Cognitive function begins to decline early in hearing loss, when the ability to hear is still functionally normal, according to a new study.

Age-related hearing loss has long been linked to cognitive decline. But previous studies defined hearing loss as the inability to hear sounds at the level of a whisper, or under 25 decibels, reported hearing specialist Justin S. Golub, M.D., MS. Instead, Golub and his colleagues found that for every 10 decibels’ decrease in hearing, at all levels, there was a significant decrease in cognitive ability.

The largest decrease in cognitive ability occurred in those whose hearing was just starting to become impaired. That’s only 10 decibels from perfect hearing, the study team reported.

While the results don’t establish cause, it’s possible that less involvement in social situations due to gradual hearing loss has a cumulative effect on cognition, theorized Golub, from Columbia University.

“[H]earing loss is not benign. It has been linked to social isolation, depression, cognitive decline, and dementia,” Golub concluded. “Hearing loss should be treated. This study suggests the earlier, the better.”

The study was published online Thursday in JAMA Otolaryngology-Head and Neck Surgery.