Faculty of Brain Sciences, UCL Division of Psychology and Language Sciences, London, UK.
UCL Ear Institute, London, UK.
Eur J Neurol. 2021 Jun;28(6):1820-1828. doi: 10.1111/ene.14753. Epub 2021 Feb 13.
A large proportion of older adults assessed for cognitive impairment likely have hearing loss, potentially affecting accuracy of cognitive performance estimations. This study aimed to develop a hearing-impaired version of the Addenbrooke's Cognitive Examination-III (HI-ACE-III) and to assess whether the HI-ACE-III can accurately distinguish people with mild cognitive impairment (MCI) and dementia from cognitively intact controls.
The HI-ACE-III was developed by converting verbal instructions into a visual, timed PowerPoint presentation. Seventy-four participants over the age of 60 years were classified into three groups: 29 had MCI, 15 had mild to moderate dementia and 30 were cognitively intact controls. Receiver operating characteristic (ROC) curves were graphed to test screening accuracy. Concurrent validity was examined through correlations between HI-ACE-III domain scores and relevant, visually presented standardized neuropsychological measures.
ROC analysis for dementia revealed an area under the curve (AUC) of 0.99, achieving excellent sensitivity (100%) and good specificity (93.3%) at an optimum cut-off of <87. The AUC for MCI was 0.86, achieving reasonable sensitivity (75.9%) and good specificity (86.7%) at an optimum cut-off of <92. HI-ACE-III subtests shared anticipated and statistically significant correlations with established measures of cognitive functioning. Internal consistency of the HI-ACE-III was excellent as verified with Cronbach's alpha (α = 0.904).
Preliminarily, the HI-ACE-III showed good reliability, validity and screening utility for MCI and dementia in older adults in a hearing-impairment context. The adapted HI-ACE-III may offer accurate and reliable indication of cognitive performance, supporting timely diagnosis and research examining links between hearing loss and cognitive decline.
在评估认知障碍的老年人中，很大一部分人可能存在听力损失，这可能会影响认知表现评估的准确性。本研究旨在开发一种适用于听力受损者的 Addenbrooke's 认知测验-III（HI-ACE-III），并评估 HI-ACE-III 是否能准确区分轻度认知障碍（MCI）和痴呆患者与认知正常的对照组。
通过将口头指令转换为视觉、定时的 PowerPoint 演示文稿，开发了 HI-ACE-III。74 名年龄在 60 岁以上的参与者被分为三组：29 名患有 MCI，15 名患有轻度至中度痴呆，30 名认知正常。绘制受试者工作特征（ROC）曲线以测试筛查准确性。通过 HI-ACE-III 各领域得分与相关的、视觉呈现的标准化神经心理学测量之间的相关性，来检验其同时效度。
ROC 分析显示痴呆的曲线下面积（AUC）为 0.99，在最佳截断值<87 时，灵敏度为 100%，特异性为 93.3%，具有极好的敏感性和特异性。MCI 的 AUC 为 0.86，在最佳截断值<92 时，灵敏度为 75.9%，特异性为 86.7%，具有合理的敏感性和特异性。HI-ACE-III 各子测验与已建立的认知功能测量方法具有预期的、统计学显著的相关性。HI-ACE-III 的内部一致性通过 Cronbach's alpha（α=0.904）得到了很好的验证。
初步研究表明，HI-ACE-III 在听力受损的老年人群中对 MCI 和痴呆具有良好的可靠性、有效性和筛查效用。经过改编的 HI-ACE-III 可能提供准确可靠的认知表现指标，支持及时诊断，并研究听力损失与认知能力下降之间的联系。
