Unveiling the potential of the Digits-in-Noise test as a hearing screening tool for older adults with cognitive impairment

BackgroundThe Digits-in-Noise (DIN) test is recognized as a promising hearing screening tool due to its feasibility and reliability, particularly in noisy environments. Although endorsed by the World Health Organization for general population hearing screening, it has not been validated in older adults with cognitive impairment, such as mild cognitive impairment (MCI), and dementia, including Alzheimer's disease.ObjectiveTo address this gap, this study aimed to evaluate diagnostic accuracy of DIN compared to pure-tone audiometry, marking the first validation of the DIN test in this specific group.MethodsParticipants with MCI and dementia were recruited from memory clinics. Each participant underwent an audiologic evaluation, including the Hearing Handicap Inventory for Elderly, pure-tone audiometry, and smartphone-based DIN test. Additionally, the Montreal Cognitive Assessment, was administered.ResultsAmong 93 adults (mean age 71.9), an optimal speech reception threshold (SRT) cutoff of -3.5 dB yielded 90.5% sensitivity and 50% specificity for detecting moderate hearing loss. The area under the curve was 0.649 for mild hearing loss and 0.746 for moderate. A significant weak positive correlation was observed between SRT and pure tone average (ρ= 0.35, p < 0.001)ConclusionOur findings underscore the potential of the DIN test in detecting disabling hearing loss among cognitively impaired individuals, which warrants immediate hearing intervention to improve their quality of life.Trial RegistrationThai Clinical Trials Registry (TCTR20221222004), https://www.thaiclinicaltrials.org/.