Sex-Related Differences in the Associations Between Montreal Cognitive Assessment Scores and Pure-Tone Measures of Hearing

Purpose: Hearing loss (HL) is associated with cognitive performance in older adults, including performance on the Montreal Cognitive Assessment (MoCA), a brief cognitive screening test. Yet, despite well-established sex-related differences in both hearing and cognition, very few studies have tested whether there are sex-related differences in auditory-cognitive associations. Method: In the current cross-sectional retrospective analysis, we examined sex-related differences in hearing and cognition in 193 healthy older adults (M = 69 years, 60% women). Hearing was measured using audiometry (pure-tone average [PTA] of thresholds at 500, 1000, 2000, and 4000 Hz in the worse ear). Cognition was assessed using the MoCA. Additionally, we calculated MoCA scores with hearing-dependent subtests excluded from scoring (MoCA-Modified). Results: Men and women did not differ in age, education, or history of depression. Women had better hearing than men. Women with normal hearing were more likely to pass the MoCA compared with their counterparts with HL In contrast, the likelihood of passing the MoCA did not depend on hearing status in men. Linear regression analysis showed an interaction between sex and PTA in the worse ear. PTAs were significantly correlated with both MoCA and MoCA-Modified scores in women, whereas this was not observed in the men. Conclusions: This study is one of the first to demonstrate significant sex-related differences in auditory-cognitive associations even when hearing-related cognitive test items are omitted. Potential mechanisms underlying these female-specific effects are discussed.