A new randomized trial adds to evidence that treating hearing loss may have cognitive benefits, though its primary endpoint missed statistical significance. The CHOICE trial, reported in JAMA Neurology, enrolled 703 older adults with moderate-to-severe hearing loss and mild cognitive impairment in Shanghai. Over 24 months, dementia-level impairment developed in 3.09% of those assigned to hearing aids versus 4.74% in the control group, a difference that was not statistically significant (RR 0.59, P=0.23).
However, a prespecified secondary outcome found cognitive improvement—defined as a return from a Clinical Dementia Rating global score of 0.5 to 0—occurred in 15.34% of the hearing aid group versus 2.36% of controls, a relative risk of 5.94 (P<0.001). The authors said this suggests treating hearing loss may help some older adults regain cognitive and functional capacity, not just slow decline.
The researchers cautioned that the trial was underpowered because the observed conversion rate was much lower than expected, and the eligibility criterion based on CDR 0.5 was not prespecified. They also noted the subjective CDR scale may introduce bias. An accompanying editorial pointed to the ACHIEVE trial, which found a significant cognitive benefit in a high-risk subgroup, and called the CHOICE secondary effect "surprisingly giant" but in need of replication.