Gaeta Laura, Azzarello Jo, Baldwin Jonathan, Ciro Carrie A, Hudson Mary A, Johnson Carole E, John Andrew B
Department of Communication Sciences and Disorders, College of Health and Human Services, California State University, Sacramento, CA.
College of Nursing, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
J Am Acad Audiol. 2019 Nov/Dec;30(10):845-855. doi: 10.3766/jaaa.17139. Epub 2019 Mar 7.
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.
听觉与认知的相互作用一直是研究人员和临床医生感兴趣的领域，尤其是随着年龄的增长，听力损失和认知能力下降的患病率不断上升。认知筛查测试通常用于评估报告记忆或功能变化的个体的认知状态，或长期监测认知状态。这些评估通过口头进行，因此听力损失可能会对测试表现产生不利影响。先前关于可听度降低对认知筛查测试分数影响的研究仅限于患有感音神经性听力损失（SNHL）的老年人或听力正常的年轻人以及模拟可听度损失的情况。尚未进行比较以确定与年龄相关的SNHL及其对认知筛查测试的影响是否能通过可听度降低成功建模。
本研究的目的是通过比较认知正常的患有SNHL的老年人和听力正常的年轻人的表现，来研究可听度降低对简易精神状态检查表（MMSE）的影响，MMSE是一种常用的床边认知筛查工具。
本研究采用1:1性别匹配的病例对照设计。
30名年龄在60 - 80岁之间患有轻度至中度重度SNHL的老年人（病例组）和30名年龄在18 - 35岁之间听力正常的年轻人（对照组）作为本研究的参与者。两组参与者如果在蒙特利尔认知评估中的认知状态在正常范围内，则被选入。
病例组参与者在背景噪声中以信噪比为 +25 dB SNR的条件下接受MMSE的录音版本测试。对照组参与者接受经过数字滤波的MMSE版本测试，该版本反映了匹配病例组参与者在信噪比为 +25 dB SNR时的可听度损失（即阈值升高）情况。MMSE的表现根据标准标准进行评分。
组间分析显示MMSE分数无显著差异。然而，组内分析表明，教育程度是病例组参与者的一个显著效应修饰因素。
可听度降低对认知功能正常的参与者的MMSE分数有负面影响，这补充并证实了早期研究的结果。研究结果表明，观察到的MMSE分数降低主要是由于测试项目的可听度丧失。可听度损失的负面影响在教育程度较低的个体中可能更大。较高的教育程度可能会抵消由于可听度降低导致的MMSE表现下降。在进行这些评估时，若未考虑可听度并优化沟通，可能会导致无效结果（如假阳性或信息遗漏）、误诊以及不适当的药物或干预建议。
