ACHIEVE Study Links Hearing Treatment to Slower Rise in Brain-Health Biomarker

A new analysis of the landmark ACHIEVE (Aging and Cognitive Health Evaluation in Elders) clinical trial suggests that treating hearing loss may slow inflammation- and degeneration-related biological changes in the aging brain.

The study, published in the September 2026 edition of EClinicalMedicine, examined blood samples from older adults who had been randomly assigned to receive either a comprehensive hearing intervention or a healthy-aging education program. After 3 years, participants receiving hearing aids and audiological care showed a significantly slower increase in a blood biomarker associated with neuroinflammation.

The findings could help researchers better understand why hearing treatment appeared to slow cognitive decline among ACHIEVE participants who were at greater risk for dementia.

“Overall, this investigation suggests that hearing intervention may reduce the progression of non-specific biomarkers of neuroinflammation among older adults with hearing loss who have multiple risk factors for incident dementia,” wrote lead author James Russell Pike and colleagues. “This finding bolsters the role of hearing loss as a modifiable target for dementia prevention, as elevated levels of non-specific biomarkers of neuroinflammation and neurodegeneration are associated with both accelerated cognitive decline and greater risk of dementia in older community-dwelling adults.”

Measuring biological changes in the blood

The original 2023 ACHIEVE study by Frank Lin et al. enrolled 977 adults ages 70-84 with untreated mild-to-moderate hearing loss but without substantial cognitive impairment. Participants were randomly assigned to a hearing intervention or a health-education control group.

The hearing program included professionally fitted hearing aids, audiological counseling, and continuing support. The control group received individual education sessions on healthy aging and chronic-disease prevention.

For this latest study, researchers examined stored blood samples collected at the beginning of the trial and 3 years later from 164 participants in ACHIEVE’s Atherosclerosis Risk in Communities, or ARIC, group. The original ACHIEVE study found that these participants generally had more health risks and a greater likelihood of cognitive decline than ACHIEVE’s healthier community volunteers.

The researchers measured two blood-based biomarkers:

• Glial fibrillary acidic protein (GFAP): A marker associated with activation of astrocytes (supporting cells in the brain that respond to injury and inflammation).
• Neurofilament light chain (NfL): A marker of damage to nerve-cell fibers and broader neurodegeneration in the brain.

Over 3 years, GFAP increased in the health-education control group but essentially remained stable in the hearing-intervention group. The difference between the groups was statistically significant.

NfL also increased more slowly among participants receiving hearing care. However, it did not reach statistical significance, meaning chance cannot be confidently ruled out as an explanation.

A possible explanation for earlier ACHIEVE results

The findings build upon ACHIEVE’s closely watched primary results, published in 2023. Across the entire group of 977 participants, hearing intervention did not significantly slow cognitive decline compared with health education.

The latest biomarker results ran in parallel with the cognitive findings in the higher-risk (ARIC) population. They therefore provide a possible biological explanation for the earlier results: treating hearing loss might affect processes involving brain inflammation and nerve-cell injury, rather than simply making it easier for participants to hear instructions and perform cognitive tests.

Other ACHIEVE research has identified additional benefits of hearing treatment. A 2025 analysis found that participants receiving hearing aids and audiological support maintained slightly larger and more diverse social networks and experienced less loneliness than those receiving health education.

Taken together, the studies suggest several potentially overlapping pathways linking hearing and cognitive health. Better hearing may help people remain socially connected, reduce the mental effort required to communicate, and possibly influence biological processes associated with cognitive decline.

Study Caveats

The researchers were careful to note several caveats about the study. They emphasize that this analysis involves only 164 participants from the higher-risk ARIC subgroup—not the full ACHIEVE population. GFAP and NfL are also indirect blood biomarkers rather than diagnoses of dementia and direct measurements of changes within the brain; the study isn’t conclusive proof that hearing aids prevent dementia or neurodegeneration. They also caution that the study findings should not be interpreted as showing that hearing treatment reduced neuroinflammation by 48% because that figure refers specifically to the difference in cognitive decline previously observed in the ARIC group.

However, the study's randomized design makes the results more robust than observational studies that simply compare hearing aid users with nonusers. The findings provide stronger support for investigating whether timely, comprehensive hearing care can help protect brain health—particularly among older adults already at elevated risk for cognitive decline.