In 2022, an estimated 4% of our adult population carried a diagnosis of dementia. Essentially gender neutral, it is estimated that the cost of care for these individuals would be $345 billion, and this does not take into account an additional $339 billion in unpaid care. As the global population ages, scientists are urgently exploring ways to delay or prevent dementia. One potential culprit, hearing loss, has been drawing attention, not just because it's common but because it is both measurable and treatable. While the science points to hearing care as a potentially powerful lever in the fight against cognitive decline, a larger question looms: Will public policy, the healthcare system and the courts support prevention?
The US Supreme Court in Kennedy v. Braidwood Management is weighing whether the federal government can require insurers to cover preventive services without cost-sharing, a central pillar of the Affordable Care Act (ACA) underpinning access to screenings, vaccines, and early interventions. At the heart of the case is whether the US Preventive Services Task Force (USPSTF), an independent panel that makes evidence-based recommendations, has constitutional authority to determine which services must be covered. The plaintiffs argue that because USPSTF members aren’t appointed by the president or confirmed by the Senate, their power violates the Appointments Clause of the Constitution.
Hearing care isn’t currently included in that federal mandate, but if the Court strips away the authority behind it, adding hearing services in the future will become even more challenging. This new study enters that conversation with compelling data - up to 32% of dementia cases could be attributed to untreated hearing loss. Therefore, if we treat hearing loss, we might prevent or delay dementia for millions. The science is sound. The cost-benefit case is strong. The political will? That remains an unknown.
Tracking Hearing Loss and Dementia
Researchers followed nearly 3,000 older adults (ages 66 to 90) over eight years as part of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS). The participants underwent both objective (audiometric testing) and subjective (self-reported) hearing assessments, and the researchers tracked who developed dementia over time.
Audiometric testing, the gold standard for assessing hearing, involves presenting tones at various pitches and volumes through headphones while the participant signals when he or she hear each tone. Hearing was subsequently classified based on decibels as normal, mild hearing loss, or moderate or greater hearing loss. They also collected self-reported hearing information, asking participants how much trouble they had hearing
Dementia was tracked based on regular neuropsychological testing of memory, language, and executive function assessments at study visits. For those who couldn’t attend in person, cognitive status was gauged through structured telephone interviews and questionnaires given to family members or caregivers. Hospital records and death certificates were also reviewed, searching for dementia-related diagnostic codes to catch cases of dementia that developed outside the study setting.
This comprehensive approach ensured that dementia cases weren’t missed—even among those who didn’t return to clinics regularly—while the objective hearing tests provided a solid foundation for linking hearing loss to future cognitive decline.
When Hearing Loss Goes Untreated, Dementia Risk Rises.
Two-thirds of the participants had objectively measured hearing loss—yet only about one-fifth reported using hearing aids. Notably, more than half of those with moderate or greater hearing loss were wearing aids, suggesting that those most aware of their impairment were more likely to seek treatment.
Over the 8-year follow-up period, 239 participants developed dementia. To estimate how much of that dementia might be linked to hearing loss, researchers used a metric called the Population Attributable Fraction (PAF). In plain terms, PAF tells us how much of a disease in a population, like dementia, could theoretically be prevented if a specific risk factor, like hearing loss, were eliminated entirely. It combines the strength of the association between the risk factor and the disease and how common the risk factor is in the population. A higher PAF means the risk factor is more significant in driving disease.
In this case, the PAF showed that up to 32% of dementia cases could be linked to audiometric hearing loss—a strikingly high number. That included about 16% from mild hearing loss and another 16% from moderate or greater hearing loss. These figures suggest that even mild hearing deficits, often brushed off as part of normal aging, may carry serious consequences for long-term brain health.
Among participants with hearing loss, those who did not use hearing aids had a PAF of 12.9% for dementia. Roughly 13% of dementia cases among those with hearing loss might have been prevented if they had used hearing aids – a protective effect described as modest.
Hearing aids aren’t the magic bullet but may serve as a meaningful buffer against cognitive decline. Even small gains in delaying dementia onset can greatly impact individuals and public health systems.
An Ounce Of Prevention Or A Pound Of Cure
Hearing loss isn’t just an inconvenience—it’s an overlooked, underreported, modifiable driver of dementia. With nearly two-thirds” of this community-based cohort showing clinically significant hearing loss and up to a third of dementia cases linked to it, this is a public health warning that shouldn’t be ignored.
Unlike many contributors to dementia, hearing loss is relatively easy to detect and already treatable. Objective hearing screening is quick, non-invasive, and widely available. Yet despite these advantages, hearing health is still not a standard part of routine medical care for older adults. Hearing loss is a rare opportunity for an upstream intervention, saving millions in downstream costs. Treating hearing loss, even for the 13 to 16% associated with dementia, is an economic good. While a hearing aid might set you back a few thousand dollars (a problem in itself), caring for someone with dementia easily exceeds that in direct and indirect costs. And that’s before factoring in the impacts of hearing loss on an individual’s sense of loneliness or the emotional and caregiving burden placed on families coping with dementia.
The US Supreme Court is considering whether the federal government can continue to mandate coverage for “preventative services without cost-sharing” under the Affordable Care Act. Hearing care isn’t even on that list yet, but if preventive coverage is gutted, adding it becomes even harder as existing services are stripped away.
This isn't just a scientific question. It's a political one. Will our healthcare system continue to lean into treating chronic illness, or will we make a MAHA shift toward prevention, early intervention, and long-term savings? Hearing loss is common, measurable, and fixable. The science is here. Now, the politics need to catch up.
Sources: Population Attributable Fraction of Incident Dementia Associated With Hearing Loss JAMA Otolaryngology-Head & Neck Surgery DOI: 10.1001/jamaoto.2025.0192
ACA Preventive Services Are Back at the Supreme Court: Kennedy v. Braidwood KFF
Chuck Dinerstein, MD, MBA
Director of Medicine
Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.
