Treating auditory impairment to preserve cognition in people with mild cognitive impairment

Research Question Is "TACT+"—a proactive, primary care embedded hearing pathway combining handheld audiometry, self-fitting hearing aids and remote coaching—effective and cost effective in slowing cognitive decline for adults ?55 with mild cognitive impairment (MCI) and hearing loss versus usual care? Background MCI affects up to one in five older adults, with 14 to 23% progressing to dementia every 18 months. At the same time, 25% of UK adults aged 50–89 have hearing loss—a key modifiable dementia risk. Untreated hearing loss increases cognitive load, accelerates neurodegeneration and fuels social isolation, yet fewer than 15% of those who could benefit use hearing aids. In our TACT pilot, run in memory services, personalised support more than tripled regular aid use (22?75%). The ACHIEVE trial reported a 62% reduction in cognitive decline among high-risk groups, comparable to our target population. We will adapt the intervention for Primary Care “hearing–cognition hubs” using handheld Tympa testing and self-fitting hearing aids, supported by a coach and an app. The app enables goal-setting, rehabilitation games, reminders and secure coach messaging, and coaches guide fitting, troubleshoot issues and build confidence through remote sessions. Aims Co-develop, evaluate and enable national roll out of TACT+ to preserve cognition, reduce inequalities and improve quality of life for people with MCI and hearing loss. Objectives 1. Co-design the TACT+ intervention, coaching, app and training (WS1). 2. Test feasibility in two PCN hubs (WS2). 3. Establish clinical and economic effectiveness in a large-scale RCT (WS3). 4. Conduct a mixed methods implementation study and NHS-ready toolkit (WS4). 5. Dissemination of results to influence policy, practice and public uptake, focusing on underserved groups (WS5). Methods WS1 Co design (M1–12): co- workshops apply the Behaviour Change Wheel to co-create Tympa assessment, immediate self-fit of hearing aids, app coaching and NHS audiology links. WS2 Field Testing (M7–18): Two contrasting hubs (London, Manchester) enrol 62 participants to test recruitment, workflows, feasibility and equity strategies. WS3 RCT (M16–63): Two arm RCT with masked assessors (n?=?424, 12?sites), including a 6-month internal pilot. Eligibility: ??55?y, MoCA?18–25 (screening rather than formal MCI diagnosis), symmetrical 30–60?dB loss. Intervention: TACT+; Care as usual: audiometry feedback with advice to consult GP. Primary outcome: MoCA change at 18?months; secondary outcomes: cost-effectiveness, dementia incidence, hearing outcomes, mood, social function. WS4 Implementation (M1–63): Normalisation Process Theory guided evaluation with fidelity metrics and >50 stakeholder interviews to identify barriers, enablers and core-plus-adaptable elements; outputs include commissioning briefs, training resources and budget tools. WS5 Dissemination (M36–63): Co created lay summaries, policy briefs, CPD resources and open-source code; partnerships with RNID, NIHR Evidence and third sector groups maximise reach into deprived and ethnic minority communities. Impact If effective, TACT+ will offer a low cost, digitally enabled route to preserve cognition, halve progression to dementia, and reduce inequalities by reaching high deprivation PCNs. Outputs - open access toolkit, commissioning brief, and co-developed PPIE resources—will position the NHS to roll out hearing care prevention at scale within six years.