The impact of mild cognitive impairment on the accuracy of an interview based assessment of vision and/or hearing loss

Purpose : The increase in older adults with vision impairment (VI), hearing impairment (HI) and dual sensory impairment (DSI) warrants valid assessment tools. Accurate and early detection of sensory loss is critical to improve functioning through rehabilitation. Older adults with sensory loss can present with mild cognitive impairment (MCI), which may limit a test’s ability to identify sensory loss. This study examines the validity of a standardized subjective first-line assessment of sensory loss, the interRAI Community Health Assessment (interRAI CHA), in respondents with and without mild cognitive impairment.Methods : The interRAI CHA, and the Montreal Cognitive Assessment (MoCA) were administered to 200 adults aged 64+ with VI, HI or DSI. The interRAI CHA is composed of closed-ended questions, two of which are used to identify DSI. The MoCA is a standardized MCI screening tool. This study compared the sensitivity and specificity of the interRAI CHA using objective measurements of hearing and vision as the gold standard. These results were then stratified based on risk of MCI, as assessed by the MoCA.Results : Sensitivity for single VI and HI was 100%, and 97% for DSI. Specificity was 99% for VI, and 93% for both HI and DSI. Sensitivity for DSI was better among respondents who passed the MoCA (97.1%) compared to those who failed it (96.4%). Specificity was higher in the absence of MCI (VI: 100%, HI: 95.89%, DSI: 95.71%), than in its presence (VI: 98.48%, HI: 90.57%, DSI: 90.48%).Conclusions : The interRAI CHA sensitivity and specificity was lower among individuals with a dual sensory loss and also among individuals with MCI, as assessed with the MoCA. All study participants were receiving rehabilitation for sensory impairment. Future research should include older adults with DSI who are not receiving rehabilitation as this may influence the ability of the assessment to flag individuals with DSI.

https://iovs.arvojournals.org/article.aspx?articleid=2746205