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

Abstract

Objectives Commonly used cognitive screening tools were not originally developed for patients with hearing loss (HL) and rely heavily on the ability to hear the instructions and test stimuli. Recently, the Montreal Cognitive Assessment (MoCA) was modified for use with hearing‐impaired populations (ie, HI‐MoCA). In order to investigate the clinical utility of the HI‐MoCA, we assessed performance between the standard MoCA and HI‐MoCA among postlingually deafened cochlear implant (CI) users. Methods We administered the standard MoCA and HI‐MoCA to 21 CI users and compared their performance. We assessed differences in pass/fail status when items from the attention and language sections and the delayed recall task were removed. Results There was no significant difference in performance between the standard MoCA and HI‐MoCA. Participants scored higher on both test versions when the delayed recall task was removed. Participants also performed better on the delayed recall task on the HI‐MoCA than on the standard MoCA. Conclusions While our findings suggest that the modality of presentation for the MoCA does not influence overall performance for postlingually deafened CI users, visual presentation of stimuli impacted performance on delayed recall. Furthermore, irrespective of presentation modality, our participants scored higher on both MoCA versions when the delayed recall task was removed. Clinically, modifications to the presentation of the MoCA might not be necessary for CI users; however, clinicians should be aware that the delayed recall task is inherently harder for these patients.

Examining Delayed Recall in Cochlear Implant Users Using the Montreal Cognitive Assessment, California Verbal Learning Test, Third Edition, and Item Specific Deficit Approach: Preliminary Results

“…Previous literature has examined cognitive performance in relation to hearing abilities for the MoCA (Dupuis et al, 2015;Ambert-Dahan et al, 2017;Lim and Loo, 2018; Significant correlation between each of the trials 1-4 with the ISDA measures except for trial 5 which did not meet significance with Bonferroni correction; α = 0.017. Hillyer et al, 2020;Parada et al, 2020;Shen et al, 2020;Utoomprurkporn et al, 2020) and CVLT-3 (Kramer et al, 2018;Moseley, 2018;Pisoni et al, 2018;Chandramouli et al, 2019), demonstrating that differences in cognitive abilities due to sensory impairments like HL should be taken into account during test administration. Our current findings present the first application of the ISDA to a population with HL.…”

“…The aim of this study was to further explore our previous findings from the MoCA where the largest change in passing rate was observed by removing the delayed recall subtest, suggesting that delayed recall is more challenging for this patient population (Parada et al, 2020). Given the potential clinical utility of the alternate MoCA scoring methods for people with HL, we considered original and alternate MoCA scores in relation to a more comprehensive delayed recall test: the CVLT-3.…”

“…Recent work suggests that using MoCA alternate scores (i.e., a scoring method whereby specific auditory subtests are systematically removed; Dupuis et al, 2015 ) may have clinical significance for the hearing-impaired population ( Al-Yawer et al, 2019 ). Our own research has demonstrated that individuals with HL, specifically those with cochlear implants (CIs; surgical implants effective for those with profound hearing loss in which other assistive hearing devices are not appropriate) performed better on the MoCA presented in both a visual and auditory format when delayed recall was removed ( Hillyer et al, 2020 ; Parada et al, 2020 ). However, removing test items from the total score may also decrease sensitivity ( Dupuis et al, 2015 ).…”

COVID-19 creating challenges in a rehabilitation facility in Australia: A discussion paper

“…Scores gained by these standardized and non-standardized cognitive assessments may therefore not be as accurate or be a correct reflection of a patient's cognitive abilities due to these difficulties with hearing. [43] Treatments which involve common equipment in a confined space are not recommended. Therefore, educating and practicing car transfers to abide by specific orthopaedic precautions (for example, posterior hip replacement precautions) is no longer conducted.…”

“Losing my glasses…losing my mind”: Perspectives on sensory impairment, loneliness, social isolation and dementia

“…In this issue, Parada et al investigated the clinical utility of an existing version of the hearing impairment‐adapted MoCA (HI‐MoCA) among post‐lingually deaf cochlear implant (CI) users. In comparing the HI‐MoCA to the standard MoCA, they found no significant difference in performance between the two versions of the tool, although participants scored higher on both test versions when the delayed recall task was removed, suggesting that the delayed recall task may be more difficult for this group of individuals.…”