Hearing Aids Slash Cognitive Improvement Rate Sixfold in Older Adults With MCI
A 703-person RCT finds hearing aids nearly 6x more likely to reverse mild cognitive impairment than education alone over 24 months.
Summary
The CHOICE trial enrolled 703 older adults in Shanghai who had both mild cognitive impairment (MCI) and moderate-to-severe hearing loss, randomizing them to hearing aids or hearing care education for 24 months. While hearing aids did not significantly reduce the rate of conversion to full dementia — the primary endpoint — a striking secondary finding emerged: 15% of the hearing aid group showed cognitive improvement (returning to normal CDR scores) versus only 2.4% in the control group, nearly a sixfold difference. The trial was well-powered and multisite, and no adverse events were reported. These results suggest that treating hearing loss in people with MCI may help reverse early cognitive decline, even if the two-year window was insufficient to demonstrate a dementia-prevention effect.
Detailed Summary
Hearing loss is one of the largest modifiable risk factors for dementia identified by the Lancet Commission, yet whether treating it can actually protect cognition in people already showing early decline has remained unresolved. The CHOICE trial was designed to answer that question directly in a population with the highest potential benefit: older adults who already have both hearing loss and mild cognitive impairment (MCI).
The multicenter, parallel-group, open-label randomized clinical trial enrolled 703 adults aged 60 and older (mean age 74.5 years; 36% female, 64% male) across six sites in Shanghai between 2021 and 2024. Participants were randomized 1:1 to receive fitted hearing aids or hearing care education only, with follow-up at 24 months. The primary outcome was conversion from MCI to dementia-level impairment, defined by a Clinical Dementia Rating (CDR) global score of 1 or more.
The primary outcome did not reach statistical significance: conversion to dementia occurred in 3.1% of the hearing aid group versus 4.7% of controls (relative risk 0.59; 95% CI 0.25–1.38; P = .23). However, a prespecified secondary analysis revealed a dramatic difference in cognitive improvement — defined as a return to a CDR score of 0. Fully 15.3% of the hearing aid group improved versus only 2.4% of controls, a relative risk of nearly 6 (RR 5.94; 95% CI 2.46–14.37).
These findings carry important clinical implications. The trial was likely underpowered to detect a dementia-prevention effect over just 24 months given the low absolute conversion rates observed, but the reversal-of-MCI signal is compelling and biologically plausible — restored auditory input may reduce cognitive load and support neural plasticity. For clinicians, the message is actionable: audiological screening and hearing aid fitting in MCI patients may meaningfully improve cognitive trajectory.
Caveats include the open-label design (blinding was not possible), the Chinese single-country population limiting generalizability, and the abstract-only availability of full methodological detail. Whether the MCI reversal effect translates into sustained dementia prevention with longer follow-up remains to be established.
Key Findings
- Hearing aids did not significantly reduce dementia conversion at 24 months (3.1% vs 4.7%; P = .23).
- Hearing aid users were nearly 6x more likely to show cognitive improvement (CDR reverting to 0) than controls.
- Cognitive improvement rate: 15.3% with hearing aids vs only 2.4% with education alone.
- No study-related adverse events were reported across 703 participants.
- Trial was underpowered for dementia prevention given low observed conversion rates over 24 months.
Methodology
Multicenter, parallel-group, open-label RCT conducted at six sites in Shanghai (September 2021–February 2026). 703 adults aged 60+ with coexisting MCI (CDR 0.5) and moderate-to-severe hearing loss were randomized 1:1 to hearing aids versus hearing care education, with 24-month follow-up. Primary outcome was conversion to dementia (CDR ≥1); secondary outcomes included CDR reversal to 0.
Study Limitations
The open-label design introduces performance and assessment bias since blinding participants to hearing aid use is not feasible. The study was conducted exclusively in Shanghai and may not generalize to other populations or hearing aid fitting practices. This summary is based on the abstract only, so full methodological details, subgroup analyses, and adherence data are unavailable.
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