Fig. 3.

Hypothesized framework for the mechanism of the hearing and dementia association. The center blue circle includes potential causal paths between peripheral hearing loss and cognitive decline or dementia, including changes to brain structure and function (i.e., sensory deprivation hypothesis), increased cognitive demands (i.e., information degradation hypothesis), and other effects such as social isolation. Additionally, a common cause such as systemic vascular disease or genetic factors may lead to both peripheral hearing loss and cognitive decline and dementia. Further inclusion of central auditory function as a result of direct and indirect effects from this causal pathway and may serve as a marker of cognitive decline or dementia. It is likely more than one of the pathways depicted may explain the link between hearing and dementia