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. 2024 Dec 4;19:93. doi: 10.1186/s13024-024-00776-y

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© The Author(s) 2024

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Fig. 3 — Potential Mechanisms Underlying the Association Between Hearing Impairment and AD. (a) Convergent Pathological Impact: Common pathological processes associated with AD or vascular disease impact both the cochlea and the ascending pathway, leading to hearing loss, while simultaneously affecting the MTL and causing dementia. (b) Cognitive Deficit: Hearing loss results in an impoverished cognitive environment, altering brain structure in the auditory cortex and hippocampus. This leads to decreased cognitive reserve and resilience against dementia due to a lack of cognitive stimulation. (c) Resource Allocation: Increased brain activity in the MTL and a broader network during speech-in-noise analysis competes for cognitive resources required for other higher cognitive functions. This mechanism is suggested to better explain cognitive deficits in older individuals with hearing loss rather than dementia itself. (d) Auditory-Cognitive Interaction: Hearing loss leads to increased activity related to pattern analysis in the MTL during challenging listening conditions, interacting with AD pathology. This model incorporates the same activity increase as in resource allocation mechanism but adds the interaction with the molecular bases of AD, specifically synaptic changes associated with the disease. Image created using Biorender