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Hearing Loss as a Potentially Modifiable Marker of Dementia Risk: Neurological Evidence, Uncertainty, and Clinical
Verónica Fuentes-Santamaría1, Carmen María Díaz García2, Juan Carlos Alvarado3
1Research Group on Neurodegenerative Diseases and Their Relationship with Neurosensory Alterations and Aging, Institute of Biomedicine of Castilla-La Mancha (IB UCLM), Department of Medical Sciences, School of Medicine of Albacete, University of Castilla-La Mancha, Albacete, Spain.
Background:
Hearing impairment has emerged as a consistently associated and potentially modifiable risk factor for cognitive decline and dementia, including Alzheimer's disease (AD). Epidemiological studies demonstrate an increased dementia risk among individuals with hearing loss, with evidence of dose-response relationships across levels of auditory decline. Despite the robustness of this association, the mechanisms linking auditory dysfunction to cognitive deterioration remain multifactorial and incompletely understood.
Summary:
By integrating biological, cognitive, and psychosocial perspectives while explicitly addressing persistent uncertainties, this critical narrative review provides a balanced framework for interpreting the relationship between hearing impairment and AD. Current evidence points to several interacting pathways, including sensory deprivation, cortical reorganization, increased cognitive load, and psychosocial consequences like social isolation. Furthermore, emerging research suggests that central auditory processing deficits may represent early functional markers of cortical vulnerability associated with neurodegeneration. Clinically, these insights emphasize the importance of routine hearing assessment in older adults, while observational evidence indicates that hearing rehabilitation, particularly hearing aid use, may be associated with more favorable cognitive outcomes.
Key Messages:
Association vs. causation: hearing loss should be regarded as a robustly associated and potentially modifiable marker of dementia risk rather than a confirmed causal determinant. Neurological implication: from a neurological standpoint, central auditory dysfunction may reflect underlying brain vulnerability in aging rather than acting as a direct causal driver of AD. Clinical outlook: while causal effects of hearing rehabilitation have yet to be firmly established, prioritizing hearing health offers a promising and practical avenue for dementia prevention and clinical practice.
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