Epidemiological studies identify midlife hearing loss as an independent risk factor for dementia, estimated to account for 9% of cases. We evaluate candidate brain bases for this relationship. These bases include a common pathology affecting the ascending auditory pathway and multimodal cortex, depletion of cognitive reserve due to an impoverished listening environment, and the occupation of cognitive resources when listening in difficult conditions. We also put forward an alternate mechanism, drawing on new insights into the role of the medial temporal lobe in auditory cognition. In particular, we consider how aberrant activity in the service of auditory pattern analysis, working memory, and object processing may interact with dementia pathology in people with hearing loss. We highlight how the effect of hearing interventions on dementia depends on the specific mechanism and suggest avenues for work at the molecular, neuronal, and systems levels to pin this down.

流行病学研究确定中年听力损失是痴呆症的一个独立危险因素，估计占痴呆症病例的 9%。我们评估这种关系的候选大脑基础。这些基础包括影响上行听觉通路和多模态皮层的常见病理、由于聆听环境贫乏而导致的认知储备耗竭，以及在困难条件下聆听时认知资源的占用。我们还提出了一种替代机制，利用对内侧颞叶在听觉认知中的作用的新见解。我们特别考虑了听觉模式分析、工作记忆和物体处理中的异常活动如何与听力损失患者的痴呆病理相互作用。我们强调听力干预对痴呆症的影响如何取决于具体机制，并提出了在分子、神经元和系统水平上确定这一点的工作途径。