Protocol · graded by use, three uses
Hearing aids with audiological counseling, for cognitive decline
Cognitive decline over 3 years in older adults with hearing loss at higher risk of decline.
Grade C: human trials exist, but they are small, mixed or not yet repeated. This is not a finding that it does not work. How to read a grade →
At a glance
This is about getting hearing aids, with counseling, to slow memory and thinking decline. One large trial gave hearing aids to people aged 70 to 84 with hearing loss for three years. Overall, their thinking declined at the same rate as people who got health classes instead. In the group at higher risk of decline, it declined more slowly, but no second trial has checked that yet. In people who already had Alzheimer's disease, a small trial found no change.
- What was measured
- Change over 3 years in overall thinking ability on a full set of memory and thinking tests.
- How big
- Overall, thinking declined by almost exactly the same amount in both groups over 3 years. In the higher risk group drawn from a long-running heart study, the effect differed, but the summary does not give its size.Read from the summary of PMID PubMed ID: the permanent number the US National Library of Medicine gives a published paper. Each one links to that paper's record on PubMed. 37478886.
- Who it applies to
- 977 adults aged 70 to 84 with untreated hearing loss and no major memory problems; the C covers the older, higher risk subgroup.
- Safety
- The trial reported no serious harmful events from the hearing program or the health education.
- Compared with
- Health education sessions with a health educator.
- Certainty
- Grade C, resting on: Randomized trials: one large multicenter trial with a prespecified subgroup analysis, one small trial in Alzheimer's disease.
- What would change this grade
- Could rise to B with: Randomized trial of hearing aids with audiological counseling against an attention-matched control, run by a group independent of ACHIEVE, with cognitive testing done blind to group. Who: Adults aged 70 and over with untreated hearing loss and raised risk of cognitive decline, defined at entry, at least 400 per arm. Measured: 3-year change in global cognition on a full neurocognitive battery, with incident dementia counted. Length: At least 3 years.
- Cost
- No price recorded yet.
- Sources
- 4 studies cited on this record, listed under Sources.
The C belongs to one of the three uses graded on this record. The other two carry their own letters.
This record carries a separate letter for each thing it has been measured on. The headline grade is the best of them, and it does not transfer to the others.
A prespecified sensitivity analysis of ACHIEVE (PMID 37478886) found slower 3-year decline with the hearing intervention in the older, higher-risk ARIC cohort and none in the healthier volunteers (p for interaction 0.010); a secondary analysis of the same trial (PMID 40369891) found 61.6% slower decline in the top quartile of predicted risk. One trial's subgroup, not independently repeated: C.
The primary analysis of ACHIEVE (PMID 37478886) found no difference in 3-year cognitive decline between hearing intervention and health education across all 977 participants. Tested, no benefit: D on Route 2 Human randomized trials have been run and did not show benefit on the stated outcome. One of the two routes to the lowest letter on EBL's scale..
Nguyen et al. (PMID 28387664) gave active or placebo An inactive substitute made to look like the real treatment, so participants cannot tell which one they received. hearing aids for 6 months; ADAS-Cog changed by 1.8 versus 1.3 points (p=0.8). Tested, no benefit: D on Route 2.
Hearing loss is linked with faster cognitive decline in observational Research that watches what people already do rather than assigning a treatment. It can show that two things travel together, not that one causes the other. studies, and it is one of the largest modifiable dementia risk factors named by the 2024 Lancet Commission. The one large randomized trial, ACHIEVE, gave hearing aids and counseling to 977 adults aged 70 to 84 for three years and found no difference in cognitive decline overall. A prespecified analysis found slower decline in the participants at higher risk, which no second trial has yet tested. Graded by use.
Why this letter
Why this gradeGrade C, small or unreplicated trials. The reasoning, and what the grade does not cover.
Grade C on 3-year cognitive decline in older adults with hearing loss at higher risk of decline: a prespecified sensitivity analysis of one large randomized trial (ACHIEVE; Lin et al., 2023; PMID 37478886) found slower decline in the higher-risk cohort, and a secondary analysis of the same trial agrees (Pike et al., 2025; PMID 40369891).
WHY NOT Bit is one trial's subgroup, and no second independent trial has tested it.
WHAT THIS GRADE DOES NOT COVERolder adults at average risk, where the same trial's primary analysis found no difference (D, tested); people who already have Alzheimer's disease (D, tested); and hearing aids for hearing itself, communication or quality of life, graded on their own record (hearing aids for age-related hearing loss, B).
A grade describes the human evidence for a named use. It is not advice, and it is not a judgment on any individual prescription. How the letters are decided →
Trials report an average. This box says whether any trial on this record looked at who the result applies to, and what it found.
For this record's Grade C · Subgroup tested, effect differedACHIEVE (Lin et al., Lancet, 2023; PMID 37478886) found the effect differed between its two recruited populations (p for interaction 0.010), with slower decline only in the older, higher-risk ARIC cohort; Pike et al. (2025; PMID 40369891) found 61.6% slower decline in the top quartile of predicted risk. A subgroup result shows who the effect appeared in within these trials. It does not change the letter.
Evidence notes: randomized trial
Endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score. graded: 3-year change in global cognition on a full neurocognitive battery (functional)
Last reviewed: October 2026
The trial that would change this grade.
A positive trial of this shape, supported by further trials, would move this entry to B.
Why the current trials fall short
The C rests on a subgroup of one trial whose overall result was null. A second, independent trial enrolling the higher-risk group from the start is what is missing.
ClinicalTrials.gov, the public registry run by the U.S. National Library of Medicine, lists studies that are recruiting volunteers. The link below searches it for Hearing Aids among studies recruiting now. EBL has no relationship with any listed study and receives no payment for this link.
Search recruiting studies of Hearing Aids on ClinicalTrials.gov
Dose, form and timing
Measured outcome in the graded trial: a global cognition factor score from a full neurocognitive battery, at baseline and over 3 years, with hearing-aid use recorded. A hearing test (pure-tone average) defines eligibility.
As studiedDose, form, population and duration for every use.
A grade describes the intervention that was tested. Where the product on the shelf differs from it, this says so.
Safety
No safety data. Each caution on this record, sorted by what it rests on.
None recorded.
None recorded.
None recorded.
None recorded.
No safety data: EBL has found no trial or report of harm for this record. That is an absence of evidence, not a finding of safety.
Grade history
How this letter has changedLatest: No. 380 · October 2026 · First graded.
Hearing loss is one of the largest modifiable dementia risk factors in observational research, and it now has its own record. The ACHIEVE trial gave hearing aids and audiological counseling to 977 adults aged 70 to 84 for three years and found no difference in cognitive decline overall (Lin et al., 2023; PMID 37478886): D, tested, no benefit. A prespecified analysis found slower decline in the participants at higher risk, and a secondary analysis of the same trial agrees (Pike et al., 2025; PMID 40369891): C, one trial's subgroup, not yet repeated. A small trial in people with Alzheimer's disease found no change in 6 months (Nguyen et al., 2017; PMID 28387664): D, tested. Applied the written grade definitions under the editor's standing instruction of October 2026 (Arnold Sandlow, D.C.).PMID 37478886 PMID 40369891 PMID 28387664
Every change to a letter on this site is dated and published. The full evidence log →
Sources
- Citations
- Every paper cited on this page is matched to its PubMed record on every build.
- Retractions
- None of these papers is retracted or under a journal expression of concern. PubMed is checked again on every build.
- Read against the papers
- October 2026. By the EBL editor, Arnold Sandlow, DC.
- Outside review
- Not yet done. No reviewer outside EBL has checked this record.
What each of these checks can and cannot show: evidence integrity.
The evidence, in fullFour papers, each linked to its PubMed record.
ACHIEVE (Lin et al., Lancet, 2023; PMID 37478886): multicenter randomized trial, 977 adults aged 70 to 84 with untreated hearing loss and without substantial cognitive impairment, hearing intervention (audiological counseling and hearing aids) versus health education, 3 years. Primary endpoint The one outcome a trial names in advance as its main test. Results on other outcomes carry less weight., 3-year change in a global cognition factor score from a full neurocognitive battery: no difference (-0.200 versus -0.202 SD; difference 0.002, 95% CI -0.077 to 0.081; p=0.96). A prespecified sensitivity analysis found the effect differed between the two recruited populations (p for interaction 0.010): slower decline in the older, higher-risk ARIC cohort and none in the healthier volunteers. Pike et al. (Alzheimers Dement, 2025; PMID 40369891), a secondary analysis of the same trial, applied a risk model built in ARIC and found 3-year decline 61.6% slower with the hearing intervention in the top quartile of predicted risk. Nguyen et al. (J Alzheimers Dis, 2017; PMID 28387664): double-blind Neither the participants nor the people assessing them know who received the real treatment until the trial ends. trial of active versus placebo hearing aids in 51 people with Alzheimer's disease and hearing loss; no difference in ADAS-Cog at 6 months. Mulrow et al. (Ann Intern Med, 1990; PMID 2197909): 194 older veterans randomized to a hearing aid or a waiting list; at 4 months social, emotional and communication function and a short cognitive screening score improved; a 4-month change on a screening questionnaire, not a decline outcome, and no letter rests on it. Funding and conflicts: ACHIEVE was funded by the US National Institutes of Health; Sonova/Phonak donated the hearing technology and several investigators report industry relationships, stated in the paper.
How EBL searched for the trials (1 search)
The search that was run, what it returned, and what was left out and why, so the absence of evidence can be checked as well as its presence.
(hearing aid*[tiab] OR "hearing intervention"[tiab] OR "hearing rehabilitation"[tiab] OR cochlear implant*[tiab]) AND (cognit*[tiab] OR dementia[tiab]) AND randomized controlled trial[pt]PubMed watch: does a new study change the grade? (nothing new)
No new paper matching the search behind this grade has been added to PubMed since October 2026.
Last run October 2026. A letter on EBL moves only after a logged review. A new paper never moves a letter by arriving: it is read, the answer is written here, and any change to the letter is published in the evidence log.
Disclosure
Educational use only · Not medical advice · EBL grades published human evidence and does not recommend treatment. Stopping a prescription is a decision for your physician.
Evidence Based Longevity, Inc. is owner-operated and edited by Arnold Sandlow, D.C., a California-licensed chiropractor. Evidence Based Longevity publishes in English only · Machine translations are not produced or reviewed by EBL for accuracy
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These statements have not been evaluated by the Food and Drug Administration. Any grade on this page describes the strength of published human trial evidence in the populations studied. It is not a recommendation for any individual and is not medical advice. Starting, stopping or changing any supplement or medication is a decision for your physician.
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