Question
Do you foresee the development of a cognitive screening tool designed specifically for hearing healthcare professionals?
Answer
Several of our research projects have shown relationships between a patient’s screened cognitive ability and a variety of audiologic outcomes. These observations suggest that screened cognitive ability may provide information that meaningfully contributes to the development of a rehabilitation plan.
Most tools for screening cognitive ability rely on speech recognition for administration. In cases of compromised audibility (i.e., a person with hearing loss and no hearing aids) patients risk misunderstanding the instructions or test material, which may yield incorrect screening results. With this consideration, common screeners of cognitive ability (e.g., the Montreal Cognitive Assessment or Mini-Mental State Exam) should only be considered when audibility of the instructions and test material is ensured.
For these reasons, we have recently collaborated with cognitive psychologists at McMaster University to investigate the feasibility of a vison-only test as a tool for screening cognitive ability. This vision-only test would not have required patients with hearing loss to require on speech recognition during test administration. Unfortunately, the test did not demonstrate the necessary psychometric properties to be considered for this purpose.
Do you think the use of some sort of cognitive screener will become standard practice in hearing clinics?
It is certainly possible that audiologists may adopt tools that assess various dimensions of a patient’s cognitive ability. This might include screening instruments intended to assess the effects of cognitive aging (e.g., the Montreal Cognitive Assessment or Mini-Mental State Exam) or functional cognitive ability such as working memory (e.g., a test of reading span). However, in each case, additional work is required to understand both the implications of administration to patients with impaired audibility. A second gap is evidentiary support of the treatment considerations that might be informed by the results of these assessment.
Do you foresee the integration of cognitive testing protocols into hearing aid programming software? In other words, taking the results of cognitive testing and inputting those results into a “Best Fit” of a hearing aid to set adaptive features, such as noise management and directional microphones.
Similar to the above, it is possible that future hearing aid programming software might include utilities for assessing some aspect of a patient’s cognitive ability. These measures could direct counseling routines that are supported by the software. Another option would be the inclusion of measures that require patients to complete a psychoacoustic task. Estimations of cognitive ability could be drawn from their performance in a manner that may guide signal processing behavior or inform the extent of acoustic distortion that is introduced by a signal processing feature.
This Ask the Expert is an excerpt from the CEU course, Leading in Hearing Science: Do Cognitive Assessments Belong in the Audiology Clinic? Click the link on the course title to register and view the course.
