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

Abstract

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.

Clinical Assessment Tools for the Detection of Cognitive Impairment and Hearing Loss in the Ageing Population: A Scoping Review

“…Adapted versions of the MMSE and MoCA to account for hearing loss were administered in 14 and seven studies, respectively. Furthermore, in two studies published post-search, there are now validated English 18 and German 19 versions of the MOCA-H for adults with hearing impairment. Due to the wide-range of global cognitive function tests used, tests that were used in only a single study pre- or post-2017 were categorized as “other” with corresponding references provided (eg, Blessed Information-Memory Concentration Test).…”

“… 12 However, sensory deficits (eg, hearing loss) have the potential to impact adversely on cognitive test performance, leading to a subsequent overestimation of cognitive decline. 13 , 14 Adapted versions of cognitive assessment tools have therefore been developed to address this impact (eg, written-MMSE; 15 , 16 MoCA-Hearing-Impaired, 17 and more recently, a validated version (MOCA-H) in English 18 and in German; 19 Cambridge Neuropsychological Test Automated Battery (CANTAB), 20 Repeated Battery for the Assessment of Neuropsychological Status for Hearing Impaired Individuals (RBANS-H)). 21 Other computerised test batteries that can be used for assessment of cognitive impairment are the RBANS, Cogstate, 22 ALACog, 23 the CDR computerized assessment system (CDR system), 24 and Factors of Longitudinal Attention, Memory and Executive Function (FLAME) test batteries.…”

Bilingualism and ageing independently impact on language processing: evidence from comprehension and production

“…The younger groups were students from these universities, and the older groups were recruited from the respective communities. Older participants were screened for mild cognitive impairment through the Montreal Cognitive Assessment questionnaire (MoCA, Nasreddine et al, 2005), and all achieved a score >= 23 (Table 1), the cut-off point recommended by Carson et al (2018;Völter et al, 2023;see Engedal et al, 2022, for normative data for Norwegian older adults). All participants had normal or corrected-to-normal vision and gave written informed consent.…”

Hearing loss, hearing aid use, and performance on the Montreal cognitive assessment (MoCA): findings from the HUNT study in Norway

“…The study also found that individuals with normal sensory acuity performed better in the MoCA than those with sensory loss, despite modifying the scores of the MoCA test for people with sensory loss. These findings led to the development of a version of the MoCA for people with hearing loss (MoCA-H) (Dawes et al, 2023;Völter et al, 2023).…”