Navigating Hearing and Cognition in Clinical Practice

Explore practical, evidence-based ways to discuss hearing and cognition with patients and families. Audiologist Erika Porter, AuD, shares guidance on communicating risk accurately, supporting patient-centered treatment, and coordinating care across the healthcare team.

AudiologyOnline: Why has the relationship between hearing and cognition become such a central focus for healthcare providers?

Erika Porter, AuD: The urgency stems from the sheer scale of the challenge. Dementia currently affects between 2.4 and 5.5 million people in the United States, and its prevalence increases dramatically with age, affecting nearly 30% of adults aged 85 and older. As healthcare providers serving this aging population, it’s a topic we need to be prepared to encounter. 

AudiologyOnline: There is often confusion regarding how to describe the link between these two areas. What do you suggest?

Erika Porter, AuD: We recognize that hearing and cognition share a dynamic and bidirectional relationship. Hearing loss can lead to reduced communication and increased cognitive load and social isolation, all of which may contribute to cognitive decline. Conversely, cognitive impairment can affect an individual’s ability to process auditory information, making effective communication more challenging. These interwoven effects can make defining this relationship challenging. We have a responsibility to provide clear, accurate information to those we serve and our communities. 

As we have these discussions, we should keep in mind the difference between risk, association, and causation so we stay accurate. Risk refers to something that increases the probability of an outcome, much like sun exposure increases the risk of skin cancer without guaranteeing it. Association describes a statistical relationship:  We know there is a strong statistical link between untreated hearing loss and dementia. However, causation is a direct cause-and-effect relationship, such as loud noise causing noise-induced hearing loss. While we do not yet have enough research to say untreated hearing loss causes dementia, we can confidently tell patients that evidence suggests hearing aid usage may decrease the risk of cognitive decline.

AudiologyOnline: How should a clinician respond when a patient asks point-blank, "Will hearing aids help my memory?"

Erika Porter, AuD: A great response is to frame it as a "toolbox" approach. Just as exercise and a healthy diet support the body, treating hearing loss is a proactive health decision to keep the hearing centers of the brain stimulated and active. You might explain that by improving the auditory signal, you are providing the brain with a clearer signal rather than making it guess. While we can't promise a memory cure, we can say that giving the brain better information to work with makes it easier for the brain to function and remember.

It’s important to move away from scare tactics and focus on the positive, proven benefits of treating hearing loss. While research, such as the ACHIEVE trial, has shown that comprehensive hearing intervention can slow cognitive decline in some participants, we can discuss a broader scope of benefit (Lin et al., 2023). Studies have shown an increase in communication function and social engagement (Sanchez et al., 2024; Reed et al., 2025). Beyond that, technology like Spheric Speech Clarity that separates speech from noise has been shown to reduce cognitive load, meaning the brain doesn't have to work as hard to understand speech (Vaisberg et al., 2025).

AudiologyOnline: Many patients fear that any memory slip is a sign of dementia. How can a clinician help them differentiate between normal aging and more serious warning signs?

Erika Porter, AuD: In normal, healthy, aging we would expect that as a person gets older there will be some diminishing cognitive functions, but not to a degree that impacts independent living. With dementia, the decline of cognitive function occurs much faster and to a much greater extent. Over time, these changes impair the ability to perform basic activities of daily living. For example, forgetting the name of someone you haven't seen in a year is normal aging. In contrast, warning signs of dementia include forgetting the name of a spouse, being confused in familiar places, or having difficulty performing routine tasks. The specific symptoms a person living with dementia experiences will depend upon what parts of the brain are affected and/or the specific disease that is causing their dementia.

AudiologyOnline: Moving now to the consultation and treatment appointments, what considerations should a provider keep in mind? 

Erika Porter, AuD: The hearing solution plan should be guided by a functional and communication needs assessment including family and communication partners as much as possible and going beyond basic pure-tone audiometry. A holistic approach includes speech-in-noise testing and psychosocial health measures to see a well-rounded picture of patient function. 

Most providers intuitively use practical modifications during the appointments including simplifying messages, using written visuals, slowing the rate of speech, and engaging family to support. When considering a treatment plan, technology with automatic processing is key so the patient doesn't have to worry about pushing buttons or making manual changes. 

The intervention must be patient and family-centered. Perceived social support is a significant predictor of hearing aid success, so involving family members in appointments is essential (Hickson et al., 2014). In some cases, you might even connect the patient’s hearing aids to the myPhonak app on a family member's phone so they can facilitate a remote support visit with the patient in the comfort of their own home. The key is to be flexible and tuned in to each individual patient’s needs.

AudiologyOnline: Finally, why is care coordination so important, and how can clinicians practically implement it?

Erika Porter, AuD: No single specialty has the expertise to handle the complex challenges of dementia alone. It requires a multidisciplinary team, including neurologists, geriatricians, PCPs, and social workers. Clinicians can establish these pathways in a variety of ways including networking at local health fairs and reaching out to primary care offices. Multidisciplinary teams may vary in their composition, but successful teams are characterized by a shared commitment to quality care and an appreciation for the contributions of each team member. 

Ultimately, our greatest success as clinicians comes with partnering with our patients and their families to help them navigate the complexities that come with changes to aging, cognition, and hearing as smoothly as possible. 

For additional information and resources, see Phonak.com/cognition and the AudiologyOnline course, Addressing Hearing and Cognition: 10 Recommendations for HCPs.

References

Lin, F. R., Pike, J. R., Albert, M. S., Arnold, M., Burgard, S., Chisolm, T., Couper, D., Deal, J. A., Goman, A. M., Glynn, N. W., Gmelin, T., Gravens-Mueller, L., Hayden, K. M., Huang, A. R., Knopman, D., Mitchell, C. M., Mosley, T., Pankow, J. S., Reed, N. S., . . . 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. The Lancet, 402(10404), 786–797. https://doi.org/10.1016/S0140-6736(23)01406-X

Reed, N. S., Chen, J., Huang, A. R., Pike, J. R., Arnold, M., Burgard, S., Chen, Z., Chisolm, T., Couper, D., Cudjoe, T. K. M., Deal, J. A., Goman, A. M., Glynn, N. W., Gmelin, T., Gravens-Mueller, L., Hayden, K. M., Mitchell, C. M., Mosley, T., Oh, E. S., . . . ACHIEVE Collaborative Research Group. (2025). Hearing intervention, social isolation, and loneliness: A secondary analysis of the ACHIEVE randomized clinical trial. JAMA Internal Medicine, 185(7), 797–806. https://doi.org/10.1001/jamainternmed.2025.1140

Sanchez, V. A., Arnold, M. L., Garcia Morales, E. E., Reed, N. S., Faucette, S., Burgard, S., Calloway, H. N., Coresh, J., Deal, J. A., Goman, A. M., Gravens-Mueller, L., Hayden, K. M., Huang, A. R., Mitchell, C. M., Mosley, T. H., Jr., Pankow, J. S., Pike, J. R., Schrack, J. A., Sherry, L., . . . ACHIEVE Collaborative Study. (2024). Effect of hearing intervention on communicative function: A secondary analysis of the ACHIEVE randomized controlled trial. Journal of the American Geriatrics Society, 72(12), 3784–3799. https://doi.org/10.1111/jgs.19185

Vaisberg, J. M., Dang, C., Jiang, Y., Qian, J., & Russo, F. A. (2025). Brain benefits of deep learning-based noise management in experienced hearing aid users using functional near infrared spectroscopy. Scientific Reports, 15, Article 41815. https://doi.org/10.1038/s41598-025-25801-y