Hearing Aids Show Promise in Reducing Cognitive Decline in Older Adults

The efficacy of hearing aids for reducing long-term cognitive decline

Using a comprehensive hearing intervention designed, tested, and implemented by researchers at the University of South Florida, the multi-site ACHIEVE study examined the efficacy of hearing aids for reducing long-term cognitive decline in older adults.

Results from the largest randomized, controlled clinical trial testing the efficacy of hearing aids for reducing long-term cognitive decline in older adults were published July 18, 2023, in the journal Lancet, as well as reported for the first time at the Alzheimer’s Association International Conference® (AAIC®) 2023, held the same day, in Amsterdam, Netherlands.

Called the Aging and Cognitive Health Evaluation in Elders (ACHIEVE) study, the multisite study found that, in older adults at increased risk for cognitive decline, hearing intervention slowed down loss of thinking and memory abilities by 48% over three years.

While the results were negative in the total study population, the hearing intervention did slow cognitive decline by 48% in a study subset of older adults with mild to moderate hearing loss who are participating in an ongoing observational study of heart health. Investigators believe that the effect of the hearing intervention on reducing cognitive decline was only apparent in the group of participants from the heart health study because this group had nearly a 3-fold faster rate of cognitive decline over the study period than the healthy volunteers that enrolled in the trial. That much faster rate of decline allowed researchers to see the beneficial effects of hearing intervention on reducing this decline within the limited 3-year period of the study.

“The hearing intervention had a significant effect on reducing cognitive change within three years in the population of older adults in the study who are at increased risk for cognitive decline,” said Frank Lin, MD, PhD, of Johns Hopkins University School of Medicine and Bloomberg School of Public Health, and co-principal investigator of the ACHIEVE study. “Hearing loss is very treatable in later life, which makes it an important public health target to reduce risk of cognitive decline and dementia, along with other dementia risk factors such as less education in early life, high blood pressure, social isolation and physical inactivity.”

The overall ACHIEVE study was led by researchers at Johns Hopkins and seven additional contributing institutions. A team of researchers from USF led the hearing intervention provided in the study. From the Department of Communication Sciences and Disorders in the USF College of Behavioral and Community Sciences, Theresa H. Chisolm, PhD, professor and vice provost for Strategic Planning, Performance and Accountability, and Michelle Arnold AuD, PhD, assistant professor, collaborated with Victoria Sanchez, AuD, PhD, assistant professor in the Department of Otolaryngology in the USF Health Morsani College of Medicine. In designing the hearing intervention, the USF team also trained the study audiologists and continuously monitored the hearing intervention that was provided in the overall study.

“The ACHIEVE Study is evidence that auditory rehabilitation, including the use of hearing aids, in older adults who had more risk factors for cognitive decline slowed the rate of cognitive decline,” said USF Health’s Dr. Sanchez. “Important risk factors for cognitive decline and dementia that could be potentially addressed to help reduce dementia include hearing loss, less education in early life, smoking, diabetes, high blood pressure, social isolation, and physical inactivity. Addressing hearing loss is one way we could reduce the increase rate of older adults living with dementia.”

Established research shows that loss of hearing can increase a person’s likelihood of cognitive decline, she said, adding that further research is needed.

“Our main trial results shared today are exciting and informative, but much more research is still needed,” Dr. Sanchez said. “Our team of multi-institution investigators are continuing to follow all participants in the ACHIEVE study beyond three years to look at longer term effects of hearing intervention on cognition and other outcomes.”

This foundational work can also help guide policymakers, she said.

“Our results will hopefully create policy changes because in many parts of the world we need improved affordable access and insurance coverage for hearing treatment/intervention,” Dr. Sanchez said. “This does not mean just a hearing aid, as hearing intervention consists of two components. First are hearing aids and related hearing technologies, and second are the diagnostic and hearing care support services of an audiologist to guide the individual in using these hearing technologies to hear and communicate optimally.

“We recommend that people who have concerns about their hearing and their risk factors for cognitive decline discuss these concerns with their doctor and be seen by an audiologist to address their hearing and communication needs.”

The ACHIEVE study is a randomized trial of older adults aged 70-84 with untreated hearing loss who were free from substantial cognitive impairment, conducted at four study sites in the United States, and 977 total participants were recruited from two study populations: 238 adults participating in the Atherosclerosis Risk in Communities (ARIC) study, and 739 healthy community volunteers newly recruited to the study.

Reference: Lin FR, Pike JR, Albert MS, et al. 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. 2023:S014067362301406X. doi: 10.1016/S0140-6736(23)01406-X

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