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Mild Cognitive Impairment

The Acquired Hearing Loss and Cognitive Decline Connection

The silent shadows of acquired hearing loss are profound.

Key points

  • Hearing is part of our ability to relate with others.
  • The ways in which we compensate and adapt to hearing loss are often designed to hide our shame.
  • The internalization of social stigmas regarding hearing loss may result in negative connotations.

The ability to communicate is a door to our relatedness with others. Much of our shared experience is through listening and talking. However, if you are someone who cannot hear the verbal messages of those around you, let alone the birds singing, one of the doors to relatedness is closed.

Loved ones may express concern, frustration, or anger toward those who have difficulty hearing, as though the hearing-impaired individual isn’t listening, doesn’t participate in conversations, or doesn’t respond when addressed. Hearing aids are a solution, but for some people, wearing hearing aids is considered an admission of weakness, so they remain in their case, or an audiology exam is never scheduled in the first place.

How we compensate and adapt to hearing loss are interesting, yet often designed to hide our shame, as though hearing loss is something to be ashamed about. As such, some people with acquired hearing loss find ways to disguise their inability to hear. Imagine a person with limited auditory ability attending a gathering at a noisy restaurant. They may sit quietly or nod, creating a deceptive appearance of listening. At other times they may memorize talking points about various subjects, though they may not clearly or accurately hear responses upon presenting a topic. Nonetheless, they may be able to anticipate the responses based on their knowledge of the people at dinner. Unfortunately, their rejoinders may lack connection and true interaction, despite the appearance of participation. This strategy fails when a novel idea or a new topic emerges. In such situations, an inability to hear accurately may lead to withdrawal. Whatever the approach to social interaction might be for someone with an acquired hearing loss, the attempt to hide the shame of a hearing impediment becomes primary.

Internalizing social stigmas regarding hearing loss may result in several self-perceived negative connotations, such as incompetence and social disability (de Silva et al., 2023). As a result, the self-stigma of acquired hearing loss may lead to withdrawal, social segregation, and negative self-perception (de Silva et al., 2023). And yet the consequences of hearing loss are more profound than we may have imagined and may extend far beyond communication breakdowns and social isolation. In fact, hearing loss has been associated with cognitive impairment (de Silva et al., 2023).

Cognitive Impairment

The incidence of dementia is higher among people with age-related hearing loss (Su et al., 2017). The findings of a recent Johns Hopkins University School of Medicine study presented at the Alzheimer’s Association International Conference (AAIC) 2023 are very convincing. The study indicated that patients with risk factors for dementia experienced a 48 percent slowing of cognitive decline after using a hearing aid for 3 years. According to Frank Lin (2023), the study's principal investigator, treating hearing loss is a powerful tool to protect cognitive function in later life and delay a dementia diagnosis.

Although hearing loss has been associated with cognitive decline, the underlying mechanisms remain uncertain (Lin et al., 2013). One speculation is that a lack of stimulation and social engagement may result in brain atrophy since hearing-impaired individuals tend to withdraw, become less socially engaged, and retreat into themselves (Lin et al., 2013). However, some experts remind us not to associate correlation with causation in this matter. Although cognitive decline may occur in people with acquired hearing loss, this does not necessarily imply that hearing loss is instrumental in causing cognitive decline. For example, it is suggested that additional risk factors such as aging or microvascular disease may be necessary to activate the ongoing degenerative process in memory loss (Nadhimi & Llano, 2021).

Rejecting Hearing Aids

More than 20 years ago, the largest study conducted on the effects of untreated hearing loss found that the use of hearing instruments improved the quality of life in people with hearing loss, including cognitive functioning, emotional stability, and interpersonal relationships, among many other factors (National Council on the Aging, 1998). So why are people refusing to listen all these years later and continue rejecting the use of hearing aids?

Unfortunately, a loss of function can evoke shame in humans, which is an emotion that motivates us to hide. In doing so, we may withdraw into ourselves, find ways to avoid the issue, attack others, or attack ourselves (Nathanson, 1994). Yet the adaptive response is to take the opportunity to learn. In the case of acquired hearing loss, we may have to learn that we need assistance.

It’s not easy to acknowledge that our functioning has become limited. So, if you have a loved one who does not hear you, be mindful of their shame and preserve their pride when their lack of auditory acuity may trigger your own intense feelings. Make it possible to help them receive the available assistance without unnecessarily raising their anxiety about the association between hearing loss and dementia. Instead, motivate them to hear better so that they will think better (Blustein et al., 2023). Besides, they may want the thrill of again hearing the birds sing.


Blustein, J., Weinstein, B. E., Chodosh, J. (2023). It is time to change our message about hearing loss and dementia. J Am Geriatr; 1–4. doi:10.1111/jgs.18323

da Silva, J. C., de Araujo, C. M., Lüders, D., Santos, R. S., Moreira de Lacerda, A. B., José, M. R., & Guarinello, A. C. (2023). The self-stigma of hearing loss in adults and older adults: a systematic review. Ear and Hearing, 10.1097/AUD.0000000000001398. Advance online publication.

Lin, F. R., Yaffe, K., Xia J. et al. (2013). Hearing loss and cognitive decline in Older Adults. JAMA Intern Med.;173(4):293–299. doi:10.1001/jamainternmed.2013.1868

Lin, F. R. (2023) presented at the Alzheimer’s Association International Conference (AAIC) 2023.

Nadhimi, Y., and Llano, D. A. (2021). Does hearing loss lead to dementia? A review of the literature. Hearing Research, 402, 108038.

Nathanson, D. D. (1994). Shame and Pride: Affect, Sex, and the Birth of the Self. Norton.

National Council on the Aging (NCOA) (1998). The Impact of Untreated Hearing Loss in Older Americans. Conducted by the Seniors Research Group. Supported through a grant from the Hearing Industries Association. Preliminary report.

Su, P., Hsu, C. C., Lin, H. C., Huang, W. S., Yang, T. L., Hsu, W. T., Lin, C. L., Hsu, C. Y., Chang, K. H., & Hsu, Y. C. (2017). Age-related hearing loss and dementia: a 10-year national population-based study. European Archives of Oto-rhino-laryngology. 274(5), 2327–2334.

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