Hearing loss becomes more common as we get older, and research has found a consistent association between hearing loss and an increased risk of cognitive decline and dementia.
This does not mean that hearing loss causes dementia, or that someone with hearing loss will develop dementia. Dementia has many different risk factors, and researchers are still working to fully understand the relationship between hearing and brain health.
Hearing loss, dementia and Alzheimer’s disease
The 2024 Lancet Commission on dementia prevention, intervention and care identifies hearing impairment as one of the most important potentially modifiable risk factors for dementia.
The Commission estimates that hearing impairment may account for around 7% of dementia cases at a population level, although this does not mean that treating hearing loss will prevent dementia in every individual.
Research has also found that the risk of dementia tends to increase with the severity of hearing loss. One long-running Johns Hopkins study reported that, compared with people with normal hearing:
- mild hearing loss was associated with around twice the risk
- moderate hearing loss was associated with around three times the risk
- severe hearing loss was associated with around five times the risk
These figures describe relative risk within the study population and should not be interpreted as an individual prediction of developing dementia.
Why might hearing and cognitive health be connected?
Researchers are still investigating exactly why hearing loss and dementia are associated.
Several possible explanations have been suggested. Hearing loss can make communication more difficult and may contribute to social isolation or reduced participation in activities. Listening can also require greater mental effort when hearing is impaired, potentially placing additional demands on the brain.
There is also evidence that some of the biological processes associated with cognitive decline may themselves affect the way the brain processes sound. It is therefore likely that the relationship between hearing loss and dementia is complex rather than being explained by one single cause.
Can hearing aids reduce the risk of dementia?
There is encouraging evidence that treating hearing loss may support cognitive health.
Observational studies have found lower rates of cognitive decline and dementia among people with hearing loss who use hearing aids compared with those who do not.
The ACHIEVE trial, the first large randomised controlled trial to examine this question, found that hearing intervention did not significantly slow cognitive decline across the study population as a whole. However, among participants who were already at greater risk of cognitive decline, hearing intervention was associated with a 48% reduction in the rate of cognitive decline over three years.
Research is continuing, and it is not yet possible to say that wearing hearing aids will prevent dementia. However, treating hearing loss can improve communication, listening ability and everyday quality of life, providing good reasons to address hearing difficulties regardless of any potential effect on dementia risk.
Supporting someone living with dementia and hearing loss
Hearing loss is common among people living with dementia, and experiencing both conditions can make everyday communication more challenging.
Difficulty hearing can add to confusion, reduce participation in conversations and make it harder to hear important sounds such as alarms or warnings.
Regular hearing checks and appropriate hearing support can therefore be valuable. This may include hearing aids where suitable, as well as practical measures such as reducing background noise, improving lighting and making sure the person can clearly see the face of whoever is speaking.
Looking after your hearing
Regular hearing checks can help identify changes in hearing and make sure appropriate support is available.
Alzheimer’s Society recommends managing hearing loss as part of looking after your overall health and reducing potentially modifiable dementia risk. If hearing aids are appropriate, using them consistently may help you stay connected to conversations, relationships and everyday activities.
Livingston G, Huntley J, Liu K et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, 2024; 404, 572-628
Lin FR, Metter EJ, O’Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Arch Neurol. 2011 Feb;68(2):214-20. doi: 10.1001/archneurol.2010.362. PMID: 21320988; PMCID: PMC3277836.
Lin F, Pike J, Albert M et al. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. The Lancet, 2023; 402, 786-797
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