For more than a decade, I worked as a senior audiologist at MD Anderson Cancer Center. Most of my patients came to us for hearing care during or after cancer treatment. Many had hearing loss linked to ototoxic chemotherapy or head and neck radiation — well-documented side effects that audiologists are trained to identify and manage.
Over time, I began to notice something that hearing care alone did not fully explain. Some patients struggled with memory, attention, or word-finding. Others had difficulty following conversations even when their hearing devices were appropriately fitted. The pattern pointed beyond the auditory system — to broader cognitive function.
As I read further into the research, the connection became clearer. Untreated hearing loss is associated with cognitive decline, with multiple longitudinal studies linking it to an increased risk of cognitive impairment and dementia. Proposed mechanisms include increased cognitive load, reduced sensory input, and social isolation. At the same time, a subset of my patients might have been experiencing what clinicians call cancer-related cognitive impairment (CRCI) — often referred to as “chemo-brain.”
I came to believe that addressing hearing loss alone was often not enough. Whether the cognitive change was related to hearing, to cancer treatment, or to a combination of factors, these patients needed a more complete approach.
Two paths to the same problem
In clinical practice, I saw two distinct groups of patients experiencing cognitive difficulties. Understanding the difference matters, because it affects how care should be delivered.
When the brain works harder to fill in sounds it cannot hear clearly, fewer cognitive resources are available for memory and thinking. The 2024 Lancet Commission on dementia prevention identified hearing loss as the largest modifiable risk factor for dementia in midlife.
Cancer treatment — including chemotherapy, radiation, and the physical and emotional toll of the treatment process itself — can affect cognition. Patients may experience changes in memory, focus, and word-finding that sometimes persist after treatment ends. When chemobrain and hearing loss occur together, hearing aids alone may not address the cognitive component.
Both groups shared overlapping symptoms: brain fog, difficulty concentrating, trouble following conversations. But the underlying causes were different — and so the care needed to be different. A hearing aid can help with sound. It cannot, on its own, rebuild the brain’s ability to focus, remember, or process language clearly.
I wanted to do something about it. I began thinking about a care model that addressed hearing and brain health together. But I did not yet have a full picture. I was a clinician observing a pattern from the outside.
Then COVID hit.
In 2020, I caught COVID. The acute illness was difficult, but what came afterward was harder. I developed what is now recognized as long COVID. For months, I lived with symptoms I had only ever heard described by patients.
My brain felt foggy. I would walk into a room and forget why I was there. I struggled to find simple words I had used my entire professional life. My focus came and went. I felt as though I were watching my own mind slow down.
I knew exactly what my patients were feeling. That changed everything for me.— Dr. Rajarshi Pratihar
For the first time, I understood brain fog from the inside. I understood the fear that comes with it — the worry that this might be how you feel forever. And I understood why some of my patients seemed distant, or asked me to repeat things even when their hearing devices were well-fitted. It was not always their hearing. Sometimes the cognitive system itself was carrying the load.
The recovery
I knew I could not simply wait and hope. I started studying how to help my own brain heal. I used tablet-based cognitive assessment tools to measure my baseline. I enrolled in a structured, computer-based brain-health training program. I practiced memory exercises, attention training, and daily habits designed to rebuild focus. I added a daily mindfulness practice with the help of mobile apps.
Slowly, things improved. The fog lifted. My word-finding returned. My scores on cognitive measures showed real, measurable progress.
To be honest, my recovery has not been 100%. I still use brain-health training programs from time to time. Brain health is broader than any single condition — it reflects how well the brain functions across cognition, sensory processing, motor coordination, and emotional regulation. Because these systems are interconnected, a disruption in one domain — such as hearing — can influence overall cognitive performance.
This recovery reflects one person's journey and is not a clinical guarantee. Outcomes from cognitive training vary, and the published evidence for these tools is most consistent for near-transfer effects (improvement on practiced skills) rather than reversal of underlying disease. We discuss what the evidence does and does not support during every consultation.
Rethinking the care: a new kind of clinic
If structured brain-health training had helped me, it could likely help my patients too — especially those with hearing loss, with or without a history of cancer treatment, who were showing signs of cognitive change. But most hearing clinics are not designed to address brain health. They test the ears. They fit a hearing aid. When cognitive change is also present, that model is incomplete.
Patients I cared about most needed something more thorough — a whole-person approach.
Why Hearing and Brain Health Belong Together
The 2024 Lancet Commission on dementia prevention identified hearing loss as the largest modifiable risk factor for dementia in midlife.
Hearing is not separate from brain health—it is part of it. When auditory input declines, the brain works harder to decode speech, which can affect memory, attention, and social connection over time. Addressing hearing loss early may help protect cognitive function and overall quality of life.
Founding AUDICOG
I founded the AUDICOG Hearing & Brain Health Institute in Bellaire, Texas to be that missing clinic. The name comes from two words: “audi” for hearing and “cog” for cognition. It is a place where we evaluate both together, because the evidence — and my own experience — suggests they belong together.
At AUDICOG, every patient receives a comprehensive hearing evaluation. When clinically appropriate, we go further: we offer computerized cognitive wellness assessment, assess how hearing affects daily life — work, family, relationships, sleep, mood — and build a care plan around the whole person, not just the ears.
What makes our approach different
- Hearing testing that goes beyond the standard battery, including how well you understand speech in noisy environments.
- Cognitive assessment when clinically appropriate, to identify changes in memory or attention early.
- Quality-of-life assessment that captures how hearing affects your day-to-day function.
- Care plans built around your goals, not a predetermined product list.
- Unhurried, one-on-one visits with a clinician who has personally experienced cognitive change and recovery.
A personal promise
Every patient who walks into AUDICOG is met by someone who understands what brain fog can feel like. I know what it is like to worry that part of yourself is changing. I also know that the right care, provided at the right time, can make a meaningful difference in how people communicate, stay connected, and maintain their quality of life.
I cannot promise to reverse cognitive decline—no ethical clinician can. What I can promise is a thoughtful, comprehensive evaluation of your hearing and its relationship to communication, listening effort, and brain health, along with a personalized plan built around your goals and ongoing support grounded in science. Our approach combines evidence-based hearing care with validated computerized brain wellness assessment and cognitive training tools to better understand hearing-related brain function and support healthier communication.
For many patients, this integrated approach leads to better communication, greater confidence, and an improved quality of life. While every person’s journey is different, our commitment remains the same: to provide compassionate, evidence-based hearing care through a brain health lens, supporting both hearing and cognitive wellness at every step. That commitment is the foundation of everything we do at AUDICOG Hearing & Brain Health Institute.
Clinical Note: AUDICOG’s computerized brain wellness tools are intended to support audiologic care by providing information about hearing-related cognitive wellness and training. They are not designed to diagnose dementia, cognitive impairment, or other neurological conditions. When appropriate, patients are referred to or managed collaboratively with their primary care physician, neurologist, neuropsychologist, or other qualified healthcare professionals for comprehensive medical evaluation and care.
