Evaluation of the non-auditory neurocognitive test MoCA-HI for hearing-impaired

Völter, Christiane; Fricke, Hannah P; Götze, Lisa; Labrenz, Franziska; Tokic, Marianne; Wirth, Rainer; Nasreddine, Ziad; Dawes, Piers

doi:10.3389/fneur.2022.1022292

Cited by 11 publications

(7 citation statements)

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“…Previous research has demonstrated that measures of cognition may be underestimated if sensory impairments are not considered or adjusted for ( 68 , 69 ). Efforts have been made to develop or adapt cognitive tests for people with hearing impairment ( 70 , 71 ). However, a scoping review of cognitive screening and assessment tools adapted for people with sensory impairment found that the sensitivity and validity of these instruments is poor ( 44 ).…”

Section: Discussionmentioning

confidence: 99%

Patient perceptions of cognitive screening in adult audiology services: A qualitative exploration

et al. 2023

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IntroductionBoth hearing loss and dementia are extremely pervasive, especially amongst older adults. As hearing loss and dementia have common symptoms, misdiagnosis can be common, and failure to address hearing loss for people with dementia could accelerate cognitive decline. The timely detection of cognitive impairment is clinically important, however the use of cognitive assessments in adult audiology services is a hotly debated topic. Although the early detection of cognitive impairment may improve patient care and quality of life, patients attending audiology services for hearing assessment might not expect to be asked questions about their cognition. The aim of this study was to qualitatively explore patient and public perspectives and preferences on the use of cognitive screening within adult audiology services.MethodsQuantitative and qualitative data were gathered from an online survey and a workshop. Descriptive statistics were applied to quantitative data and an inductive thematic analysis was performed on free-text responses.ResultsIn total, 90 respondents completed the online survey. Overall, cognitive screening in audiology was reported to be acceptable to participants (92%). A reflexive thematic analysis of the qualitative data reported four themes: i) knowledge of cognitive impairment and screening, ii) implementation of cognitive screening, iii) impact of screening on patient and iv) contributions to future care and research. A workshop was held with five participants to discuss and reflect on the findings in more detail.DiscussionParticipants found cognitive screening to be acceptable within adult audiology services providing audiologists had suitable training, and sufficient explanation and justification were provided. However, implications such as additional time and staff resource and supplementary training for audiologists would be required to address participants concerns.

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Section: Discussionmentioning

confidence: 99%

Patient perceptions of cognitive screening in adult audiology services: A qualitative exploration

et al. 2023

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“…4 Another study revealed that compared to individuals with moderate to profound hearing loss, those with normal hearing or mild hearing loss performed similarly on the MoCA Hearing Impaired Version (MoCA-HI) 20 but significantly better on the standard MoCA. 21 Previous literature also revealed that studies frequently use subjective participant reporting rather than measured hearing thresholds to characterize hearing ability. 3 This is of concern because subjective reports of hearing have been found to underestimate hearing loss in older adults.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, results from a study examining performance on the Montreal Cognitive Assessment (MoCA), a cognitive screening, revealed that a greater proportion of individuals with normal hearing pass than those with hearing loss, a relationship that persists despite the removal of auditory test components 4 . Another study revealed that compared to individuals with moderate to profound hearing loss, those with normal hearing or mild hearing loss performed similarly on the MoCA Hearing Impaired Version (MoCA‐HI) 20 but significantly better on the standard MoCA 21 …”

Section: Discussionmentioning

confidence: 99%

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Hearing loss and cognition: A protocol for ensuring speech understanding before neurocognitive assessment

Kolberg,

Morales,

Thallmayer

et al. 2023

Alzheimer's & Dementia

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INTRODUCTIONMany neurocognitive evaluations involve auditory stimuli, yet there are no standard testing guidelines for individuals with hearing loss. The ensuring speech understanding (ESU) test was developed to confirm speech understanding and determine whether hearing accommodations are necessary for neurocognitive testing.METHODSHearing was assessed using audiometry. The probability of ESU test failure by hearing status was estimated in 2679 participants (mean age: 81.4 ± 4.6 years) using multivariate logistic regression.RESULTSOnly 2.2% (N = 58) of participants failed the ESU test. The probability of failure increased with hearing loss severity; similar results were observed for those with and without mild cognitive impairment or dementia.DISCUSSIONThe ESU test is appropriate for individuals who have variable degrees of hearing loss and cognitive function. This test can be used prior to neurocognitive testing to help reduce the risk of hearing loss and compromised auditory access to speech stimuli causing poorer performance on neurocognitive evaluation.

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“…Therefore it is an imperative to reliably detect cases of cognitive impairment. Due to the high comorbidity of hearing loss and cognitive impairment ( Lin et al, 2013 ; Teipel et al, 2015 ; Fritze et al, 2016 ; Huang et al, 2023 ; Tamblay et al, 2023 ), cognitive screening has gained increasing awareness beyond geriatric or psychiatric settings ( Mordenfeld et al, 2020 ; Susano et al, 2020 ; Canavan and O’Donnell, 2022 ; Jammula et al, 2022 ; Tsui et al, 2022 ) including ENT departments and audiology ( Mosnier et al, 2018 ; Humes, 2020 ; Sanders et al, 2021 ; Völter et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Validation of the German Montreal-Cognitive-Assessment-H for hearing-impaired

Völter

Fricke

Faour

et al. 2023

Front. Aging Neurosci.

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BackgroundHearing loss and dementia are highly prevalent in older age and often co-occur. Most neurocognitive screening tests are auditory-based, and performance can be affected by hearing loss. To address the need for a cognitive screening test suitable for people with hearing loss, a visual version of the Montreal-Cognitive-Assessment was developed and recently validated in English (MoCA-H), with good sensitivity and specificity for identifying cases of dementia. As the MoCA is known to perform differently across languages, revalidation of the German MoCA-H was necessary. The aim of the present study was to assess the diagnostic accuracy of the German MoCA-H among those with normal cognition, mild cognitive impairment (MCI) and dementia and to determine an appropriate performance cut- off.Materials and methodsA total of 346 participants aged 60–97 years (M = 77.18, SD = 9.56) were included; 160 were cognitively healthy, 79 with MCI and 107 were living with dementia based on the GPCOG and a detailed medical questionnaire as well as a comprehensive examination by a neurologist in case of cognitive impairment. Performance cut-offs for normal cognition, MCI and dementia were estimated for the MoCA-H score and z-scores using the English MoCA-H cut-off, the balanced cut-off and the Youden’s Index.ResultsA mean score of 25.49 (SD = 3.01) points in the German MoCA-H was achieved in cognitively healthy participants, 20.08 (SD = 2.29) in the MCI and 15.80 (SD = 3.85) in the dementia group. The optimum cut-off for the detection of dementia was ≤21 points with a sensitivity of 96.3% and a specificity of 90%. In the MCI group, a cut-off range between 22 and 24 points is proposed to increase diagnostic accuracy to a sensitivity and specificity of 97.5 and 90%, respectively.ConclusionThe German MoCA-H seems to be a sensitive screening test for MCI and dementia and should replace commonly used auditory-based cognitive screening tests in older adults. The choice of a cut-off range might help to better reflect the difficulty in clinical reality in detecting MCI. However, screening test batteries cannot replace a comprehensive cognitive evaluation.

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Evaluation of the non-auditory neurocognitive test MoCA-HI for hearing-impaired

Cited by 11 publications

References 39 publications

Patient perceptions of cognitive screening in adult audiology services: A qualitative exploration

Patient perceptions of cognitive screening in adult audiology services: A qualitative exploration

Hearing loss and cognition: A protocol for ensuring speech understanding before neurocognitive assessment

Validation of the German Montreal-Cognitive-Assessment-H for hearing-impaired

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