PP601 - Administering Cognitive Screenings in Routine Audiological Care

Abstract:
There is a plethora of research that describes the relationship between hearing loss and cognitive decline. Cognitive decline can present similarly to hearing loss. Audiologists have opportunities to observe changes or declines in patient behavior, such as patient tardiness, forgetfulness, and/or difficulty to follow step-by-step instructions. Screening, diagnosis and early intervention of cognitive decline is important to holistically treat the patient. The aim of this poster is to provide a research-based strategy of when to administer cognitive screenings in a clinical audiology setting and to understand how the results can change the audiologic rehabilitation plan.

Summary
Untreated hearing loss and cognitive decline can present similarly, such as symptoms of anxiety, depression, and isolation. In order to holistically treat an older adult, it is important to assess both hearing and cognition. Audiologists are specialists in hearing, communication, and patient-centered care and they have the skills to screen for cognitive status.

Primary care providers and audiologists interact with the same population, but primary care providers may only interact with an older adult once per year. Audiologists are more likely to see their patient’s multiple times a year. Audiologist’s may be the first healthcare provider to notice concerning patient behaviors such as a patient’s tardiness, forgetfulness, and/or difficulty to follow step-by-step instructions. Or, family members may hint that the patient “doesn’t even remember what they had for dinner last night”. It is easy to attribute these characteristics to aging, but what if it is something more? Audiologist’s are equipped to administer cognitive screenings as the results provide a holistic view of the patient and the results may suggest a modified audiologic rehabilitation plan.

Before a cognitive screening is completed, it is important to address the peripheral hearing status of the patient. If the patient cannot understand the administrator, research demonstrates that the results may be skewed to having greater cognitive decline than actually present. Therefore, pure-tone audiometry should be completed before a cognitive screening is administered. Audiologist’s can administer the cognitive screening in an ideal communication environment, such as a quiet room, talking slightly slower, and emphasizing words. Or, hearing status can be addressed with hearing aids or a pocket talker to complete the cognitive screening

The goal of a cognitive screening such as the Montreal Cognitive Assessment (MoCA) or Mini Mental State Exam (MMSE) is to identify the likelihood that the patient has mild cognitive impairment. If the patient scores below the screening protocol, the patient should be referred to a neuropsychologist in the area for an in-depth cognitive evaluation. Early identification of mild cognitive impairment is imperative in delaying or reducing the effects of cognitive decline.

Identifying the likelihood of cognitive impairment can also modify the audiologic rehabilitation protocol. Research suggests having a limited number of programs and automatic volume control for patients with cognitive decline. Additionally, a significant other or family member may be highly encouraged to participate in audiologic appointments. A written hearing aid cleaning and wearing schedule may be provided at the first appointment. The audiologic rehabilitation plan <

The goal of this poster is to discuss how cognitive screenings can be used to refer the patient to a physician that can complete in-depth cognitive testing. Early identification and treatment for cognitive decline is beneficial for the patient, family, and the patient’s healthcare providers. An audiologist may modify the audiologic rehabilitation plan based on the cognitive screening results.