Association of Age-Related Hearing Loss with Domain-Specific Cognitive Performance in Older Adults

Background/Objectives: Age-related hearing loss (ARHL) is highly prevalent among older adults and has been linked to cognitive decline. However, the specific cognitive domains most vulnerable to ARHL and whether these associations exhibit lateralized effects remain unclear, which is critical for understanding and mitigating its broader impact on neurocognitive function. This study aimed to characterize the clinical profile of ARHL and examine associations between hearing thresholds and cognitive performance across domains, including the influence of educational attainment as a proxy for cognitive reserve. Methods: Audiometric assessments and cognitive screening using the Mini-Mental State Examination were conducted in older adults, including normal-hearing listeners (NHL, n = 31, mean age 71.4) and those with hearing loss (HL, n = 46, mean age 73.1). Associations between pure-tone averages, clinical complaints, and cognitive domains were analyzed while considering educational attainment. Results: HL participants exhibited a higher prevalence of tinnitus (NHL: 33.3% vs. HL: 65.2%) and slightly more frequent dizziness compared to their normal-hearing peers. Cognitive assessment revealed that decreased cognitive performance was strongly associated with hearing loss (p < 0.05), and this association was influenced by low educational level. Orientation was the most affected domain (p < 0.01), while recall and language were also significantly associated with low- and high-frequency pure-tone averages, respectively. Conclusions: These findings reinforce the relationship between ARHL and cognitive decline, suggesting an attentional basis whereby higher listening effort to decode the degraded auditory input may affect cognitive performance. The results also highlight the influence of educational attainment as a moderating factor.