Home Ahead of print Instructions Contacts
About us Current issue Submit article Advertise  
Editorial board Archives Subscribe Login   

 Table of Contents  
Year : 2022  |  Volume : 28  |  Issue : 4  |  Page : 275-278

Association between hearing loss and dementia in elderly

Department of Otorhinolaryngology, KS Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India

Date of Submission16-May-2021
Date of Decision04-Oct-2021
Date of Acceptance28-Oct-2021
Date of Web Publication29-Dec-2022

Correspondence Address:
Dr. Rajeshwary Aroor
Department of Otorhinolaryngology, KS Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/indianjotol.indianjotol_68_21

Rights and Permissions

Background: Long standing hearing-loss often leads to the setting in of dementia as hearing-loss. In this study, elderly population were screened for hearing-loss and dementia using Hindi-Mental State Examination. Aims: To know the association between the dementia and Hearing loss Method 206 participants in the age group of 60-80 years (110 were females and 96 were males) were subjected to audiological evaluation and dementia screening using HMSE dementia scoring scale and it was compared with hearing level. Results: Out of 206 subjects, 110 were females and 96 were males. Right ear hearing-loss was seen in 147 cases and left ear in 130 cases. 48 individuals had no hearing-loss, 39 participants had unilateral hearing-loss and 119 participants had bilateral hearing-loss. Most common type of hearing-loss observed was mild hearing-loss 124 participants had no dementia, 82 had dementia. 60 had mild cognitive impairment and 22 had severe cognitive impairment. 49 out of 82 participants with dementia had bilateral hearing-loss. As the hearing handicap percentage increases from 1-100, dementia score decreases. But it was not statistically significant. More number of men were affected with hearing-loss but more number of female participants had dementia. Conclusion: Hearing-loss is more common in men in elderly population but dementia is more commonly seen in females.

Keywords: Dementia, elderly, hearing loss

How to cite this article:
Sinha D, Aroor R, Bhat VS, Saldanha M, Kamath SD, Kotian S. Association between hearing loss and dementia in elderly. Indian J Otol 2022;28:275-8

How to cite this URL:
Sinha D, Aroor R, Bhat VS, Saldanha M, Kamath SD, Kotian S. Association between hearing loss and dementia in elderly. Indian J Otol [serial online] 2022 [cited 2023 Mar 29];28:275-8. Available from: https://www.indianjotol.org/text.asp?2022/28/4/275/365964

  Introduction Top

Normal hearing is required to learn language, communicate, work, and socialize. It helps us to stay connected with outside world and keeps us safe by warning us of potential danger. Hearing loss in the elderly is a matter of concern. It is often neglected and left untreated. Around 5.3% of the world population suffers from hearing loss.[1] The risk of hearing loss increases with age (age-related hearing loss [ARHL]), 40% of the individuals above the age of 65,[2] and 75% individual older than 80 years[3] suffer from hearing loss. ARHL, also known as presbycusis, is a progressive, bilateral and symmetrical hearing loss and is primarily observed in the high-frequency region. Long-standing hearing loss in them leads to social isolation because they are not able to understand the daily conversations and hence isolate themselves from social interactions. This may lead to the setting in of dementia. Dementia is a leading cause of disability in the world affecting 6.5% of the population above 65 years of age.[4],[5] There is disturbance of multiple higher cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgment. Consciousness is not clouded. The impairments of cognitive function are commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behavior, or motivation. Dementia and hearing loss are both highly prevalent in older adults, each having considerable impact on quality of life.[6],[7] Therefore, in this study, we tried to study the association between hearing loss and dementia by evaluating the elderly population for hearing loss and screening them for any dementia using Hindi Mental State Examination (HMSE).[8]

  Methods Top

After informed consent, 206 participants in the age group of 60–80 years who were willing to participate in the study were subjected to audiological evaluation using AC-40 pure tone audiometer to find the baseline hearing levels of both the ears at 500, 1000, 2000, 4000 Hz. Individuals with preexisting neurological conditions such as Alzheimer's disease, Parkinson's disease, organic cause for dementia altered level of sensorium were excluded from study. Individuals who were not able to follow the commands were also excluded.

An average of all the four frequencies was taken as hearing level of that particular ear. Hearing level of 25 dB and above, in the speech frequency, was considered as hearing loss. Depending on the hearing level of the participants, they were further classified into normal hearing and hearing loss groups. In those with bilateral hearing loss, a hearing handicap percentage was calculated.

All the participants were further subjected to dementia screening using HMSE[8] in their vernacular language. Based on the score obtained, they were categorized as having dementia or no dementia. The score between 24 and 31 is considered normal, 17–23 indicates mild cognitive impairment, and 0–16 is severe cognitive impairment. If a patient was found to have dementia based on the score obtained, he/she was referred to the Department of Psychiatry for further management.

Ethical clearance

Ethical approval for this study (INST.EC/EC/098/2018-19) was provided by the Ethical Committee of KS Hegde Medical academy, Nithyanandanagar, Mangalore, on 22 October 2018.

  Results Top

Out of 206 subjects, 110 were females and 96 were males. Maximum number of participants in our study were females, and they were in the age group of 60–64 years followed by 65–69 years.

Right ear hearing loss was seen in 147 cases and left ear in 130 cases.

Out of 206 participants, 48 individuals had no hearing loss (hearing level ≤25 dB), 39 participants had unilateral or one-sided hearing loss, and 119 participants had bilateral hearing loss. Most common type of hearing loss observed was mild hearing loss (127 out of 412 ears) in both right and left ear [Table 1].
Table 1: Hearing loss in right and left ear

Click here to view

124 participants (69.9%) had no dementia, 82 had dementia. 60 (19.4%) out of total participants had mild cognitive impairment, and 22 (10.7%) had severe cognitive impairment. Among the participants with dementia, most number of individuals (52) were in the age group of 65–74 years.

49 out of 82 participants with dementia had bilateral hearing loss [Table 2]. As the hearing handicap percentage increases from 1 to 100, HMSE score decreases. However, it was not statistically significant when Mann–Whitney U-test was used. When hearing handicap percentage was compared with HMSE score in individuals with bilateral hearing loss, it was observed that the lowest dementia score (22) was in the category of individuals with maximum hearing handicap % (81–100). Most of the individuals belonged to the category of 1–20 of hearing handicap % [Table 3].
Table 2: Distribution of dementia according to bilateral hearing loss (unilateral hearing loss patients were considered to be normal as hearing handicap percentage calculation is only for bilateral hearing loss)

Click here to view
Table 3: Distribution of hearing handicap percentage and Hindi Mental State Examination scores

Click here to view

More number of men were affected with hearing loss but more number of female participants had dementia (49) compared to males (33) [Table 4]. The female gender had lower HMSE scores compared to the males in unilateral right-sided hearing loss, bilateral hearing loss, and those with normal hearing.
Table 4: Distribution of gender and dementia grading

Click here to view

  Discussion Top

The advancements in health-care facilities and its accessibility to individuals of all strata of society have led to a gradual increase in life span of human beings. Dementia and age related disorders are common in elderly. Dementia can lead to significant disability, morbidity, mortality, and an increased expenditure on health care. The social and financial burden of dementia and hearing loss is rising rapidly with aging.[9] Early detection of risk factors and identifying causes of dementia can help to reduce the burden of the disease. It has been observed and studied that hearing loss can give rise to dementia. The hearing loss may lead to auditory volume loss in the brain.[10],[11] It can also cause accelerated atrophy in certain areas of the brain.[10] Hence, detecting hearing loss on time and taking preventive and curative measures can help to reduce the occurrence of dementia and cognitive impairment. Majority of elderly people suffer from ARHL. These individuals suffer from social isolation because of not being able to actively participate in the conversations. This social isolation can lead to early occurrence of dementia and other cognitive impairment. Therefore, there is a need to identify this hearing loss on time so that appropriate interventions can be taken up to treat it or prevent it from getting worse and in turn preventing dementia from setting in.

In our study, we tried to find an association between hearing loss and dementia in elderly individuals. Using HMSE, dementia scores of individuals with unilateral and bilateral hearing loss were measured and compared with the normal individuals. The majority of participants in our study were in the age group of 60–69 years, females were more than males in all age groups. Mini–Mental State Examination is the most widely used to screen dementia.[12] HMSE is more convenient to use in Indian scenario as it is simple and does not contain any subtraction or calculation.[8],[13]

In this study, female participants were more compared to males, similar results were observed in other studies.[14] This could be because of the increased life expectancy among the females compared to males.[15] Mild hearing loss was the most prevalent level of hearing loss in elderly.[14],[16] We also found in our study that mild hearing loss was more as compared to other grades of hearing loss. 127 (right 68+ left 59) out of 412 ears had mild hearing loss. Age distribution of our study shows the decline in the number of participants as age advances which corresponds to the age distribution in general population. In majority of the elderly population, hearing loss is taken as granted and considered as part of aging process and often neglected. The elderly population in the age group of 60–70 are usually not dependent on their family members for hospital visits compared to the more advanced age group. This may be the other reason for more number of participants in the age group of 60–64 followed by 65–70.

Right ear was more affected than the left ear.[17] Even in our study, right ear hearing loss was more compared to the left ear both in unilateral and bilateral hearing loss cases. Overall involvement of right ear was seen in 147 participants whereas left ear involvement in 130 cases. In unilateral hearing loss, right side was involved in 28 participants whereas left side in only 11. Hearing impairment can cause reduction in the whole brain volume, especially the right temporal region, over a period of 6.4 years.[10]

Unilateral right ear hearing loss was seen more in females compared to bilateral and unilateral left-sided hearing loss. Although females were more in our study, hearing loss was more commonly seen in men. It has been observed that hearing loss was more in men compared to women.[18] According to Pearson et al.,[19] hearing impairment occurs at a faster rate in men when compared to women at all ages and frequencies. This could be the possible explanation of males more affected with hearing loss in our study population, even though we had more number of females in our sample. Men when compared to women are more exposed to environmental sounds owing to their nature of profession, such as driving, working in factories, and military.

A total of 82 individuals in this study showed dementia (mild and severe) while 124 of them had normal cognitive functioning. 49 out of those 82 had bilateral hearing loss (P = 0.638), whereas 33 did not have bilateral hearing loss (either normal hearing or unilateral hearing loss). Unilateral hearing loss individuals were considered as normal as it does not give rise to major disability. The hearing loss individuals are more prone to all-cause dementia (dementia secondary to any cause).[20] Over the age of 65 years, the mean time for developing dementia was 10.3 years in those with hearing loss at baseline versus 11.9 years for counterparts with normal hearing.[21] People with mild, moderate, severe hearing loss were found to have twice, thrice and 5 times the risk of developing dementia, respectively.[20],[22]

The median dementia score of both bilateral and unilateral hearing loss groups is 26 and P = 0.921. Even in bilateral hearing loss individuals when compared with the normal hearing individuals, there is no significant difference in dementia score (P = 0.702). There is no significant difference between the dementia score of right-sided hearing loss compared to the left-sided hearing loss.

Female gender was more prone to develop dementia, even we have observed the same.[23],[24] When dementia scores of men were compared with that of women, no significant differences were observed in both unilateral, bilateral hearing losses, and normal hearing participants. We feel that the reason for no difference in dementia scores among these groups is probably due to majority of our study population being in mild hearing loss category which does not give rise to major disability.

We have observed that as the hearing handicap % increases, dementia score decreases. Majority of mild and severe dementia cases were in the age group of 65–74 years. Younger individuals with hearing loss are more prone to develop dementia.[25] Liu and Lee in their study found that lower age group participants were at a higher risk of developing dementia.[26] The median dementia score of participants with hearing handicap grading from one to 20 was 26, whereas for 81–100 it was 22, in this study. In our study population, maximum number of participants were in the minimum hearing handicap group (one to 20), compared to the severe hearing handicap group. This is probably due to majority of our study population were in 60–64 age group and majority of them had mild hearing loss. Difficulty in communicating with the severely handicapped participants may be the other cause for less number of participants in severely handicapped group, as these individuals were excluded from the study.

We also observed that even though a greater number of male participants had hearing loss compared to females, higher number of female participants had dementia. Su et al.[23] and Mick et al.[24] who studied the association of social isolation with hearing loss also concluded that female gender was more prone to develop dementia.

  Conclusion Top

Hearing loss is more common in men compared to females in elderly population, but dementia is more commonly seen in females. Majority of them suffer from mild hearing loss. We would like to conclude that hearing loss is a risk factor for dementia in elderly population, as the hearing handicap percentage increases, dementia score (HMSE score) decreases though statistical significance could not be established. Early detection of hearing loss and intervention may prevent the cognitive impairment in the elderly and improve the quality of life. A larger series in future followed up on a long-term basis may give us more accurate results.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Ford AH, Hankey GJ, Yeap BB, Golledge J, Flicker L, Almeida OP. Hearing loss and the risk of dementia in later life. Maturitas 2018;112:1-11.  Back to cited text no. 1
Gates GA, Mills JH. Presbycusis. Lancet 2005;366:1111-20.  Back to cited text no. 2
Lin FR, Ferrucci L. Hearing loss and falls among older adults in the United States. Arch Intern Med 2012;172:369-71.  Back to cited text no. 3
Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, et al. Global prevalence of dementia: A Delphi consensus study. Lancet 2005;366:2112-7.  Back to cited text no. 4
Wu YT, Beiser AS, Breteler MM, Fratiglioni L, Helmer C, Hendrie HC, et al. The changing prevalence and incidence of dementia over time – Current evidence. Nat Rev Neurol 2017;13:327-39.  Back to cited text no. 5
Dalton DS, Cruickshanks KJ, Klein BE, Klein R, Wiley TL, Nondahl DM. The impact of hearing loss on quality of life in older adults. Gerontologist 2003;43:661-8.  Back to cited text no. 6
Bowling A, Rowe G, Adams S, Sands P, Samsi K, Crane M, et al. Quality of life in dementia: A systematically conducted narrative review of dementia-specific measurement scales. Aging Ment Health 2015;19:13-31.  Back to cited text no. 7
Tsolaki M, Iakovidou V, Navrozidou H, Aminta M, Pantazi T, Kazis A. Hindi Mental State Examination (HMSE) as a screening test for illiterate demented patients. Int J Geriatr Psychiatry 2000;15:662-4.  Back to cited text no. 8
Prince M, Wimo A, Guerchet M, Ali GC, Wu YT, Prina M. World Alzheimer Report 2015. The Global Impact of Dementia. London Alzheimer's Disease International; 2015. Available from: https://www.alz.co.uk/research/world-report-2015. [Last accessed on 2020 Sep 05].  Back to cited text no. 9
Lin FR, Ferrucci L, An Y, Goh JO, Doshi J, Metter EJ, et al. Association of hearing impairment with brain volume changes in older adults. Neuroimage 2014;90:84-92.  Back to cited text no. 10
Lin Y, Wang J, Wu C, Wai Y, Yu J, Ng S. Diffusion tensor imaging of the auditory pathway in sensorineural hearing loss: Changes in radial diffusivity and diffusion anisotropy. J Magn Reson Imaging 2008;28:598-603.  Back to cited text no. 11
Tiwari S, Tripathi R, Kumar A. Applicability of the mini-mental state examination (MMSE) and the Hindi mental state examination (HMSE) to the urban elderly in India: A pilot study. Int Psychogeriatr 2008;21:123.  Back to cited text no. 12
Ganguli M, Ratcliff G, Chandra V, Sharma S, Gilby J, Pandav R, et al. A Hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriatr Psychiatry 1995;10:367-77.  Back to cited text no. 13
Mattos LC, Veras RP. The prevalence of hearing loss in an elderly population in Rio de Janeiro: A cross-sectional study. Braz J Otorhinolaryngol 2007;73:654-9.  Back to cited text no. 14
Cueto M, Brown TM, Fee E. Life Expectancy. Geneva: World Health Organization; 2019. [doi: 10.1017/9781108692878].  Back to cited text no. 15
Deal JA, Betz J, Yaffe K, Harris T, Purchase-Helzner E, Satterfield S, et al. Hearing impairment and incident dementia and cognitive decline in older adults: The health ABC study. J Gerontol A Biol Sci Med Sci 2017;72:703-9.  Back to cited text no. 16
Huh M. The relationships between cognitive function and hearing loss among the elderly. J Phys Ther Sci 2018;30:174-6.  Back to cited text no. 17
Cruickshanks KJ, Dhar S, Dinces E, Fifer RC, Gonzalez F 2nd, Heiss G, et al. Hearing impairment prevalence and associated risk factors in the Hispanic Community Health Study/Study of Latinos. JAMA Otolaryngol Head Neck Surg 2015;141:641-8.  Back to cited text no. 18
Pearson JD, Morrell CH, Gordon-Salant S, Brant LJ, Metter EJ, Klein LL, et al. Gender differences in a longitudinal study of age-associated hearing loss. J Acoust Soc Am 1995;97:1196-205.  Back to cited text no. 19
Lin FR, Yaffe K, Xia J, Xue QL, Harris TB, Purchase-Helzner E, et al. Hearing loss and cognitive decline in older adults. JAMA Intern Med 2013;173:293-9.  Back to cited text no. 20
Gurgel RK, Ward PD, Schwartz S, Norton MC, Foster NL, Tschanz JT. Relationship of hearing loss and dementia: A prospective, population-based study. Otol Neurotol 2014;35:775-81.  Back to cited text no. 21
Lin FR, Metter EJ, O'Brien RJ, Resnick SM, Zonderman AB, Ferrucci L. Hearing loss and incident dementia. Arch Neurol 2011;68:214-20.  Back to cited text no. 22
Su P, Hsu CC, Lin HC, Huang WS, Yang TL, Hsu WT, et al. Age-related hearing loss and dementia: A 10-year national population-based study. Eur Arch Otorhinolaryngol 2017;274:2327-34.  Back to cited text no. 23
Mick P, Kawachi I, Lin FR. The association between hearing loss and social isolation in older adults. Otolaryngol Head Neck Surg 2014;150:378-84.  Back to cited text no. 24
Mick P, Pichora-Fuller MK. Is hearing loss associated with poorer health in older adults who might benefit from hearing screening? Ear Hear 2016;37:e194-201.  Back to cited text no. 25
Liu CM, Lee CT. Association of hearing loss with dementia. JAMA Netw Open 2019;2:e198112.  Back to cited text no. 26


  [Table 1], [Table 2], [Table 3], [Table 4]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
Article Tables

 Article Access Statistics
    PDF Downloaded129    
    Comments [Add]    

Recommend this journal