Preprint · Jan 2026
Social Activity and Loneliness as Modifiers of the Relationship Between Hearing Loss and Cognitive Function
By Carpio R, Grilli MD, Sbarra D
Age-related hearing loss (ARHL) is associated with adverse cognitive outcomes, including lower cognitive functioning, accelerated decline, and a higher likelihood of diagnosis with Alzheimer’s disease and related dementias (ADRD) (Fortunato et al., 2016; Powell et al., 2022; Davies et al., 2017). The magnitude of the association may be relatively large, with significant hearing loss linked to cross-sectional cognitive impairment that is estimated to be equivalent to seven years of aging (Lin et al., 2011). Additionally, several longitudinal studies have identified age-related hearing loss as a prominent risk factor for future cognitive impairment/decline and dementia (Wang et al., 2022; Laughrey et al., 2017). In contrast to the accumulating evidence of a possible causal link between ARHL and adverse cognitive functioning, there is less research examining modifiable lifestyle factors that may provide resilience to this adverse sensory and cognitive functioning relationship. To help address this gap in knowledge, the present study aims to investigate adaptive social factors that may weaken, or mitigate, the association between ARHL and cognitive functioning. Prior literature has put forth two proposed mechanisms for the adverse relationship between hearing loss and cognitive decline. The cognitive load hypothesis suggests that an individual with ARHL may dedicate excessive cognitive effort toward listening, therefore compromising the availability of cognitive resources for other cognitive tasks, potentially leading to cognitive decline through lack of diverse cognitive engagement (Park et al., 2022; Wingfield, 2016; Zhao et al., 2024). The sensory deprivation hypothesis, in comparison, proposes that prolonged sensory deprivation may lead to neural restructuring and, as a result, worse cognitive functioning (Zhao et al., 2024; Humes et al., 2013). For example, studies have found ARHL to be associated with reduced gray matter in the auditory cortex and increased activity in frontal brain regions when perceiving speech (Eckert et al., 2012; Husain et al., 2011; Rosemann & Thiel, 2018). Similar to the cognitive load hypothesis, the sensory deprivation hypothesis also suggests that hearing loss may lead to less cognitive stimulation, resulting in accelerated cognitive decline (Zhao et al., 2024; Dawes et al., 2015; Whitson et al., 2018). Prior research raises the possibility that social activity and social support may help build resilience against the potential negative consequences of hearing loss on cognition. Multiple aspects of social functioning, including relationship quality, social activity, and communicative abilities, are positively associated with future cognitive functioning (Fortunato et al., 2016; James et al., 2011; Lin et al., 2011, 2013). For instance, a longitudinal study found that older adults who are more socially active have a reduced risk for future cognitive decline across several domains (James et al., 2011). Likewise, a decrease in social support and high rates of loneliness are tied to an increased risk of developing ADRD and cognitive decline both cross-sectionally (Joyce et al., 2021) and longitudinally (Freak-Poli et al., 2022; Dickinson et al., 2011). Higher quality social functioning, therefore, may buffer against cognitive decline. Increased social activity and decreased loneliness, in fact, are linked to overall better health outcomes (Veiga et al., 2015; Tcymbal et al., 2022; Levasseur et al., 2008; Steffens et al., 2016). Also, a recent meta-analysis (Li et al., 2026) identified three studies that have examined social functioning as a moderator of the association between self-reported ARHL and cognition. This meta-analysis found that social activity, measured as a self-report of one’s social network, support, and participation (i.e. frequency of going out, participating in a hobby or sport group, and meeting friends), was a significant moderator, with cognition measured using a brief cognitive screen (i.e., the MMSE). Despite the evidence of a moderating role for social activity on the relationship between ARHL and cognition, several fundamental questions remain. First, prior studies have focused on examining social participation as a moderator. Whether other aspects of social functioning, such as loneliness, moderates the relationship between ARHL and cognition is unclear. Moreover, by relying on a global cognitive measure, prior studies have not shed light on which aspects of cognition are most impacted by social functioning (Gluhm et al., 2013). However, prior research has suggested that hearing loss may be more strongly linked to executive functioning, auditory working memory, and mental processing speed relative to other domains (Lin et al., 2013; Park et al., 2022; Stickel et al., 2024). Therefore, it is important to determine which aspects of social lifestyle factors may serve as moderators of this sensory-cognition association, and for which aspects of cognitive functioning, the impact of ARHL is weakened. To better understand social functioning as a moderator of the relationship between ARHL and cognition, in the present study, we investigate multiple aspects of social activity and cognitive functioning. We draw on publicly available data from the Precision Aging Network, which is a large study of cognitive and brain aging conducted at multiple sites within the United States. Drawing on the available data in the Precision Aging Network, we measure social activity through the UCLA three-item loneliness scale and a Precision Aging Network scale that assesses a variety of social activities such as, participating in volunteer work, community activities, working a paid job position, social gatherings, and cultural events. We measure cognition using Precision Aging Network MindCrowd tasks of processing speed, executive functioning, and episodic memory, as well as a standard neuropsychological measure of episodic memory (i.e., the Auditory Verbal Learning Test).