Development and validation of the Montreal cognitive assessment for people with hearing impairment (MoCA-H).
Montreal cognitive assessment
cognitive screening
dementia
hearing impairment
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
revised:
12
12
2022
received:
06
11
2022
accepted:
18
12
2022
medline:
12
5
2023
pubmed:
2
2
2023
entrez:
1
2
2023
Statut:
ppublish
Résumé
Hearing impairment is common among older adults and affects cognitive assessments for identification of dementia which rely on good hearing function. We developed and validated a version of the Montreal Cognitive Assessment (MoCA) for people with hearing impairment. We adapted existing MoCA 8.1 items for people with hearing impairment by presenting instructions and stimuli in written rather than spoken format. One Attention domain and two Language domain items required substitution by alternative items. Three and four candidate items respectively were constructed and field-tested along with the items adapted to written form. We used a combination of individual item analysis and item substitution to select the set of alternative items to be included in the final form of the MoCA-H in place of the excluded original items. We then evaluated the performance and reliability of the final tool, including making any required adjustments for demographic factors. One hundred and fifty-nine hearing-impaired participants, including 76 with normal cognition and 83 with dementia, completed the adapted version of the MoCA. A further 97 participants with normal hearing completed the standard MoCA as well as the novel items developed for the MoCA-H to assess score equivalence between the existing and alternative MoCA items and for independence from hearing impairment. Twenty-eight participants were retested between 2-4 weeks after initial testing. After the selection of optimal item set, the final MoCA-H had an area under the curve of 0.973 (95% CI 0.952-0.994). At a cut-point of 24 points or less sensitivity and specificity for dementia was 92.8% and 90.8%, respectively. The intraclass correlation for test-retest reliability was 0.92 (95%CI 0.78-0.97). The MoCA-H is a sensitive and reliable means of identifying dementia among adults with acquired hearing impairment.
Sections du résumé
BACKGROUND
Hearing impairment is common among older adults and affects cognitive assessments for identification of dementia which rely on good hearing function. We developed and validated a version of the Montreal Cognitive Assessment (MoCA) for people with hearing impairment.
METHODS
We adapted existing MoCA 8.1 items for people with hearing impairment by presenting instructions and stimuli in written rather than spoken format. One Attention domain and two Language domain items required substitution by alternative items. Three and four candidate items respectively were constructed and field-tested along with the items adapted to written form. We used a combination of individual item analysis and item substitution to select the set of alternative items to be included in the final form of the MoCA-H in place of the excluded original items. We then evaluated the performance and reliability of the final tool, including making any required adjustments for demographic factors.
RESULTS
One hundred and fifty-nine hearing-impaired participants, including 76 with normal cognition and 83 with dementia, completed the adapted version of the MoCA. A further 97 participants with normal hearing completed the standard MoCA as well as the novel items developed for the MoCA-H to assess score equivalence between the existing and alternative MoCA items and for independence from hearing impairment. Twenty-eight participants were retested between 2-4 weeks after initial testing. After the selection of optimal item set, the final MoCA-H had an area under the curve of 0.973 (95% CI 0.952-0.994). At a cut-point of 24 points or less sensitivity and specificity for dementia was 92.8% and 90.8%, respectively. The intraclass correlation for test-retest reliability was 0.92 (95%CI 0.78-0.97).
CONCLUSION
The MoCA-H is a sensitive and reliable means of identifying dementia among adults with acquired hearing impairment.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1485-1494Subventions
Organisme : Department of Health
ID : BRC-1215-20007
Pays : United Kingdom
Informations de copyright
© 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
Références
Uhlmann RF, Teri L, Rees TS, Mozlowski KJ. Impact of mild to moderate hearing loss on mental status testing: comparability of standard and written mini-mental state examinations. J Am Geriatr Soc. 1989;37(3):223-228.
Dupuis K, Pichora-Fuller MK, Chasteen AL, Marchuk V, Singh G, Smith SL. Effects of hearing and vision impairments on the Montreal cognitive assessment. Aging Neuropsychol Cogn. 2015;22:413-437.
Jorgensen LE, Palmer CV, Pratt S, Erickson KI, Moncrieff DJ. The effect of decreased audibility on MMSE performance: a measure commonly used for diagnosing dementia. J Am Acad Audiol. 2016;27:311-323.
Utoomprurkporn N, Woodall K, Stott J, Costafreda SG, Bamiou DE. Hearing-impaired population performance and the effect of hearing interventions on Montreal cognitive assessment (MoCA): systematic review and meta-analysis. Int J Geriatr Psychiatry. 2020;35:962-971.
Lim MYL, Loo JHY. Screening an elderly hearing impaired population for mild cognitive impairment using mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA). Int J Geriatr Psychiatry. 2018;33:972-979.
Allen NH, Burns A, Newton V, et al. The effects of improving hearing in dementia. Age Ageing. 2003;32:189-193.
Pye A, Charalambous AP, Leroi I, Thodi C, Dawes P. Screening tools for the identification of dementia for adults with age-related acquired hearing or vision impairment: a scoping review. Int Psychogeriatr. 2017;29:1771-1784.
Al-Yawer F, Pichora-Fuller MK, Phillips NA. The Montreal cognitive assessment after omission of hearing-dependent subtests: psychometrics and clinical recommendations. J Am Geriatr Soc. 2019;67(8):1689-1694.
Nasreddine Z, Phillips N, Bédirian V, et al. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-699.
Matias-Guiu JA, Valles-Salgado M, Rognoni T, Hamre-Gil F, Moreno-Ramos T, Matías-Guiu J. Comparative diagnostic accuracy of the ACE-III, MIS, MMSE, MoCA, and RUDAS for screening of Alzheimer disease. Dement Geriatr Cogn Disord. 2017;43:237-246.
Lin VY, Chung J, Callahan BL, et al. Development of cognitive screening test for the severely hearing impaired: hearing-impaired MoCA. Laryngoscope. 2017;127:S4-S11.
Utoomprurkporn N, Stott J, Costafreda SG, North C, Heatley M, Bamiou DE. The screening accuracy of a visually based Montreal cognitive assessment tool for older adult hearing aid users. Front Aging Neurosci. 2021;13:521.
Dawes P, Pye A, Reeves D, et al. Protocol for the development of versions of the Montreal cognitive assessment (MoCA) for people with hearing or vision impairment. BMJ Open. 2019;9:e026246.
Lobo A, Launer LJ, Fratiglioni L, et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurology. 2000;54:S4-S9.
Brodaty H, Pond D, Kemp NM, et al. The GPCOG: a new screening test for dementia designed for general practice. J Am Geriatr Soc. 2002;50(3):530-534.
Frank T, Durrant JD, Lovrinic JM. Maximum permissible ambient noise levels for audiometric test rooms. Am J Audiol. 1993;2:33-37.
Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15:155-163.
O'Driscoll C, Shaikh M. Cross-cultural applicability of the Montreal cognitive assessment (MoCA): a systematic review. J Alzheimers Dis. 2017;58:789-801.
Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med. 2015;175:1450-1458.
Saunders GH, Echt KV. An overview of dual sensory impairment in older adults: perspectives for rehabilitation. Trends Amplif. 2007;11:243-258.
Kehrberg KL, Kuskowski MA, Mortimer J, Shoberg TD. Validating the use of an enlarged, easier-to-see Allen cognitive level test in geriatrics. Phys Occup Ther Geriatrics. 1993;10:1-14.
Bruhn P, Dammeyer J. Assessment of dementia in individuals with dual sensory loss: application of a tactile test battery. Dementia Geriatric Cognit Disord Extra. 2018;8:12-22.
Gros A, Manera V, De March CA, et al. Olfactory disturbances in ageing with and without dementia: towards new diagnostic tools. J Laryngology Otology. 2017;131:572-579.