Hearing loss can lower dementia-screening scores when a person misses spoken words or instructions. A low score may reflect reduced audibility, genuine cognitive impairment, or both. A dementia screen is a brief check for possible problems with memory and thinking. It can identify the need for further evaluation, but it cannot determine the cause by itself.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- Why missed words can look like memory loss
- How much can hearing affect a score?
- What should happen before and during testing?
- What should you do after a low score?
Why missed words can look like memory loss
The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) include orally delivered material. As a 2021 Frontiers in Psychology review explains, untreated hearing loss can therefore lower scores without proving a memory deficit. Suppose an examiner reads several words and asks the person to remember them.
If the person hears only some of the words, later recall begins with incomplete information. The resulting error may look like forgetting even though the person never heard every word clearly. Misheard instructions can create similar problems. A person may complete the wrong task, respond incompletely, or spend extra effort decoding speech instead of concentrating on the test.
How much can hearing affect a score?
A study of 114 adults ages 55 to 86 found that each additional 10 decibels of hearing loss was associated with 2.8% lower MMSE scores and 3.5% lower MoCA scores. The researchers concluded that poor hearing can confound results and that some registration and recall errors probably reflected reduced audibility, according to the July 2018 International Journal of Geriatric Psychiatry study. These findings describe an association across a group.
They do not provide a formula for correcting an individual score, so a clinician cannot simply add those percentages to a result. Hearing-related error also cannot be assumed whenever someone scores poorly. The person may have cognitive impairment, a hearing barrier, or both, which is why the testing conditions and wider clinical picture matter.
What should happen before and during testing?
The 2023 international practice recommendations advise clinicians to check hearing before a cognitive evaluation and reduce avoidable communication barriers. Recommended measures include: These accommodations help ensure that the test measures thinking rather than access to spoken material. They do not guarantee a higher score or rule out dementia.
- Check for suspected or known hearing loss before testing.
- Have the person use hearing aids that provide their best available correction.
- Conduct the test one-to-one in a quiet setting.
- Use a validated non-auditory version when hearing loss is suspected.
What should you do after a low score?
A brief cognitive screen is not a dementia diagnosis. The Alzheimer's Association's cognitive assessment guidance says people who fail a screen need further evaluation or specialist referral; diagnosis also considers history, daily function, examination, and other testing.
After a low result, ask how hearing was checked, whether words or instructions had to be repeated, and whether the testing format suited the person's hearing. Also tell the clinician about changes in memory, judgment, communication, and everyday tasks, because hearing conditions cannot explain those changes by themselves. Before another assessment:.
- Bring and use the person's hearing aids.
- Report any difficulty hearing during the earlier test.
- Ask for a quiet, one-to-one setting.
- Ask whether a validated hearing-appropriate screen should be used.
- Continue the recommended diagnostic evaluation even if hearing may have affected the first score.
