Development and validation of the Montreal cognitive assessment for people with hearing impairment (MoCA-H)

Piers Dawes, David Reeves, Wai Kent Yeung, Fiona Holland, Anna Pavlina Charalambous, Mathieu Côté, Renaud David, Catherine Helmer, Robert Laforce, Ralph N Martins, Antonis Politis, Annie Pye, Gregor Russell, Saima Sheikh, Marie-Josée Sirois, Hamid R Sohrabi, Chyrssoula Thodi, Kathleen Gallant, Ziad Nasreddine, Iracema Leroi

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Hearing impairment is common among older adults and affects cognitive assessments for identification of dementia which rely on good hearing function. We developed and validated a version of the Montreal Cognitive Assessment (MoCA) for people with hearing impairment.

METHODS: We adapted existing MoCA 8.1 items for people with hearing impairment by presenting instructions and stimuli in written rather than spoken format. One Attention domain and two Language domain items required substitution by alternative items. Three and four candidate items respectively were constructed and field-tested along with the items adapted to written form. We used a combination of individual item analysis and item substitution to select the set of alternative items to be included in the final form of the MoCA-H in place of the excluded original items. We then evaluated the performance and reliability of the final tool, including making any required adjustments for demographic factors.

RESULTS: One hundred and fifty-nine hearing-impaired participants, including 76 with normal cognition and 83 with dementia, completed the adapted version of the MoCA. A further 97 participants with normal hearing completed the standard MoCA as well as the novel items developed for the MoCA-H to assess score equivalence between the existing and alternative MoCA items and for independence from hearing impairment. Twenty-eight participants were retested between 2-4 weeks after initial testing. After the selection of optimal item set, the final MoCA-H had an area under the curve of 0.973 (95% CI 0.952-0.994). At a cut-point of 24 points or less sensitivity and specificity for dementia was 92.8% and 90.8%, respectively. The intraclass correlation for test-retest reliability was 0.92 (95%CI 0.78-0.97).

CONCLUSION: The MoCA-H is a sensitive and reliable means of identifying dementia among adults with acquired hearing impairment.

Original languageEnglish
JournalJournal of the American Geriatrics Society
Early online date1 Feb 2023
Publication statusE-pub ahead of print - 1 Feb 2023


  • Montreal cognitive assessment
  • cognitive screening
  • dementia
  • hearing impairment


Dive into the research topics of 'Development and validation of the Montreal cognitive assessment for people with hearing impairment (MoCA-H)'. Together they form a unique fingerprint.

Cite this