LM316 - Cognitive Screenings and Clinical Audiology

Abstract:
As life expectancy increases, so does the incidence of age-related disorders. Currently, there are ~55-60 million people living with dementia, which is expected to triple in the next 27 years. Interventions which can delay the onset of dementia by 1 year may result in a >10% decrease in global prevalence of dementia by 2050.

Given the lack of effective interventions, identification of modifiable risk factors, i.e. hearing loss, is critical. As such, audiologist play a vital role in early identification. This learning module will provide an overview of neurocognitive disorders, including dementia, associated risk factors and methods of early identification.

Age related hearing loss (ARHL) was reported to be the leading modifiable risk factor for dementia (Livingston, 2020). Accordingly, audiologists can expect to see an increase in referrals for evaluation of hearing status and listening ability in persons considered at risk for dementia, and for those with a clinical higher index of suspicion.  Therefore, audiologists must be able to distinguish between typical age-related audiologic changes and behaviors, versus non-audiology signs and symptoms which may be symptomatic of cognitive decline and dementia.  The signs and symptoms of hearing loss overlap and masquerade (Kricos, 2009) with many of the signs and symptoms of dementia and audiologists must be equipped with the skill set to distinguish between these age-related declines. 

Equipping audiologists with an understanding of dementia, the behaviors associated with dementia and the role of audiologists in identifying cognitive decline will contribute to early identification and help reinforce the necessity of dementia screenings for people with age related hearing loss.

Unidentified hearing loss can lead to over-diagnosis of dementia, and many complaints from people with dementia can parade as hearing loss, underscoring the importance of cognitive screening and the pivotal role of audiologists and otolaryngologists in terms of early identification and referrals to obtain early diagnostic tests. Our efforts can provide people with non-normative cognitive screening results the opportunity for early intervention.

Given the importance of reducing and mitigating cognitive risk, and given the apparent relationship between hearing loss, cognitive decline, and dementia, audiologists and other hearing healthcare professionals are on the frontlines of cognitive healthcare.

Following a brief overview of dementia, communication needs of persons with dementia, and the relevance of memory loss to audiologic interventions we will provide a rationale for conducting cognitive screenings in adults with hearing difficulty based on the audiogram, SIN tests or self-report.  Modifications to hearing aid fittings, hearing aid counseling, and rehabilitative interventions will be discussed including an overview of communication needs and strategies for communicating with persons with cognitive decline.

This course has three goals:

1. To educate the audiologist the pathophysiology of neurocognitive disorders (including mild cognitive impairment and dementia), the behaviors associated with persons with cognitive decline/dementia; twelve modifiable risk factors, and to help professionals better recognize the signs and symptoms, of Neurocognitive Disorders (NCDs) and to suggest case history questions and interview queries to better evaluate the patients’ index of suspicion/risk NCDs.
2. Describe the rationale for cognitive screening of older adults with ARHL including an overview of cognitive screening techniques, tools and their advantages and disadvantages.
3. Review amplification selection and programming options, as well as strategies for optimizing adoption and use and the role of communication partners in the intervention process.