Effect of Reduced Audibility on Mini-Mental State Examination Scores

Abstract

The interaction of audition and cognition has been of interest to researchers and clinicians, especially as the prevalence of hearing loss and cognitive decline increases with advancing age. Cognitive screening tests are commonly used to assess cognitive status in individuals reporting changes in memory or function or to monitor cognitive status over time. These assessments are administered verbally, so performance may be adversely affected by hearing loss. Previous research on the impact of reduced audibility on cognitive screening test scores has been limited to older adults with sensorineural hearing loss (SNHL) or young adults with normal hearing and simulated audibility loss. No comparisons have been conducted to determine whether age-related SNHL and its impact on cognitive screening tests is successfully modeled by audibility reduction.The purpose of this study was to examine the effects of reduced audibility on the Mini-Mental State Examination (MMSE), a common bedside cognitive screening instrument, by comparing performance of cognitively normal older adults with SNHL and young adults with normal hearing.A 1:1 gender-matched case–control design was used for this study.Thirty older adults (60–80 years old) with mild to moderately severe SNHL (cases) and 30 young adults (18–35 years old) with normal hearing (controls) served as participants for this study. Participants in both groups were selected for inclusion if their cognitive status was within normal limits on the Montreal Cognitive Assessment.Case participants were administered a recorded version of the MMSE in background noise at a signal-to-noise ratio of +25-dB SNR. Control participants were administered a digitally filtered version of the MMSE that reflected the loss of audibility (i.e., threshold elevation) of the matched case participant at a signal-to-noise ratio of +25-dB SNR. Performance on the MMSE was scored using standard criteria.Between-group analyses revealed no significant difference in the MMSE score. However, within-group analyses showed that education was a significant effect modifier for the case participants.Reduced audibility has a negative effect on MMSE score in cognitively intact participants, which contributes to and confirms the findings of earlier studies. The findings suggest that observed reductions in score on the MMSE were primarily due to loss of audibility of the test item. The negative effects of audibility loss may be greater in individuals who have lower levels of educational attainment. Higher levels of educational attainment may offset decreased performance on the MMSE because of reduced audibility. Failure to consider audibility and optimize communication when administering these assessments can lead to invalid results (e.g., false positives or missed information), misdiagnosis, and inappropriate recommendations for medication or intervention.

Auditory biases in cognitive assessment – Insights from hearing-loss simulation for dementia screening

“…Several caveats regarding the reported findings should be noted: First, a relatively small number of participants was tested in the present study. However, the observation of a significant effect of simulated HL on cognitive-test performance echoes results from previous impairment-simulation studies investigating other cognitive tests using smaller and larger sample sizes [17,24,26,[28][29][30]. Second, only the effect of simulated HL on immediate verbal recall after a single presentation of the word list was assessed; delayed recall and recognition, which are also part of the revised version of the HLVT [31] and often used as independent or complementary indicators for changes in memory functions, were not explored.…”

Hearing, listening and deep neural networks in hearing aids

“…That is, people with better thresholds perceived sound at a greater SNR than people with worse thresholds. Gaete and colleagues 11 similarly reported reduced audibility negatively impacts scores on the Mini Mental State Examination, even in cognitively intact people.…”

Impact of Hearing Loss on Geriatric Assessment

“…In line with that Gaeta found that the performance in the MMSE was comparable in 30 elderly hearing impaired with a mean age of 69.4 and 30 younger adults aged 24.2 when a hearing loss was simulated. 56 Also, Verhaegen undermined these findings in a verbal recall task. 61 Augmentation by hearing aid use can reverse the bad performance in hearing-impaired subjects as shown by Jorgensen, Gaeta, Wong and MacDonald.…”

“…52,53 The majority of currently used neurocognitive test batteries are based on oral instructions and include subtests relying on auditory functions which rise the bias of false positive results in multiple ways, especially in subjects with a lower educational background. [54][55][56][57] In the most frequently used neurocognitive screening batteries, the MMSE and the MoCA (Montreal Cognitive Assessment), 7 versus 10 out of 30 points depend on auditory presented stimuli, respectively. 47,48,58,59 This is also true for the DemTect, which is highly sensitive to (mild cognitive impairment) MCI detection and quite popular in Germany.…”

“…61 Augmentation by hearing aid use can reverse the bad performance in hearing-impaired subjects as shown by Jorgensen, Gaeta, Wong and MacDonald. 54,56,62,63 The cognitive domain which seems to be mostly influenced by hearing loss is working memory and associative learning. Jayakody demonstrated in a study on 119 subjects, 47 NH, 51 with a mild to moderate HI and 21 with a severe to profound hearing loss that for every dB improvement in the hearing threshold the working memory task assessed by the CANTAB test battery improved by 2.85 points and the learning task by 11.79 points.…”