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Hearing Loss and the Risk of Cognitive Decline – Alison Coetzee Audiology

Hearing Loss and the Risk of Cognitive Decline

Everyone experiences aging.

The process of cognitive aging presents with significant inter-individual variations. Different aspects of physical, mental, emotional, and psychosocial development interact to produce a variety of individual growth and loss trajectories as well as stability over the course of life.  The degree, pace, and pattern of age-related cognitive changes experienced differ significantly amongst individuals.  Though performance levels for other cognitive functions like language, semantic knowledge, abstract reasoning, and visuospatial ability are generally not affected by aging, declines are typically seen in cognitive functions like processing speed, executive functions, episodic and working memory.

Compensating for age related changes.

Those who want to age well must adjust to and make up for changes that could affect speech comprehension, which is an essential component of communication. Age-related changes in brain regions essential to speech understanding as well as normal and elevated hearing threshold levels are linked to declines in speech understanding under challenging listening conditions. Numerous parts of the brain that are not typically thought of as part of the language network are recruited to support speech understanding when listening situations become complex, the acoustics deteriorate, and the signal to noise ratio is unfavorable. Loss of resources for other cognitive tasks, listening fatigue, and loss of attention are just a few of the cognitive and behavioral effects of using extra cognitive resources for speech understanding.


With more than 55 million cases of dementia reported globally, and predictions that the number will triple by 2050, dementia is a significant public health concern (Alzheimer’s Association, 2021). In light of their own cognitive decline, many older adults are especially worried about memory loss. They also worry about having to care for someone else who has dementia. Dementia is a term used to describe irreversible and progressive changes in brain function that are not a normal aspect of aging. Along with memory loss, dementia also affects several higher-order cognitive abilities, including language, executive function, perception, motor skills, and social cognition. Personality shifts as well as behavioral and emotional issues that affect social functioning are expected symptoms. Over the past few decades, a lot of attention has been paid to the interaction between age-related changes in auditory and cognitive processing during listening and speech understanding. Hearing loss is now the biggest modifiable risk factor for dementia at the population level, and hearing loss starting in midlife increases that risk, according to the most recent 2017 and 2020 Lancet Commission reports on dementia prevention.


The importance of receiving hearing care throughout life, its connection to integrated care, and the promotion of healthy aging are all highlighted by the rising incidence of age-related hearing loss and the increase in life expectancy.  A proactive health promotion approach to ageing well from middle age, rather than a reactive approach after hearing loss has already caused significant disability, could help to prevent many of the negative consequences of hearing loss in later life.

Key messages about brain ageing, adapted from the Institute of Medicine, 2015 (The Gerontological Society of America, 2020):

  • Much like other parts of the body, the brain ages. 
  • Ageing cognitively is not an illness. It’s a normal, ongoing process that happens to every person.
  • Each person’s experience of cognitive aging is unique.
  • As one gets older, certain cognitive abilities (like experience-based wisdom) get better.
  • Individuals can take actions to support and maintain their cognitive health.

Did you know? 1 in 4 people think that nothing can be done to prevent dementia.

Reference: Julia Sarant, Ulrike Lemke, Nathalie Giroud, Sigrid Scherpiet & Barbara Weinstein (2023) Promoting hearing and cognitive health in audiologic rehabilitation for the well-being of older adults, International Journal of Audiology, DOI: 10.1080/14992027.2023.2260099

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