World Alzheimer’s Day – a key part of World Alzheimer’s Month – is bringing focus on the 2024 theme ‘Time to act on dementia, time to act on Alzheimer’s’. 

In the past year, there’s been a substantial rise in conversations around the possible links between hearing loss and dementia risk, with recent weeks seeing new campaigns launched around the apparent connections. It’s a hotly debated topic, with evidence to suggest that hearing loss is one of the leading risk factors of dementia, as well as concerns that studies aren’t substantial enough to provide conclusive evidence yet.

Here, to coincide with World Alzheimer’s Day, we’re exploring both sides of the coin as well as considering where – as an industry – we can go from here.

What does the research say about the links between hearing loss and dementia?

The recent 2024 Lancet study on dementia prevention, intervention and care found that the evidence connecting hearing loss and risk of dementia is getting stronger and that tackling hearing loss could therefore reduce a person’s potential for developing dementia. This research has – this month – formed the basis of a campaign between Alzheimer’s Society and Hidden Hearing, which claims that mild hearing loss doubles your risk of dementia, while moderate triples it and severe increases it by up to five times. It also says that out of 14 modifiable risk factors that can impact your chances of developing dementia, hearing loss plays the biggest role.

In 2023, Alzheimer’s Research UK launched its Think Brain Health Check-in, which highlighted hearing loss as one of the risk factors for dementia that people may have the ability to influence. It was reported that up to 40% of dementia cases could be prevented if 12 risk factors for dementia, which included hearing loss, were to be fully addressed.

Dr Susan Mitchell, Head of Policy at Alzheimer’s Research UK, said: “While there’s no sure-fire way to prevent dementia, which is caused by a complex mix of our age, genes and lifestyle, we know that there are steps we can all take that could reduce our risk. These include getting our hearing checked. Research has shown that people with unaddressed hearing loss are five times more likely to develop dementia than those without hearing loss. While we still need more research to fully understand the link between hearing loss and dementia, we’d encourage anyone who has concerns about their hearing to seek support.”

Alongside the study, a YouGov poll commissioned by Alzheimer’s Research UK showed that 35% of people surveyed had concerns about their hearing, but more than half (59%) of these people said they were yet to do anything about those concerns. Another study from Johns Hopkins University found that those with hearing impairments who wore hearing instruments had a 32% lower prevalence of dementia. Reasons for this could include an increased confidence and interest in going out and socialising with other people (and in activities) which engage the brain.

“Hearing loss can make the brain work harder as it strains to fill in the gaps – this, unsurprisingly, comes at the expense of other cognitive functions. While we cannot solve hearing loss, we can treat and improve it. By getting their hearing checked and having hearing instruments fitted, individuals will not have to push their brain as much, which could potentially jeopardise their memory systems,” said Paul.

What is the case against the research connecting dementia and hearing loss?

Although there is a significant buzz around the impact of untreated hearing loss on cognitive decline, a 2024 article published in the Ear and Hearing Journal challenged existing research by saying that while there is some evidence to link hearing ability and cognitive function, it isn’t sufficient enough to make such considerable claims. The article suggested that by leaning into these links, audiologists and hearing instrument manufacturers could find themselves shifting into a scare tactics method of messaging compared to positive messaging focused on the overall benefits of addressing hearing loss.

This presents us as an industry with a real challenge – do we push the connections or do we shift away from them? Paul Surridge, BIHIMA Chairman, said: “Although we agree that we do not want hearing loss messages lost to dementia fears, we do think it’s important that people are aware of the risks. We know, for example, that social isolation can contribute to a person’s risk of developing dementia. We also know that untreated hearing loss can lead to isolation and loneliness.

“We continue to listen carefully to every voice in this discussion, but we do strongly believe that any well managed message that draws people’s attention to understanding, treating and preventing hearing loss is a positive thing.

“Which begs the question – how do we manage this message in the best possible way? There is clearly a need for more research and conversation in this area before we can find a solution that doesn’t risk misinforming or confusing people.”

Hearing loss and dementia | How do we move forward from here?

Conversations around hearing loss and dementia must be carefully managed. While it is clear that hearing loss has an enormous impact on a person’s ability to socialise and communicate, which in turn can lead to cognitive decline, there is still a need for ongoing research to further examine the link between hearing loss and dementia and maximise the number of people booking regular hearing tests.

“With more data on a larger, international level, the hearing and health industry can make a stronger case for increasing funding into health campaigns, improving access to hearing tests and ensuring the journey to having a hearing instrument fitted is easier and smoother,” said Paul.

“The entire process, however, must be done in a way that doesn’t detract from the need to treat hearing loss for its own sake. Untreated hearing loss can have a range of effects on a person’s life and it is imperative that the hearing health industry puts emphasis into the overall benefits of treating hearing loss for its own sake – not just to mitigate the risk of dementia.” 

Some of the responses in our 2023 audiologist survey suggested that using a ‘scare tactic’ of motivating people to seek help for hearing loss by linking it to the risk of dementia could actually make people less likely to engage in the message being communicated. The argument is that linking hearing loss to dementia risks could reinforce stigma.

In addition, while there is a lack of consensus around whether hearing instruments can actually reduce cognitive decline, it is irrefutable that they do support independent functions in daily life which, consequently, can reduce a person’s risk of dementia.

“We believe that the benefits of treating hearing loss in improving a person’s ability to independently function, be an active member in society and enhance their ability to communicate are incredibly important to share. These are all important factors of a person’s wellbeing while also contributing to cognitive function. We don’t want the narrative around dementia to be lost entirely and we must work collectively as an industry to ensure it is accurately portrayed,” concluded Paul.

If you work in audiology and want to share your thoughts on the possible links between hearing loss and dementia, take part in the 2024 BIHIMA Audiologist Survey.