An early sign of dementia may be hiding in your voice, new research suggests

Voice disorders affect roughly 18 million U.S. adults annually and encompass a broader set of problems than you might think.

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Washington Post

Erica Sloan, The Washington Post

Published Sep 11, 2026  •  6 minute read

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Hearing loss and voice disorders – which include abnormalities in vocal quality, pitch or volume – can go hand-in-hand, as you rely on your hearing to modify your tone of voice. Both problems also get more common with age.

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Now, new research suggests another connection between the two: Similar to hearing loss, voice problems also may be tied to a higher dementia risk, even in those who have no hearing troubles.

For the study, published in the Journal of Voice, researchers conducted the first large analysis of voice disorders and cognitive decline, using data from primary care visits of more than 833,000 adults aged 50-plus over the course of several years.

People who had been diagnosed with both voice and hearing issues had about double the risk of developing cognitive impairment or dementia, compared with a control group of people with neither diagnosis. Those with a voice disorder and no hearing loss had the second-highest risk versus a control, followed by those with hearing loss alone.

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Voice disorders affect roughly 18 million U.S. adults annually and encompass a broader set of problems than you might think.

“Any person who doesn’t have a clear, reasonably loud voice that’s sustainable for as long as [they] need to speak has a voice abnormality,” said senior study author Robert Sataloff, professor and chair of the Department of Otolaryngology–Head & Neck Surgery and a senior associate dean at Drexel University College of Medicine. This could sound strained, choppy, gurgly or shrill, but it also could just involve shifts in pitch that occur suddenly or involuntarily.

A variety of issues can underlie these vocal problems, including nodules, cysts, scars and inflammation caused by, for instance, vocal strain, smoking or acid reflux, Sataloff said. “As we age, we can also lose tissue bulk, nerve endings and respiratory strength, or the power source of the voice,” he added, leading voices to become softer or breathier, or to develop a tremor.

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But many people don’t clock these differences as problems to treat, Sataloff said. For example, “you can have a gravelly voice, and not only do people not mind, but sometimes you can make a living out of it,” he pointed out. Consider the actors, singers, sportscasters, radio hosts and politicians known for their rasp. It’s a big reason plenty of voice disorders go untreated, Sataloff said.

In one 2023 survey, as many as 40 percent of people with a voice issue did not seek medical care for it. In the nationally representative sample of 1,522 people, 20 percent of respondents said they had a voice disorder at some point in their lives, and they were more common in certain occupations, such as singer or teacher.

The new study puts forth a powerful reason to pay attention to vocal changes, even if they aren’t affecting your daily life in a dramatic or obvious way.

The researchers first compared people who were diagnosed with a voice disorder (such as dysphonia, which includes a hoarse, strained or otherwise impaired voice; or aphonia, meaning loss of the voice) with a control group of people who saw their primary care doctor for any other reason.

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They tracked the doctor visits of both groups over several years, looking for diagnoses of mild cognitive impairment, Alzheimer’s disease or dementia, starting at one year after the initial appointment and stopping at the point of diagnosis or the last recorded visit. Overall, the voice disorder group was about 29 percent more likely to develop a cognitive condition than the control group.

In a second analysis, the researchers wanted to see how much of that effect may actually be driven by hearing loss, given its established link with both voice disorders and a higher dementia risk. So they broke up the voice disorder group into two: those who only had a voice disorder and those who had a voice disorder alongside hearing loss. The combo group had more than double the risk of cognitive trouble compared with a control group with neither condition. Interestingly, the voice-only group still showed a 58 percent greater risk versus a control group with neither issue.

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This suggests that voice disorders are independently tied to cognitive decline, regardless of hearing loss, Sataloff said.

However, the voice and hearing groups were compared with different control groups, so it’s hard to know based on this data if one issue poses a greater risk than the other, said Kimberly Mueller, associate professor in the Communication Sciences and Disorders Department at University of Wisconsin at Madison. (Mueller was not involved in the study.)

Another limitation of the study is that it was observational, so it can’t prove that voice disorders cause dementia, only that they are linked with a greater likelihood of developing it. That also means we don’t yet know whether treating a voice disorder will reduce the risk. But there is evidence that treating hearing loss, for instance with hearing aids, can decrease the risk of cognitive decline. It’s possible that resolving a voice problem may have similar benefits.

It isn’t yet known why voice disorders are linked to higher risk of cognitive trouble, but there are a few theories.

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One of the strongest has to do with social isolation. “If it’s hard to speak, or you’re straining to be heard, then social interaction becomes a lot of work,” Mueller said. So people with voice disorders are more likely to withdraw from social settings, which is linked to an increased dementia risk.

By speaking less, you also may not activate your brain as much, which could raise dementia risk, said Heather Whitson, director of the Duke Center for the Study of Aging and Human Development, who was not involved in the study. “It’s the idea that if you don’t use it, you lose it.”

A final theory suggests certain biological changes in the brain might drive both voice and cognition issues. “The same things that are affecting the nerves that mediate memory could also affect the nerves that mediate these other neurological functions that relate to your voice or your hearing,” Whitson said.

It’s easy to ignore voice changes. “Sometimes, people will think that a quivering or soft voice is just the effects of aging, and they shouldn’t think that,” Whitson said.

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Getting evaluated for voice shifts or difficulties offers an opportunity for care that can make you feel “more confident and comfortable speaking,” Whitson said. This can help with improving quality of life and increasing social engagement, Mueller noted.

People may not realize that there are a wide variety of treatments available, depending on the diagnosis. For issues with vocal cord function, the typical starting point is therapy with a speech-language pathologist who specializes in voice care, Sataloff said. If there’s a structural problem, such as a cyst, it can be removed with a minor surgery, he added. Other simple procedures can help with vocal cords that fail to close (which is necessary to speak).

A workup is also key to rule out other underlying causes, Whitson added. For example, a thyroid problem can cause hoarseness or vocal fatigue, and neurological issues such as Parkinson’s disease, multiple sclerosis and stroke can stifle speech.

In any case, the study suggests that voice problems may be a clue into future brain health – one that doctors could use to find and track people at higher risk of dementia earlier in life. “When health care providers see somebody with hearing loss, they think about cognitive assessment,” Sataloff said. “Now, when they see people with voices that don’t sound right, they should also be thinking of cognitive assessment.”

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