Maximize Patient’s Time to Assess Overall Hearing and Cognitive Health
By Nicole Klutz, Phonak Audiology Manager
As hearing care providers (HCP), we are often one of the many medical professionals who our patients see over the course of the year, and perhaps, we are the most often visited. Our patients spend, on average, 5 to 6 times a year with us in our office discussing their hearing health and rehabilitative goals. For many, a single visit, once a year, may be the only time they see their general physician to check their wellbeing and overall health.
Why is this so important? As an HCP, we have the opportunity to maximize the time we spend with our patients and their family members, using that time to assess not only their hearing health but perhaps their cognitive health as well.
Hand-in-hand: Hearing Health and Cognitive Decline
June is cognitive awareness month. The healthcare field is buzzing with emerging research and long-term studies establishing the impact of cognitive decline as we age, as well as comorbidities associated with not only cognitive health, but also hearing health.
As HCPs, we may be the one healthcare professional who our patient sees multiple times a year. And it’s important to maximize the time spent together. However, with busy schedules, it’s not unmerited to worry about our schedule and the time it would take to add another test into our already jam packed patient schedule.
But what if it only took 5 to 10 minutes to assess a patient’s cognitive health, potentially adding an early warning system for cognitive health assessment and concerns? What level of value and service would that provide to your patient and their families?
Understanding Cognitive Reserve
An important concept to understand in cognitive health is that of cognitive reserve: the brain’s ability to improvise and find alternate ways of achieving a task.* Our brains change the way they operate, accessing various resources depending upon the task at hand.
As we grow and learn, our brains become more agile and better able to deal with cognitive obstacles and challenges. Just as muscles tone and develop on our body as we train them, our brain develops various levels of muscle in cognitive reserve as we age and, when developed, aid in starving off cognitive damage and decline that may be consistent with cognitive diseases, such as Alzheimer’s disease and dementia.
With tests like the Montreal Cognitive Assessment (MoCA) tool, HCPs now have a validated, quick screening tool to assess and monitor our patient’s cognitive health.
MoCA is a widely used screening assessment for detecting cognitive impairment.1 It was validated in the setting of mild cognitive impairment, and it has subsequently been adopted in numerous other settings clinically. The MoCA test is a one-page, 30-point test administered in approximately 10 minutes.2
In this clock drawing task, the patient is asked to draw a clock with the hours and showing the time 2:30. Successive results show a deterioration of pattern processing ability in a subject as they progress from mild cognitive impairment (MCI) to severe Alzheimer’s disease (AD).
The MoCA assesses several cognitive domains:
Short-term memory recall
Multiple aspects of executive function
Attention, concentration and working memory
Orientation to time and place
Since the MoCA assesses multiple cognitive domains, it may be a useful cognitive screening tool for several neurological diseases that affect younger populations, such as Parkinson’s disease 3, vascular cognitive impairment, Huntington’s disease 4, multiple sclerosis 5 and other conditions.
The MoCA is a simple, brief test that helps HCPs determine in a short amount of time whether a patient has abnormal cognitive function and if they may need a more thorough follow-up with their general physician.
Enhancing the Value
With the opportunity provided to HCPs, implementing a simple, effective and time-efficient test like the MoCA provides an added level of value and service to our patients and their families. As the importance of understanding cognitive health continues to grow and research continues to evolve – it is important to take the opportunity, no matter how small, to assess our patient’s complete health and not just their hearing health.
With a simple, easy-to-use tool, incorporating this task into a patient’s appointment becomes easier, providing more value, service and satisfaction.
1. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H (2005). “The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment”. J Am Geriatr Soc. 53 (4): 695–9. doi:10.1111/j.1532-5415.2005.53221.x. PMID 15817019.
2. Maust, Donovan; Cristancho, Mario; Gray, Laurie; Rushing, Susan; Tjoa, Chris; Thase, Michael E. (2012-01-01). Psychiatric rating scales. Handbook of Clinical Neurology. 106. pp. 227–237. doi:10.1016/B978-0-444-52002-9.00013-9. ISBN 9780444520029. ISSN 0072-9752. PMID 22608624.
3. Dalrymple-Alford, J. C.; MacAskill, M. R.; Nakas, C. T.; Livingston, L.; Graham, C.; Crucian, G. P.; Melzer, T. R.; Kirwan, J.; Keenan, R. (2010-11-09). “The MoCA: well-suited screen for cognitive impairment in Parkinson disease”. Neurology. 75 (19): 1717–1725. doi:10.1212/WNL.0b013e3181fc29c9. ISSN 1526-632X. PMID 21060094.
4. Videnovic, Aleksandar; Bernard, Bryan; Fan, Wenqing; Jaglin, Jeana; Leurgans, Sue; Shannon, Kathleen M. (2010-02-15). “The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington’s disease”. Movement Disorders. 25(3): 401–404. doi:10.1002/mds.22748. ISSN1531-8257. PMID 20108371.
5. Videnovic, Aleksandar; Bernard, Bryan; Fan, Wenqing; Jaglin, Jeana; Leurgans, Sue; Shannon, Kathleen M. (2010-02-15). “The Montreal Cognitive Assessment as a screening tool for cognitive dysfunction in Huntington’s disease”. Movement Disorders. 25(3): 401–404. doi:10.1002/mds.22748. ISSN1531-8257. PMID 20108371.
Nicole Klutz, Au.D., is Manager of Audiology at the Phonak Audiology Research Center (PARC) in Warrenville, IL. In her role, she provides audiological support and professional training to employees and hearing care professionals around the country.