Listen Care-fully: Healthcare Design for Listening Effort and Cognitive Function


For today’s ageing population, both the number of people living with hearing loss and dementia is projected to increase, and recent research suggests that hearing loss is the highest modifiable risk factor for dementia in later stages of life (Livingston et al., 2017, 2020). Even at mild levels, hearing loss is associated with cognitive decline and the onset of dementia (Lin et al., 2013). Research also suggests that hearing aid use hearing aid use has a mitigating effect on the trajectories of cognitive decline in older adults and may reduce the excess risk from hearing loss (Amieva & Ouvrard, 2020; Livingston et al., 2020). However, little is still known about the mechanisms linking hearing loss and cognitive decline.

This project considers the cognitive load hypothesis in the relationship between hearing and cognitive function. The overuse of cognitive resources for auditory processing may reduce the resources available for other cognitive processing and may result in resource depletion over time. If listening effort does play a role in the progression or onset of cognitive decline, the reduction of listening effort could play a role in future interventions in cognitive healthcare.

Project objectives

This project combines clinical research with engineering systems design to visualise pathways for change at the intersection of hearing and cognitive healthcare. This project investigates the mechanisms underlying hearing loss and cognitive decline and explores the closer integration of hearing-based interventions in cognitive healthcare.

This project measures listening effort using pupillometry and its association with cognitive function in normal-hearing older adults with MCI. These are the first series of studies to objectively examine listening effort in older persons with cognitive dysfunction. Additionally, this project examines the effect of hearing aid use on listening effort, as well as the identification of barriers and benefits regarding hearing aid use and hearing health-seeking behaviours among a population with cognitive dysfunction. The results from this project are considered new knowledge, and are taken as preliminary evidence towards the conceptualisation of future interventions.

This project is an interdisciplinary collaboration between DTU – Department of Technology, Management and Engineering, Danish Dementia Research Centre – Nationalt Videnscenter for Demens (NVD) at Rigshospitalet and the University of Copenhagen and the Health and Care Administration at the Municipality of Copenhagen.

Central research questions

  • Could increased listening effort be an early risk factor of cognitive decline?
  • Can hearing aids reduce listening effort in both healthy individuals and those experiencing cognitive impairment?
  • How prevalent is hearing loss among MCI patients at the memory clinic?
  • Are hearing needs being addressed among this patient group?
  • How can we integrate hearing-based interventions in cognitive healthcare?


Listen Care-fully is funded by DTU Management, the Copenhagen Center for Health Technology (CACHET) and William Demant Foundation, with special thanks to Annemette Ljungdalh Nielsen from the Municipality of Copenhagen and Hysse Forchhammer from Hjernesagen for early dialogue in project preparation and for inspiring the project title.


  1. Feldman, A., Patou, F., Baumann, M., Stockmarr, A., Waldemar, G., Maier, A., & Vogel, A. (2022) The Listen Carefully protocol: An exploratory study of the association between listening effort and cognitive function. BMJ Open. https://bmjopen.bmj.com/content/12/3/e051109
  2. Feldman, A., Bruus, A., Zhang, Y., Patou, F., Waldemar, G., Maier, A. Vogel, A. (under review) Listening effort in mild cognitive impairment: an exploratory study using pupillometry. International Psychogeriatrics.
  3. Feldman, A., Zhang, Y., Baumann, M., Bruus, A., Vogel, A., Waldemar., G., Maier., A. (2022). Effect of hearing aid use on listening effort and cognitive function for normal hearing patients with mild cognitive impairment [Poster presentation and abstract in proceedings] Cognitive Hearing Science for Communication: CHSCOM 2022, Linköping, Sweden. https://www.trippus.se/eventus/userfiles/181764.pdf.
  4. Feldman, A. N., Patou, F., & Maier, A. (2022) Driving change in social systems: how to design healthcare pathways. Proceedings of the Design Society: DESIGN Conference. https://doi.org/10.1017/pds.2022.128
  5. Feldman, A., Patou, F., Baumann, M., Waldemar, G., Maier, A., & Vogel, A. (2021) Listen Carefully: An exploratory study of the association between listening effort and cognitive function. [Poster and abstract] Demensdagene 2021, Copenhagen, Denmark.
  6. Feldman, A., Patou, F., Maier, A., Waldemar, G., & Vogel, A. M. (2021). Clinical Trial Registration of "Listen Carefully: An Exploratory Study of the Association Between Listening Effort and Cognitive Function". https://clinicaltrials.gov/ct2/show/NCT04593290?term=hearing&cntry=DK&d raw=2&rank=1
  7. Feldman, A. N., Patou, F., & Maier, A. (2020) From evidence to implementation: How systems design can foresee complex healthcare interventions. Proceedings of the Design Society: DESIGN Conference, 1, 1891–1900. https://doi.org/10.1017/dsd.2020.135
  8. Feldman, A., Patou, F., Waldemar., G., Maier., A. (2019). Listening effort and cognitive decline: an exploratory study using pupillometry [Poster presentation and abstract in proceedings] Cognitive Hearing Science for Communication: CHSCOM 2019, Linköping, Sweden. p.132. https://www.trippus.se/eventus/userfiles/123505.pdf



Alix Nessa Feldman
PhD student
DTU Management
+45 45 25 60 26


Anja Maier
DTU Management
+45 45 25 60 45


Gunhild Waldemar
+45 26 30 25 80