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Hearing Loss and Dementia: What the ACHIEVE Trial Really Found

Not yet expert-reviewed · Last updated October 29, 2026

Hearing Loss and Dementia: What the Research Really Says

Key takeaways

Hearing loss is common: about 1 in 3 Americans ages 65–74 has it, and nearly half of those over 75 have trouble hearing.[1]
Hearing loss is linked with faster memory and thinking decline. A link is not proof that one causes the other.[2]
In the ACHIEVE trial, hearing aids did not slow 3-year thinking decline in the whole group.[2]
In one higher-risk subgroup, the results suggest hearing care might help. This needs more research.[2]
Better hearing helps with safety, conversations, and staying connected—good reasons to get checked anyway.[1]
Related: Memory loss vs. dementia signs
Related: Loneliness and social isolation

What ACHIEVE tested

ACHIEVE was a U.S. randomized controlled trial published in The Lancet in 2023.[2]

Detail	What the study reported
Who	977 adults ages 70–84 with untreated hearing loss and no major thinking problems; average age 76.8
Where	4 community sites in the U.S.
Two groups	(1) Hearing care: audiology counseling + hearing aids; (2) Health education sessions
Main question	Did thinking scores change differently over 3 years?
Main result	No significant difference (difference 0.002 SD; p = 0.96)
Subgroup	Results differed between two recruited groups (p for interaction = 0.010)
Safety	No significant study-related harms in either group

Source for all rows: Lin et al., 2023.[2]

What the subgroup result means—and doesn't

The trial drew people from two sources:[2]

ARIC volunteers, from a long-running heart study. They were older, had more risk factors for decline, and lower starting scores.
New community volunteers, who were generally healthier.

The authors concluded hearing care might reduce 3-year thinking decline in people at higher risk, but not in lower-risk people.[2] This was a prespecified sensitivity analysis, not the main result.

Plain-English bottom line: Hearing aids are not proven to prevent dementia. They may help some higher-risk people. Get your hearing treated for the benefits we already know about.

Quick hearing self-check (from NIDCD)

NIDCD suggests getting checked if you answer "yes" to 2 or more or "sometimes" to 3 or more of these:[1]

Your options

Option	Good fit when	Notes
Over-the-counter (OTC) hearing aids	Perceived mild to moderate loss, adults	FDA created this category in 2022; no exam or prescription needed[1]
Hearing professional (audiologist, ENT)	Complex symptoms, OTC didn't work, trouble hearing loud sounds	NIDCD advises professional help in these cases[1]
Cochlear implant	Severe or profound loss	Surgical; evaluated by specialists[1]
Assistive devices	Phones, TV, places of worship	Amplified phones, apps, hearing loops[1]

See a doctor promptly for sudden hearing loss, ear pain, or hearing loss in only one ear.

FAQ

Do hearing aids prevent dementia?
Not proven. In ACHIEVE's main analysis, they did not slow thinking decline over 3 years.[2]

Is it still worth getting hearing aids?
Yes, for many people. Hearing well helps you follow a doctor's advice, hear smoke alarms, and enjoy time with family.[1]

Does Medicare pay for hearing aids?
See our guide to Medicare Advantage vs. Medigap and check your plan.

Sources

National Institute on Deafness and Other Communication Disorders. Age-Related Hearing Loss (Presbycusis). NIH/NIDCD. https://www.nidcd.nih.gov/health/age-related-hearing-loss. Accessed October 29, 2026.
Lin FR, Pike JR, Albert MS, et al. Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial. Lancet. 2023;402(10404):786-797. PMID: 37478886. https://pubmed.ncbi.nlm.nih.gov/37478886/. Accessed October 29, 2026.

Disclaimer

This article is for general education only and is not medical, legal, or financial advice. Talk to your doctor about your situation. In an emergency, call 911. If you or someone you love is in emotional crisis or thinking about suicide, call or text 988 (988 Suicide & Crisis Lifeline).

Attribution

Portions of this page are adapted from "HowToLiveBetter" (高性价比人生指南) by eternity4719, https://github.com/eternity4719/HowToLiveBetter, licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Changes: topic idea (hearing aids) adapted from Chapter 33; all content written fresh from NIDCD and the ACHIEVE trial; adapted and rewritten for the U.S. context (not a direct translation), and re-sourced to U.S. research and official guidance.

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Last updated October 29, 2026