Hearing loss and cognitive decline: The connection you shouldn’t ignore

Hearing loss is a risk factor for dementia you can actually control

Hearing isn’t just about sound. It’s how your brain makes sense of the world and connects you with it. Simply put, we hear with our brains — and not just our ears.

Hearing loss is common as we age, and it affects nearly two-thirds of adults over age 70. But many cases go untreated — and that can impact brain health.

“When hearing changes, everyday conversations can take extra effort. Over time, that added workload may affect attention and memory,” says Glen Finney, MD, a behavioral neurologist at Geisinger. “And research shows a strong connection between hearing loss and cognitive decline — including a higher risk of dementia — when hearing goes untreated.”

The good news: Hearing loss is a risk factor for cognitive decline that you can control.

How hearing loss and cognitive decline are connected

When sound signals are faint or unclear, the brain has to work harder to understand speech. That extra listening effort pulls resources away from memory, attention and reasoning. Over time, this can contribute to changes in thinking abilities.

Research also shows physical changes in the brain are linked to hearing loss. Brain scans have shown that a reduction in sound signals can cause structural atrophy (shrinkage) to the area that processes sound.

“Regions that usually process sound may shrink, while other areas work overtime to interpret language,” says Dr. Finney. “These shifts can affect how different brain networks — like attention and memory — work together and can negatively impact learning, planning and decision making.”

Finally, there’s a social impact. “When conversations start to feel tiring or frustrating because of hearing loss, you may avoid social situations,” he adds. “And social isolation is a known risk factor for cognitive decline and depression.”

Signs of hearing loss

Hearing changes often happen gradually. You might start to notice difficulties with everyday conversations, especially in noisy environments like restaurants and stadiums.

Other early signs of hearing loss may include:

Turning up the TV louder than others prefer
Asking people to repeat themselves
Ringing in the ears (tinnitus)
Feeling like others are mumbling
Avoiding social situations
Feeling fatigued after long conversations

Signs of dementia

Early signs of dementia can be subtle and may be mistaken for normal aging.

But as dementia progresses, a person may:

Become more confused and forgetful
Repeat questions
Struggle to do things like bathing or dressing
Have trouble managing daily affairs, like appointments or medications

Dementia typically affects at least 2 of these areas:

Memory
Speech/language
Judgment
Planning and organizing

“Because hearing loss and dementia can share overlapping signs — like appearing distracted or forgetful — it’s a good idea to include a hearing evaluation when memory or attention concerns arise,” says Dr. Finney.

Can hearing aids reduce the risk of dementia?

Evidence points to yes. Hearing aids and devices like cochlear implants improve how clearly the brain receives sound. When listening takes less effort, your brain has more energy for things like memory, focus and day-to-day thinking.

Hearing devices also restimulate the auditory part of the brain that’s been neglected due to hearing loss.

“Studies suggest that consistent use of well-fitted hearing devices is linked with a lower risk of cognitive decline compared with leaving hearing loss untreated,” says Arun Gadre, MD, a Geisinger otolaryngologist subspecializing in neurotology. “Hearing aids don’t treat dementia, but improved auditory input reduces listening effort and supports social engagement — both important for better outcomes.”

Hearing aids are becoming more accessible than ever. Many insurance plans, including Medicaid in some states, cover hearing aids. There are also over-the-counter options for mild to moderate hearing loss.

Regular hearing checks can protect brain health

Because hearing loss is treatable, early intervention matters. With regular screenings, you can catch hearing loss early.

Start by scheduling a baseline test in midlife. After age 60, annual hearing tests are recommended.

If you or a loved one notice changes in hearing, memory or mood, don’t wait to schedule an evaluation. There’s no downside to using a hearing aid — and they make a world of difference for most people.

“Getting fitted with a hearing device improves communication and reduces the mental effort required to listen,” says Dr. Gadre. “And the earlier you act, the better the outcome.”