Clinical application of cognitive assessment in audiology

Sensorineural hearing loss is a risk factor for cognitive impairment, with older hearing-impaired adults being several times more likely to develop dementia than similarly-aged adults with normal hearing. Hearing-impaired adults with low abilities in one or more cognitive domains also have poorer overall communication ability and receive less benefit from standard-of-care treatment (e.g., hearing aid fitting) than hearing-impaired adults with intact cognitive ability. For these reasons, professional organizations and proponents of public health have advocated for audiologists to include cognitive tests in their assessment battery. However, there is little guidance regarding which tests to use and whether scores from those tests can be considered with other auditory results in treatment and counseling. To address these information gaps, the proposed project will compare conventional and computerized, self-administered screeners for older adults with hearing loss, describe the relationships between subscores of those assessments to established tests of the same abilities as well as to the patient’s overall communication in noise. Participants will be adults over 60 years of age with sensorineural hearing loss seen for hearing evaluations at an audiology private practice. Cognitive tests include two multi-domain assessments along with tests of specific abilities known to impact communication (e.g., working memory, executive function). Cognitive test scores will be related to clinical measures of speech in noise. The proposed project will serve multiple goals. First, it will compare two leading (although very different) approaches to screening for cognitive decline in the context of an audiology assessment. Second, it will illustrate relationships between cognitive ability, as measured by assessments suited to audiology practice, and degree of communication difficulty. We anticipate that the proposed work will generate pilot data to support a larger multisite funding application.