Omar Rohani, Forbes Marina, Vaid Diya, Crawley James, Clare Dawn, Costafreda Sergi G, Schilder Anne Gm
National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, UK.
Ear Institute, Faculty of Brain Sciences, University College London, London, UK.
Sci Prog. 2025 Apr-Jun;108(2):368504251335410. doi: 10.1177/00368504251335410. Epub 2025 Apr 15.
BackgroundCognitive impairment is common in older adults and negatively affects hearing aid use. Audiologists hold the opportunity to identify signs of undiagnosed cognitive impairment and tailor care to optimise hearing aid use.ObjectiveTo assess the feasibility of introducing a brief cognitive assessment in hearing aid appointments for older adults.MethodsProspective feasibility cohort study incorporating quantitative and observational data. Participants were patients aged ≥65 years, new or existing hearing aid users, attending an NHS community hospital hearing aid clinic. Clinical audiologists were trained to conduct the Ascertain Dementia 8 (AD8) and visually-adapted shortened version of the Montreal Cognitive Assessment (mini-MoCA). A research audiologist took informed consent, observed appointments recording outcomes and followed up participants at 3 months. Feasibility was assessed using the following outcome measures: practicality of implementation in a clinical setting and resource requirements; acceptability in terms of recruitment/completion rates; onward care; experiences through standardised intensity scoring of observed emotions and analysis of free-text observations of participant reactions, participants' comments and informal conversations with clinical audiologists.ResultsTwenty patients were recruited, average age 78.6 years, 14 (70%) attended alone. All completed cognitive assessment, average duration was 14 minutes. AD8 and mini-MoCA average scores were 2.4 (range: 0-7) and 12.8 (range: 8-15), respectively. Ten (50%) participants had AD8 scores and one (5%) a Mini-MoCA score indicating potential cognitive impairment. Four of those (40%) contacted their GP, three were referred for further cognitive evaluation, one was diagnosed with dementia, two were awaiting appointments.ConclusionsIntroducing cognitive assessment in hearing aid clinics seems feasible and may provide an opportunity for identifying cognitive impairment in older adults, though further research is needed to establish its clinical utility and impact on care pathways. There are considerable resource implications, highlighting the importance of involving professional organisations, healthcare funders and policy makers early in this discussion.
背景
认知障碍在老年人中很常见，并且会对助听器的使用产生负面影响。听力学家有机会识别未被诊断出的认知障碍迹象，并调整护理方式以优化助听器的使用。
目的
评估在老年人助听器预约中引入简短认知评估的可行性。
方法
采用前瞻性可行性队列研究，纳入定量和观察性数据。参与者为年龄≥65岁的患者，新的或现有的助听器使用者，在国民保健服务（NHS）社区医院的助听器诊所就诊。临床听力学家接受培训以进行简易痴呆筛查量表8（AD8）和视觉适应的蒙特利尔认知评估简短版（迷你蒙特利尔认知评估量表，mini-MoCA）。一名研究听力学家获取知情同意，观察预约过程、记录结果并在3个月时对参与者进行随访。使用以下结果指标评估可行性：在临床环境中实施的实用性和资源需求；在招募/完成率方面的可接受性；后续护理；通过对观察到的情绪进行标准化强度评分以及对参与者反应、参与者评论和与临床听力学家的非正式对话的自由文本观察进行分析来评估体验。
结果
招募了20名患者，平均年龄78.6岁，14名（70%）独自就诊。所有患者均完成认知评估，平均时长为14分钟。AD8和mini-MoCA的平均得分分别为2.4（范围：0 - 7）和12.8（范围：8 - 15）。10名（50%）参与者的AD8得分以及1名（5%）参与者的Mini-MoCA得分表明可能存在认知障碍。其中4名（40%）联系了他们的全科医生，3名被转诊进行进一步的认知评估，1名被诊断为痴呆，2名正在等待预约。
结论
在助听器诊所引入认知评估似乎是可行的，并且可能为识别老年人的认知障碍提供机会，不过需要进一步研究以确定其临床效用以及对护理途径的影响。这会带来相当大的资源问题，凸显了在这一讨论中尽早让专业组织、医疗保健资助者和政策制定者参与的重要性。
