The authors concluded that the MoCA-H reduced but did not eliminate poorer performance of hearing impaired versus non-impaired participants. The MoCA-H had a higher pass rate than the standard MoCA among people with HL (71% vs 53%), but fewer people with HL achieved passing scores with proportionally adjusted cut-off scores (to account for the deleted items) versus the normal hearing group (53% vs 85%). Dupuis et al 4 tested adults with HL (audiometric thresholds >25 dB HL n=43) and normal hearing (n=79). There were no data about the sensitivity and specificity of the computerised visual MoCA for detection of impaired cognitive function.ĭupuis et al 4 also developed a version of the MoCA for people with hearing impairment via deletion of hearing-dependent items from the standard MoCA (language repetition, attention to letters, digit span and delayed recall) to create the MoCA-H. Lin et al reported no difference in computerised visual MoCA scores between those with normal hearing and those with hearing impairment. All participants were screened to have normal cognitive function. 15 Adults with normal hearing (n=103) or severe-to-profound hearing loss (HL) (n=49) completed the visual version of the MoCA. Lin et al developed a computerised visual version of the MoCA with verbal instructions converted into visual instructions. There have been two previous attempts to adapt the MoCA for people with hearing impairment. The MoCA has previously been validated in populations with vascular dementia, frontotemporal dementia, 12 Parkinson’s disease 13 and Alzheimer’s disease (AD) 14 and has good sensitivity and specificity for the detection of both dementia and mild cognitive impairment (MCI). Administration time is usually less than 20 min. The MoCA consists of a single page, 30-item test that measures abilities in eight domains: visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall and orientation.
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11 The MoCA is a widely used screening measure that is available free of charge and has been translated into 55 different languages. To address the need for reliable screening measures of cognitive function for people with acquired sensory impairment, we propose to develop and validate versions of the Montreal Cognitive Assessment (MoCA). 10 Unfortunately, deletion of hearing-dependent or vision-dependent items may adversely impact sensitivity and specificity of the adapted tests. Previous attempts to adapt cognitive tests for people with sensory impairment involved deleting or substituting written versions of hearing-dependent items and deleting or substituting spoken or tactile versions of vision-dependent items. In two UK studies, hearing impairment was identified in 94% of people with a cognitive impairment attending a memory clinic 8 and a national survey identified visual impairment (visual acuity worse than 6/12) in 32.5% of a sample of people with dementia. 7 Hearing and vision impairment commonly co-occur with cognitive impairment in older adults. 1–6 The confounding of cognitive tests by hearing or vision impairment may lead to false positive identification of cognitive impairment and/or over-estimation of the severity of cognitive impairment. People with hearing or visual impairment and simulated hearing or vision impairment perform more poorly on tests of cognition than those with normal sensory function. Commonly used tests for cognitive impairment mostly consist of items presented in the visual and/or auditory modality and rely on good sensory function.
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