Test Administration Methods and Cognitive Test Scores in Older Adults with Hearing Loss

Abstract

In light of the high prevalence of hearing loss and cognitive impairment in the aging population, it is important to know how cognitive tests should be administered for older adults with hearing loss. The purpose of the present study is to examine this question with a cognitive screening test and a working memory test. Specifically, we asked the following questions in 2 experiments. First, does a controlled amplification method affect cognitive test scores? Second, does test modality (visual vs. auditory) impact cognitive test scores? Three test administration conditions were created for both Montreal Cognitive Assessment (MoCA) and working memory test (a word recognition and recall test): auditory amplified, auditory unamplified, and visual. The auditory administration was implemented through a computer program to control for presentation level while the visual condition was implemented through timed computer slides. Data were collected from older individuals with mild-to-moderate sensorineural hearing loss. We did not find any effect of amplification or test modality on the total score of the cognitive screening test (i.e., MoCA). Amplification improved working memory performance as measured by word recall performance, but test modality (auditory vs. visual) did not. These results are consistent with literature in demonstrating a downstream effect of audibility on working memory performance. From a clinical perspective, these findings are informative for developing clinical administration protocols of these tests for older individuals with hearing loss.

Performance on the standard and hearing‐impaired Montreal Cognitive Assessment in cochlear implant users

“…We found no differences in performance in our sample of postlingually deafened CI users. Though unexpected, these findings are consistent with the results of Lin et al among their NH participants and results from a recent study by Shen et al that showed minimal to no differences in performance in a sample of HI participants. Altogether, these results highlight the construct validity of the HI‐MoCA, suggesting that either version of the test will measure the same cognitive domains and that modifications to the modality of test administration are not necessary when working with this population of CI users.…”

“…Saunders et al found that amplification of test materials and stimuli by way of hearing aids (HAs) did not improve performance scores on the MoCA. Similarly, Shen et al amplified stimuli binaurally in individuals with mild‐to‐moderate sensorineural HL and found no difference in MoCA overall performance. They did, however, find that amplification helped increase performance on the delayed recall task.…”

Impact of Hearing Loss on Geriatric Assessment

“…Overall, the MoCA score was not significantly influenced by the test modality but with the WARRM, better scores were obtained when the sound pressure level (SPL) was amplified. 67 In line with that MacDonald reported that amplification by hearing aid use in 192 subjects aged 82.4 was related to significantly better test results in the MMSE, but not in the AMT (Abbreviated Mental Test) in which only one out of 10 points relies on auditory stimuli. 63 So far, there are only few investigations on the potential impact of different degrees of hearing loss on cognitive testing.…”

“…As the awareness of the influence of sensory impairment on cognitive tasks has recently risen, several attempts have been made to adapt the existing screening tools to the needs of people with sensory impairment either by introducing a new cut-off score for people with hearing loss, removing of auditory stimuli, or providing non-auditory presentation of the stimuli. 66 , 67 …”

“…As the awareness of the influence of sensory impairment on cognitive tasks has recently risen, several attempts have been made to adapt the existing screening tools to the needs of people with sensory impairment either by introducing a new cut-off score for people with hearing loss, removing of auditory stimuli, or providing non-auditory presentation of the stimuli. 66,67 The first one to pay attention to this topic was Uhlmann in 1989 who presented the instructions of the MMSE in a written version in addition to the original one in Alzheimer patients with and without hearing loss. 19 Silva et al tested 55 NH subjects and 27 subjects with moderate-to-severe hearing loss with a mean age of 81.2 using both a written and the original version of the MMSE.…”