid users in observational data. Those findings fit the idea that treatment might help.

But people who obtain and use hearing aids can differ from people who don’t in health, support and access to care. Comparing them can’t fully separate the device from those differences. The studies and limitations are below.

How could hearing affect thinking?

The ACHIEVE researchers describe several possibilities. Deciphering muffled speech takes mental effort. Hearing difficulty can also make conversation and social contact harder. Shared health problems may affect both the ear and the brain.

More than one explanation could be true. Picture trying to follow a sentence while half the words are missing: the brain has extra work before it even gets to remembering the message. That’s a way to understand listening effort, not proof of the dementia pathway.

What changes when we judge hearing care by the conversations it helps now, separately from a possible long-term brain benefit?

What did the treatment trial find?

ACHIEVE, led by Johns Hopkins researcher Frank Lin, compared hearing aids plus audiologist support with health education in older adults with untreated hearing loss. Across the whole trial, thinking and memory declined at a similar rate in both groups.

A higher-risk group showed slower decline with hearing treatment. Lower-risk volunteers didn’t show that advantage. The trial was publicly funded, devices were donated by a manufacturer, and Lin’s center has hearing-industry support. Full trial details and disclosures are below.

Why doesn’t one group settle the answer?

Because a result in higher-risk older adults may not apply to younger people or people with different health histories. The comparison was planned in advance, which adds credibility, but it still needs to be read alongside the trial’s overall result.

Neither “hearing aids prevent dementia” nor “hearing aids have no value” describes what the study found. We can hold a narrower, more useful answer: some people may gain a cognitive benefit, and the reasons still need investigation.

Why hearing care matters today

The NIA describes hearing loss as affecting conversation, social connection and awareness of warning sounds. Those are everyday outcomes, with no need to wait for a dementia study to explain why they matter.

Hearing aids can help, though the FDA notes that they don’t restore normal hearing and adjustment takes time. The benefit depends on the loss, the device and the support someone receives.

What comes before choosing a device?

The National Institute on Deafness and Other Communication Disorders (NIDCD) points people toward a primary care clinician, an ear specialist or an audiologist. An assessment helps establish the type and severity of the problem.

In the US, FDA guidance limits over-the-counter hearing aids to adults with perceived mild-to-moderate loss. More severe loss and certain symptoms need professional evaluation. A sound amplifier is a different product and isn’t a substitute for a hearing aid.

When medical assessment comes first

The FDA advises medical assessment before buying for sudden or fluctuating hearing changes, one-sided problems, ear pain, drainage, a spinning sensation (vertigo), excess wax or an unusual or injured ear. Sudden hearing loss needs prompt attention rather than a wait-and-see device purchase.

Could hearing affect a memory test?

Yes: the NIA notes that people who don’t hear well can be mistaken for confused or unresponsive. If a question is spoken, not hearing it can affect the answer. Hearing needs to be considered during assessment; it doesn’t explain away every memory concern.

What would help a clinician distinguish difficulty hearing a question from difficulty remembering it?

What’s Interesting

Hearing treatment’s immediate purpose can show up in a conversation. Its possible dementia effect takes years to study. Those timelines explain why a clear hearing benefit and an uncertain brain benefit can both be true. We don’t have to make one disappear to understand the other.

What This Means in Practice

The NIA advises discussing signs of hearing loss with a doctor. Useful topics include listening fatigue, missed conversations, safety sounds and whether symptoms need medical assessment before choosing a device.

For living longer and better, hearing research connects communication with broader health, while lifespan and dementia prevention remain separate questions. Brain Health After 60 explores the wider picture. New memory or daily-function changes still need their own evaluation.

Bottom Line

Hearing loss and dementia are linked. ACHIEVE suggests hearing treatment may slow cognitive decline in some higher-risk adults, without establishing a universal prevention effect. Hearing assessment can address today’s communication problem while researchers work out the longer-term connection.

A NOTE FROM LONGEVITY365

We read research, consult expert perspectives and work to make complicated health information easier to understand. What you’re reading here reflects how we’ve interpreted and organized that information. It is educational content—not personal medical advice, diagnosis or treatment guidance.

We’re not perfect, and neither is the available research. Evidence changes, new studies emerge and what’s appropriate for one person may not be appropriate for another.

Use this article as a starting point for your own research and conversations with qualified professionals. Always talk with your doctor or another trusted healthcare professional before making decisions that could affect your health, particularly if you take medications, are receiving treatment, have existing health conditions, are pregnant or have other circumstances that could affect what’s appropriate for you.

Extra Insights & Sources

Reader Questions

A few questions to carry into the comments or your next conversation. Please leave out identifying or personal medical details.

  • 01What would make a hearing-care discussion useful even if the dementia question remained open?
  • 02Which everyday communication outcomes deserve more attention in hearing research?

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Extra Insights & Sources

For readers who want the details behind each claim above.

What We Know

  • Objectively measured hearing loss is associated with higher dementia risk in long-term cohorts. Supported (observational).
  • Hearing-aid use is associated with lower rates of cognitive decline in observational studies. Supported (observational; confounding possible).
  • Hearing intervention improves self-reported communication. Established (ACHIEVE).
  • ACHIEVE found no reduction in three-year cognitive decline overall, with slower decline in a prespecified higher-risk group. Randomized evidence; effect differs by group.
  • OTC hearing aids are intended for US adults with perceived mild-to-moderate loss. Regulatory fact.

What We Don’t Know

  • Whether hearing loss causes dementia. Unknown.
  • Whether hearing aids prevent dementia in the general population. Not established; ACHIEVE’s primary analysis was null.
  • Which risk profile, age or length of treatment produces a cognitive benefit. Promising but unresolved.
  • Whether the higher-risk effect persists or turns into fewer dementia diagnoses. Unknown pending longer follow-up.
  • Whether treating hearing loss affects lifespan. Unknown; no study has tested it.

The Lancet Commission’s hearing analysis

In the statistics below, HR (hazard ratio) compares how quickly an outcome occurs over time; RR (risk ratio) compares its likelihood over a stated period. A value of 1 means no difference. CI (confidence interval) shows uncertainty around an estimate; I² describes how much study results differ beyond chance, and n is the number of participants. SD (standard deviation) describes spread in the measurements. A result expressed in SD units is a standardized score difference, not a percentage change.

Livingston G, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission, The Lancet, 2024. The Commission ran a new random-effects meta-analysis of six cohort studies that measured the quietest tones people could hear (pure-tone audiometry), followed people for more than five years and adjusted for age, cardiovascular factors and cognition or education. Result: HR 1.37 (95% CI 1.00–1.87; I² = 80%; n = 666,370). Follow-up ran 6 to 12 years; mean baseline ages ranged from 59 to 77. Four smaller studies reported hearing-aid use (18–64.5% of people with hearing loss); the estimate wasn’t adjusted for hearing aids, which the authors describe as conservative. All four studies that examined dose found dementia risk rose as hearing worsened, by 4% to 24% per 10-decibel (dB) worsening in hearing threshold—the sound level needed to hear a tone. The authors note they did not preregister these meta-analyses.

The population attributable fraction (PAF) estimates how much dementia at population level might theoretically be linked to a risk factor, under assumptions about cause and overlap between risks. It is not an individual prediction or a measured treatment benefit. The Commission reported: midlife hearing loss, RR 1.4 (1.0–1.9), prevalence 59%, weighted PAF 7.0% (high low-density lipoprotein (LDL) cholesterol 6.9%). All 14 risk factors together: 45.3%. The Commission says the evidence that treating hearing loss lowers dementia risk is now stronger than when its previous report was published. It cites longer duration of hearing loss (maximum risk after more than 25 years) as support for a causal link.

Disclosures: several commissioners report pharmaceutical consulting or grants (listed in the paper); none of the declared interests involves a hearing-device company.

Hearing-aid users in observational studies

Yeo et al., JAMA Neurology, 2023. Systematic review of 31 studies (137,484 participants). Meta-analysis of 8 studies (126,903 participants; follow-up 2–25 years): hearing-aid users had lower hazards of long-term cognitive decline, HR 0.81 (95% CI 0.76–0.87; I² = 0%). Eleven small studies (568 participants) showed a 3% short-term improvement in cognitive test scores after hearing-aid use. The Lancet Commission cites the same review for dementia specifically: HR 0.83 (0.77–0.90; four studies). The authors reported no conflicts and called for randomized trials.

Cribb et al., Neurology, 2026. An observational analysis designed to mimic a trial (target-trial emulation), using Australian participants of the ASPREE aspirin study, with self-reported hearing problems as an indirect measure of moderate hearing impairment. Missing participant information and thinking-test results were estimated in several datasets using multiple imputation, a statistical method for filling gaps while accounting for uncertainty. Across those datasets, the median counts were 2,777 eligible people and 664 with a new hearing-aid prescription—not one observed cohort count. Mean age was 75, 48% were female, and follow-up lasted 7 years. Mean cognition among survivors: difference 0.03 SD (−0.14 to 0.21). Seven-year dementia risk: 5.0% with prescription vs 7.5% without (RR 0.67; 0.37–0.97). Cognitive impairment: 36.1% vs 42.4% (RR 0.85; 0.70–1.00). More frequent use tracked with lower risk. (Note 1) The authors graded it Class III evidence, “cannot rule out residual confounding”—unmeasured differences between people with and without hearing-aid prescriptions—and call long-term randomized trials “justified.” (Note 2)

ACHIEVE in detail

Main trial. Lin FR, et al. The Lancet, 2023. Multicentre, parallel-group, unmasked randomized trial (NCT03243422) at four US community sites (Forsyth County, North Carolina; Jackson, Mississippi; Minneapolis suburbs, Minnesota; Washington County, Maryland). Of 3,004 people screened, 977 were randomized: 490 to hearing intervention (audiological counseling plus hearing aids) and 487 to health education. Mean age 76.8; 54% female; 88% White. Main outcome: three-year change in a score combining several thinking skills. Change was −0.200 SD with hearing intervention and −0.202 SD with control (difference 0.002; 95% CI −0.077 to 0.081; p = 0.96). Prespecified sensitivity analysis: the effect differed by cohort (p for interaction = 0.010). Participants from the long-running Atherosclerosis Risk in Communities (ARIC) heart-health study were the higher-risk group (n = 238): difference 0.191 (0.022 to 0.360), a 48% reduction in three-year decline. Newly recruited, lower-risk volunteers (n = 739): not significantly different. No significant study-related adverse events. The Commission reports incident cognitive impairment at three years in 24% of ARIC participants vs 8% of volunteers.

Device use and communication: hearing-aid users reported a mean 7.2 hours of use a day at year three (SD 5.2), and Hearing Handicap Inventory scores fell from 15.7 to 7.8. The authors’ interpretation: hearing intervention might slow cognitive change over three years in older adults at higher risk of cognitive decline, but not in those at lower risk. Because the trial was unmasked, participants knew which group they were in.

Risk-based secondary analysis. Pike JR, et al. Alzheimer’s & Dementia, 2025. A model built in 2,692 ARIC participants predicted each ACHIEVE participant’s risk of decline. In the top quarter, decline was 61.6% slower with hearing intervention (95% CI 33.7%–94.1%).

Blood biomarkers. Pike JR, et al. eClinicalMedicine, September 2026. Among 164 ARIC-cohort participants, hearing intervention was associated with a slower three-year rise in GFAP, a marker of inflammation in the nervous system (difference −0.175; 95% CI −0.322 to −0.028; p = 0.019). NfL, a marker of nerve-cell damage, moved in the same direction but not significantly (p = 0.098).

Disclosures. Funded by the US National Institutes of Health. Frank Lin reports consulting fees from Apple (and, in 2023, Frequency Therapeutics); scientific advisory boards for Fondation Pour L’Audition and Sharper Sense; an in-kind donation from Sonova/Phonak to Johns Hopkins for the hearing technology used in ACHIEVE; and directing a research center funded in part by a philanthropic donation from Cochlear. In the 2026 biomarker paper he also reports paid expert-witness work for the plaintiff in a class action over an insurer’s non-coverage of hearing aids. Other co-authors report honoraria, research contracts or devices from hearing companies including Sonova, Phonak, Oticon Medical and GN Resound, and one reports employment by Amplifon USA (2026).

Where the experts land

  • Lancet Commission (2024): reads the trial as showing a large protective effect of hearing aids on cognition in the high-risk ARIC cohort. It suggests hearing aids in high-risk groups might also change social contact, mood and communication, while noting that the evidence for this doesn’t exist yet.
  • National Academies committee (2025): notes that the trial “found no difference in cognitive decline over a 3-year period between those given hearing aids and associative services compared with an active control group.” It concluded that “hearing care may cause minimal harm and could potentially benefit cognition” but that “more research is needed to justify cognition as a core outcome,” citing “the deep limitations of observational literature in this space and the null overall finding in the only powered randomized clinical trial.”
  • FDA: its OTC page says: “Using hearing aids may reduce the frequency or severity of cognitive decline, depression, and other health problems in adults.”
  • NIA: cites “a recent analysis of several studies” finding lower long-term cognitive decline among people using hearing aids or cochlear implants.

Hearing devices and FDA rules

The OTC hearing-aid category took effect October 17, 2022. OTC devices are “limited in their maximum output and may not be adequate to treat more severe hearing losses.” Prescription hearing aids “are only available through a licensed hearing health care professional who can program the device to your unique level of hearing loss.” The FDA also notes that hearing aids “do NOT restore normal hearing” and “can be expensive.” As of September 25, 2026, its pages were marked current as of November 18, 2022 (benefits and limitations), May 3, 2023 (OTC) and May 4, 2023 (hearing aids vs PSAPs), and NIDCD’s age-related hearing loss page was last updated March 17, 2023.

Sources

Notes

Note 1: Figures from the Cribb study in this article come from a published summary, not the full paper: the study’s abstract as PubMed shows it on September 25, 2026. A correction to the paper was published in April 2026.

Note 2: Funded by grants from the US National Institute on Aging, according to the study’s PubMed record. The authors’ full competing-interests statement isn’t in its public record.

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