Predicting Speech Outcomes After Cochlear Implantation in Older Adults Using the Self-administered Gerocognitive Examination Test

Abstract

Purpose: The purpose of this study is to determine if a cognitive test, Self-administered Gerocognitive Examination (SAGE), correlates with speech recognition outcomes 1 year after cochlear implantation in adults over 65 years of age. Methods: Retrospective study was conducted at a single institution. Surgery was performed by two surgeons on adult patients (>65 yrs) with postlingual bilateral sensorineural hearing loss meeting clinical and audiological candidacy for unilateral cochlear implantation. Patients who performed SAGE preimplantation, and speech testing (CNC, AzBio in quiet, AzBio in noise) before and 1 year after implantation were included. Results: Forty patients with a mean age of 78 were included. The overall mean preoperative SAGE score was 17.4 (95% CI 16.2–18.7). Greater than 17 is considered normal. Data demonstrated a statistically significant linear correlation between preoperative SAGE scores with change in speech testing 1 year postoperatively: CNC—Adjusted R-squared: 0.1955, p value: 0.002508; AzBio in quiet—Adjusted R-squared: 0.1564, p value: 0.006686; AzBio in noise—Adjusted R-squared: 0.1543, p value: 0.007053. Multivariate linear regression analysis revealed that age and SAGE scores both statistically correlated with speech testing 1 year after implantation (p = 0.01 for both). Patients who passed the SAGE (≥17) had statistically significant higher CNC, AzBio in quiet, and AzBio in noise scores 1 year postoperatively compared with patients with low SAGE scores (<17) despite statistically similar age means in each group. Conclusion: SAGE can predict speech recognition testing 1 year after cochlear implantation in older adults over 65 years of age.

Cochlear Implantation in US Military Veterans: A Single Institution Study

“…Factors that were predictive of better and/or more improved AzBio or CNC scores at various postoperative time points included “normal” SAGE cognition scores, younger age, and shorter duration of amplification. These findings are consistent with prior studies, which have previously demonstrated these relationships 21 . In our practice, all CI candidates with SAGE scores less than 17 are referred for neuropsychological evaluation prior to proceeding with implantation.…”

“…These findings are consistent with prior studies, which have previously demonstrated these relationships. 21 In our practice, all CI candidates with SAGE scores less than 17 are referred for neuropsychological evaluation prior to proceeding with implantation. While most patients were able to proceed with implantation with familial support, 2 patients with SAGE scores of 7 or less were not offered CI based on neuropsychological evaluation.…”

Exploring neurocognitive factors and brain activation in adult cochlear implant recipients associated with speech perception outcomes—A scoping review

“…These four more clinical tests, mostly used to detect early signs of Dementia (see Table 5a for an overview), are: (1) The Mini-Mental State Examination (MMSE) which did not significantly correlate with word perception in quiet ( r 2 = 0.061, p = 0.280, N = 15) ( Zucca et al, 2022 ). (2) The Self-Administered Gerocognitive Examination (SAGE), where preoperative screening of cognitive functions significantly positively correlated with word recognition in quiet [ r 2 (32) = 0.1955, p = 0.0025] and sentence perception in quiet [ r 2 (32) = 0.1564, p = 0.0067] and noise [ r 2 (32) = 0.1543, p = 0.007] ( Wazen et al, 2020 ). (3) The Montreal Cognitive Assessment (MoCA), which was included in a multivariate model explaining variance in sentence perception performance in noise.…”

“…These did not predict word perception in quiet with a sample size of 15 ( Zucca et al, 2022 ). However, research including a larger sample size (df = 32) ( Wazen et al, 2020 ) did show the effectiveness of a quick cognitive assessment for predicting sentence perception in quiet and noise preoperatively. Furthermore, it might be beneficial to consider social cognition, the only cognitive domain currently not covered in the literature.…”

Cognition and Cognitive Reserve in Cochlear Implant Recipients

“…Further, an association of auditory and cognitive performance following cochlear implantation has been rarely reported ( Cosetti et al, 2016 ; Wazen et al, 2020 ; Zhan et al, 2020 ; Knopke et al, 2021 ). Zhan et al found only a correlation of sentence recognition in quiet after 6 months with the incompatible Stroop and the Symbol Span test, but not for the Digits or Object Span test ( Zhan et al, 2020 ).…”