Hearing Loss and Dementia Risk: What the Research Shows

Hearing loss is common in later life, and researchers take it seriously as a dementia risk factor. That does not make hearing aids a proven way to prevent dementia; the best trial so far had mixed results. This page explains what the research shows, how to get hearing checked, what US over-the-counter hearing aids are, and how to make conversation easier.

Why does hearing matter for brain health?

Hearing loss is linked with a higher risk of dementia. The 2024 Lancet Commission estimates that it accounts for about 7% of dementia worldwide. That ties it with high LDL cholesterol for the largest share among the 14 modifiable risk factors in the Commission’s model, according to UCL’s summary of the report.

Key findings from the Commission:

• Higher risk with hearing loss. In its pooled analysis of six high-quality studies, people with hearing loss had about a 37% higher risk of dementia than people with normal hearing.
• More loss, more risk. Studies that looked at severity found that risk rose as hearing got worse.
• Possible reasons, not yet proven. Ideas include loneliness and withdrawal, depression, less stimulation for the brain, and the extra mental effort that listening takes.

Hearing loss is common. The National Institute on Aging (NIA) says about one-third of older adults have it, and the chance rises with age.

What did the ACHIEVE hearing aid trial find?

ACHIEVE was the first randomized trial of hearing aids and cognitive decline. Its results are often misreported, so here are the details from the published trial report.

• Who took part: 977 adults aged 70 to 84 with untreated hearing loss and no substantial thinking problems, at four US community sites.
• What was compared: Half received hearing aids plus counseling sessions with an audiologist. The other half received a health education program about healthy aging.
• Main result: After three years, there was no difference in cognitive decline between the two groups overall.
• Subgroup result: The trial recruited from two sources. 238 people came from a long-running heart health study (ARIC), and as a group they were at higher risk of cognitive decline. In this group, decline was 48% slower with hearing aids. Among the 739 healthy community volunteers, there was no clear effect.

How to read this honestly:

• The overall answer was no effect.
• The subgroup finding was planned in advance, but it came from a secondary analysis of a smaller group. It needs to be confirmed in other studies.
• Participants knew which program they were in, which can affect results.
• The Lancet Commission reads the evidence as showing that hearing aids appear especially helpful for people who have hearing loss along with other dementia risk factors.

The bottom line is that hearing aids are not a proven way to prevent dementia. They do help people hear, take part in conversations and stay connected, which is reason enough to consider them.

How do I know if hearing should be checked?

The NIA suggests seeing a doctor if you or someone you care for:

• Has trouble understanding people on the phone
• Finds it hard to follow conversations when two or more people are talking
• Often asks people to repeat themselves
• Turns up the TV so loud that others complain
• Struggles to understand speech when there is background noise
• Thinks other people seem to mumble

Start with a primary care doctor, who may refer you to an audiologist (a hearing specialist) or an ear, nose and throat doctor. Earwax build-up is one common cause of hearing loss that a doctor can check for. Sudden hearing loss is a medical emergency, and the NIA advises seeing a doctor immediately.

Hearing loss can be mistaken for confusion. The NIA notes that older people who cannot hear well are sometimes wrongly thought to be confused, unresponsive or uncooperative. If someone you love seems withdrawn or is missing what is said, a hearing check is a good early step.

What are over-the-counter hearing aids?

Since October 17, 2022, the FDA has allowed a category of over-the-counter (OTC) hearing aids. Here is how they compare with prescription aids:

The FDA says OTC aids are not meant for severe or profound hearing loss. It advises seeing a doctor, preferably an ear, nose and throat specialist, before buying if you have:

• Ear pain or discomfort
• Fluid, pus or blood from the ear in the past six months
• Sudden or fluctuating hearing changes
• Worse hearing in one ear, or ringing in only one ear
• Dizziness or vertigo
• A lot of earwax

Getting used to hearing aids takes practice, so check the return policy before you buy, as the FDA suggests. The NIA suggests asking whether your insurance covers part of the cost. For someone living with dementia, an audiologist can help decide which type of aid and fitting will be easiest to manage day to day.

How can I talk more easily with someone who has hearing loss?

The NIA suggests:

1. Face the person and keep eye contact, in good light, so they can see your lips and expressions.
2. Find a quiet spot. Turn off the TV or move away from noise.
3. Speak a little louder, but do not shout. Speak naturally and at a reasonable pace.
4. Keep your mouth clear. Do not eat, chew gum or cover your mouth while talking.
5. Rephrase rather than repeat when something is missed.
6. One person at a time. In a group, make a point of including the person.
7. Be patient and ask how you can help.

These tips work well alongside our dementia communication tips. Picture-based activities also take pressure off listening. Picture Pairs and Conversation Cards work through what you see, and Finish the Saying lets you show the ending instead of saying it. For calls, see our guide to phone and video calls.

Vision matters too

In 2024 the Lancet Commission added untreated vision loss as a new risk factor. UCL’s summary puts it at about 2% of dementia cases, and the Commission recommends making screening and treatment for vision problems available to all. The NIA advises a dilated eye exam every year or two after age 60, and checking glasses prescriptions too. Even small changes in sight can raise the risk of falls.

Talk with a doctor

Ask a doctor about hearing and vision checks if you notice any of the signs above. Seek care right away for sudden hearing loss, ear pain, or fluid from the ear. If you care for someone living with dementia, tell their doctor about hearing or vision changes, which can affect mood, safety and how well the person can join in.

This page is general information, not medical advice. See our medical disclaimer. Read more about social connection and brain health.