Validation of Cognitive Screenings for the Hearing Impaired

Study Overview
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Brief Summary
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There are currently no cognitive tests that have been validated as screening tools for people with dementia and comorbid hearing loss. This is particularly important given the high prevalence of hearing impairment in older adults presenting to memory services and the risk of misdiagnosis of dementia in this population as outlined above. Cognitive tests validated in hearing impaired populations will also be important as outcome tools for interventional research aiming to find out if treating hearing loss may reduce dementia risk in the longer term.

Detailed Description
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Hearing loss is very prevalent in older population. This leads to further problems such as communication problem, isolation from the community and depression. Moreover, hearing impairment may potentially affect the patients' cognitive function as demonstrated in the above mentioned published papers. Communication problems that arise from a hearing loss alone can also interfere with administration of cognitive test battery, as a previous study showed that re-administered of MMSE test with assistive listening device can immediately improve the test score among elderly (1). Therefore, special adaptation of the cognitive test battery to address the needs of hearing impaired older adult is necessary. This is to ensure that the test result reflects the exact cognitive state of the older adult with hearing impairment, not effected by hearing loss. Moreover, appropriate cut-off point scores for hearing impaired population should be identified for these new cognitive screening tools. This is to ensure appropriate referral for further diagnosis and prompt management for cognitive impairment/dementia among older adults with hearing loss. In addition, since hearing loss can potentially lead to deterioration in patients' cognitive function over time (2). Follow up assessments of cognitive function among older adults with hearing impairment can determine the rate of deterioration in retrospective trial(2). This prospective trial follow up of cognitive function among hearing loss participants may uncover additional risk factors associated with the deterioration. Better understanding of these risk factors can potentially lead to further intervention in order to delay decline in patients' cognitive function.

Official Title
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Validation of Montreal Cognitive Assessment (MoCA) and Addenbrooke's Cognitive Examination III (ACE-III) as a Cognitive Screening Tools for the Hearing Impaired

Conditions
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Dementia, Hearing Loss, Auditory Processing Disorder

Intervention / Treatment
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* Diagnostic Test: Cognitive tests and hearing tests


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age over 65 years Documented Hearing loss (currently wearing hearing aids and/or hearing testing with a hearing average of >/= 30dB HL in D-HI,MCI-HI group) Exclusion criteria Uncorrected visual impairment; cognitive and/or physical disability(s) which prevent the performance of the written/drawing elements of the tests, in the opinion of the researcher. Severe to profound hearing loss (PTA >70dBHL)

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: 3 participants arms Diagnostic tools validation
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: dementia (D-HI)<br>hearing impaired dementia | Diagnostic Test: Cognitive tests and hearing tests<br>* Several cognitive and hearing (peripheral and (central) auditory process) tests<br>|
| Other: Mild cognitive impairment (MCI-HI)<br>MCI with hearing loss | Diagnostic Test: Cognitive tests and hearing tests<br>* Several cognitive and hearing (peripheral and (central) auditory process) tests<br>|
| Active Comparator: normal (N-HI)<br>normal cognition with hearing loss | Diagnostic Test: Cognitive tests and hearing tests<br>* Several cognitive and hearing (peripheral and (central) auditory process) tests<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The adapted version Montreal Cognitive Assessment (MoCA) questionnaire total score among dementia/mild cognitive impairment/normal cognition group of hearing impaired older adult. | The score will be used to calculate the appropriate cut-point score for differentiating each group of hearing impaired older adults.(total score ranging from 0-30 points with higher score indicate better cognitive function) | approximately 1 years (expected to recruit 30 participants for each group) | 
| The adapted version Addenbrooke's Cognitive Examination III (ACE-III) questionnaire total score among dementia/mild cognitive impairment/normal cognition group of hearing impaired older adult. | The score will be used to calculate the appropriate cut-point score for differentiating each group of hearing impaired older adults (total score ranging from 0-100 points with higher score indicate better cognitive function) | approximately 1 years (expected to recruit 30 participants for each group) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hearing handicap score from the Modified Amsterdam Inventory for Auditory Disability and Handicap (mAIAD) (total score ranging from 0-84 with higher score indicate smaller perceived hearing difficulty) | The score from mAIAD and the hearing threshold from audiogram (in dB HL) along with the MoCA and ACE-III test scores will be used to determine what best predicts hearing handicap in the cognitively impaired population. | approximately 1 years (expected to recruit 30 participants for each group) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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dementia, hearing loss, auditory process