Integrated digit-in-noise testing for hearing and cognitive screening.

INTRODUCTION: Hearing loss and cognitive decline often coexist in aging, and reduced audibility can bias cognitive screening. We evaluated integrated digit-in-noise (iDIN) testing for paired screening. METHODS: Among 962 community-screened adults 55 years of age or older, 495 had linked audiometry, iDIN, and the Hong Kong version of the Montreal Cognitive Assessment (HK-MoCA). Outcomes were better-ear four-frequency pure-tone average (PTA4) >35 dB hearing level (HL) and HK-MoCA <22. RESULTS: In linked participants, 294 (59.4%) had PTA4 >35 dB HL and 195 (39.4%) were HK-MoCA screen-positive. Backward-recall speech reception threshold (SRT) difference scores discriminated HK-MoCA <22 (SRT3b-3/SRT3b-2 area under the curve [AUC] = 0.807/0.800). SRT3b-3 correlated with HK-MoCA (Spearman rs = -0.520), not PTA4 (rs = 0.018). SRT2/SRT3 similarly classified hearing loss (AUC = 0.878/0.874). DISCUSSION: iDIN may support brief prediagnostic triage by pairing hearing characterization with cognitive-load screening, rather than replacing multidomain assessment or diagnosis.