Research explainer
What Hearing Aids Changed in Two Trials of Cognitive Aging
The CHOICE and ACHIEVE trials asked different questions about cognition. Everyday communication showed a clearer benefit than dementia prevention.
Two years in Shanghai
Could treating hearing loss change how often an older adult with mild cognitive impairment progresses to more substantial difficulty? In September 2026, researchers in Shanghai reported an answer from the CHOICE trial. They enrolled 703 adults who already had mild cognitive impairment and moderate to severe hearing loss. By random assignment, one group received a hearing aid intervention and the other received education about hearing care. After two years, about three in a hundred in the first group and five in a hundred in the second reached the study’s threshold for dementia-level impairment. The difference was too uncertain to establish a preventive effect.
Movement in the other direction
The investigators used a clinical rating scale, which allowed them to ask a second question. How many people moved from mild impairment to a score of zero? More participants receiving hearing aids reached that score, about 15 percent compared with 2 percent receiving education. That finding merits attention on its own terms. The study had separate measures for improvement and for progression. A treatment could help some people perform better on an assessment while researchers still have too few cases of progression to determine whether it prevents them. A change on a rating scale also leaves open the question of how long the improvement lasts.
Why another trial produced a much-quoted percentage
In the US ACHIEVE trial, researchers enrolled 977 people aged 70 to 84 who had untreated hearing loss but no substantial cognitive impairment. Over three years, average changes in a combined thinking and memory score were nearly identical between the hearing care and health education groups. A planned comparison looked separately at 238 participants recruited through a long-running heart health study. In that group, which had more risk factors at entry, the score declined about 48 percent more slowly with hearing care. The figure describes the pace of change on tests in one group. Using it to predict an individual’s chance of developing dementia would change both the population and the outcome being measured.
A result people can hear in daily life
ACHIEVE participants also answered questions about the communication difficulties they experienced. Those offered hearing aids and audiological counseling reported improvement relative to the education group by six months, and the difference persisted through year three. For a person who keeps losing the thread of a family meal or missing a question at an appointment, that outcome matters in its own right. It gives a conversation about hearing care a concrete starting point even while the evidence about longer-term cognitive protection remains unsettled.
Sources & references
- Chen and colleagues, the CHOICE randomized clinical trial
- Lin and colleagues, the ACHIEVE randomized trial
- Sanchez and colleagues, communication outcomes in ACHIEVE
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