Large-Scale Study Suggests Protective Benefit of Hearing Aids in Development of Dementia

Alexa S. Beiser, PhD

A study recently published in JAMA Neurology revealed that patients with hearing loss (HL) with hearing aids had reduced risk for dementia among those younger than 70 years at the time of hearing evaluation, when followed up for up to 20 years. Overall, these data point to the importance of early intervention for HL for possible prevention of dementia.¹

The analysis comprised 2953 patients from the Framingham Heart Study (FHS), 583 (20%) of whom developed incident all-cause dementia over the 2-decade follow-up. Patients included were at least 60 years or older without dementia who underwent pure-tone audiometry at the 15^th biennial examination (1977-1979; original cohort) and the 6^th quadrennial examination (1995-1998; offspring cohort).

Patients were then followed up for 20 years, and pure-tone average (PTA) was defined as the mean of hearing thresholds at frequencies of 0.5, 1.0, 2.0, and 4.0 kHz. HL was defined as a PTA of 26 dB or higher HL in the better ear with self-reported hearing aid use. The study investigators, which included senior author Alexa S. Beiser, PhD, a professor in the School of Public Health at Boston University, conducted several different analyses using Cox proportional hazards regression models, as well as 2 other models that adjusted for Framingham Stroke Risk Profile (FSRP), a summary measure of vascular risk, and educational level.

Among those who developed all-cause dementia at the 2-decade follow-up, 42% (n = 245) were younger than 70 years at hearing assessment. Compared with participants with HL without hearing aids, those with HL with hearing aids had a 61% lower risk (HR, 0.39; 95% CI, 0.17-0.89; P = .03) for incident all-cause dementia among those younger than 70 years at HL diagnosis. Of note, participants with no HL had a 29% lower risk (HR, 0.71; 95% CI, 0.54-0.95; P = .02) for incident all-cause dementia.

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Coming into the study, the investigators recorded baseline data on educational level, blood pressure, antihypertensive medication use, prevalent cardiovascular disease, body mass index, total cholesterol, HDL, diabetes, noise exposure, and HL by severity, among other characteristics. Overall, the risk of incident all-cause dementia was unaffected by additional adjusting for either FSRP or educational level. In addition, the study found no association between hearing aid use and incident dementia in people 70 years or older.

The study was strengthened by the large sample size, standardized hearing assessment, rigorous dementia follow-up for up to 2 decades after hearing evaluation, and adjustment for potential confounders. In contrast, some of the study’s limitations include the reliance on a binary response to a hearing aid use question, which does not capture the extent of use; inability to differentiate between early intervention in terms of age or HL severity; and inability to control for socioeconomic status beyond educational level.

This was not the first time a study suggested hearing aids have a protective benefit against development of dementia. The ACHIEVE study, a parallel-group, unmasked, randomized controlled trial of adults aged 70-84 years with untreated hearing loss and cognitive impairment, was published in 2023 to further showcase the benefits of hearing aids. In the study, patients were randomly assigned to either the hearing intervention (n = 490; 50%; audiological counseling and provision of hearing aids) or to a health education control (n = 487; 50%; individual sessions with a health educator covering topics on chronic disease progression).²

In the primary analysis of ACHIEVE, which combined the ARIC and de novo cohorts, 3-year cognitive change was not significantly different between the hearing intervention and health education control groups (hearing intervention: –0.200 [95% CI, –0.256 to –0.144] vs control: –0.202 [95% CI, –0.258 to –0.145]; P = .96). Despite this, a prespecified sensitivity analysis showed a significant difference in the effect of the hearing intervention on 3-year cognitive change between the ARIC and de novo cohorts (P interaction = 0.010). Other prespecified sensitivity analyses that varied analytical parameters used in the total cohort did not change the observed results.

REFERENCES
1. Francis L, Seshadri S, Dillard LK, et al. Self-Reported Hearing Aid Use and Risk of Incident Dementia. JAMA Neurol. Published online August 18, 2025. doi:10.1001/jamaneurol.2025.2713
2. Lin FR, Pike JR, Albert MS, 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. Lancet. 2023;402(10404):786-797. doi:10.1016/S0140-6736(23)01406-X