A large new clinical trial examining hearing aid use in older adults with both hearing loss and mild cognitive impairment (MCI) has produced an intriguing, though mixed, set of findings.
Hearing aids did not significantly reduce the number of participants who progressed to dementia-level impairment over two years—the study’s primary measure. However, participants who received hearing aids were considerably more likely to show cognitive improvement during the study.
The findings from the CHOICE randomized clinical trial were published September 28 in JAMA Neurology. The study included 703 adults age 60 and older in Shanghai, China, and adds to growing research examining the relationship between hearing treatment and cognitive health later in life.1
An accompanying editorial published in JAMA Otolaryngology–Head & Neck Surgery highlighted the importance of studying hearing intervention specifically in people who already have mild cognitive impairment.2
Studying Hearing Aids in People With Mild Cognitive Impairment
Mild cognitive impairment describes measurable changes in memory or thinking that are greater than expected with normal aging but do not necessarily interfere substantially with everyday independence. Some people with MCI eventually develop dementia, while others remain stable or improve.
For the CHOICE trial, researchers screened more than 21,000 adults and ultimately enrolled 703 participants with hearing loss and mild cognitive impairment. Their average age was about 75.
Participants were randomly divided into two groups. One group of 353 people received bilateral Widex Evoke hearing aids fitted by audiologists, along with ongoing adjustments and hearing aid support. The other 350 participants received hearing care education that included information about hearing loss, healthy lifestyles, chronic disease management and strategies aimed at maintaining cognitive health.1
Researchers followed the participants for two years to determine whether hearing aid treatment affected their cognitive trajectory.
Hearing Aids Did Not Significantly Reduce Progression to Dementia-Level Impairment
The study’s main question was whether hearing aids could reduce progression from mild cognitive impairment to dementia-level impairment.
After 24 months, 3.09% of participants in the hearing aid group had progressed to dementia-level impairment, compared with 4.74% of those receiving hearing care education.1
Although fewer participants in the hearing aid group progressed to dementia-level impairment, the difference between the groups was not large enough for researchers to conclude that hearing aids reduced the risk of progression during the two-year study.
“This trial demonstrated that among older adults with coexisting hearing loss and MCI, hearing aid intervention did not significantly reduce the dementia-level impairment incidence at 24 months as the primary outcome.”
That finding is important because the study does not establish that hearing aids prevent dementia in people with MCI.
But the researchers found something noteworthy when they looked at participants whose cognitive status improved.
More Participants Receiving Hearing Aids Showed Cognitive Improvement
Researchers used the Clinical Dementia Rating, or CDR, to track participants’ cognitive and functional status. The scale considers areas such as memory, orientation, judgment and problem-solving, activities in the community, hobbies and personal care.
Everyone entered the study with a CDR score of 0.5, representing the level of impairment used by the researchers to identify the study’s MCI population. A score of 0 indicates no measurable impairment on the scale.
After two years, 15.34% of participants receiving hearing aids had improved from a CDR score of 0.5 to 0, compared with 2.36% of participants in the hearing education group.1
Put another way, roughly one in six participants in the hearing aid group improved to a CDR score considered unimpaired, compared with about one in 42 in the comparison group.
The researchers also examined the individual areas measured by the CDR. The clearest difference between the groups was seen in memory. Differences in orientation, judgment and problem-solving, community activities, hobbies and personal care were less clear.1
Importantly, cognitive improvement was a secondary outcome rather than the study’s primary measure. That means the finding is encouraging, but it should not be interpreted as definitive evidence that hearing aids improve cognition.
“A prespecified secondary analysis demonstrated a higher rate of cognitive improvement (CDR from 0.5 to 0) in the intervention group; however, this exploratory finding warrants cautious interpretation and further investigation.”
Adding to the Evidence on Hearing and Cognitive Health
The CHOICE trial adds to a growing body of research examining whether treating hearing loss can influence cognitive health.
One of the most closely watched studies in this area has been the ACHIEVE randomized trial, which studied older adults with hearing loss who did not have substantial cognitive impairment when they entered the study.
ACHIEVE did not find that hearing intervention slowed cognitive decline across its overall study population. However, researchers observed a 48% reduction in the rate of cognitive decline among a prespecified group of participants who entered the trial with more risk factors for cognitive decline.3
CHOICE approached the question differently by specifically enrolling people who already had mild cognitive impairment along with hearing loss.
The results add to evidence suggesting that the relationship between hearing treatment and cognition may be more complicated than whether hearing aids simply “prevent dementia.” Improving access to sound could potentially influence communication, social engagement, cognitive stimulation and other factors connected with cognitive health, although researchers are still working to understand these relationships.
Why the Results Need to Be Interpreted Carefully
Several factors are important when considering what the CHOICE results mean.
One of the biggest was that fewer participants progressed to dementia-level impairment than researchers expected when the trial was designed. Because relatively few people reached the study’s primary endpoint, it became more difficult to determine whether the difference between the hearing aid and education groups represented a true effect.1
Two years may also be a relatively short period for evaluating progression to dementia. The researchers noted that longer follow-up could be important for understanding whether hearing treatment influences cognitive outcomes over time.
Hearing aid use also varied. Participants in the intervention group wore their devices for an average of about 5.9 hours per day. The researchers noted that this was lower than daily use reported in the ACHIEVE trial and suggested that memory difficulties among people with MCI may make consistent hearing aid use more challenging.1
There are also questions about how broadly the findings can be applied. The trial was conducted entirely in China, and more than 90% of participants lived with family members. The researchers noted that language, family support and differences in hearing aid adoption could potentially influence outcomes, making additional studies in other populations important.1
Another consideration involves how mild cognitive impairment was defined. Researchers used a CDR score of 0.5 to identify the study population, but that score is not the same as a comprehensive clinical diagnosis of MCI. The authors acknowledged that this approach resulted in a more specific study population and may limit how broadly the findings can be applied to other people diagnosed with MCI.1
What the Study Means for Hearing Care
The CHOICE trial does not show that hearing aids prevent dementia. Its primary outcome—progression from MCI to dementia-level impairment—was not significantly different between the two groups after two years.
At the same time, the substantially higher percentage of hearing aid users who improved from a CDR score of 0.5 to 0 provides an important signal for researchers to investigate further.
The findings also reinforce an important distinction in conversations about hearing and cognitive health: hearing aids are an established intervention for hearing loss and can improve access to communication, even while their potential role in altering the course of cognitive decline remains under investigation.
“The hearing aid is an important intervention for hearing loss, and thus, for communication improvement, even if its effect on dementia prevention among individuals with MCI remains uncertain.”
Longer studies and trials involving more diverse populations will be needed to determine whether the cognitive improvement observed in CHOICE can be replicated and whether hearing treatment can meaningfully influence longer-term cognitive outcomes.
References
1. Chen Y, Shi H, Xiang M, et al. Hearing Intervention for Older Adults With Mild Cognitive Impairment: The CHOICE Randomized Clinical Trial. JAMA Neurology. Published online September 28, 2026. doi:10.1001/jamaneurol.2026.3395.
2. Wang RM, Sanchez VA, Golub JS. Treating Hearing Loss and Improved Mild Cognitive Impairment. JAMA Otolaryngology–Head & Neck Surgery. Published online September 28, 2026. doi:10.1001/jamaoto.2026.3413.
3. 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. doi:10.1016/S0140-6736(23)01406-X.
