ANS007 - NEUROTOLOGY FELLOW AWARD Do Cognitive Impairment Screening Scores Correlate with Cochlear Implant Speech Outcomes?
Saturday, April 30, 2022
2:31 PM – 2:38 PM CT
Location: Landmark A
Mallory J. Raymond, MD
Cheng Ma, BS
Kara Leyzac, AuD, PhD, CCC-A
Elizabeth L. Camposeo, AuD, CCC-A
Shaun A. Nguyen, MD
Ted A. Meyer, MD, PhD
Theodore R. McRackan, MD, MSCR
Fellow Medical University of South Carolina Charleston, South Carolina
Objective: Because age-related hearing loss is associated with cognitive impairment, many cochlear implant (CI) centers screen patients for cognitive impairment as part of the CI evaluation process. It is unknown if these screening results can validly be used to counsel patients regarding CI outcomes. This study seeks to determine whether there is a correlation between cognitive screening scores and post-operative CI speech recognition improvement.
Study Design: Retrospective review
Setting: Tertiary cochlear implant center
Patients: Seventy-seven adult CI recipients (aged 36-92)
Interventions: Cochlear implantation for patients with bilateral moderate to profound hearing loss
Main Outcome Measures: Preoperative Montreal Cognitive Assessment (MoCA) scores; pre-CI (aided) to 12-month post- CI CNC word/phoneme and AzBio sentences in quiet score improvement
Results: The mean MoCA score for the cohort was 25.1±3.6 (range:13-30). Thirty-five patients (45.5%) had scoressuggesting mild cognitive impairment and three (3.9%) suggesting moderate cognitive impairment. Only two patients had previous diagnoses of cognitive impairment. There were no significant differences (p>0.05) in pre-CI to 12-month post-CI speech recognition improvements for patients who screened positive for cognitive impairment compared to those who did not (CNC phoneme [53.6±23.5 versus 43.3±26.2], CNC word [51.8±21 versus 37.3±23.7], and AzBio in quiet [52±34.7 versus 43.8±34.8]. In addition, MoCA scores demonstrated absent to weak correlations with improvement in speech recognition scores (r range=-0.17- -0.05).
Conclusions: While there is a high prevalence of patients screening positive for cognitive impairment during the CI evaluation process, the degree of post-CI speech recognition improvement does not appear to be different between those who do and do not screen positive for cognitive impairment.
*Professional Practice Gap & Educational Need: Given the association of cognitive impairment and hearing loss, cognitive screening tests are being incorporated into evaluations of patients with hearing loss. Little is known of the relationship between screening scores and speech outcomes after cochlear implantation. Understanding the relationship between speech outcomes and cognitive impairment screening scores is important for preoperative patient counseling and setting realistic post-CI expectations.
*Learning Objective: To state the prevalence of cognitive impairment as assessed by the MoCA in adults undergoing CI evaluation; determine the correlation between preoperative MoCA scores and speech outcomes; compare the change from pre- to 12-month postoperative speech scores between patients with and without cognitive impairment;
*Desired Result: Attendees will: (1) understand the prevalence of cognitive impairment in adults with moderate to profound hearing loss who are seeking cochlear implant care; 2) appreciate the lack of correlation between preoperative cognitive impairment screening scores and 12-month postoperative change in aided speech outcomes after cochlear implantation; 3) utilize cognitive screening of adults undergoing CI evaluation as a tool to direct further comprehensive cognitive evaluation but not to limit cochlear implant candidacy
*Level of Evidence: Level V
*Indicate IRB or IACUC: Medical University of South Carolina IRB #Pro00073019, approved 12/20/2017