Hearing Aids Did Not Reduce Dementia Progression in Mild Cognitive Impairment Trial: JAMA
China: Researchers have found in the CHOICE trial that hearing aids did not significantly reduce the incidence of dementia among people with mild cognitive impairment and hearing loss.
However, hearing aid use was associated with a higher rate of cognitive improvement as a secondary outcome. The study had a low rate of progression to dementia, limiting its statistical power and making further studies necessary to confirm these findings.
The study, published in JAMA Neurology, was led by Ying Chen, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China, and colleagues. The researchers evaluated whether hearing intervention could prevent progression from mild cognitive impairment (MCI) to dementia-level impairment in older adults with hearing loss.
Hearing impairment has been identified as a potentially modifiable risk factor for cognitive decline, but whether treating hearing loss can preserve cognitive function remains uncertain. The multicentre, open-label randomized clinical trial was conducted at three tertiary otology clinics and three community health stations in Shanghai between September 2021 and February 2024, with follow-up completed in February 2026.
Of 21,908 adults aged 60 years or older assessed for eligibility, 703 participants with MCI and moderate to severe hearing loss were enrolled. Participants had a mean age of 74.53 years, and 64.44% were men. They were randomly assigned to receive either hearing aid intervention (353 participants) or hearing care education (350 participants), with 610 participants completing the 24-month follow-up.
The primary outcome was conversion from MCI to dementia-level impairment, defined as a Clinical Dementia Rating (CDR) global score of 1 or higher. Cognitive improvement, defined as a CDR score of 0, was assessed as a prespecified secondary outcome.
The findings showed:
- Dementia-level impairment developed in 3.09% of participants receiving hearing aids compared with 4.74% in the hearing care–education group.
- The difference in dementia conversion was not statistically significant (risk difference, −2.07%).
- Cognitive improvement occurred in 15.34% of the hearing aid group compared with 2.36% of the control group.
- Hearing intervention was associated with a significantly higher rate of cognitive improvement (risk difference, 12.00%; relative risk, 5.94).
- No adverse events related to the study intervention were reported.
The researchers noted limitations, including the non-prespecified CDR 0.5 eligibility criterion, which may have introduced selection bias and limited generalizability. Reliance on the subjective CDR scale could have affected outcome assessment, while the lower-than-expected dementia conversion rate reduced statistical power. Health education in the control group and free hearing aids may also have influenced cognitive outcomes.
The authors concluded that hearing aid intervention did not significantly reduce dementia-level impairment over 24 months among older adults with hearing loss and MCI. However, the higher rate of cognitive improvement observed with hearing intervention warrants further investigation in adequately powered, longer-term trials.
Reference:
Chen Y, Shi H, Xiang M, et al. Hearing Intervention for Older Adults With Mild Cognitive Impairment: The CHOICE Randomized Clinical Trial. JAMA Neurol. Published online September 28, 2026. doi:10.1001/jamaneurol.2026.3395
Next Story