Is Age-Related Hearing Loss a Modifiable Risk Factor for Cognitive Decline? Mechanisms, Evidence, and Future Directions.

Age-related hearing loss (ARHL), also known as presbycusis, is one of the most prevalent long-term sensory difficulties in older people. It affects more than two-thirds of people over 70. In addition to communication challenges, ARHL has recently been revealed as a possible modifiable risk factor for cognitive decline and dementia. Comprehending this link is crucial for creating preventative interventions and maintaining healthy cognitive aging. This narrative review intended to analyze the evidence comprehensively relating age-related hearing loss (ARHL) with cognitive decline, define the possible pathophysiological mechanisms that may explain this association and assess the plausibility of hearing rehabilitation as a preventative therapy. A full literature search was done in PubMed, MEDLINE, Google Scholar and Frontiers databases employing the phrases "hearing loss" AND ("cognitive decline" OR "aging"). We only looked at articles that were published in English between 2014 and 2024 and were either systematic reviews, meta-analyses, or original research. We did not include any papers that were not peer-reviewed, not about people or not written in English. A total of 37 publications satisfied the inclusion criteria and underwent extensive review. There is strong evidence that ARHL is associated with rapid cognitive decline and an increased risk of dementia. Epidemiological studies suggest that hearing loss contributes to roughly 8-9% of worldwide dementia cases, which represents one of the primary modifiable risk factors. Some of the suggested ways that ARHL and cognitive decline are connected include through increased cognitive load, neuroplastic rearrangement, vascular dysfunction, oxidative stress and social isolation. Neuroimaging studies have revealed a reduction in gray matter and cortical atrophy in the auditory and associative areas of the brain in individuals with hearing loss. Hearing rehabilitation with hearing aids and cochlear implants has been connected to increased communication, higher social engagement and decreased cognitive decline; nevertheless, findings are rather inconsistent due to methodological errors and limited follow-up periods. Age-related hearing loss is a moderately widespread risk factor for cognitive decline and dementia that can be reduced. Early examination and effective auditory therapy can slow down cognitive decline and make life better for older people. Future longitudinal, multicenter and interventional studies are important to explain causal pathways, enhance intervention timing and assess cost-effective public health techniques for sustaining cognitive health in aging populations.

The Longitudinal Relationship Between Hearing Loss and Cognitive Decline

Hearing Loss in Older Adults

Age-related hearing loss is associated with a decrease in hearing abilities for high frequencies and therefore leads to impairments in understanding speech—in particular, under adverse listening conditions. Growing evidence suggests that age-related hearing loss is related to various neural changes, for instance, affecting auditory and frontal brain regions. How the decreased auditory input and the increased listening effort in daily life are associated with structural changes is less clear, since previous evidence is scarce and mostly involved low sample sizes. Hence, the aim of the current study was to investigate the impact of age-related untreated hearing loss and subjectively rated daily life listening effort on grey matter and white matter changes in a large sample of participants (n = 71). For that aim, we conducted anatomical MRI and diffusion tensor imaging (DTI) in elderly hard-of-hearing and age-matched normal-hearing participants. Our results showed significantly lower grey matter volume in the middle frontal cortex in hard-of-hearing compared to normal-hearing participants. Further, higher listening effort was associated with lower grey matter volume and cortical thickness in the orbitofrontal cortex and lower grey matter volume in the inferior frontal cortex. No significant relations between hearing abilities or listening effort were obtained for white matter integrity in tracts connecting auditory and prefrontal as well as visual areas. These findings provide evidence that hearing impairment as well as daily life listening effort seems to be associated with grey matter loss in prefrontal brain regions. We further conclude that alterations in cortical thickness seem to be linked to the increased listening effort rather than the hearing loss itself.

AGE-RELATED HEARING LOSS AS A RISK FACTOR FOR LATE LIFE DEPRESSION AND COGNITIVE DECLINE: Session 408

Do Hearing Aids Help Prevent Cognitive Decline?

Age-related hearing loss and cognitive decline — The potential mechanisms linking the two

Hearing Aid User Perspectives: Reasons and Recommendations for Prescription and Over-The-Counter Device Uptake

THE ARGUMENT FOR FITTING BIMODALLY If you see a child tomorrow with a hearing loss in both ears, will you recommend one hearing aid or two? The obvious answer is two. You would have a hard time finding a dispensing professional today who does not agree that the benefits of bilateral hearing aid fitting make it the standard of care for those with binaural hearing loss. While the benefits of binaural hearing and the advantage of bilateral fitting are beyond the scope of this article (e.g., see Litovsky et al.,1 Kochkin2), these facts are undisputed in hearing healthcare circles. The industry's confidence in bilateral hearing aids is supported by current trends in fitting. In 1980 only 27% of hearing aid fittings were bilateral.3 Today, it is an amazing 86% for those with binaural hearing loss.4 So, what is bimodal fitting and why should dispensing professionals care? Bimodal fitting means different stimuli are presented to each ear. For the purposes of this paper, it means a cochlear implant in one ear and a hearing aid in the other. But, you may ask, don't cochlear implant audiologists take care of that? The answer is no, at least not usually. Personal experience (first author), communication with cochlear implant audiologists, and the literature5 suggest that most hearing aids in bimodal devices are fitted outside the cochlear implant center. Thus, if you have a patient who receives a cochlear implant in one ear, you will most likely be the one responsible for the continuing care of the hearing aid in the contralateral ear. It is in the best interests of both your patient and you to know how to optimize the hearing aid fitting for the best bimodal performance. If you fit hearing aids on children, the question is not if you will be responsible for managing a child with bimodal devices, but rather when. The number of unilateral cochlear implant recipients who continue to use contralateral hearing aids is clearly increasing (Figure 1). The conventional wisdom that cochlear implants and hearing aids should not be used simultaneously is archaic,6,7as we will show in this paper.Figure 1: Percentage of unilateral cochlear implant users choosing to wear a hearing aid in the contralateral ear. Sources: Tyler et al.,8 Cowan and Chin-Lenn9.BIMODAL DEVICE USE IN CI WEARERS Significant advances over the years in cochlear implant technology, speech-coding strategies, and surgical techniques have resulted in substantial improvements in the auditory-only speech-understanding abilities of cochlear implant recipients.10 As a result, the candidacy criteria approved for cochlear implantation in the United States has progressively expanded. When Cochlear Corporation, Ltd., introduced the original Nucleus® cochlear implant in 1985, the only candidates approved by the Food and Drug Administration were adults with profound bilateral sensorineural hearing loss of post-linguistic origin who had 0% open-set speech recognition using hearing aids. Now, under the FDA criteria approved in 2005, candidates can be adults or children aged 12 months and older, and can have either pre- or post-lingual onset of hearing loss. Although mid- and high-frequency hearing must still be profound (hearing thresholds >90 dB HL), low-frequency hearing loss can be moderate for adults (hearing thresholds >40 dB HL) and severe for children over age 2 (hearing thresholds >70 dB HL). Further, best-aided pre-operative speech-recognition criteria have been raised from 0% to <60%. Figure 2 shows the current criteria for each age group.Figure 2: Current FDA-approved audiometric and speech-recognition criteria for cochlear implantation with the Nucleus device, by age group. (For children, the open-set word-recognition test recommended is the Lexical Neighborhood Test [LNT] or Multisyllabic Lexical Neighborhood Test [MLNT], which are available from www.auditec.com.)For persons with bilaterally profound sensorineural deafness (the purple-shaded area in Figure 2), cochlear implants are clearly the intervention of choice because many obtain little or no benefit from hearing aids. However, for children aged 2 years and up and for adults, there is a range of low-frequency thresholds (the green and yellow areas, respectively) that fall within the approved audiometric range for cochlear implants. Hearing aids often fail to provide adequate performance for these patients,11but a unilateral cochlear implant alone does not provide all the known benefits that arise from listening with two ears rather than one. Binaural benefits from perception of interaural differences in time and intensity are well known to improve speech-recognition performance, particularly in background noise, due to a combination of head shadow, binaural redundancy, and binaural squelch effects (e.g., see Byrne, 198112 for a review). Further, bilateral inputs provide the potential for good localization ability. Finally, a strong argument can be made for bilateral stimulation, especially in children, in light of the impact of auditory deprivation on perception. When a hearing-impaired ear remains unaided, speech-recognition ability in that ear significantly deteriorates over time,13,14 and there appears to be a limited window of opportunity for auditory system stimulation if the patient is to achieve maximal binaural functioning.15 Bilateral implantation is not for everyone. For example, there might be significant usable hearing in one ear. There may be insurance reimbursement or financial barriers. Parents may worry about surgery or preserving one ear for possible future technology or treatments. These concerns may or may not be well-founded. Insurance reimbursement is not the obstacle it once was. Cochlear brand implants are designed to be “backward compatible” so future advances can be applied to implants done today. Cotanche reported that treatment, e.g., hair cell regeneration, may be 20 years or more away.16 However, unilateral versus bilateral implantation in children is ultimately the parents' choice and their wishes must be respected. The less expensive, non-invasive fitting of a hearing aid on the ear contralateral to a cochlear implant allows preservation of hearing in that ear and may provide the benefits of binaural stimulation. SUMMARY OF THE LITERATURE The bimodal fitting approach was first reported in the literature in the early 1990s (e.g., Shallop et al., 199217). Concerns were initially expressed that patients might be unable to combine the two very different sound sources for central processing. Fortunately, this has not proven to be the case. In fact, some researchers have argued that bimodal stimulation may provide “complementary” cues for processing of signals that may be advantageous to speech perception.18 Specifically, the lower frequencies provided by the hearing aid can provide information about the fundamental frequencies of a talker's voice and vowel information, while the mid- and high-frequency information from the cochlear implant can provide information needed on manner and place of articulation of consonants. It has also been suggested that localization ability, sound quality, and music perception may be enhanced by bimodal devices compared with bilateral cochlear implants.19,20 Studies have reported significant speech-recognition improvements for bimodal listening compared to either the patients' pre-operative bilateral hearing aid use or their post-operative use of the hearing aid or cochlear implant alone. This has been shown in adults17,21–23 and in children.24–26 For example, in a study by Luntz et al.,26 12 subjects (3 post-lingually impaired adults and 9 pre-lingually impaired adults and children aged 7 and older) were tested on sentences in noise after 7 to 12 months of using bimodal devices. Both speech (at 55 dB HL) and noise (at 45 dB HL) were presented from a frontal loudspeaker. Average speech-recognition scores were only 12.9% for the hearing aid alone and 60.7% for the cochlear implant alone, but bimodal listening produced an average score of 75.6% correct. Localization abilities have been shown to improve with bimodal devices relative to use of either device alone for some, although not all, adult2728 and pediatric1,24 patients. Many users of bimodal devices have also reported higher levels of satisfaction and perceived benefit than with hearing aids worn pre-implantation, although cosmetic and handling concerns of using the two devices have sometimes been expressed,29 emphasizing the need for sufficient counseling and training. It is also important to consider that children may need more time to learn to use bimodal cues.25 There is debate over the relative effectiveness of bilateral cochlear implants versus bimodal devices. Overall, however, the published literature on bimodal devices has been quite positive (e.g. see Ching et al. for a review18). A judicious approach would be to fit a hearing aid contralaterally to the implant on patients who show sufficient benefit from the hearing aid and are able to use the binaural cues provided. FACTORS IN FITTING THE HEARING AID Certain aspects of the fitting need to be considered and possibly modified for optimal use of bimodal devices. Dispensing professionals who follow proven, evidence-based protocols for hearing aid fitting, however, will require minimal adaptation of their normal procedure. The American Academy of Audiology has published a Pediatric Amplification Protocol and all professionals dispensing hearing aids to children should be familiar with it.30 Optimization of the hearing aid in bimodal fittings essentially requires three steps. First, the cochlear implant map must be stable. You will need to communicate with the cochlear implant audiologist to know when this has been accomplished. Second, a frequency response should be selected for the hearing aid that will provide the best speech intelligibility. This is established by starting with a hearing aid that has been fitted and verified using a prescriptive formula. While the first author has had success using NAL-NL1,31 and Ching recommended it as an optimal starting point,32 those who are proficient with DSL[i/o]33 or another validated prescriptive approach should not be discouraged from using it as the starting point. From the initial prescription, two alternate frequency responses should be programmed into the hearing aid and adjusted for equal loudness. This is easy in multiple-memory digital hearing aids. As the limits of the hearing aid permit, program one should be the selected prescriptive formula frequency response. Program two should have 6-dB per octave less amplification in the low frequencies (-6 dB at 1000 Hz, -12 dB at 500 Hz, and -18 dB at 250 Hz). Program three should have 6-dB per octave more amplification in the low frequencies (+6 dB at 1000 Hz, +12 dB at 500 Hz, and +18 dB at 250 Hz). Once the programs are established, the child should listen to connected discourse while the audiologist switches between programs to determine which one provides the clearest speech. This can be done by playing a recorded story or watching a child-friendly video. The cochlear implant should be turned off during this frequency response selection process. Ching reported that this procedure is appropriate for children as young as 6 years.32 For younger children, the professional may choose to default to the prescriptive response. Finally, the third step in the fitting protocol is to match overall loudness between the hearing aid and cochlear implant. Both the implant and the aid are turned on and the child is asked to report if the hearing aid is louder or softer than the cochlear implant. The aid is then adjusted accordingly. This can also be done while the child listens to a recorded story or watches a video. A chart like that in Figure 3 can be helpful for this task. Some children might experience loudness discomfort from amplification. If so, Ullauri et al. suggest starting with a lower volume setting on the hearing aid and raising it over time as acclimatization occurs until the level of balanced loudness is achieved.34Figure 3: Loudness balancing scale. Source: Cochlear in-house material.A flow chart for fitting the hearing aid in bimodal devices is shown in Figure 4. This recommended protocol has been validated in children and found to provide good binaural benefits.24 For the reader wishing more in-depth training, a tutorial is available at www.cochlearcollege.com. Ching et al. have also published excellent articles on fitting and adjusting the hearing aid for children wearing bimodal devices.2,35Figure 4: Optimizing the hearing aid in bimodal fitting. Source: Cochlear in-house material.CONCLUSIONS The use of bimodal devices is the recommended treatment option for children who meet cochlear implant candidacy but who either have some usable hearing in one ear or for other reasons get only one implant. Bimodal devices can be a successful alternative to bilateral hearing aids or to one cochlear implant alone. It is important to remember these three vital rules: (1) Work with the implant center to make sure the implant map is stable. (2) Fit the hearing aid frequency response for maximal speech intelligibility. (3) Balance the loudness with the cochlear implant and hearing aid. Bimodal fitting can provide optimal use of the different, but potentially complementary, bilateral cues provided by the acoustic amplifier and the electric stimulation from the implant.

Background and objectiveAge-related hearing loss (ARHL) is a significant risk factor for cognitive decline that can be mitigated using hearing aids (HAs). This study investigated the impact of HAs on cognitive function in ARHL, specifically targeting delayed recall and spatial orientation, and identified the influencing factors using multivariate logistic regression.MethodsThis is a cross-sectional study. A total of 104 ARHL patients from July 2023 to October 2025 were enrolled, dividing them into HA users (HA+ group, n = 47) and non-HA (HA− group, n = 57). The patients underwent audiological and cognitive assessments, including pure tone average (PTA), Montreal Cognitive Assessment (MoCA), and Mini-Mental State Examination (MMSE). Group comparisons were performed using these measures. Logistic regression was used to identify predictors of impaired delayed recall and spatial orientation, considering variables such as age, sex, HA+/− status, education, severity of hearing loss, depressive symptoms, living alone, smoking, alcohol consumption, diabetes, and hypertension.ResultsThe HA + group had significantly better MoCA (24.49 ± 2.78 vs. 21.00 ± 3.63; Z = −4.881, p < 0.001) and MMSE (25.81 ± 2.45 vs. 23.33 ± 3.33; Z = −4.118, p < 0.001) scores than the HA- group, notably in delayed recall (Z = −2.653, p = 0.008) and spatial orientation (Z = −3.643, p < 0.001). HAs were a significant protective factor for both delayed recall [OR = 0.271, 95% confidence interval (CI) = (0.080, 0.914)] and spatial orientation [OR = 0.233, 95% CI = (0.066, 0.823)]. Additionally, higher educational levels were associated with better cognitive function.DiscussionHAs improved cognitive function in patients with ARHL, especially in terms of delayed recall and spatial orientation, with education offering additional protection.

Background Age-related hearing loss (ARHL) is a major cause of chronic disability among the elderly. Individuals with ARHL not only have trouble hearing sounds, but also with speech perception. As the perception of auditory information is reliant on integration between widespread brain networks to interpret auditory stimuli, both auditory and extra-auditory systems which mainly include visual, motor and attention systems, play an important role in compensating for ARHL. Objectives To better understand the compensatory mechanism of ARHL and inspire better interventions that may alleviate ARHL. Methods We mainly focus on the existing information on ARHL-related central compensation. The compensatory effects of hearing aids (HAs) and cochlear implants (CIs) on ARHL were also discussed. Results Studies have shown that ARHL can induce cochlear hair cell damage or loss and cochlear synaptopathy, which could induce central compensation including compensation of auditory and extra-auditory neural networks. The use of HAs and CIs can improve bottom-up processing by enabling ‘better’ input to the auditory pathways and then to the cortex by enhancing the diminished auditory signal. Conclusions The central compensation of ARHL and its possible correlation with HAs and CIs are current hotspots in the field and should be given focus in future research.

Age-related hearing loss (ARHL) is one of the most common chronic conditions that impacts on everyday life far beyonds speech understanding. Chronic hearing loss has been associated with social isolation, depression, and cognitive decline. Early diagnosis and appropriate treatment are recommended. To give an overview of surgical and non-surgical treatment options for ARHL and the gap between the high prevalence of ARHL and its inadequate treatment to date. A selective literature search was carried out in PubMed. In case of mild to moderate hearing loss, provision of air conduction hearing aids is still the method of choice as it leads to alarge benefit in speech understanding and hearing-specific quality of life, and to a slight improvement in overall quality of life. Implantable middle ear systems are used for the treatment of special types of hearing impairment. In case of severe to profound hearing loss, cochlear implantation should be considered; however, only asmall number of older people with hearing loss are supplied with hearing aids or cochlear implants despite the well-known benefits of both. This also applies to high-income countries where the costs are covered by health insurance funds. Considering the low rate of properly treated people with hearing loss, large-scale screening programs, including better counselling of older people, should be developed.

Age-related hearing loss (presbycusis) is one of the most common health conditions in adults over 50 years old. It is important to recognize and treat acquired hearing loss because it is linked to many adverse consequences, such as communication difficulties, social isolation, depression, and diminished quality of life.1,2 Despite the high prevalence of age-related hearing loss, many adults have hearing loss that goes unrecognized. People may miss identifying their age-related hearing loss because the onset is typically slow and gradual. They may not notice subtle changes in their hearing-related behaviors that attempt to compensate for the loss, such as increasing the volume on audio devices. Of course, someone who is not aware of their hearing loss is not likely to report the problem to health care providers, and he or she is subsequently less likely to receive screenings or referrals to audiology. This is a problem because early identification of age-related hearing loss allows for timely intervention and improved outcomes.3 In fact, adults who delay treatment until their hearing loss is severe do not respond to interventions as well as those who initiate interventions early in the course of their hearing loss.3 A good deal of research has focused on adults with diagnosed hearing loss that goes untreated (e.g., the problem of low uptake and use of hearing aids).4 Unfortunately, little is known about people who are unaware of their hearing loss.iStock/Manuel-F-O, internet, telehealth, hearing loss.Our research aimed to explore characteristics that differentiate adults with unrecognized hearing loss from those with recognized hearing loss and adults with normal hearing.5 By definition, it is difficult to conduct systematic research on a population of individuals who are unaware of their impairment and not seeking evaluation or treatment for it. We had a serendipitous opportunity to do so in the process of completing a study on assessment of verbal memory among adults with diagnosed hearing loss. In our initial study, we sought a comparison group of older adults with hearing in the normal range. We then worked with older adults who presented themselves as healthy volunteers for a study that specifically required participants with normal hearing.6 Each participant completed a hearing screen as part of a larger assessment. The screening paradigm identified a surprisingly large subgroup of people who had substantial hearing loss but self-reported that their hearing was normal. Although this unique group was excluded from the original study, we understood that their data presented a rare opportunity to learn more about the characteristics of people with unrecognized hearing loss, which might eventually improve efforts in identifying individuals who are least likely to seek out services independently. STUDY HIGHLIGHTS Our study recruited older adults with and without hearing loss from the Henry Ford Health System (HFHS), Wayne State University (WSU), and the greater Metropolitan Detroit community. Thus, there was an opportunity for participation regardless of hearing status, and no requirement was placed that might motivate potential volunteers to misreport their self-perceived hearing abilities. The total sample comprised 130 adults aged 55 to 85 years old. Of these, 61 were diagnosed with age-related sensorineural hearing loss; they were largely recruited from the audiology services at HFHS and WSU. These volunteers were documented to have speech-frequency pure-tone average (PTA) of air-conduction thresholds of > 25 decibels hearing level (dB HL) at 0.5, 1, 2, and 4 kHz in the better ear. Participants who volunteered for the normal hearing group underwent hearing screens using a portable audiometer as part of the research study. Of the 69 adults who volunteered for that group, our hearing screens indicated that only 39 had hearing in the normal range. Unrecognized hearing loss was identified in 30 volunteers who had described themselves as having no hearing difficulty, but whose hearing thresholds were >25 dB at 0.5, 1, 2, or 4 kHz. As part of the original study, participants completed a subjective and objective assessment of their physical health, various measures of cognition, and personality assessment of their traits for positive and negative affectivity (emotionality). The groups were equivalent in general physical health status, education, estimated IQ, and various cognitive abilities. Marital status and likelihood of living alone also did not differ among the groups. However, consistent with the known risk factors for hearing loss, individuals with unrecognized hearing loss were more likely to be men (60%) and tended to be older (average age of 70 years old) compared with participants with normal hearing (31% men, average age of 65 years old). Importantly, participants with hearing loss were similar in age and proportion of men regardless of whether the hearing loss was recognized or not. Thus, age and gender alone cannot be used to identify individuals particularly at risk for unrecognized hearing loss. Interestingly, individuals in the unrecognized hearing loss group could be differentiated from the groups with hearing in the normal range and recognized hearing loss by their higher levels of positive affectivity. In fact, positive affectivity predicted group membership in the unrecognized hearing loss group even after accounting for age, gender, physical health, and cognitive health. In contrast, negative affectivity did not differ meaningfully among the groups. These results suggest that high positive affectivity may be related to discounting health declines and subsequently delaying intervention. CLINICAL IMPLICATIONS It is widely accepted that hearing screening is an important component of health care for older adults. However, the method used to identify hearing loss and the effectiveness of screening are quite variable. Frequently used techniques include self-report questionnaires or even simply asking if a person has noticed any difficulty hearing.7 However, as highlighted in our study, there is a sizeable subset of people who are likely to deny hearing difficulty upon questioning but have meaningful hearing loss. Individuals who report high positive affectivity are particularly at risk for biased responding on self-reported hearing measures. Typically, positive affectivity is associated with physical health, self-esteem, and subjective well-being;8 yet, it may also be associated with an overly rosy outlook that downplays negative things such as age-related decline, including hearing loss. Some studies have linked optimism and positive affectivity to denial and avoidance. For example, research indicates that people who engage in optimistic denial also tend to underrate their level of health risk.9 Providing educational materials on hearing screening and support for interdisciplinary referrals of patients to audiology services can help promote early identification of and intervention for individuals with age-related hearing loss.10,11 In light of the findings from our study, it is important to keep in mind that a patient's denial of hearing difficulty does not preclude the need for a referral for a hearing screening or assessment. Further research should explore the best practices in psychoeducation about hearing screening that targets patients who do not endorse hearing loss. This may help optimize the likelihood of patient follow-up with assessment and intervention. Previous research has shown that self-perceived hearing problems and hearing-related functional impairment are positively related to help-seeking, hearing aid use, and hearing aid satisfaction across the spectrum of mild-to-severe hearing loss.12,13 Broadly targeted screening programs that specifically comment on the high prevalence (and associated risks) of unrecognized hearing loss may help increase the identification of hearing loss through heightened self-awareness and/or awareness within the person's family and social network. Subsequently, highlighting the importance of early intervention and prevention may enhance motivation and adherence with follow-up treatment among people with unrecognized hearing loss who are identified via screening. Including psychological assessment of readiness for change may also help in understanding a patient's level of awareness of hearing loss and motivation for intervention compliance.14 It may also be useful in engaging family members in discussions about hearing interventions for patients with poor awareness of their hearing impairment.

Can age-related hearing loss affect language rehabilitation in aphasic patients?

Objective Recent literature has shown a growing interest in the relationship between presbycusis and cognitive decline, but significant evidence about the long-term benefit of rehabilitation on cognitive functions has not been reported yet. The aim of the study was to analyze audiological and neuropsychological performances in patients with cochlear implant (CI) or hearing aids (HAs) over time. Materials and Method Forty-four bilaterally deaf patients aged more than 60 years (25 with CI candidacy and 19 with HA candidacy) were enrolled. Patients were subjected to audiological evaluation, to a battery of neuropsychological tests (Mini-Mental State Examination [MMSE], Rey Auditory Verbal Learning Task [RAVLT], Rey-Osterreith Complex Figure Test, Digit/Corsi Span Forward and Backward, Multiple Features Target Cancellation, Trail-Making Test, Stroop Test, and Phonological and Semantic Word Fluency), and to a quality of life assessment (Short Form 36, Glasgow Benefit Inventory, Glasgow Health Status Inventory) at the baseline and after a long-term follow-up (6-12 months). Results Speech recognition scores in quiet and in noise were significantly improved even 6 months after auditory rehabilitation. Significant differences between pre- and post-rehabilitation scores were reported in physical and emotional impacts in life, general global health, vitality, and social activities. MMSE and RAVLT scores were significantly improved in both groups after 6 months of follow-up, suggesting a global involvement of memory domain. Mnesic performances remained unchanged between the first and second follow-up, but a further significant improvement in executive functions (Stroop Test) was detected in patients with CI reevaluated 12 months after implantation. A significant correlation of the RAVLT with signal-to-noise ratio at +10 dB speech-in-noise scores and the MMSE with signal-to-noise ratio at 0 dB speech-in-noise scores suggests the pivotal role of executive functions in recognition in noisy environment. Conclusions Our preliminary data confirm that hearing deprivation in aged patients represents a truly modifiable risk factor for cognitive decline, which can be positively faced by acoustic rehabilitation. The improvement of short- and long-term memory performances and the amelioration of executive and attentive functions suggest that hearing restoration with both HAs and CI may provide a recovery of superior cognitive domains probably through a reallocation of cortical resources altered by hearing deprivation.