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- Title
Association of Cognitive Impairment Screening Scores With Improvements in Speech Recognition and Quality of Life After Cochlear Implantation.
- Authors
Raymond, Mallory J.; Ma, Cheng; Schvartz-Leyzac, Kara C.; Camposeo, Elizabeth L.; Nguyen, Shaun A.; Meyer, Ted A.; McRackan, Theodore R.
- Abstract
This case series assesses whether there is an association between cognitive impairment screening scores and cochlear implant outcomes. Key Points: Question: Is there an association between cognitive impairment screening scores and improvements in cochlear implant speech recognition and quality-of-life measures? Findings: In this case series of 52 adult cochlear implant recipients, nearly half of the patients screened positive for cognitive impairment. Preoperative Montreal Cognitive Assessment scores were not associated with change in preoperative to 12-month postoperative Consonant-Nucleus-Consonant phonemes and words, AzBio sentences in quiet, or Cochlear Implant Quality of Life-35 Profile scores. Meaning: Cognitive impairment screening scores may have a limited role in counseling patients regarding cochlear implant outcomes. Importance: Many cochlear implant centers screen patients for cognitive impairment as part of the evaluation process, but the utility of these scores in predicting cochlear implant outcomes is unknown. Objective: To determine whether there is an association between cognitive impairment screening scores and cochlear implant outcomes. Design, Setting, and Participants: Retrospective case series of adult cochlear implant recipients who underwent preoperative cognitive impairment screening with the Montreal Cognitive Assessment (MoCA) from 2018 to 2020 with 1-year follow-up at a single tertiary cochlear implant center. Data analysis was performed on data from January 2018 through December 2021. Exposures: Cochlear implantation. Main Outcomes and Measures: Preoperative MoCA scores and mean (SD) improvement (aided preoperative to 12-month postoperative) in Consonant-Nucleus-Consonant phonemes (CNCp) and words (CNCw), AzBio sentences in quiet (AzBio Quiet), and Cochlear Implant Quality of Life-35 (CIQOL-35) Profile domain and global scores. Results: A total of 52 patients were included, 27 (52%) of whom were male and 46 (88%) were White; mean (SD) age at implantation was 68.2 (13.3) years. Twenty-three (44%) had MoCA scores suggesting mild and 1 (2%) had scores suggesting moderate cognitive impairment. None had been previously diagnosed with cognitive impairment. There were small to medium effects of the association between 12-month postoperative improvement in speech recognition measures and screening positive or not for cognitive impairment (CNCw mean [SD]: 48.4 [21.9] vs 38.5 [26.6] [d = −0.43 (95% CI, −1.02 to 0.16)]; AzBio Quiet mean [SD]: 47.5 [34.3] vs 44.7 [33.1] [d = −0.08 (95% CI, −0.64 to 0.47)]). Similarly, small to large effects of the associations between 12-month postoperative change in CIQOL-35 scores and screening positive or not for cognitive impairment were found (global: d = 0.32 [95% CI, −0.59 to 1.23]; communication: d = 0.62 [95% CI, −0.31 to 1.54]; emotional: d = 0.26 [95% CI, −0.66 to 1.16]; entertainment: d = −0.005 [95% CI, −0.91 to 0.9]; environmental: d = −0.92 [95% CI, −1.86 to 0.46]; listening effort: d = −0.79 [95% CI, −1.65 to 0.22]; social: d = −0.51 [95% CI, −1.43 to 0.42]). Conclusions and Relevance: In this case series, screening scores were not associated with the degree of improvement of speech recognition or patient-reported outcome measures after cochlear implantation. Given the prevalence of screening positive for cognitive impairment before cochlear implantation, preoperative screening can be useful for early identification of potential cognitive decline. These findings support that screening scores may have a limited role in preoperative counseling of outcomes and should not be used to limit candidacy.
- Publication
JAMA Otolaryngology-Head & Neck Surgery, 2023, Vol 149, Issue 4, p344
- ISSN
2168-6181
- Publication type
Article
- DOI
10.1001/jamaoto.2022.4825