Department of Psychological and Brain Sciences, Washington University in St Louis, St Louis, Missouri.
Department of Communication Sciences and Disorders, St Louis University, St Louis, Missouri.
JAMA Otolaryngol Head Neck Surg. 2021 May 1;147(5):442-449. doi: 10.1001/jamaoto.2021.0012.
Accurate assessment of hearing is critically important regardless of a person's cognitive ability. The degree to which hearing can be reliably measured in adults with mild dementia has not been determined.
To obtain quantitative measures of reliability to evaluate the degree to which audiologic testing can be accurately conducted in older adults with mild dementia.
DESIGN, SETTING, AND PARTICIPANTS: This repeated-measures cross-sectional study consisted of a comprehensive audiologic assessment on 2 occasions separated by 1 to 2 weeks performed in the department of otolaryngology at the Washington University School of Medicine from December 3, 2018, to March 4, 2020. Participants were 15 older adults with a verified diagnosis of mild dementia and 32 older adults without a verified diagnosis of mild dementia who were recruited from the Knight Alzheimer Disease Research Center at Washington University in St Louis.
Test-retest reliability was assessed for tympanometry, acoustic reflex thresholds, otoacoustic emissions, hearing sensitivity, speech reception threshold, speech perception in noise, and hearing handicap, using standard clinical audiology measures.
A total of 47 older adults (26 women; mean [SD] age, 74.8 [6.0] years [range, 53-87 years]), including 32 with normal cognitive function and 15 with very mild or mild dementia, completed the study protocol. For participants with mild dementia, high test-retest reliability (Spearman ρ > 0.80) was found for most measures typically included in a comprehensive audiometric evaluation. For acoustic reflex thresholds, agreement was moderate to high, averaging approximately 83% across frequencies for both groups. Scores for the screening Hearing Handicap Inventory for the Elderly at time 1 and time 2 were highly correlated for the group with normal cognitive function (r = 0.84 [95% CI, 0.70-0.93]) and for the group with mild dementia (r = 0.96 [95% CI, 0.88-0.99]). For hearing thresholds, all rank-order correlations were above 0.80 with 95% CIs at or below 15% in width, with the exception of a moderate correlation of bone conduction thresholds at 500 Hz for the group with normal cognitive function (r = 0.69 [95% CI, 0.50-0.84]) and slightly wider 95% CIs for low-frequency bone conduction thresholds for both groups. For speech reception thresholds, correlations were high for groups with normal cognitive function (r = 0.91 [95% CI, 0.84-0.95]) and mild dementia (r = 0.83 [95% CI, 0.63-0.94]).
Test-retest reliability for hearing measures obtained from participants with mild dementia was comparable to that obtained from cognitively normal participants. These findings suggest that mild cognitive impairment does not preclude accurate audiologic assessment.
无论认知能力如何，准确评估听力都至关重要。目前尚未确定在轻度痴呆的成年人中，听力能否可靠地测量。
获得定量可靠性测量值，以评估在轻度痴呆的老年人中进行听力学测试的准确性。
设计、设置和参与者：这是一项在华盛顿大学医学院耳鼻喉科进行的两次重复测量的横断面研究，时间间隔为 1 至 2 周。研究对象为 2018 年 12 月 3 日至 2020 年 3 月 4 日期间从圣路易斯华盛顿大学骑士阿尔茨海默病研究中心招募的 15 名经证实的轻度痴呆症老年患者和 32 名无轻度痴呆症诊断的老年患者。
使用标准临床听力学测量方法，评估鼓室图、声反射阈值、耳声发射、听力敏感度、言语接受阈、噪声下言语感知和听力障碍的测试-重测可靠性。
共有 47 名老年人（26 名女性；平均[SD]年龄 74.8[6.0]岁[范围：53-87 岁]）完成了研究方案，包括 32 名认知功能正常者和 15 名轻度或极轻度痴呆者。对于轻度痴呆症患者，大多数综合听力评估中通常包含的测量指标的测试-重测可靠性较高（Spearman ρ＞0.80）。对于声反射阈值，两组的一致性为中度至高度，平均约为 83%。在认知功能正常组（r=0.84[95%CI，0.70-0.93]）和轻度痴呆组（r=0.96[95%CI，0.88-0.99]）中，在第一次和第二次测试时，筛查性老年人听力障碍问卷（Screening Hearing Handicap Inventory for the Elderly）的评分高度相关。对于听力阈值，除了认知功能正常组 500 Hz 骨导阈值的中度相关性（r=0.69[95%CI，0.50-0.84]）和两组低频骨导阈值稍宽的 95%CI 外，所有秩相关系数均大于 0.80。在认知功能正常组（r=0.91[95%CI，0.84-0.95]）和轻度痴呆组（r=0.83[95%CI，0.63-0.94]）中，言语接受阈的相关性较高。
从轻度痴呆症患者中获得的听力测量的测试-重测可靠性与从认知功能正常的患者中获得的可靠性相当。这些发现表明，轻度认知障碍不会妨碍准确的听力学评估。
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