What this means for patients
Research stage: not yet standard treatment.
This Chinese randomized trial found that hearing aids helped some older adults with mild cognitive impairment and hearing loss improve their thinking and memory, but it did not clearly reduce progression to dementia over 24 months. The results are early and apply only to this specific group of patients, so hearing aids should not be seen as a proven way to prevent or treat dementia. Talk with a doctor about hearing testing and whether a hearing aid is right for you.
On September 28, 2026, the results of the “Chinese Hearing Solution for Improvement of Cognition in Elders” (CHOICE-RCT), a randomized controlled study led by Professor Wu Hao’s (吴皓) team from the Department of Otorhinolaryngology-Head and Neck Surgery at Shanghai Ninth People’s Hospital (上海交通大学医学院附属第九人民医院), the Ear Science Institute of Shanghai Jiao Tong University School of Medicine, and the Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, were officially published online in the international top clinical medicine journal 《JAMA Neurology》 (impact factor 23.6, Q1).
Hearing loss is the most important modifiable risk factor for dementia, yet among the elderly population in China, there is a prominent contradiction of “high prevalence and low intervention rate.” A previous systematic review pooling 31 studies worldwide with over 130,000 participants suggested that users of hearing aids and other auditory assistive devices had a lower risk of cognitive decline; however, because most included studies were observational, differences among wearers in economic conditions, education level, and health awareness could not be ruled out. The conclusion explicitly stated that high-quality randomized controlled trials are needed to verify the protective effect of hearing intervention on cognitive function in the elderly. Meanwhile, existing randomized controlled trials internationally only targeted elderly individuals with normal cognitive function, and there was no reliable evidence for elderly populations already showing cognitive decline.
CHOICE-RCT was led by Shanghai Ninth People’s Hospital, in collaboration with Shanghai Sixth People’s Hospital, Ruijin Hospital, and Shanghai Mental Health Center. Recruitment was completed at otorhinolaryngology outpatient clinics of 3 tertiary hospitals and 3 community sites in Shanghai. A total of 703 elderly individuals with mild cognitive impairment and moderate-to-severe hearing loss were enrolled, randomized 1:1 to receive hearing aid intervention or hearing health education, with 610 completing 24-month follow-up.
Results showed that although the proportion progressing to dementia within 24 months (3.09% vs 4.74%) did not reach statistical significance between the two groups, on another prespecified key endpoint, the proportion of cognitive function returning to normal in the intervention group was 15.34%, compared with 2.36% in the control group, with a risk ratio of 5.94. No study-related adverse events were reported during the study period. This study is the first to use randomized controlled data from a Chinese population to suggest that although hearing aid intervention did not significantly reduce short-term dementia conversion risk, it can significantly increase the chance of cognitive improvement in elderly individuals with mild cognitive impairment.
As a non-pharmacological intervention, hearing screening and hearing aid fitting do not depend on new drug development; once evidence is sufficient, they can be scaled up at the community level. At the same time, compared with drug development, promoting hearing screening and hearing aid intervention requires lower investment and has stronger replicability. It is estimated that if the hearing aid wearing rate among elderly patients with presbycusis in China increases from the current less than 10% to 30%-40%, comparable to developed countries, it could save the country tens of billions of yuan in dementia-related care costs each year.
There is still a long way to go from a scientific research study to inclusive public health practice. But the CHOICE project has taken a key step: it has used the highest-level evidence from the Chinese population to prove that this path is feasible. In the future, the team will continue to delve deeply into the field of elderly hearing and cognitive health, extend the follow-up period, expand the community cohort, and continuously promote the translation of evidence into policy, providing more scientific basis for addressing the challenges of aging.
This study was led by the Department of Otorhinolaryngology-Head and Neck Surgery at Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, the Ear Science Institute of Shanghai Jiao Tong University School of Medicine, and the Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, in collaboration with the Department of Otorhinolaryngology-Head and Neck Surgery at Shanghai Sixth People’s Hospital, the Department of Otorhinolaryngology-Head and Neck Surgery at Ruijin Hospital, and the Department of Geriatric Psychiatry at Shanghai Mental Health Center.
Professor Wu Hao (吴皓) from Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine is the sole corresponding author of the paper; Chen Ying (陈颖) from Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shi Haibo (时海波) from Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Xiang Mingliang (向明亮) from Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Li Xia (李霞) from Shanghai Mental Health Center Affiliated to Shanghai Jiao Tong University School of Medicine, Wang Zhili (王智立) from Shanghai Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Lu Wen (路文) from Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shen Yilin (沈怡琳) from Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and Fang Yuan (房圆) from Shanghai Mental Health Center Affiliated to Shanghai Jiao Tong University School of Medicine are co-first authors of the paper. The study was supported by the National Natural Science Foundation of China, Shanghai Shenkang Hospital Development Center, Shanghai Clinical Key Medical Center, and the Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases construction project, among others.
Original report: Shanghai Ninth People's Hospital. This article is an English translation of the original report.