Treating hearing loss may help some people regain cognitive and functional capacity, suggest data from a recent trial in China, detailed in JAMA Neurology, reports MedPage Today.
A hearing aid intervention did not reduce dementia incidence among people with mild cognitive impairment and hearing loss in the CHOICE trial, but a secondary outcome suggested that it may have increased the rate of cognitive improvement, the researchers concluded.
The primary outcome was the conversion rate from mild cognitive impairment to dementia based on Clinical Dementia Rating (CDR) scores, which was 3.09% in the intervention group and 4.74% in the control group. The risk difference was -2.07% and the relative risk (RR) was 0.59 (P=0.23), reported Hao Wu, MD, PhD, of the Shanghai Jiao Tong University School of Medicine in China, and co-authors.
The rate of cognitive improvement, however, was 15.34% in the intervention group and 2.36% in the control group, suggesting a nearly six times greater chance of improvement for people who received hearing aids (RR 5.94, P<0.001), the researchers noted.
“These findings suggest that treating hearing loss may help a meaningful minority of older adults with mild cognitive impairment regain everyday cognitive and functional capacity, and not simply slow decline,” Wu told MedPage Today.
“Because the observed 24-month conversion rate was substantially lower than we anticipated, the primary outcome was underpowered. Therefore, the null primary result should be read as ‘not proven’, rather than ‘no benefit’,” he added. “Meanwhile, the secondary outcome provided a signal that the rate of cognitive improvement was markedly higher in the intervention group than in the control group.”
Hearing loss is considered a key modifiable risk factor for dementia. In 2023, the ACHIEVE trial – the first study to evaluate a hearing intervention to prevent cognitive decline – reported no overall treatment effect after three years among cognitively intact older adults.
In ACHIEVE, an analysis of a high-risk subgroup demonstrated a significant 48% relative reduction in cognitive change for people who received the hearing intervention, observed Justin Golub, MD, MS, of Columbia University Irving Medical Centre in New York City, and co-authors in a JAMA Otolaryngology – Head & Neck Surgery editorial.
“ACHIEVE thus substantiates the significant secondary outcome of CHOICE … where all participants had mild cognitive impairment at randomisation and were therefore at high risk for cognitive decline,” the editorialists wrote.
The “surprisingly giant effect size” of the secondary outcome in CHOICE requires replication, particularly in light of the null primary outcome finding, but “altogether, these findings suggest that intervention with hearing aids may have an important protective effect for older adults at increased risk of cognitive decline, which is not observed among lower-risk counterparts”, Golub and colleagues noted.
CHOICE was conducted from 2021 to 2026 at three tertiary otology outpatient clinics and three CHOICE cohort community health stations in Shanghai. The study enrolled 703 older adults with moderate-to-severe hearing loss and co-existing mild cognitive impairment, defined as a CDR global score of 0.5.
The sample size was based on preliminary data from a pilot study and published research of dementia conversion rates, which showed that dementia-level impairment developed in 10% of hearing aid users with mild cognitive impairment and 18% of non-users, the researchers said.
CHOICE participants had a mean age of 74.5 and 64% were men. All were randomised to receive either a hearing aid intervention (353 people) or hearing care education (350 people).
The trial’s primary outcome was the conversion rate from mild cognitive impairment (CDR global score of 0.5) to dementia-level impairment (CDR global score of 1) over 24 months. CDR global scores can range from 0 (normal cognition) to 3 (severe dementia). Prespecified secondary outcomes included the rate of cognitive improvement from a CDR global score of 0.5 to 0.
The study had several limitations, Wu and co-authors acknowledged. The eligibility criterion of a CDR score of 0.5 was not prespecified in the protocol or trial registration, which may have introduced potential selection bias. Relying on the subjective CDR scale for both screening and outcomes also may have introduced evaluation bias.
“Hearing aids have well-established benefits for communication, social engagement, and quality of life, regardless of any effect on cognition,” Wu said. “What CHOICE adds is a signal that, over two years and in this population, hearing intervention was associated with a substantially higher rate of cognitive improvement from mild cognitive impairment back to a CDR of 0.
“This finding is exploratory and needs confirmation, but it indicates that hearing treatment deserves more attention in this population,” he added.
Study details
Hearing Intervention for Older Adults With Mild Cognitive Impairment: CHOICE Randomised Clinical Trial
Ying Chen, Haibo Shi, Mingliang Xiang et al.
Published in JAMA Neurology on 28 September 2026
Importance
Hearing loss is a significant modifiable risk factor for cognitive decline, but the effectiveness of hearing intervention for cognition stabilisation or improvement still remains controversial.
Objective
To investigate whether hearing intervention could reduce dementia-level impairment incidence in older adults with co-existing hearing loss and mild cognitive impairment (MCI).
Design, Setting, and Participants
This multicentre, parallel-group, open-label randomised clinical trial was conducted between September 2021 and February 2024, with the 24-month follow-up completed in February 2026. This study was conducted at three tertiary otology outpatient clinics and three CHOICE cohort community health stations in Shanghai, China. Of 21 908 adults aged 60 or older assessed for eligibility, 703 participants with co-existing MCI (Clinical Dementia Rating [CDR] global score of 0.5) and moderate to severe hearing loss were enrolled and randomised. These data were analysed from February 2026 to July 2026.
Interventions
Participants were randomised 1:1 to receive either hearing aid intervention (n = 353) or hearing care education (n = 350).
Main Outcomes and Measures
The primary outcome was the conversion rate from MCI to dementia-level impairment over 24 months, defined as a CDR global score 1 or more. Key prespecified secondary outcomes comprised rate of cognitive improvement (CDR = 0) and CDR global and domain scores.
Results
Among 703 randomised patients (mean [SD] age, 74.53 [7.16] years; range, 60-96 years; 250 female [35.56%] and 452 male [64.44%]), 610 (86.77%) completed the trial. No significant difference was observed in the primary outcome, in which the conversion rate from MCI to dementia-level impairment was 3.09% (95% CI, 1.62%-5.74%) in the intervention group vs 4.74% (95% CI, 2.60%-8.29%) in the control group (risk difference [RD], −2.07%; 95% CI, −4.74% to 0.61%; relative risk [RR], 0.59; 95% CI, 0.25-1.38; P = .23). Meanwhile, prespecified secondary analysis demonstrated that hearing intervention increased the rate of cognitive improvement (15.34%; 95% CI, 11.84%-19.62% vs 2.36%; 95% CI, 0.99%-5.22%; RD, 12.00%; 95% CI, 8.79%-15.21%; RR, 5.94; 95% CI, 2.46-14.37). No study-related adverse events were reported.
Conclusions and Relevance
In this study, among older adults with mild cognitive impairment and co-existing hearing loss, a hearing aid intervention did not significantly reduce the incidence of dementia-level impairment at 24 months.
MedPage Today article – Unexpected Cognitive Improvement Emerges in Hearing Aid Trial (Open access)
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