Changes in vocal pitch, volume or clarity could signal a greater probability of developing dementia or cognitive impairment, according to new research. The findings point to voice disorders as a possible marker of future cognitive problems, though researchers cautioned that such conditions do not make dementia inevitable.

The study involved 833,417 participants who were 50 or older. Researchers examined the relationship between voice disorders, hearing loss, or a combination of both and the later development of cognitive impairment or dementia, including Alzheimer’s disease.

The research team came from the Drexel University College of Medicine in Philadelphia, and its findings were published in the Journal of Voice. The analysis tracked cognitive outcomes beginning one year after participants received diagnoses for voice disorders or hearing loss.

Participants who had a voice disorder without hearing loss showed a 58% increased likelihood of developing dementia or other cognitive issues in the future. Among participants who had both a voice disorder and hearing loss, the study reported a 104% chance.

Across all participants with voice disorders, regardless of whether they also had hearing loss, researchers found a 29% increased probability of developing dementia or cognitive impairment. Participants who had hearing loss alone faced a 27% greater risk.

The strongest association appeared among people dealing with both vocal and hearing difficulties. Robert Sataloff, a professor and chair at the Drexel University College of Medicine, discussed the findings in comments reported by Science Alert.

“We found the strongest link with dementia among patients experiencing a voice disorder and hearing loss,” Sataloff said. His comments highlighted the particularly notable results for participants experiencing both conditions.

“Importantly, we found that those with a voice disorder and no hearing loss were at greater risk than patients who experience hearing loss only,” he added. That comparison suggests vocal problems may deserve attention even when a patient does not have diagnosed hearing loss.

Voice disorders can affect how a person sounds or how comfortably that person can speak or sing. Examples include laryngitis, vocal cord paralysis, vocal cord lesions and spasmodic dysphonia, also known as laryngeal dystonia, according to the Cleveland Clinic.

Researchers also noted a possible connection involving social interaction. Hearing loss and difficulty speaking may discourage people from socializing, while studies have shown that social engagement can stimulate the brain and play a role in warding off dementia.

Sataloff said it was “only natural” for voice disorders and hearing loss to be connected with cognitive impairment. People who experience pain or discomfort while talking or singing may withdraw from activities that involve communication and interaction.

Those individuals might “participate less often in brain-supporting social or other engaging activities,” he noted. The findings therefore suggest that obtaining treatment for a voice disorder could offer benefits beyond addressing the vocal problem itself.

The study does not establish that everyone with a voice disorder will eventually experience cognitive impairment. A vocal condition also does not guarantee that a decline in brain function has already begun or that dementia or Alzheimer’s disease is developing.

That distinction is important because voice problems can include a range of conditions and symptoms. The research identifies an association with future cognitive outcomes, but it does not make vocal changes a certain predictor of dementia.

Still, the results place voice disorders alongside hearing loss as conditions that may warrant closer attention in older adults. For patients experiencing changes in pitch, volume, clarity or comfort while speaking, the study offers another reason to seek evaluation and treatment without assuming that dementia is certain.