Cognitive impairment and hearing loss

By Marcello Cherchi, MD PhD

For patients

Normal, healthy aging comes with decline in all bodily functions, including hearing and thinking. Emerging evidence suggests that hearing loss can cause cognitive deficits beyond what would be explained by aging alone. Research is beginning to show that treating hearing loss in these cases may retard, or in some cases reverse, the cognitive decline. It is always reasonable to evaluate hearing in an individual with hearing symptoms, but results from this emerging research suggests that if a patient experiencing cognitive decline additionally has hearing loss, then intervening on the hearing loss may have a beneficial effect on cognition.

For clinicians

It is very well established that some degree of hearing loss comes with normal healthy aging, and insofar as such hearing loss is “expected,” the term presbycusis refers to age-associated hearing loss. The degree of “expected” age-associated hearing loss is somewhat broad, and distinguishing presbycusis from hearing loss attributable to diagnosable disease is a nuanced task generally undertaken by an audiologist.

Some degree of cognitive decline is also “expected” with normal healthy aging; we might apply the term “presbymentia” to age-associated cognitive decline, but we are not aware of this term being used in the literature. Determining “age-appropriate” cognitive deficits from deficits due to diagnosable disease (such as various dementias) is a complex task, appropriate evaluation of which is generally undertaken by a cognitive neurologist.

Since presbycusis and “presbymentia” appear to occur with healthy aging, it is difficult to ascertain whether these influence each other; specifically, it is difficult to distinguish whether both declines are due to a common generalized age-associated attrition of function, or whether there is a causal link between them. However, a growing body of research suggests that hearing loss can accelerate cognitive decline beyond what would be expected for age (Yeo, Song et al. 2022).

We tend to view this observation as being in keeping with other bodies of research demonstrating that depriving an individual of a sensory modality from which they have had lifelong input appears to increase the risk of cognitive decline. This has been frequently observed in the association between visual decline and cognitive decline (Ong, Cheung et al. 2012, Lim, Chee et al. 2020, Fang, Fang et al. 2021, Tai, Tseng et al. 2022, Vu, Gupta et al. 2022, Mohammed, Kee et al. 2023).

Such associations, if causal, raise the possibility that ameliorating the sensory deficit may offer an avenue for retarding or reversing the associated cognitive decline. Strikingly, this has been demonstrated for the sensory modality of hearing; specifically, some studies have shown that the use of hearing restorative devices appears to decrease the risk of long-term cognitive decline (Yeo et al. 2022), though not all studies reach this conclusion (Cribb et al. 2026).

This has potential relevance for individuals diagnosed with dementia, most forms of which are not directly treatable. If such individuals have correctable hearing loss, then this would be one of the few interventions with demonstrable efficacy.

Practically, we suggest that if an individual perceives a limitation in hearing that is interfering with their ability to function, then it is always reasonable to consult an audiologist for evaluation. If an individual with cognitive decline (of whatever cause) has never had a hearing evaluation, then the research cited above suggests that this would be medically reasonable.

References