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Verbal fluency after cochlear implantation: a longitudinal comparison with untreated hearing loss in the ELSA cohort
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DOI：10.3389/fnins.2026.1854922.png)
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Abstract
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IntroductionHearing loss is associated with accelerated cognitive decline; and auditory rehabilitation via cochlear implantation (CI) may mitigate this trajectory. In the past; the impact of cochlear implantation on different cognitive subdomains has been described. However; verbal fluency (VF); which requires fast semantic retrieval; executive control; and processing speed; and is predictive of dementia risk and overall survival; has been rarely studied and control groups are mostly missing due to ethical reasons. The present study compares long-term VF trajectories in CI recipients and untreated hearing-impaired controls from a large population-based aging study.Materials and methodsVF was assessed in 74 CI recipients (M = 65.6 years; SD = 9.1) at pre-operative baseline and 1; 2; 4.5; and up to 9 years post-implantation; and in 383 untreated hearing-impaired participants (M = 72.6 years; SD = 10.0) from the English Longitudinal Study of Ageing (ELSA) across a comparable time frame. Scores were z-standardized within each study to enable cross-cohort comparison. Linear mixed-effects models were used to compare VF trajectories; with age; sex; and education as covariates.ResultsVF trajectories differed significantly between groups (Time × Study interaction: b = 0.562; p < 0.001). The ELSA cohort showed a steady linear decline over time (b = −0.261; p = 0.001); whereas the CI cohort exhibited an inverted-U trajectory with initial improvement followed by a plateau. After propensity score matching; results remained robust.ConclusionCochlear implantation is associated with more favorable long-term verbal fluency trajectories compared to untreated hearing loss. These findings add to the growing evidence that auditory rehabilitation may help preserve cognitive function in older adults.
Keywords:
dementia
hearing loss
ELSA
verbal fluency
cochlear implantation
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