Cognitive and Audiological Outcomes Following Cochlear Implantation in the Elderly: A Systematic Review and...

BackgroundAge-related hearing loss is strongly associated with cognitive decline and dementia. Cochlear implantation (CI) has emerged as an effective intervention for severe-to-profound hearing loss and may influence cognitive and psychosocial outcomes in older adults. This systematic review and meta-analysis aimed to evaluate the cognitive, audiological, psychological, and quality-of-life outcomes following CI in the elderly.MethodsA systematic search of four databases was conducted for studies published up to February 2026. Studies including adults aged ≥55 years with bilateral hearing loss who underwent CI and reported pre- and post-implantation outcomes were eligible. The primary outcome was change in global cognitive function, assessed using multiple validated cognitive instruments - the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the hearing-adapted Repeatable Battery for the Assessment of Neuropsychological Status (RBANS-H) - with no single test treated as a reference ("gold-standard") measure of cognition. Secondary outcomes included domain-specific cognitive measures, audiological and speech perception performance, psychological outcomes (depression and anxiety), and patient-reported quality of life and subjective hearing ability. Pooled analyses were conducted using random-effects models, and results were expressed as mean differences (MD) with 95% confidence intervals (CI).ResultsA total of 31 studies involving 1,210 participants were included. Findings for global cognition differed by instrument. Scores on the MMSE, a verbally administered screening tool, showed no statistically significant change following CI (MD = 0.20, 95% CI: -0.75 to 1.15, p = 0.68). By contrast, global cognition assessed using the hearing-adapted RBANS-H and the MoCA improved significantly. Significant improvements were also observed in audiological performance and speech perception measures. Significant reductions were also observed in anxiety and depressive symptoms assessed using the Hospital Anxiety and Depression Scale, alongside substantial improvements in patient-reported hearing-related quality of life and subjective hearing ability. In contrast, no statistically significant improvements were observed in several executive function and working memory measures, including tests assessing cognitive flexibility, inhibition, and short-term memory. Depressive symptoms assessed using the Geriatric Depression Scale also showed no significant change.ConclusionCI in older adults provides substantial benefits in auditory performance and hearing-related quality of life. Cognitive benefit, drawn from the totality of cognitive testing rather than from the MMSE alone, was evident as improved global cognition on the hearing-adapted RBANS-H and the MoCA, with particular gains in memory and attention; by contrast, the MMSE - a verbally administered screening tool - together with executive function and working memory measures, did not change significantly. Considered across this full range of measures, the findings support CI as an effective intervention that may help alleviate the cognitive and psychosocial consequences of severe hearing loss in the aging population. Because recipients may under-recognise their own social gains, future studies should also incorporate family-perceived benefit and social-interaction outcomes as additional patient-centred measures, using parallel family- or caregiver-reported instruments rather than recipient-reported speech outcomes alone.