My Costco visit; Do I listen to them or to audiologists?

@user990 said:

I don’t think there is one cause for dementia. It’s a combination of multiple things including hearing loss.

I fully agree. There is no one cause for dementia. I think it may be partially genetic, environmental, diet, personality etc.

The point I was trying to make is that hearing loss does not cause dementia - rather the social isolation is far more likely the actual cause. In short there is an issue of correlation does not equal causation. I think that hearing aid dispensers are jumping on this to push sales

I don’t think we can say that social isolation causes dementia. At best, we can say there is some correlation that seems to suggest that when combined with the other correlations there is an increased risk of dementia.

However, I do agree that being deaf does not cause dementia.

@Roberto said:

I think that hearing aid dispensers are jumping on this to push sales

Perhaps, however, it would seem to bad practice not to mention that there is some correlation that not being able to hear well enough to carry on a conversation with an increase risk of dementia.

As you can read right here, there is two difference points of view. One says yes get hearing aids and the other says only get hearing aids if you are missing parts of a conversation.

The Costco fitter is probably thinking that this person will not experience enough benefit from getting hearing aids and will just return the hearing aid for a refund.

@Neville said:

Are you having functional difficulties yet? If yes, try hearing aids. If not, you can leave it for now.

That works unless one is in denial about functional difficulties.

Yes, fair. Then you need to poll your loved ones.

ChatGPT echoes my thoughts on this:

“Costco is underreacting. A 40–60 dB loss at 4–6 kHz is clinically significant and affects speech clarity, even if overall hearing seems “okay.” Those frequencies carry consonants that the brain needs to understand speech efficiently.

There is strong scientific evidence that untreated moderate hearing loss increases dementia risk, and treating it with hearing aids—especially in your 60s—can significantly reduce cognitive decline. The brain cannot fully compensate for missing input, and tinnitus itself is a sign of auditory deprivation.

Most audiologists would recommend hearing aids based on those thresholds, not just for hearing improvement but for long-term brain health. It would be wise to consult a doctoral audiologist (AuD) and strongly consider treatment.”

@MJ_Wisconsin said:

There is strong scientific evidence that untreated moderate hearing loss increases dementia risk

Oof. ChatGPT is incorrect. A reflection of its direct, overconfident default mode perhaps.

I’ve seen many examples of A.I. being confidently wrong, and I always suspected that the whole hearing loss vs dementia risk was exaggerated to scare old folks into buying hearing aids. So I put some specific questions to Gemini and the results are below. I’m not going to delve into all those references but I’d be interested in your take on the subject. It would be good to know both how accurate Gemini was here, and if those studies are meaningful or need additional interpretation.

"The link between hearing loss and cognitive decline is one of the most significant breakthroughs in geriatric health over the last decade. Research suggests that even “mild” or “moderate” hearing loss can significantly increase the risk of developing dementia.

Key Research & Decibel (dB) References

The most cited studies in this field establish a dose-response relationship: as hearing thresholds (measured in decibels) worsen, the risk of dementia climbs proportionally.

Deep Dive into the Specific Evidence

1. The “Lin Study” (Archives of Neurology)

This is the foundational study that put numbers to the risk. Frank Lin and his team followed 639 adults for nearly 12 years. They found that for every 10 dB of hearing loss, the extra risk of developing dementia increased by 20%.

For someone with moderate hearing loss, the cognitive load required to decode speech leaves fewer resources for memory and processing, leading to what researchers call “cognitive depletion.”

2. The Lancet Commission on Dementia (2020/2024 Updates)

The Lancet Commission identified hearing loss as the largest potentially modifiable risk factor for dementia in midlife.

• The Decibel Connection: They highlight that even a hearing loss starting at 25 dB (the threshold for “mild” loss) begins to impact brain structure, specifically causing accelerated atrophy in the temporal lobe.

3. The ACHIEVE Trial (2023)

Published in The Lancet, this is one of the first large-scale randomized controlled trials to look at whether treating hearing loss (via hearing aids) actually slows down cognitive decline.

• Result: In older adults at higher risk for cognitive decline, using hearing aids for three years reduced cognitive change by 48%.

Why does this happen?

Scientists generally point to three main theories:

1. Cognitive Load: The brain works so hard to hear that it “borrows” power from the parts of the brain used for thinking and memory.
2. Brain Structure: Lack of stimulation causes the auditory centers of the brain to shrink (atrophy).
3. Social Isolation: People who can’t hear well often withdraw from conversation, and social engagement is a known “buffer” against dementia.

Note: “Moderate” hearing loss (41–60 dB) is often the “sweet spot” where people feel they can still “get by,” but it is precisely the stage where the brain begins to struggle significantly with background noise and complex processing.

Recommended Resources for Further Reading

• Johns Hopkins: Hearing Loss and Dementia
• The Lancet Commission 2020 Report
• NIA: Hearing Loss and Cognitive Decline

In this case, AI is quoting multiple very reliable studies. Call it AI all you want, but those multiple sources can’t be ignored.

I started this thread. I’ve also done an incredible amount of research and have appointments tomorrow with an ENT and an audiologist. I’ve already made my conclusions and I’ll post them tomorrow after I see these doctors and get the final input.

There is no doubt at this point that there’s a correlation between dementia and hearing loss. What I quibble with is any wording that implies that if you don’t get hearing aids you will get dementia or if you do get hearing aids you will avoid dementia, which is not something we know yet. Language has to be used very carefully here. It is clearly the case that in groups of people with dementia there are higher numbers of people with untreated hearing loss. It appears to be the case that people who wear hearing aids are less likely to have dementia than people with hearing loss who do not wear hearing aids. Or, to flip it around, people who have dementia and hearing loss are less likely to wear hearing aids than people without dementia and with hearing loss. There’s a reason that The Lancet Commission called hearing loss the largest potentially modifiable risk factor. We don’t clearly know yet that if an individual can actually lower their risk of getting dementia by getting and wearing hearing aids.

There’s a group in the USA that leans very heavily into Lin’s risk multiplier to sell hearing aids, which I think is grossly unethical. They actually have patients sign a form that says something like, “My audiologist has made me aware that by not treating my hearing loss I am 5x more likely to develop dementia”. (Already in medicine doctors try to avoid using risk multipliers like that because they are misleading. Birth control users, for example, have something like a 2x higher risk of stroke, which sounds pretty scary. When you look at actual incidence it is the difference between 2.5 in 100,000 and 5 in 100,000 which sounds much less scary.)

We also don’t know the mechanism. If it’s social isolation, for example, mild loss at 4 and 6 kHz isn’t realistically going to effect that. There’s also a world of nuance hidden in “mild” hearing loss. Someone with a flat 40 dB hearing loss has a “mild” hearing loss that is actually functionally enormous–they are missing ~58% of speech sounds at a conversational level. Someone who has normal hearing out to 2 kHz which then drops down to a moderate hearing loss at 8 kHz is only missing ~13% of speech sounds. We don’t even put hearing aids on kids with a hearing loss like that.

As an aside, IIRC, note that the non-high-risk group of individuals with hearing loss in the achieve study did not have a higher incidence of dementia than the normal hearing group. The high risk group all had cardiovascular comorbidities I think (which also, by the by, can increase hearing loss).

There is some interesting early work out of Anu Sharma’s lab showing that cognitive test scores improve after six months of wearing hearing aids in people with hearing loss. Does that mean that hearing aids can actually reverse dementia? Or was it ever dementia at all?

I don’t know, this has been a rather unorganized stream of thought. But don’t get hearing aids because of a fear of dementia. Get hearing aids because they help you in day-to-day communication. If you’re scared of dementia, the low hanging fruit is probably actually diet and exercise. I know that’s harder, but I doubt that hearing aids will be so helpful that you can just be lazy about those things. Edit: Oh god, and smoking. Everyone quit smoking.

@Neville said:

But don’t get hearing aids because of a fear of dementia. Get hearing aids because they help you in day-to-day communication.

Excellent comment; appreciate your thoughts, Neville!

I’m going to address this a little different from what I have been reading-not about cognitive decline- but about hearing and using hearing aids. You are working harder to hear expecialliy if in noise aor with high frequency speech as well as clarity of sound with music. Because hearing loss is usually gradual we can go a long time “getting by” putting in more effort to hear/understand but not realizing it. So here is my thoughts and how I address someone with hearing like this. I ask about where you struggle/notice more difficulty. This guides me more than the numbers on the audiogram. What we don’t know is what was your hearing when you were young as “0” is average best hearing which also means there are many with better than “0” hearing thresholds as there are with 10-20 dB hearing thresholds. NOte: I am one of those that had -10 dB hearing thresholds. So for someone like me your loss would be a mild with a high frequency moderate to severe hearing loss. So before doing anything consider what problems you are having. If you not some then consider at least a trial with amplification. JMHO

I’m the original poster.

My question had nothing to do with whether or not I needed hearing aids but whether what I was hearing from professionals regarding the corrolation of hearing loss to cognintive decline was exagerated, or was the HIS at Costco just not aware of the studies and conclusions.

Since my Costco visit, I have done extensive research, much of which was echoed by many of the replies to this post. The studies have been conclusive and my GP, ENT, and Audiologist all strongly agree.

Some have suggested that having hearing aids will not guarantee that cognitive decline will be prevented, nor will not wearing them guarantee that you will experience decline. But that makes no sense. Vaccines will not guarantee this, yet we still take them and receive a benefit. Cholesteral and blood pressure meds also won’t make these guarantees, yet we all know they are important and beneficial. How many here are taking vitamin supplements? Same thing. Why are hearing aids judged more strictly by some people than vitamins, vaccines and medications? Why are hearing aids required by some to meet a standard that is unattainable, but equally unattainible by the vitamins, vacccines, and medications that we gladly accept?

There is a strong corrolation between uncorrected hearing loss and congnitive decline among those of us at the older end of the age spectrum, and another corrolation that hearing aids can indeed prevent decline, and it’s proven through several peer reviewed studies by such leading organizations as Johns Hopkins. The only disagreements I have seen have been from people who have given personal opinions which are clearly lacking in any significant research.

Therefore, I’m listening to the experts and ordering my hearing aids. And I will recommend to those I know to do the same.

My sincere thanks to all of those who contributed to this important issue.

Sorry, mine was a really confusing post, at best! In terms of how hearing aids will “change how you hear”, what I meant was, HAs process sound so that there’s subtle changes between how one hears naturally, with perfect hearing, say–and how the world will sound if you process that sound through HAs. We all have hearing loss and those golden days of great natural hearing are gone. HAs seem to restore our hearing and they do in many ways. But it’s not the same hearing that we had before our loss.

I wear custom domes, with a small vent in one and no vent in my right. I think that effectively means that all sound coming in from the world are processed by the HA, even in the range where I don’t need help. But you are probably right about how you use your HAs to minimize processing in the ranges that are normal for you. However–if you stick fingers in your ears, figuratively speaking–that is, use domes–I wonder if the aids dont still need to process the sound in order to compensate for the loss caused by the blockage of the obstruction of the domes. I mean, when my ears are partially blocked by wax, I experience a muffling of sound. My thought was that aids need to compensate for this. And that requires they process sound.

I really don’t know the answer to this and my impression could be entirely wrong! Do aids ‘do nothing’ and merely allow natural sound to, well, sound in our ears and then only process the damaged registers? Could be. I honestly don’t know. I hope that you or someone has answers to this, as I don’t.

I wear custom molds; my left has a small vent and my right is entirely blocked. So ALL sound is definitely processed by my aids in my right ear. It’s hard to imagine that natural sounds enter through the tiny vent in my left mould, without any loss of volume. And if theres a loss of volume, that would mean that my HAs would have to compensate. And to do that, they process the sound.

Anyway, you’re right about my mis-speaking about ““the low end of the spectrum”. I meant the high end! I was reading left to right and stupidly considered the spectrum to go “low” as the graph sank/declined over towards the right. by analogy, when discussing a guitar, sometimes people will mis-speak and call the six string bass E the “high” E string because its the string at the top when holding the guitar.

Vaccine efficacy research is not a great comparison. The benefits of vaccines are very clear.