Before a memory test, get your hearing checked — or at least tell the clinician about any hearing loss — because untreated hearing loss can make a healthy senior score like someone with cognitive impairment. Standard memory, attention, and language tests rely on spoken questions, and according to NIHR Evidence, people with hearing loss score worse on them, which can lead to a false dementia diagnosis.
The overlap is large. Johns Hopkins Medicine reports that about 1 in 3 US adults aged 65–74 has hearing loss, and nearly half of those over 75 have difficulty hearing. Preparing well for both appointments — the hearing test and the memory assessment — protects the accuracy of each.
Table of Contents
- Why hearing status changes memory test results
- Preparing for the hearing test
- Preparing for the memory assessment
- What Medicare covers
- Do hearing aids protect memory?
- Bring someone with you
- Frequently Asked Questions
Why hearing status changes memory test results
Cognitive screenings like the MMSE are delivered by voice. A question half-heard is a question half-answered, and the score records it as a memory failure rather than a hearing one. The effect goes deeper than missed words.
A 2020 simulation study reported in PMC found short-term-memory and working-memory scores dropped significantly under simulated hearing loss even when the test words remained intelligible. Straining to decode speech drains the same mental resources the test is trying to measure. The practical takeaway: a low score in a person with untreated hearing loss is ambiguous. It may reflect cognitive decline, hearing loss, or both — and only accounting for hearing separates them.
Preparing for the hearing test
Audiology practices, including guidance collected by Soundly, recommend a short checklist: A real audiogram matters even in the era of over-the-counter devices. Under the FDA rule in effect since October 17, 2022, adults can buy OTC hearing aids for perceived mild-to-moderate loss without an exam — but the FDA notes that "perceived" is the catch: gradual loss that feels mild can actually be severe. Test first, then choose a device.
- Bring your medication list, medical history, any prior audiograms, and current hearing aids.
- Write down specific listening situations that are hard — restaurants, phone calls, TV volume disputes.
- Avoid loud noise (concerts, power tools) in the days before the test.
- Reschedule if you are congested from a cold or allergies; ear pressure changes skew results.
Preparing for the memory assessment
Tell the office about hearing loss when you book, not when you arrive. Adapted tests exist for exactly this situation: a Frontiers in Aging Neuroscience review describes a written MMSE and the validated MoCA-H, both designed for hearing-impaired patients.
Ask whether a hearing-adapted version will be used. On the day: If hearing aids are new, mention that too. A clinician who knows you spent years mishearing conversations can weigh reports of "forgetting" what was said accordingly.
- Wear your hearing aids with fresh batteries or a full charge.
- Bring the same medication list and history you took to the audiologist, plus the audiogram itself.
- Note real examples of memory concerns — missed appointments, repeated questions — with rough dates.
What Medicare covers
Medicare's free annual wellness visit must include detection of cognitive impairment, done through direct observation plus reports from the patient and family, per Medicare.gov. No separate appointment is needed to raise a memory concern — the wellness visit is the built-in screening point.
If impairment is suspected there, Medicare covers a separate, more thorough cognitive assessment and care-plan visit. That second visit is where a full evaluation and a written care plan happen, so a worrying screen is a next step, not a verdict.
Do hearing aids protect memory?
The best evidence is the ACHIEVE randomized trial of 977 adults aged 70–84 with untreated hearing loss, published in The Lancet in July 2023. Across all participants, three years of hearing aids plus audiologist counseling showed no overall benefit.
In the prespecified higher-risk ARIC subgroup, though, the intervention slowed cognitive decline by 48%. A 2024 Lancet commentary frames the honest conclusion: hearing aids address a modifiable dementia risk factor, particularly for higher-risk seniors, but they are not a proven prevention for everyone. Treat hearing loss for hearing's sake — clearer conversation, accurate test scores — with possible cognitive protection as a bonus, not a promise.
Bring someone with you
Take a family member or friend to both appointments. Audiologists recommend it because a companion helps recall what was discussed and can describe listening difficulties you no longer notice.
For the memory side it carries formal weight: Medicare's cognitive screening explicitly counts concerns raised by family and caregivers as part of the detection process. Ask your companion to jot down, beforehand, two or three specific changes they have observed and roughly when each began — that written note is often the most useful thing in the room.
Frequently Asked Questions
Can I just buy over-the-counter hearing aids instead of getting tested?
You can — the FDA has allowed OTC sales for perceived mild-to-moderate loss since October 2022 — but gradual loss that feels mild can be severe, so get an audiogram first.
What if a memory screen at the wellness visit looks concerning?
Medicare covers a separate, more thorough cognitive assessment and care-plan visit; the screen is a trigger for that fuller evaluation, not a diagnosis.
Should hearing aids be worn during a memory test?
Yes — wear them with fresh batteries, and ask whether a hearing-adapted test like the MoCA-H or a written MMSE will be used.