Hearing loss goes with a higher risk of dementia in cohort studies, but whether treating it protects the brain has not been shown. A meta-analysis of 49 cohort studies found a hazard ratio of 1.32 for dementia in people with hearing loss, [readman-2025] while the ACHIEVE trial, which its authors describe as the first of its kind, found no difference in three-year cognitive decline overall. [lin-2023] This guide covers the link, whether it is causal, what the trial found and what is sensible to do about your hearing. Our overview of dementia covers the wider picture.
Is hearing loss linked to dementia?
Yes, in studies that follow people over time, hearing loss goes with a higher risk of dementia. Readman and colleagues pooled cohort studies of dementia-free people whose hearing was assessed at the start and who were followed for at least two years. Across 49 studies, hearing loss (yes or no) was associated with increased dementia risk, with a hazard ratio of 1.32 (95% confidence interval 1.23 to 1.41). [readman-2025]
A hazard ratio of 1.32 means people with hearing loss developed dementia at about 1.3 times the rate of people without it. Earlier estimates ranged from 1.28 to 2.39, and a 2024 narrative review described nearly two times greater risk. [readman-2025] [huang-lin-2024] The pooled estimate was largest for Oceania and smallest for Asia, and with Oceania excluded the hazard ratios did not differ significantly by continent, so the association looks consistent around the world. [readman-2025]
| Hearing loss | Hazard ratio for dementia | 95% confidence interval |
|---|---|---|
| Any | 1.32 | 1.23 to 1.41 |
| Mild | 1.35 | 0.86 to 2.11 |
| Moderate | 1.39 | 0.57 to 3.35 |
| Severe | 1.66 | 0.59 to 4.64 |
The severity rows are too imprecise to rank. Each interval includes 1, which means the data are also consistent with no increase, so the review could not say whether risk rises as hearing gets worse. [readman-2025]
Does hearing loss cause dementia?
It has not been shown to. Cohort studies observe who develops dementia, and they cannot separate cause from association. The ACHIEVE authors note that inferences from observational studies of hearing aid use are limited because measured factors (such as education and income) and unmeasured ones (such as health behaviours) might confound the association with reduced cognitive decline. [lin-2023]
The pathways proposed so far are hypotheses. A 2024 review lists three: hearing loss could increase cognitive load, change brain structure and function, and decrease social engagement. [huang-lin-2024] The ACHIEVE report adds that reports from the Lancet Commission on dementia identified hearing loss as the single largest potentially modifiable risk factor, which is why a trial was run. [lin-2023]
Does treating hearing loss lower dementia risk?
Not yet shown. ACHIEVE found no overall difference in three-year cognitive decline between a hearing intervention and a health education control, although one prespecified analysis suggested a benefit in people at higher risk. The trial randomly assigned 977 older adults with hearing loss, mean age 76.8, 490 to the hearing intervention and 487 to the control. [lin-2023]
In the primary analysis, three-year cognitive change was −0.200 standard deviations in the hearing group and −0.202 in the control group, a difference of 0.002 (95% confidence interval −0.077 to 0.081; p = 0.96). [lin-2023]
Three-year cognitive change reported in the primary analysis of Lin et al. (2023), ACHIEVE: 490 adults in the hearing intervention group and 487 in the health education control. Both groups declined by about the same amount.
The trial combined two groups of participants: 238 from the long-running Atherosclerosis Risk in Communities (ARIC) study, who were older, had more risk factors for cognitive decline and scored lower at the start, and 739 recruited fresh for the trial. A prespecified sensitivity analysis showed a significant difference in the effect of the hearing intervention between those two groups (p for interaction 0.010). The authors concluded that a hearing intervention might reduce cognitive change over three years in populations at increased risk of decline, but not in populations at decreased risk. [lin-2023]
That finding comes from one analysis inside one trial. It points towards a possible benefit for people at higher risk, and it needs testing in its own right before anyone treats it as settled.
What do the studies not show about hearing loss and dementia?
They do not show that hearing loss causes dementia, and they do not show that treating it prevents dementia. ACHIEVE measured cognitive change over three years, not dementia diagnoses, so it cannot say whether treating hearing loss changes who goes on to develop dementia. [lin-2023]
The trial was unblinded, funded by the US National Institutes of Health, and most participants were White (88%). Its declarations of interest list a donation of hearing technology from a manufacturer for use in the study. [lin-2023] The meta-analysis pooled observational studies, so a hazard ratio of 1.32 describes a link and not an effect you can expect from treatment. [readman-2025]
Is it worth getting your hearing checked?
Yes, for the sake of hearing, and the brain benefit is an unproven extra. Hearing loss is common: globally, 65% of adults over 60 have it. [huang-lin-2024] It is treatable with hearing aids and related support services, which the ACHIEVE authors say are underused, with fewer than 20 to 30% of people with hearing loss in high-income countries using hearing aids. The trial reported no significant adverse events attributed to either the hearing intervention or the control. [lin-2023]
Is it worth getting your hearing checked?
Tick anything that is true for you most of the time. This is a prompt for reflection, not a test, and it produces no diagnosis.
0 of 5 ticked
Several of these together suggest hearing may be making daily life harder. A doctor or an audiologist can test your hearing and talk through the options, including hearing aids.
One or two of these is common. Notice whether the list grows, and book a test if conversations start to feel like work.
Nothing on this list applies right now. A routine hearing check is still reasonable if you are over 60 and have not had one.
No screener on this site assesses hearing or dementia. The hub above covers anxiety, depression, stress, sleep, burnout, self-esteem and loneliness.
When to seek help
Speak to a doctor about a hearing test if conversations have become hard to follow, and speak to one about memory if you or someone close notices changes that affect daily life. Our guide to the early signs of dementia covers what to look for, and depression or dementia explains why untreated hearing loss can look like cognitive decline from the outside.
If you care for someone with dementia, our guide to supporting someone with dementia covers the practical side.
How MyFreud can help
Hearing loss can make conversations tiring and days more isolating. Daily mood tracking in MyFreud shows how your days go, including after social events that were hard to follow, and the notepad is somewhere to write down questions before a hearing or memory appointment. It does not replace a clinician.
Download MyFreud and start today: App Store or Google Play.