When hearing declines, get a hearing aid; the reason is to hear now, not to prevent dementia

The claim that “hearing aids prevent dementia” has not held up so far. A nearly thousand-person three-year trial showed no overall difference. A difference appeared only in the subgroup already at higher risk of cognitive decline. So the reason to get a hearing aid is to hear now, talk with people, and hear cars when crossing the street — not for the brain decades later.

Cost

Hearing aids cost several thousand to tens of thousands of yuan; most are out of pocket. Fitting is required, plus several return visits for tuning.

Benefit

The ACHIEVE trial ran in 4 U.S. communities and enrolled 977 people aged 70 to 84 with untreated hearing loss and no clear cognitive impairment. They were randomized to hearing intervention (hearing counseling and hearing aids) or health-education control, with follow-up every 6 months. The primary endpoint was 3-year change in global cognitive score. In the main analysis pooling both source populations, the two groups did not differ significantly: hearing intervention −0.200 (95% CI −0.256 to −0.144), control −0.202 (95% CI −0.258 to −0.145), difference 0.002 (95% CI −0.077 to 0.081), P=0.96. A pre-specified sensitivity analysis showed the intervention effect differed between the two source populations (interaction P=0.010). Participants from that long-term cardiovascular-health observational study were older, had more risk factors for cognitive decline, and had lower baseline cognitive scores. In that subgroup of 238 people, hearing intervention reduced 3-year cognitive decline by 48% (difference 0.191, 95% CI 0.022–0.360, P=0.027). In the other 739 newly recruited healthy volunteers, the groups did not differ significantly (difference −0.061, 95% CI −0.151 to 0.028, P=0.18). The investigators concluded that hearing intervention may reduce 3-year cognitive change in people at higher risk of cognitive decline, and not in those at lower risk. The trial reported no serious adverse events attributed to the study

Notes

Contested: the line “hearing aids cut cognitive decline by nearly half” comes from a 238-person subgroup in this trial, not the primary result, which showed no difference between groups. Separate “get a hearing aid” from “prevent dementia”: do the former; do not use the latter as the reason. Candidates with hearing disability can be exempted from foreign-language listening on the gaokao (高考) — see item 13 of this section (reasonable accommodations). Drivers with hearing impairment should wear a hearing aid — see item 15 of this section (C5).

Sources · 1

1. Lin FR, Pike JR, Albert MS, et al.; ACHIEVE Collaborative Research Group (2023). 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, 402(10404):786-797. doi.org/10.1016/S0140-6736(23)01406-X