The Effect of Decreased Audibility on MMSE Performance: A Measure Commonly Used for Diagnosing Dementia

Background: Hearing loss and dementia are both prevalent in late adulthood. The most common test used to determine cognitive status in late adulthood, the Mini Mental State Examination (MMSE), is presented face to face, usually in the context of the physician's office in the presence of background noise. Despite the problems of hearing loss and cognitive problems in late life, there is an absence of evidence linking hearing-related deficits to performance on the MMSE and dementia diagnoses. Purpose: This study examined the effect of decreased audibility on performance on the MMSE. Research Design: A between-subjects design was implemented. Participants were randomly assigned to one of five degrees of simulated hearing loss conditions and were blinded to condition assignment. Study Sample: One hundred and twenty-five young normal-hearing participants were randomized into five conditions of varying degrees of simulated hearing loss. Data Collection and Analysis: Performance on the MMSE was scored and cognitive status was categorized based on the scores. Analysis of variance with conditions as a between-subjects factor was conducted with post hoc multiple comparisons to determine the effect of audibility on performance. Results: Reduced audibility significantly affected performance on the MMSE in a sample of young adults, resulting in greater apparent cognitive deficits as audibility decreased. Conclusions: Apparent cognitive deficits based on MMSE scores obtained in test conditions in which audibility is reduced could result in incorrectly identified cognitive loss if clinicians are not alert to hearing loss when patients are evaluated. Furthermore, health care providers should be cautious when using family report of cognitive impairment to diagnose dementia without accounting for hearing loss because the impression of family members may be based on misinterpretation of the effects of hearing loss.