Relationship between age-related hearing loss, phonological working memory, and global cognitive performance

Age-related hearing loss is associated with lower cognitive performance in later life, but the behavioral pathways linking these domains remain unclear. Phonological working memory, as assessed by nonword repetition, depends on both auditory input quality and availability of cognitive resources and may represent a candidate pathway linking hearing and cognition. This study examined whether hearing sensitivity and global cognitive performance are independently associated with nonword repetition and whether nonword repetition accounts for part of their association. One hundred twenty adults aged 55-80 years completed pure-tone audiometry, a standardized nonword repetition task, and the Montreal Cognitive Assessment (MoCA). Associations among hearing sensitivity, nonword repetition, and global cognitive performance were examined using regression and mediation analyses controlling for age, sex, and education. Poorer hearing sensitivity and poorer cognitive performance were each independently associated with reduced nonword repetition accuracy, with hearing sensitivity showing a stronger association. Both factors explained unique variance in performance, with additive (non-interactive) effects. Mediation analyses indicated that nonword repetition accounted for part of the association between hearing sensitivity and global cognitive performance. The results showed that nonword repetition is a task that is independently associated with hearing sensitivity and global cognition in older adults. The findings support a framework in which degraded auditory input imposes primary constraints on phonological processing, with cognitive resources providing limited compensation. Nonword repetition may offer a useful behavioral measure for assessing combined auditory and cognitive variability in adults in mid-to-late life.