Hearing loss and cognition: A protocol for ensuring speech understanding before neurocognitive assessment

Elizabeth R. Kolberg, Emmanuel E.Garcia Morales, Tara W. Thallmayer, Michelle L. Arnold, Sheila Burgard, Theresa H. Chisolm, Josef Coresh, David Couper, Kathleen M. Hayden, Alison R. Huang, Frank R. Lin, Christine M. Mitchell, Thomas H. Mosley, Lisa Gravens-Mueller, Tiffany A. Owens, James S. Pankow, James Russell Pike, Nicholas S. Reed, Victoria Sanchez, Jennifer A. SchrackJennifer A. Deal, Adele M. Goman

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Many neurocognitive evaluations involve auditory stimuli, yet there are no standard testing guidelines for individuals with hearing loss. The ensuring speech understanding (ESU) test was developed to confirm speech understanding and determine whether hearing accommodations are necessary for neurocognitive testing. METHODS: Hearing was assessed using audiometry. The probability of ESU test failure by hearing status was estimated in 2679 participants (mean age: 81.4 ± 4.6 years) using multivariate logistic regression. RESULTS: Only 2.2% (N = 58) of participants failed the ESU test. The probability of failure increased with hearing loss severity; similar results were observed for those with and without mild cognitive impairment or dementia. DISCUSSION: The ESU test is appropriate for individuals who have variable degrees of hearing loss and cognitive function. This test can be used prior to neurocognitive testing to help reduce the risk of hearing loss and compromised auditory access to speech stimuli causing poorer performance on neurocognitive evaluation.

Original languageEnglish (US)
Pages (from-to)1671-1681
Number of pages11
JournalAlzheimer's and Dementia
Issue number3
StatePublished - Mar 2024

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.


  • aging
  • cognition
  • dementia
  • hearing loss
  • mild cognitive impairment
  • neurocognitive evaluation
  • speech understanding

PubMed: MeSH publication types

  • Journal Article


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