- According to research, hearing loss
is the leading potentially modifiable risk factor
for dementia later in life.
So in this video, I'm reviewing the Cognivue Thrive,
the future of cognitive screening.
Coming up.
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Hi guys, Cliff Olson, doctor of audiology and founder
of Applied Hearing Solutions in Phoenix, Arizona.
And on this channel,
I cover a bunch of hearing related information
to help make you a better informed consumer.
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There is a growing mountain of evidence
that is linking hearing loss with an increased risk
of cognitive decline, and ultimately dementia.
Now I know that there are some individuals out there
who call individuals like me an alarmist,
because hey, when you get older, you get hearing loss,
and when you get older you're at higher likelihood
for developing dementia.
However, as data pours in, researchers continue
to identify that when controlling for age,
the prevalence of dementia is still higher
in individuals with a hearing loss
versus individuals who do not have a hearing loss.
Perhaps the most compelling data released
in the last six months linking hearing loss
to cognitive decline and dementia
is the Lancet Commissions report,
that not only identified hearing loss
as a potentially modifiable risk factor
in mid-life for developing dementia,
at 8%, hearing loss is the single highest risk factor out
of the 12 risk factors that were identified in their study.
There is also additional research out there
that indicates when individuals
have their hearing loss treated with hearing aids,
that their rate of cognitive decline decreases over time.
Now I don't know about you, but to me,
this is very compelling data,
and I will link both of these studies in the description.
Based on all this research,
it's becoming quite clear that your hearing loss
could be impacting your cognitive function.
However, what most people don't realize is that not
only can your hearing loss impact your cognitive function,
but your cognitive function can also impact your hearing.
You see, hearing requires two forms of processing.
It requires bottom up processing,
which is where your cochlea sends information
up to your brain with afferent nerve fibers,
but it also requires top down processing,
where your brain sends information down to your cochlea
through efferent nerve fibers.
This top-down processing requires cognitive effort,
and cognitive factors such as attention, listening effort,
memory, multi-sensory integration, and prediction
all impact your ability to hear,
especially in complex listening situations.
Since hearing loss, cognitive decline, and dementia
are so closely linked at this point,
you can make the argument that it makes a lot of sense
for an audiologist to evaluate your cognitive abilities
at the same time that they're testing your hearing.
Well that's exactly why I wanted to test
the Cognivue Thrive system inside of my clinic.
The Cognivue Thrive system uses
the same FDA cleared technology used
by neurologists to test cognitive function.
By using
the five minutes self-administered computerized screening,
we can evaluate three domains of cognitive function,
including memory, visuospatial, and executive function.
We can also evaluate two speed performance parameters,
including reaction time and processing speed.
Let me explain what each of these mean.
For the cognitive domains, memory is your ability
to store and use information when needed.
Visuospatial is your ability to process
and interpret visual information
about yourself and your surroundings.
Executive function is your ability
to concentrate and problem solve.
For the speed performance parameters.
Reaction time is your ability
to physically react to situations.
And processing speed is the time
it takes to mentally process a task.
The only interaction you have with the computer
is the cog wheel that you spin
in order to do a variety of tasks.
These include word memory, word perception,
shape memory, and shape perception.
Upon completion of the screening,
you are given a score for each of the five domains tested.
Green means that you have good ability
in that particular domain.
Yellow means that you have moderate ability.
And red means that you have poor ability in a domain.
This information can help in a few ways.
First, it helps us understand whether or not
there is some level of cognitive decline
that is potentially being caused by hearing loss.
Second, it helps us to identify if that cognitive decline
is negatively impacting an individual's ability to hear.
Third, the information obtained from the cognitive screening
can actually change my recommendations to my patient,
and change the way that I counsel my patient.
Fourth, it can act as a baseline for future testing
after treating my patients with hearing aids
to see if hearing treatment actually improves
their cognitive functioning down the road.
And fifth, it helps me understand whether
or not I should be referring my patient back
to their primary care physician
for additional cognitive testing.
If any of these cognitive domains fall
into the green category,
then I know that my patient is looking really good
from a cognitive perspective,
to where the hearing loss is not yet impacting
their cognitive abilities and their cognitive abilities
are not gonna have a negative impact
on their ability to hear.
If they fall into any one of the yellow categories,
that's something I'm going to want to keep an eye on
over the course of the next three to six months,
and to see if hearing treatment
actually improves these scores.
And if any of these domains are in the red category,
then I know that I need to refer
that individual back to their primary care physician
for additional cognitive testing.
Now I could see someone make the argument that,
yeah it's great to have
the cognitive information for this individual,
but how does that actually change anything
that I would do in the clinic?
Well, I see this information as being a lot like
the information that I would obtain
from a speech and noise test.
If I never test someone in a noisy environment,
I don't know how they're going
to actually perform with hearing treatment
once they go into a noisy environment.
The results of the speech and noise test
can help me understand how I need to counsel a patient
on what their level of expectations should be
going into a noisy environment.
It can lead me to a recommendation
of assistive listening devices, like a remote microphone,
that can help in noisy environments as well.
And it can also lead to a stronger recommendation
to perform auditory training exercises
to help that individual process information better.
The more information that I have about my patients
above and beyond what I get
from just a standard hearing test,
helps me better identify whether or not I need
to perform additional testing,
and it can also help me make
a better recommendation for treatment.
Before using the Cognivue
I would use the Min-Cog screening tool, which was great,
but it was never sensitive enough to really identify whether
or not someone was sustaining a mild cognitive impairment.
The Mini-Cog also had low test retest reliability,
possibly because of my bias that I introduced into the test
because I'm the one who has to administer the test.
Not only does the Cognivue remove my biases
as a tester because the patient self-administers
the tests or the computerized program,
but it also removes biases associated
with socioeconomic status, education level and demographics.
A couple of other things that I really like
about the Cognivue is that it's very sensitive,
meaning it can identify if there's some level
of cognitive decline, even before there's
a mild cognitive impairment.
And it's very repeatable,
so you know if there's a change in performance
that is likely due to a change in cognitive function.
Now all of these things are great,
but there are several things that you should
at least be aware of when it comes
to cognitive screening using the Cognivue.
First, you cannot diagnose dementia with the Cognivue.
The Cognivue is a screening tool,
so even if you score in the red on every single
one of the domains, it does not mean that you have dementia.
That means that you should be getting referred
back to your point primary care physician
so your primary care physician can get you
the proper testing to identify if you do have dementia.
Second, I have not seen any cold hard data
that indicates if you treat your hearing loss
with hearing aids, that your scores will improve
with the Cognivue testing.
Even though that there are anecdotal reports stating
that there are individuals who have seen improvement
in their Cognivue scores
when they've treated their hearing loss.
Third, some hearing care professionals may use
the Cognivue screening results
to scare you into buying hearing aids.
If someone ever tells you that you are going
to get dementia if you do not treat
your hearing loss with hearing aids,
you need to get up and leave
to find a different hearing care provider,
because that provider is just trying to scare you
into purchasing hearing aids from them.
And fourth, Cognivue cognitive screening,
at least at the time of this recording, is not being done
by a lot of hearing care professionals out there
so it can be very difficult
to find someone who actually does it.
At the current moment, Cognivue does not have
a provider locator tool on their website,
so it might be worth checking back
on their website periodically from time to time,
or it might be worth actually calling around
the different clinics in your local area
to see if any of them have the Cognivue.
Negatives aside, I think the Cognivue Thrive system
is the best system out there if you want
a full understanding of how your cognition
is impacting your hearing and how your hearing
is potentially impacting your cognition.
At the end of the day, since hearing loss,
cognitive decline and dementia are so closely linked,
I think it's just a matter of time
before cognitive screening becomes
a standard part of audiologic care.
But until that time, finding a clinic
who can actually evaluate your cognitive performance
could be like finding a needle in a haystack.
That's it for this video.
If you have any questions,
leave them in the comment section below.
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Also feel free to check out my website, drcliffaud.com
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