1
|
Gaire BP, Koronyo Y, Fuchs DT, Shi H, Rentsendorj A, Danziger R, Vit JP, Mirzaei N, Doustar J, Sheyn J, Hampel H, Vergallo A, Davis MR, Jallow O, Baldacci F, Verdooner SR, Barron E, Mirzaei M, Gupta VK, Graham SL, Tayebi M, Carare RO, Sadun AA, Miller CA, Dumitrascu OM, Lahiri S, Gao L, Black KL, Koronyo-Hamaoui M. Alzheimer's disease pathophysiology in the Retina. Prog Retin Eye Res 2024; 101:101273. [PMID: 38759947 DOI: 10.1016/j.preteyeres.2024.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
The retina is an emerging CNS target for potential noninvasive diagnosis and tracking of Alzheimer's disease (AD). Studies have identified the pathological hallmarks of AD, including amyloid β-protein (Aβ) deposits and abnormal tau protein isoforms, in the retinas of AD patients and animal models. Moreover, structural and functional vascular abnormalities such as reduced blood flow, vascular Aβ deposition, and blood-retinal barrier damage, along with inflammation and neurodegeneration, have been described in retinas of patients with mild cognitive impairment and AD dementia. Histological, biochemical, and clinical studies have demonstrated that the nature and severity of AD pathologies in the retina and brain correspond. Proteomics analysis revealed a similar pattern of dysregulated proteins and biological pathways in the retina and brain of AD patients, with enhanced inflammatory and neurodegenerative processes, impaired oxidative-phosphorylation, and mitochondrial dysfunction. Notably, investigational imaging technologies can now detect AD-specific amyloid deposits, as well as vasculopathy and neurodegeneration in the retina of living AD patients, suggesting alterations at different disease stages and links to brain pathology. Current and exploratory ophthalmic imaging modalities, such as optical coherence tomography (OCT), OCT-angiography, confocal scanning laser ophthalmoscopy, and hyperspectral imaging, may offer promise in the clinical assessment of AD. However, further research is needed to deepen our understanding of AD's impact on the retina and its progression. To advance this field, future studies require replication in larger and diverse cohorts with confirmed AD biomarkers and standardized retinal imaging techniques. This will validate potential retinal biomarkers for AD, aiding in early screening and monitoring.
Collapse
Affiliation(s)
- Bhakta Prasad Gaire
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dieu-Trang Fuchs
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Haoshen Shi
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Altan Rentsendorj
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ron Danziger
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jean-Philippe Vit
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nazanin Mirzaei
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jonah Doustar
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julia Sheyn
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harald Hampel
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Andrea Vergallo
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Miyah R Davis
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ousman Jallow
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Filippo Baldacci
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | | | - Ernesto Barron
- Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Los Angeles, CA, USA
| | - Mehdi Mirzaei
- Department of Clinical Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Vivek K Gupta
- Department of Clinical Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Stuart L Graham
- Department of Clinical Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia; Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | - Mourad Tayebi
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Roxana O Carare
- Department of Clinical Neuroanatomy, University of Southampton, Southampton, UK
| | - Alfredo A Sadun
- Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Los Angeles, CA, USA
| | - Carol A Miller
- Department of Pathology Program in Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Shouri Lahiri
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Liang Gao
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Keith L Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Division of Applied Cell Biology and Physiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| |
Collapse
|
2
|
Zhang X, Wang S, Liu S, Du Z, Wu G, Liang Y, Huang Y, Shang X, Hu Y, Zhu Z, Sun W, Zhang X, Yu H. Epidemiologic association and shared genetic architecture between cataract and hearing difficulties among middle-aged and older adults. Hum Genomics 2024; 18:39. [PMID: 38632618 PMCID: PMC11022469 DOI: 10.1186/s40246-024-00601-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024] Open
Abstract
Age-related cataract and hearing difficulties are major sensory disorders that often co-exist in the global-wide elderly and have a tangible influence on the quality of life. However, the epidemiologic association between cataract and hearing difficulties remains unexplored, while little is known about whether the two share their genetic etiology. We first investigated the clinical association between cataract and hearing difficulties using the UK Biobank covering 502,543 individuals. Both unmatched analysis (adjusted for confounders) and a matched analysis (one control matched for each patient with cataract according to confounding factors) were undertaken and confirmed that cataract was associated with hearing difficulties (OR, 2.12; 95% CI, 1.98-2.27; OR, 2.03; 95% CI, 1.86-2.23, respectively). Furthermore, we explored and quantified the shared genetic architecture of these two complex sensory disorders at the common variant level using the bivariate causal mixture model (MiXeR) and conditional/conjunctional false discovery rate method based on the largest available genome-wide association studies of cataract (N = 585,243) and hearing difficulties (N = 323,978). Despite detecting only a negligible genetic correlation, we observe polygenic overlap between cataract and hearing difficulties and identify 6 shared loci with mixed directions of effects. Follow-up analysis of the shared loci implicates candidate genes QKI, STK17A, TYR, NSF, and TCF4 likely contribute to the pathophysiology of cataracts and hearing difficulties. In conclusion, this study demonstrates the presence of epidemiologic association between cataract and hearing difficulties and provides new insights into the shared genetic architecture of these two disorders at the common variant level.
Collapse
Affiliation(s)
- Xiayin Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shan Wang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Shunming Liu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zijing Du
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Guanrong Wu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yingying Liang
- Department of Ophthalmology, Guangzhou First people's Hospital, Guangzhou, China
| | - Yu Huang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianwen Shang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yijun Hu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, VIC, East Melbourne, Australia
| | - Wei Sun
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
| | - Xueli Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China.
| |
Collapse
|
3
|
Grove NC, Pelak VS, Christopher KL, Wagner BD, Lynch AM, Patnaik JL. Cataract Phacoemulsification in People with Dementia: Characterization and Outcomes. Ophthalmic Epidemiol 2023:1-9. [PMID: 37971269 DOI: 10.1080/09286586.2023.2279113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE To characterize cataract surgery in people with dementia (PWD) using a cataract surgery outcomes database. METHODS Demographics, medical and ocular history, surgical characteristics, and postoperative measures were analyzed for differences between PWD and non-PWD cohorts. Patient-level data were analyzed with Fisher's Exact Test, and eye-level data were analyzed with logistic regression using generalized estimating equations to account for correlation of eyes from the same individual. RESULTS 507 eyes from 296 PWD were identified using appropriate ICD codes and cross-referenced to a cataract surgery outcomes database containing 12,949 eyes from 7,853 patients who underwent cataract phacoemulsification at a single center between January 2014 and October 2019. PWD were older (p < .001), had shorter duration cataract surgeries (p = .006), and were more likely to have mature cataract (p = .017). The rate of general anesthesia was higher in PWD (p = .005). There were no differences in complication rates between PWD and non-PWD cohorts. Both preoperative best corrected LogMAR distance visual acuity (CDVA) (p < .001) and postoperative CDVA (p < .001) were worse in PWD. CDVA significantly improved in both groups (p < .001); however, the average magnitude of improvement in CDVA was not significantly different between groups (p = .169). CONCLUSIONS PWD present for cataract surgery at a later age and were more likely to have mature cataracts and general anesthesia, but did not have higher rates of complication, and showed significant improvement in CDVA following surgery. These findings should be encouraging to PWD undergoing counseling for cataract surgery, and for the potential for improved function in PWD.
Collapse
Affiliation(s)
- Nathan C Grove
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Biostatistics & Informatics, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Victoria S Pelak
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Karen L Christopher
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Brandie D Wagner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Biostatistics & Informatics, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA
| |
Collapse
|
4
|
Lee C, Shin E, Kim M, Bae Y, Chung TY, Seo SW, Jang H, Lim DH. The Effect of Cataract Surgery on the Risk of Dementia: A Nationwide Cohort Study. J Clin Med 2023; 12:6441. [PMID: 37892580 PMCID: PMC10607014 DOI: 10.3390/jcm12206441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 09/27/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND An advanced age and the female sex are widely recognized risk factors for both cataract and dementia. We investigated the effect of cataract surgery on the incidence of dementia in a Korean population aged ≥ 45 years with a previous diagnosis of cataract. METHODS This nationwide cohort study was performed using Korean National Health Insurance Service data collected from 2006 to 2017. A total of 300,327 subjects aged ≥ 45 years with a history of cataract diagnosis but no previous diagnosis of dementia were analyzed. The relationship between cataract surgery and dementia was evaluated, applying a time-varying analysis to evaluate the hazard ratio (HR) and 95% confidence interval (CI) values according to dementia. It was calculated via a multivariable Cox regression model, with adjustments for age, sex, visual acuity (VA), ocular and systemic comorbidities, and social factors (including body mass index, income, smoking, and drinking). RESULTS In the multivariate analysis, the cataract surgery group showed a marginal difference in dementia development (HR 1.10 [95% CI 1.02-1.19]) because both cataract and dementia share common risk factors. However, in the subgroup analysis, men (HR 0.49 [95% CI 0.26-0.90]) and patients under 65 years of age (HR 0.88 [95% CI 0.79-0.99]) in the group with cataract surgery and good VA showed a significantly lower incidence of dementia. CONCLUSION Through visual improvement, together with timely surgical intervention, the procedure can alleviate the risk of dementia in visually impaired patients, especially in younger and male patients.
Collapse
Affiliation(s)
- Chaeyeon Lee
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (C.L.); (T.-Y.C.)
| | - Eunhae Shin
- Seoul Nunevit Eye Clinic, Seoul 05551, Republic of Korea;
| | - Mina Kim
- Department of Data Science, Hanmi Pharmaceutical Co., Ltd., Seoul 05545, Republic of Korea; (M.K.); (Y.B.)
| | - Yoonjong Bae
- Department of Data Science, Hanmi Pharmaceutical Co., Ltd., Seoul 05545, Republic of Korea; (M.K.); (Y.B.)
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (C.L.); (T.-Y.C.)
- Renew Seoul Eye Center, Seoul 06615, Republic of Korea
| | - Sang Won Seo
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul 06351, Republic of Korea;
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Hyemin Jang
- Department of Neurology, Seoul National University, Seoul 03080, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (C.L.); (T.-Y.C.)
- Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| |
Collapse
|
5
|
Xiong Z, Li X, Yang D, Xiong C, Xu Q, Zhou Q. The association between cataract and incidence of cognitive impairment in older adults: A systematic review and meta-analysis. Behav Brain Res 2023; 450:114455. [PMID: 37148915 DOI: 10.1016/j.bbr.2023.114455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Cataract has been shown to be associated with an increased risk of cognitive impairment. However, the results of previous studies have been inconsistent. This systematic review and meta-analysis aimed to investigate the association between cataract and the incidence of cognitive impairment in older adults. METHODS A comprehensive search of electronic databases from inception to January 2023 was performed to identify relevant studies. Data were extracted from eligible studies and a meta-analysis was performed to calculate the pooled hazard ratio (HR) and 95% confidence interval (CI). RESULTS We included 13 studies with 25 study arms involving a total of 798,694 participants. Compared with participants without cataract, those with cataract had a higher risk of developing all-cause dementia (pooled HR: 1.22; 95% CI: 1.08-1.38; I2=86%; 9 studies), Alzheimer's disease dementia (pooled HR: 1.18; 95% CI: 1.07-1.30; I2=0%; 9 studies), vascular dementia (pooled HR: 1.21; 95% CI: 1.02-1.43; I2=77%;3 studies) and mild cognitive impairment (pooled HR: 1.30; 95% CI: 1.13-1.50; I2=0%;2 studies). There was no significant association between cataract and mixed dementia (pooled HR: 1.03; 95% CI: 0.52-2.04; I2=78%;2 studies). We assessed the risk of bias of the included studies using the Newcastle-Ottawa Scale and found that most of them had a low or moderate risk of bias. The number of studies in each meta-analysis ranged from two to nine, with more studies available for all-cause dementia and Alzheimer's disease dementia than for vascular dementia and mixed dementia. CONCLUSIONS The findings suggest that cataract may be associated with cognitive impairment in older adults. However, the causal relationship between cataract and cognition remains unclear and requires further investigation.
Collapse
Affiliation(s)
- Zhenrong Xiong
- Public relations department, The First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China.
| | - Xinming Li
- Department of Neurology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Dejiang Yang
- Department of Neurology, The Third Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
| | - Chongyu Xiong
- Public relations department, The First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China.
| | - Qinggang Xu
- Jiangxi College of Traditional Chinese Medicine, Fuzhou, Jiangxi, China.
| | - Qi Zhou
- Department of Neurology, The First People's Hospital of Fuzhou, Fuzhou, Jiangxi, China.
| |
Collapse
|
6
|
Hussain ZS, Khan A, Loya A, Shah K, Woreta FA, Riaz KM. Early Lifetime Substance Use and Development of Visual Impairment: Analysis of the National Survey on Drug Use and Health Data. Clin Ophthalmol 2023; 17:849-860. [PMID: 36968284 PMCID: PMC10030542 DOI: 10.2147/opth.s401167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Purpose To investigate the association between early lifetime substance use on the development of severe visual acuity impairment or blindness on a national level. Methods National Survey of Drug Use and Health data was used to identify cases of substance use before 21* years of age, within the past year, and cases of self-reported blindness or visual impairment. Univariable and multivariable binary logistic regression with time-dependency was performed to evaluate odds of visual impairment influenced by 16 substances separated into three classes: prescription, non-prescription, and illicit drugs. Adjusted variables of interest included gender, marital status, race, level of education, total family income, poverty level, population density, and history of chronic disease. Results 55,824 total responses were analyzed with 2577 (4.6%) cases of self-reported blindness or significant visual impairment. All early-use substance categories, including prescription, non-prescription, and illegal substances, were significantly associated with self-reported VI (OR 2.068, CI 1.451-2.949, p<0.001; OR 1.352, CI 1.227-1.489, p<0.001); OR 1.211, CI 1.086-1.352, p<0.001), respectively). Non-prescription substances displayed parallel significances amongst all constituents (alcohol, cigarettes, inhalants, and marijuana) (OR=1.227, CI 1.12-1.344, p<0.001; OR 1.363, CI 1.243-1.495, p<0.001; OR 1.418, CI 1.134-1.774; OR 1.388, CI 1.27-1.518, p<0.001, respectively). Univariable and multivariable analysis revealed several significant demographical and clinical adjustors. Conclusion Early lifetime use of all three classes of substances is associated with enhanced odds of subsequent visual impairment or blindness. Several readily available and commonly used substances have a greater risk. These findings may help clinicians and public health agencies in mitigation ventures including education, prevention, and rehabilitation efforts.
Collapse
Affiliation(s)
- Zain S Hussain
- University of Medicine and Health Sciences, Basseterre, Saint Kitts and Nevis
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA
| | - Asher Khan
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA
- College of Medicine, University of Oklahoma, Oklahoma City, OK, USA
| | - Asad Loya
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA
| | - Kaushal Shah
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Fasika A Woreta
- Department of Ophthalmology, Johns Hopkins Wilmer Eye Institute, Baltimore, MD, USA
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, Oklahoma City, OK, USA
- Correspondence: Kamran M Riaz, Dean McGee Eye Institute/University of Oklahoma, 608 Stanton L Young Blvd, Suite 313, Oklahoma City, OK, 73104, USA, Tel +1-405-271-1095, Fax +1-405-271-3680, Email
| |
Collapse
|
7
|
Deng X, Geng Z, Yu J, Dai X, Kuang X, Chen X, Li R, Liu T, Li C. The Association Between Cataract and Cognitive Functions in Older Adults: A Longitudinal Cohort Study. J Alzheimers Dis 2023; 91:1097-1105. [PMID: 36565122 DOI: 10.3233/jad-220963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between cataracts and cognitive functions has been reported in several studies. However, the dynamic trajectories of cognitive changes in patients with cataracts remain unelucidated. OBJECTIVE The aim of the study was to evaluate the dynamic trajectories of cognitive changes in patients with cataracts. METHODS This observational cohort study recruited 1,146 patients with age-related cataracts (ARC) from the Department of Ophthalmology, Daping Hospital, from September 2020 to November 2021. The cognitive functions of the patients were assessed using a Chinese version of the Telephone Interview of Cognitive Status-40 (TICS-40) test at baseline and 6 months of follow-up. The trajectories and the associated risk factors for the longitudinal cognitive decline during the 6-month follow-up were investigated. RESULTS Patients with severe ARC [median (IQR): 0 month, 24 (22, 25); 6 months, 23 (21,25)] had lower TICS-40 scores than those with non-severe ARC [0 month, 31 (24, 33), p < 0.001; 6 months, 31 (23,33), p < 0.001] and controls [0 month, 32 (28, 35), p < 0.001; 6 months, 32 (28, 35), p < 0.001] at both baseline and 6 months of follow-up. Age (OR: 1.311, 95% CI: 1.229 to 1.398) and cataract grade (OR: 5.569, 95% CI: 2.337 to 13.273) were found to be the risk factors of cognitive decline as indicated by a decrease in the TICS-40 scores. CONCLUSION ARC is associated with an increased risk of longitudinal cognitive decline; however, the reversibility of such declines needs to be investigated further.
Collapse
Affiliation(s)
- Xiaoli Deng
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhao Geng
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Juan Yu
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xiaoyan Dai
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Xunjie Kuang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing, China
| | - Xia Chen
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ruifeng Li
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Ting Liu
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chongyi Li
- Department of Ophthalmology, Daping Hospital, Army Medical University, Chongqing, China
| |
Collapse
|
8
|
Evaluation of the impact of cataract surgery on cognitive function in very elderly patients: a prospective, observational study. Aging Clin Exp Res 2022; 34:661-669. [PMID: 34505254 DOI: 10.1007/s40520-021-01962-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/09/2021] [Indexed: 12/28/2022]
Abstract
AIM To evaluate the impact of cataract surgery on cognitive function in very elderly patients (≥ 85 years). METHODS A prospective, nonrandomized, comparative study of very elderly patients (≥ 85 years), and elderly patients (≥ 65 < 85 years) scheduled for first time cataract surgery. Cognitive function, quality of life (QoL), best corrected visual acuity (BCVA), endothelial cell count (ECC), and central corneal thickness (CCT) were assessed at 90 days before surgery (T0), at surgery (T1), and at 30 (T2) and 90 days (T3) after surgery. Macular thickness (MT) was evaluated at T2. Six-item cognitive impairment test (6CIT) was used to evaluate cognitive function while the Catquest-9SF test was used to assess QoL. The confusion assessment method (CAM) was used to evaluate the presence of delirium episodes at within 48 h from T1. RESULTS A total of 78 patients (very elderly n = 24, elderly n = 54) were enrolled; average age 80.3 ± 6.2 years old. Significant improvements for cognitive function, BCVA, QoL (p < 0.01) during the observational period were observed among the cohort. A greater improvement in cognitive function was observed in the very elderly patients between T1 and T2 (p = 0.02), while there was no difference in BCVA and QoL between the groups. There were no significant differences in ECC and CCT changes between the groups. No delirium episodes or significant macular abnormalities were registered. CONCLUSIONS Cataract surgery in very elderly patients seems to offer a greater improvement in cognitive function as compared to elderly patients, and it is associated with a significant improvement in QoL, without any incidence of postoperative delirium.
Collapse
|
9
|
Kuźma E, Littlejohns TJ, Khawaja AP, Llewellyn DJ, Ukoumunne OC, Thiem U. Visual Impairment, Eye Diseases, and Dementia Risk: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2021; 83:1073-1087. [PMID: 34397414 DOI: 10.3233/jad-210250] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Visual impairment and eye diseases have been associated with dementia, though with mixed findings and often in cross-sectional studies. OBJECTIVE To identify prospective studies investigating associations between visual impairment or common eye diseases and risk of all-cause dementia or key dementia subtypes. METHODS We searched Medline, PsycINFO, and Embase from inception to January 2020. We also conducted backward and forward citation searches of included studies and set up alerts to identify studies published after the search date. Random-effects meta-analysis was used to combine adjusted estimates across studies. RESULTS Thirty studies met our eligibility criteria. For visual impairment, pooled estimates indicated an increased risk of all-cause dementia (37,705 participants, 3,415 cases, risk ratio [RR] = 1.38, 95%confidence interval [CI]: 1.19-1.59, I2 = 28.6%). Pooled estimates also suggested an increased dementia risk associated with cataract (6,659 participants, 1,312 cases, hazard ratio [HR] = 1.17, 95%CI 1.00-1.38, I2 = 0.0%) and diabetic retinopathy (43,658 participants, 7,060 cases, HR = 1.34, 95%CI 1.11-1.61, I2 = 63.9%), respectively. There was no evidence of an association between glaucoma (175,357 participants, 44,144 cases, HR = 0.97, 95%CI 0.90-1.04, I2 = 51.5%) or age-related macular degeneration (7,800,692 participants, > 2,559 cases, HR = 1.15, 95%CI 0.88-1.50, I2 = 91.0%) and risk of dementia, respectively. CONCLUSION As visual impairment, cataract, and diabetic retinopathy are associated with an increased likelihood of developing dementia, early diagnosis may help identify those at risk of dementia. Given most causes of visual impairment are treatable or preventable, the potential for dementia prevention warrants further investigation.
Collapse
Affiliation(s)
- Elżbieta Kuźma
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany
| | - Thomas J Littlejohns
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Anthony P Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - David J Llewellyn
- College of Medicine and Health, University of Exeter, Exeter, United Kingdom.,Alan Turing Institute, London, United Kingdom
| | - Obioha C Ukoumunne
- NIHR ARC South West Peninsula (PenARC), University of Exeter Medical School, Exeter, United Kingdom
| | - Ulrich Thiem
- Albertinen-Haus Centre for Geriatrics and Gerontology, University of Hamburg, Hamburg, Germany.,University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
10
|
The Evolving Role of Ophthalmology Clinics in Screening for Early Alzheimer's Disease: A Review. Vision (Basel) 2020; 4:vision4040046. [PMID: 33138202 PMCID: PMC7711816 DOI: 10.3390/vision4040046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/03/2022] Open
Abstract
Alzheimer’s disease (AD) is the leading cause of dementia, which is a growing public health concern. Although there is no curative treatment for established AD, early recognition and modification of the known risk factors can reduce both severity and the rate of progression. Currently, an early diagnosis of AD is rarely achieved, as there is no screening for AD. The cognitive decline in AD is gradual and often goes unnoticed by patients and caregivers, resulting in patients presenting at later stages of the disease. Primary care physicians (general practitioners in the UK) can administer a battery of tests for patients presenting with memory problems and cognitive impairment, however final diagnosis of AD is usually made by specialised tertiary level clinics. Recent studies suggest that in AD, visuospatial difficulties develop prior to the development of memory problems and screening for visuospatial difficulties may offer a tool to screen for early stage AD. AD and cataracts share common risk and predisposing factors, and the stage of cataract presentation for intervention has shifted dramatically with early cataract referral and surgical intervention becoming the norm. This presentation offers an ideal opportunity to administer a screening test for AD, and visuospatial tools can be administered at post-operative visits by eye clinics. Abnormal findings can be communicated to primary care physicians for further follow up and assessment, or possible interventions which modify risk factors such as diabetes, hypertension and obesity can be undertaken. We propose that eye clinics and ophthalmology facilities have a role to play in the early diagnosis of AD and reducing the burdens arising from severe dementia.
Collapse
|
11
|
Vidal KSM, Bertola L, Suemoto CK, Moreno AB, Duncan B, Schmidt MI, Maestri M, Barreto SM, Lotufo PA, Benseñor IM, Brunoni AR. Glaucoma, but not cataracts, predicts lower verbal fluency performance: 3.8-year follow-up from the ELSA-Brasil study. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:871-883. [PMID: 33073671 DOI: 10.1080/13825585.2020.1837723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Glaucoma, cataracts, and cognitive decline are most common in older ages. Although cross-sectional studies showed that these disorders are associated, follow-up studies are lacking. To investigate this issue, baseline and follow-up data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were employed. We evaluated participants ≥ 55 years-old at follow-up without diagnosis of dementia, stroke, and other eye conditions except for glaucoma and cataracts. Cognition was evaluated using delayed word recall, verbal fluency, and trail making (version B) tests. Regression models were employed to investigate associations between glaucoma and cognition, adjusted by several confounders. Out of 3,867 participants, 379 and 118 presented cataracts and glaucoma, respectively. Only glaucoma was apredictor of lower verbal fluency (B = -0.23, 95% CI -035 to -012, p< 0.001). Other associations were not significant (ps>0.57). Our results suggest that glaucoma may be related to declining cognition.
Collapse
Affiliation(s)
| | - Laiss Bertola
- Department of Internal Medicine, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil
| | - Claudia K Suemoto
- Division of Geriatrics, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil
| | - Arlinda B Moreno
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Bruce Duncan
- Postgraduate Studies Program in Epidemiology and Hospital De Clínicas De Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Postgraduate Studies Program in Epidemiology and Hospital De Clínicas De Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Marcelo Maestri
- Department of Ophthalmology and Otorhinolaryngology, Faculdade De Medicina Da Universidade Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Sandhi M Barreto
- Faculdade De Medicina & Hospital Das Clínicas, Universidade Federal De Minas Gerais, Minas Gerais, Brazil
| | - Paulo A Lotufo
- Department of Internal Medicine, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade De São Paulo, São Paulo, Brazil
| | - Isabela M Benseñor
- Department of Internal Medicine, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade De São Paulo, São Paulo, Brazil
| | - Andre R Brunoni
- Department of Internal Medicine, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade De São Paulo, São Paulo, Brazil.,Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil
| |
Collapse
|
12
|
Jindahra P, Hengsiri N, Witoonpanich P, Poonyathalang A, Pulkes T, Tunlayadechanont S, Thadanipon K, Vanikieti K. Evaluation of Retinal Nerve Fiber Layer and Ganglion Cell Layer Thickness in Alzheimer's Disease Using Optical Coherence Tomography. Clin Ophthalmol 2020; 14:2995-3000. [PMID: 33061285 PMCID: PMC7537846 DOI: 10.2147/opth.s276625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the feasibility of using optical coherence tomography (OCT) for the detection of Alzheimer's disease (AD), by measuring the thickness of the retinal nerve fiber layer (RNFL) and the ganglion cell layer and inner plexiform layer (GCL-IPL). Material and Methods This was a single-center, cross-sectional study. The study included 29 patients with AD (mean age ± standard deviation: 75.61 ± 6.24 years) and 29 healthy age- and sex-matched controls. All participants underwent cognitive evaluations using the Montreal Cognitive Assessment test. Measurements of the RNFL thickness, as well as GCL-IPL thickness, were obtained for all participants using OCT. Both RNFL and GCL-IPL parameters were adjusted for best-corrected visual acuity, hypertension, diabetes and dyslipidemia. Results The mean RNFL thickness was significantly thinner in the AD group than in the control group (85.24 and 90.68 µm, respectively, adjusted P=0.014). The superior quadrant was thinner in the AD group (adjusted P=0.033). The thicknesses did not differ significantly between groups for the other quadrants. The mean GCL-IPL thickness in the AD (68.81 µm) was significantly thinner than that in the controls (76.42 µm) (adjusted P=0.014). Overall, there was a negative correlation between age and mean RNFL; and between age and GCL-IPL thickness (r=-0.338, P=0.010 and r=-0.346, P=0.008, respectively). Conclusion The mean RNFL and GCL-IPL thicknesses were thinner in the AD group than in the control group. These findings suggest that RNFL and GCL-IPL thickness may be biological markers for AD.
Collapse
Affiliation(s)
- Panitha Jindahra
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Nitchanan Hengsiri
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pirada Witoonpanich
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Anuchit Poonyathalang
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Teeratorn Pulkes
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Supoch Tunlayadechanont
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kunlawat Thadanipon
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
13
|
Peeters G, Almirall Sanchez A, Llibre Guerra J, Lawlor B, Kenny RA, Yaffe K, Llibre Rodriguez J. Risk Factors for Incident Dementia Among Older Cubans. Front Public Health 2020; 8:481. [PMID: 33014976 PMCID: PMC7511701 DOI: 10.3389/fpubh.2020.00481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Little is known about risk factors of dementia in Latin American countries. We aimed to identify socio–demographic, health and lifestyle risk factors of incident dementia in Cuban older adults. Methods: Data were from 1,846 participants in the Cuban cohort of the 10/66 Dementia Research Group. Participants completed questionnaires, health examinations, and cognitive tests at baseline (2003–2006) and 4.5 years later (2007–2010). Associations between risk factors (baseline) and incident dementia (follow-up) were examined using logistic regression. Results: Just over 9% of participants developed dementia. Overall, older age and low physical activity were associated with incident dementia. In those 65–74 years of age, depression, stroke and low physical activity were associated with incident dementia. In those ≥75 years of age, low physical activity, never eating fish, and smoking were associated with incident dementia. Conclusions: Modifiable lifestyle factors play an important role in developing dementia in Cuban older adults. This knowledge opens up opportunities for preventive strategies.
Collapse
Affiliation(s)
- Geeske Peeters
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
| | - Arianna Almirall Sanchez
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
| | - Jorge Llibre Guerra
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States.,Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States.,Department of Psychiatry, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland.,The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Kristine Yaffe
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States.,Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, San Francisco, CA, United States
| | - Juan Llibre Rodriguez
- Facultad de Medicina Finley-Albarrán, Universidad de Ciencias Médicas de la Habana, Havana, Cuba
| |
Collapse
|
14
|
Campos JL, Höbler F, Bitton E, Labreche T, McGilton KS, Wittich W. Screening for Vision Impairments in Individuals with Dementia Living in Long-Term Care: A Scoping Review. J Alzheimers Dis 2020; 68:1039-1049. [PMID: 30909236 PMCID: PMC6484267 DOI: 10.3233/jad-181129] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Vision impairments are prevalent, but underdiagnosed in individuals with dementia living in long-term care (LTC). Effective screening tools could identify remediable vision problems. This scoping review was conducted to identify vision screening tests used with individuals with dementia and assesses their suitability for administration by nurses in LTC. A literature search using the Arksey and O’Malley (2005) method included research articles, conference proceedings, and dissertations. Data were included from participants over 65 years of age with a diagnosis of probable dementia. A panel of vision experts evaluated the suitability of the candidate vision tests. The search yielded 179 publications that met the inclusion criteria. Of 134 vision tests that were identified, 19 were deemed suitable for screening by nurses in LTC. Tests screened for acuity (12), visual field (1), anatomy (2), color vision (2), and general visual abilities (2). Tests were excluded because of complexity of interpretation (90), need for specialized training (83), use in research only (57), need for specialized equipment (54), not assessing visual function (44), long test duration (21), uncommonness (13), and needing an act reserved for specialists (7). Psychometric properties were not often reported for tests. Few of the tests identified had been validated for use with individuals with dementia. Based on our review, few tests were deemed suitable for use by nurses to assess this population in LTC. Identifying appropriate tools to screen vision in individuals with dementia is a necessary first step to interventions that could potentially improve functioning and quality of life.
Collapse
Affiliation(s)
- Jennifer L Campos
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Fiona Höbler
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Etty Bitton
- École d'optométrie, Université de Montréal, Montréal, Québec, Canada
| | - Tammy Labreche
- School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
| | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Walter Wittich
- École d'optométrie, Université de Montréal, Montréal, Québec, Canada.,Center for Interdisciplinary Rehabilitation Research of Greater Montreal, Montréal, Québec, Canada
| |
Collapse
|
15
|
Gombault‐Datzenko E, Gallini A, Carcaillon‐Bentata L, Fabre D, Nourhashemi F, Andrieu S, Rachas A, Gardette V. Alzheimer’s disease and related syndromes and hospitalization: a nationwide 5‐year longitudinal study. Eur J Neurol 2020; 27:1436-1447. [DOI: 10.1111/ene.14256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/01/2019] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Affiliation(s)
| | - A. Gallini
- Department of Epidemiology University Hospital of Toulouse Toulouse France
- UMR1027 Epidemiology and Analyses in Public Health INSERM Toulouse France
- Faculty of Medicine Department of Epidemiology and Public Health Université de Toulouse III Toulouse France
| | | | - D. Fabre
- Department of Medical Information University Hospital of Toulouse Toulouse France
| | - F. Nourhashemi
- Faculty of Medicine Department of Epidemiology and Public Health Université de Toulouse III Toulouse France
- Gérontopole Cité de la Santé University Hospital of Toulouse Toulouse France
| | - S. Andrieu
- Department of Epidemiology University Hospital of Toulouse Toulouse France
- UMR1027 Epidemiology and Analyses in Public Health INSERM Toulouse France
- Faculty of Medicine Department of Epidemiology and Public Health Université de Toulouse III Toulouse France
| | | | - V. Gardette
- Department of Epidemiology University Hospital of Toulouse Toulouse France
- UMR1027 Epidemiology and Analyses in Public Health INSERM Toulouse France
- Faculty of Medicine Department of Epidemiology and Public Health Université de Toulouse III Toulouse France
| |
Collapse
|
16
|
Chellappa SL, Bromundt V, Frey S, Schlote T, Goldblum D, Cajochen C, Reichert CF. Intraocular cataract lens replacement and light exposure potentially impact procedural learning in older adults. J Sleep Res 2020; 30:e13043. [PMID: 32285996 DOI: 10.1111/jsr.13043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 03/03/2020] [Accepted: 03/17/2020] [Indexed: 02/03/2023]
Abstract
Procedural learning declines with age and appropriately timed light exposure can improve cognitive performance in older individuals. Because cataract reduces light transmission and is associated with cognitive decline in older adults, we explored whether lens replacement (intraocular blue-blocking [BB] or UV-only blocking) in older patients with cataracts enhances the beneficial effects of light on procedural learning. Healthy older participants (n = 16) and older patients with post-cataract surgery (n = 13 with BB or UV lens replacement) underwent a randomized within-subject crossover laboratory design with three protocols. In each protocol, 3.5 hr dim-dark adaptation was followed by 2 hr evening blue-enriched (6,500K) or non-blue-enriched light exposure (3,000K or 2,500K), 30 min dim post-light, ~8 hr sleep and 2 hr morning dim light. Procedural learning was assessed by the alternating serial reaction time task (ASRT), as part of a larger test battery. Here, ASRT performance was indexed by type of trial (random or sequence) and sequence-specific (high or low probability) measures. During evening light exposure, we observed a significant effect of the interaction of "group" versus "light condition" on the type of trial (p = .04; p = .16; unadjusted and adjusted p-values, respectively) and sequence-specific learning (p = .04; p = .16; unadjusted and adjusted p-values, respectively), whereby patients with UV lens replacement performed better than patients with BB lens or non-cataract controls, during blue-enriched light exposure. Lens replacement in patients with cataracts may potentially be associated with beneficial effects of blue light on procedural learning. Thus, optimizing spectral lens transmission in patients with cataracts may help improve specific aspects of cognitive function, such as procedural learning.
Collapse
Affiliation(s)
- Sarah L Chellappa
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA.,Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Vivien Bromundt
- Department of Neurology, Sleep Wake Epilepsy Center, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Sylvia Frey
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | | | - David Goldblum
- Department of Ophthalmology, University Hospital Basel, University Basel, Basel, Switzerland
| | - Christian Cajochen
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| | - Carolin F Reichert
- Centre for Chronobiology, Psychiatric Hospital of the University of Basel, Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Basel, Switzerland
| |
Collapse
|
17
|
Singh AK, Verma S. Use of ocular biomarkers as a potential tool for early diagnosis of Alzheimer's disease. Indian J Ophthalmol 2020; 68:555-561. [PMID: 32174567 PMCID: PMC7210832 DOI: 10.4103/ijo.ijo_999_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/10/2019] [Accepted: 10/26/2019] [Indexed: 02/05/2023] Open
Abstract
Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide which unfortunately has no known effective cure to date. Despite many clinical trials indicating the effectiveness of preclinical treatment, a sensitive tool for screening of AD is yet to be developed. Due to multiple similarities between ocular and the brain tissue, the eye is being explored by researchers for this purpose, with utmost attention focused on the retinal tissue. Besides visual functional impairment, neuronal degeneration and apoptosis, retinal nerve fiber degeneration, increase in the cup-to-disc ratio, and retinal vascular thinning and tortuosity are the changes observed in the retinal tissue which are related to AD. Studies have shown that targeting these changes in the retina is an effective way of reducing the degeneration of retinal neuronal tissue. Similar mechanisms of neurodegeneration have been demonstrated in the brain and the eyes of AD patients. Multiple studies are underway to investigate the potential of diagnosing AD and detection of amyloid-β (Aβ) levels in the retinal tissue. Since the tissues in the anterior segment of the eye are more accessible for in vivo imaging and examination, they have more potential as screening biomarkers. This article provides a concise review of available literature on the ocular biomarkers in anterior and posterior segments of the eye including the cornea, aqueous humour (AH), crystalline lens, and retina in AD. This review will also highlight the newer technological tools available for the detection of potential biomarkers in the eye for early diagnosis of AD.
Collapse
Affiliation(s)
- Ajay K Singh
- Consultant and Anterior Segment Surgeon, Department of Ophthalmology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - Shilpa Verma
- WNS Global Services Pvt. Ltd., Gurugram, Haryana, India
| |
Collapse
|
18
|
Wu AM, Wu CM, Tseng VL, Greenberg PB, Giaconi JA, Yu F, Lum F, Coleman AL. Characteristics Associated With Receiving Cataract Surgery in the US Medicare and Veterans Health Administration Populations. JAMA Ophthalmol 2019; 136:738-745. [PMID: 29800973 DOI: 10.1001/jamaophthalmol.2018.1361] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Considerable variation exists with respect to the profiles of patients who receive cataract surgery in the United States. Objective To identify patient characteristics associated with receiving cataract surgery within the US Medicare and Veterans Health Administration (VHA) populations. Design, Setting, and Participants In this population-based retrospective cohort study of 3 073 465 patients, Medicare and VHA patients with a cataract diagnosis between January 1, 2002, and January 1, 2012, were identified from the 2002-2012 Medicare Part B files (5% sample) and the VHA National Patient Care Database. Patient age, sex, race/ethnicity, region of residence, Charlson Comorbidity Index (CCI) scores, and comorbidities were recorded. Cataract surgery at 1 and 5 years after diagnosis was identified. Data analysis was performed from July 1, 2016, to July 1, 2017. Main Outcomes and Measures Odds ratios (ORs) of cataract surgery for selected patient characteristics. Results The study sample included 1 156 211 Medicare patients (mean [SD] age, 73.7 [7.0] years) and 1 917 254 VHA patients (mean [SD] age, 66.8 [10.2] years) with a cataract diagnosis. Of the 1 156 211 Medicare patients, 407 103 (35.2%) were 65 to 69 years old, 683 036 (59.1%) were female, and 1 012 670 (87.6%) were white. Of the 1 917 254 VHA patients, 905 455 (47.2%) were younger than 65 years, 1 852 158 (96.6%) were male, and 539 569 (28.1%) were white. A greater proportion of Medicare patients underwent cataract surgery at 1 year (Medicare: 213 589 [18.5%]; VHA: 120 196 [6.3%]) and 5 years (Medicare: 414 586 [35.9%]; VHA: 240 884 [12.6%]) after diagnosis. Factors associated with the greatest odds of surgery at 5 years were older age per 5-year increase (Medicare: OR, 1.24 [95% CI, 1.23-1.24]; VHA: OR, 1.18 [95% CI, 1.17-1.18]), residence in the southern United States vs eastern United States (Medicare: OR, 1.38 [95% CI, 1.36-1.40]; VHA: OR, 1.40 [95% CI, 1.38-1.41]), and presence of chronic pulmonary disease (Medicare: OR, 1.26 [95% CI, 1.24-1.27]; VHA: OR, 1.40 [95% CI, 1.38-1.41]). Within Medicare, female sex was associated with greater odds of surgery at 5 years (OR, 1.14; 95% CI, 1.13-1.15). Higher CCI scores (CCI score ≥3 vs 0-2) were associated with increased odds of surgery among VHA but not Medicare patients at 5 years (Medicare: OR, 0.94 [95% CI, 0.92-0.95]; VHA: OR, 1.24 [95% CI, 1.23-1.36]). Black race vs white race was associated with decreased odds of cataract surgery 5 years after diagnosis (Medicare: OR, 0.79 [95% CI, 0.78-0.81]; VHA: OR, 0.75 [95% CI, 0.73-0.76]). Conclusions and Relevance Within both groups, older age, residence in the southern United States, and presence of chronic pulmonary disease were associated with increased odds of cataract surgery. Findings from this study suggest that few disparities exist between the types of patients receiving cataract surgery who are in Medicare vs the VHA, although it is possible that a smaller proportion of VHA patients receive surgery compared with Medicare patients.
Collapse
Affiliation(s)
- Annie M Wu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Connie M Wu
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Victoria L Tseng
- Stein Eye Institute, David Geffen School of Medicine, UCLA (University of California, Los Angeles).,Department of Epidemiology, Fielding School of Public Health, UCLA
| | - Paul B Greenberg
- Warren Alpert Medical School of Brown University, Providence, Rhode Island.,Section of Ophthalmology, Veterans Affairs Medical Center, Providence, Rhode Island
| | - JoAnn A Giaconi
- Stein Eye Institute, David Geffen School of Medicine, UCLA (University of California, Los Angeles).,Ophthalmology Division, West Los Angeles Veterans Affairs Medical Center, Los Angeles, California
| | - Fei Yu
- Department of Epidemiology, Fielding School of Public Health, UCLA.,Department of Biostatistics, Fielding School of Public Health, UCLA
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Anne L Coleman
- Stein Eye Institute, David Geffen School of Medicine, UCLA (University of California, Los Angeles).,Department of Epidemiology, Fielding School of Public Health, UCLA.,Department of Biostatistics, Fielding School of Public Health, UCLA
| |
Collapse
|
19
|
Li E, Margo CE, Greenberg PB. A Primary Care Provider's Guide to Cataract Surgery in the Very Elderly. Fed Pract 2019; 36:176-180. [PMID: 31138970 PMCID: PMC6503909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Planning for cataract surgery and perioperative care in the very elderly requires the teamwork of the patient's primary care provider and the ophthalmologist.
Collapse
Affiliation(s)
- Emily Li
- is an Ophthalmology Resident at Yale University School of Medicine in New Haven, Connecticut. is an Instructor in the Department of Ophthalmology, Pathology and Cell Biology at Morsani College of Medicine, University of South Florida in Tampa. is Chief of Ophthalmology at the Providence Veterans Affairs Medical Center in Rhode Island and Professor of Surgery (Ophthalmology) at the Warren Alpert Medical School of Brown University in Providence
| | - Curtis E Margo
- is an Ophthalmology Resident at Yale University School of Medicine in New Haven, Connecticut. is an Instructor in the Department of Ophthalmology, Pathology and Cell Biology at Morsani College of Medicine, University of South Florida in Tampa. is Chief of Ophthalmology at the Providence Veterans Affairs Medical Center in Rhode Island and Professor of Surgery (Ophthalmology) at the Warren Alpert Medical School of Brown University in Providence
| | - Paul B Greenberg
- is an Ophthalmology Resident at Yale University School of Medicine in New Haven, Connecticut. is an Instructor in the Department of Ophthalmology, Pathology and Cell Biology at Morsani College of Medicine, University of South Florida in Tampa. is Chief of Ophthalmology at the Providence Veterans Affairs Medical Center in Rhode Island and Professor of Surgery (Ophthalmology) at the Warren Alpert Medical School of Brown University in Providence
| |
Collapse
|
20
|
Koyanagi A, Lara E, Stubbs B, Carvalho AF, Oh H, Stickley A, Veronese N, Vancampfort D. Chronic Physical Conditions, Multimorbidity, and Mild Cognitive Impairment in Low- and Middle-Income Countries. J Am Geriatr Soc 2018; 66:721-727. [PMID: 29427504 PMCID: PMC5906176 DOI: 10.1111/jgs.15288] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/23/2017] [Accepted: 12/22/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To assess the association between chronic physical conditions and multimorbidity and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs). DESIGN Nationally representative, cross-sectional, community-based study. SETTING Six countries that participated in the World Health Organization Study on Global Ageing and Adult Health. PARTICIPANTS Individuals aged 50 and older (N=32,715; mean age 62.1 ± 15.6; 51.7% female). MEASUREMENTS The definition of MCI was based on the recommendations of the National Institute on Ageing and Alzheimer's Association. Ten chronic conditions were assessed (angina pectoris, arthritis, asthma, cataract, chronic lung disease, diabetes mellitus, edentulism, hearing problems, hypertension, stroke). Multivariable logistic regression analysis was conducted to assess the association between chronic physical conditions, multimorbidity (≥2 chronic conditions), and MCI. RESULTS The prevalence of multimorbidity was 49.8% (95% confidence interval (CI)=48.1-51.5%) and of MCI was 15.3% (95% CI=14.4-16.3%). After adjustment for potential confounders, edentulism (odds ratio (OR)=1.24), arthritis (OR=1.24), chronic lung disease (OR=1.29), cataract (OR=1.33), stroke (OR=1.94), hearing problems (OR=2.27), and multimorbidity (OR=1.40) were significantly associated with MCI. There was a gradual increase in the likelihood of MCI (1 condition: OR=1.21, 95% CI=1.03-1.42; ≥4 conditions: OR=2.07, 95% CI=1.70-2.52). CONCLUSION These results highlight the need to investigate the underlying mechanisms linking chronic conditions and MCI and whether prevention or treatment of chronic conditions or multimorbidity can reduce the onset of cognitive decline and subsequent dementia, especially in LMICs.
Collapse
Affiliation(s)
- Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Elvira Lara
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Andre F. Carvalho
- Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Hans Oh
- University of Southern California, School of Social Work, CA, USA
| | - Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - Nicola Veronese
- Geriatrics Unit, Department of Geriatric Care, OrthoGeriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genova, Italy
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
| |
Collapse
|
21
|
Lin H, Zhang L, Lin D, Chen W, Zhu Y, Chen C, Chan KC, Liu Y, Chen W. Visual Restoration after Cataract Surgery Promotes Functional and Structural Brain Recovery. EBioMedicine 2018; 30:52-61. [PMID: 29548900 PMCID: PMC5952227 DOI: 10.1016/j.ebiom.2018.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/01/2018] [Accepted: 03/04/2018] [Indexed: 01/19/2023] Open
Abstract
Background Visual function and brain function decline concurrently with aging. Notably, cataract patients often present with accelerated age-related decreases in brain function, but the underlying mechanisms are still unclear. Optical structures of the anterior segment of the eyes, such as the lens and cornea, can be readily reconstructed to improve refraction and vision quality. However, the effects of visual restoration on human brain function and structure remain largely unexplored. Methods A prospective, controlled clinical trial was conducted. Twenty-six patients with bilateral age-related cataracts (ARCs) who underwent phacoemulsification and intraocular lens implantation and 26 healthy controls without ARC, matched for age, sex, and education, were recruited. Visual functions (including visual acuity, visual evoke potential, and contrast sensitivity), the Mini-Mental State Examination and functional magnetic resonance imaging (including the fractional amplitude of low-frequency fluctuations and grey matter volume variation) were assessed for all the participants and reexamined for ARC patients after cataract surgery. This trial was registered with ClinicalTrials.gov (NCT02644720). Findings Compared with the healthy controls, the ARC patients presented decreased brain functionality as well as structural alterations in visual and cognitive-related brain areas preoperatively. Three months postoperatively, significant functional improvements were observed in the visual and cognitive-related brain areas of the patients. Six months postoperatively, the patients' grey matter volumes in these areas were significantly increased. Notably, both the function and structure in the visual and cognitive-related brain areas of the patients improved significantly and became comparable to those of the healthy controls 6 months postoperatively. Interpretation We demonstrated that ocular reconstruction can functionally and structurally reverse cataract-induced brain changes. The integrity of the eye is essential for maintaining the structure and function of the brain within and beyond the primary visual pathway. Cataract patients with reduced visual function presented a simultaneous decrease in brain function and grey matter volume. Cataract surgery can reverse cerebral changes in both visual and cognitive-related regions associated with visual decline. The integrity of the eye is essential for maintaining the structure and function of the brain.
The eyes and brain are anatomically and functionally connected. Age related cataract (ARC) is associated with structural and functional impairments of the brain. However, whether these changes are reversible after cataract surgery is largely unknown. We assessed the patients based on subjective cognitive evaluations and objective functional magnetic resonance imaging before and after surgery. Significant improvements in brain function and increases in the grey matter volumes of the visual, cognitive-related, and somatosensory brain areas were observed, demonstrating that the impaired brain function and structure of ARC patients can be reversed after restoration of visual acuity.
Collapse
Affiliation(s)
- Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China.
| | - Li Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China; Department of Ophthalmology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430014, People's Republic of China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China
| | - Wan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China; Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China; Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Kevin C Chan
- NYU Eye Center, Department of Ophthalmology, NYU School of Medicine, NYU Langone Health, New York University, New York, NY 10016, USA; Department of Radiology, NYU School of Medicine, NYU Langone Health, New York University, New York, NY 10016, USA
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China.
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China.
| |
Collapse
|
22
|
Miyata K, Yoshikawa T, Morikawa M, Mine M, Okamoto N, Kurumatani N, Ogata N. Effect of cataract surgery on cognitive function in elderly: Results of Fujiwara-kyo Eye Study. PLoS One 2018; 13:e0192677. [PMID: 29462175 PMCID: PMC5819799 DOI: 10.1371/journal.pone.0192677] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022] Open
Abstract
Purpose To determine whether there is a significant association between prior cataract surgery and cognitive function in an elderly Japanese cohort. Setting Nara Medical University, Nara, Japan. Design The Fujiwara-kyo Eye Study was a cross-sectional epidemiological study. Methods The subjects were ≥ 68-years who lived in the Nara Prefecture and responded to recruitment notices. All of the subjects received comprehensive ophthalmological examinations, and answered questionnaires on their socio-demographic and medical history including prior cataract surgery. The association between prior cataract surgery and cognitive function was determined. Results A total of the 2764 subjects whose mean age was 76.3±4.8 years (±standard deviation) was studied. Of these, 668 individuals (24.2%) had undergone cataract surgery. Of these, 150 (5.4%) had dementia as determined by the Mini-Mental State Examination (MMSE) score ≤23, and 877 individuals (31.7%) had mild cognitive impairment (MCI; MMSE score 24–26). The subjects who had prior cataract surgery had significantly lower odds ratio (OR) of having MCI (OR = 0.78, 95% confidence interval; CI 0.64–0.96, P = 0.019) than those who had not had cataract surgery after adjusting for age, sex, body mass index, education, hypertension, diabetes, depression, and history of stroke. The OR was still lower when the visual acuity was also added to the adjusted factors (OR 0.79, 95% CI 0.64–0.97, P = 0.025). However, prior cataract surgery did not contribute significantly to the low OR for dementia. Conclusions Cataract surgery may play a role in reducing the risk of developing MCI independently of visual acuity but not for dementia.
Collapse
Affiliation(s)
- Kimie Miyata
- Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan
| | - Tadanobu Yoshikawa
- Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan
| | | | - Masashi Mine
- Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan
| | - Nozomi Okamoto
- Department of Community Health and Epidemiology, Nara Medical University, Kashihara, Nara, Japan
| | - Norio Kurumatani
- Department of Community Health and Epidemiology, Nara Medical University, Kashihara, Nara, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, Kashihara, Nara, Japan
- * E-mail:
| |
Collapse
|
23
|
Daveckaite A, Grusauskiene E, Petrikonis K, Vaitkus A, Siaudvytyte L, Januleviciene I. Cognitive functions and normal tension glaucoma. Indian J Ophthalmol 2017; 65:974-978. [PMID: 29044063 PMCID: PMC5678334 DOI: 10.4103/ijo.ijo_756_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: Only a few studies have analyzed the potential link between glaucoma and cognitive function impairment. They have found controversial results. This study aims to perform quick cognitive function assessment with clock drawing test (CDT) using two different scoring systems and compare between normal tension glaucoma (NTG) and cataract patients. Methods: Totally, 30 NTG and 30 patients with cataracts were included in a prospective, pilot study. The predrawn circle was given, and patients were asked to draw the clock showing a time of 11:10. The test was evaluated using two methods – Freund method using a 7-point scoring scale (optimal cutoff ≤4) and Rakusa using a 4-point scoring scale (optimal cutoff ≤3). The level of significance was set at P < 0.05. Results: CDT result was significantly better in cataract group than in NTG group: 3.5 (2) versus 2 (2) by Freund, (P = 0.003) and 6.5 (1) versus 4.5 (2.75) by Rakusa, respectively (P = 0.004). Sixty percent (n = 18) of NTG group and 10% (n = 3) of cataract group patients completed the CDT in the specific picture manner (the short hand on 11 and the long hand between 11 and 12), (P = 0.001). Conclusions: Lower CDT results were seen in NTG patients according to two different scoring systems. NTG patients showed a specific manner of drawing. Further prospective studies are needed to investigate the CDT reliability as fast screening test of cognitive function impairment in glaucoma patients.
Collapse
Affiliation(s)
- Akvile Daveckaite
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Evelina Grusauskiene
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Kestutis Petrikonis
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Antanas Vaitkus
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Lina Siaudvytyte
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Ingrida Januleviciene
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| |
Collapse
|
24
|
Artigas JM, García-Domene MC, Navea A, Botella P, Fernández E. Intra-ocular lens optical changes resulting from the loading of dexamethasone. BIOMEDICAL OPTICS EXPRESS 2017; 8:4621-4628. [PMID: 29082089 PMCID: PMC5654804 DOI: 10.1364/boe.8.004621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 07/19/2017] [Accepted: 07/21/2017] [Indexed: 06/07/2023]
Abstract
To study the optical changes on hydrogel-silicone intraocular lenses (IOLs) resulting from loading them with dexamethasone. We used prototype hydrogel(pHEMA)-silicone IOLs and loaded the matrices with an anti-inflammatory drug (dexamethasone). The optical properties we analyzed experimentally were a) modulation transfer function (MTF); b) spectral transmission; c) diopter power. These determinations were performed on drug-loaded IOLs, IOLs that had released the drug, and IOLs that had not been drug-loaded. Loading a hydrogel-silicone IOL with dexamethasone results in impairment of its optical qualities, in particular its MTF and spectral transmission, but not dioptric power. However, once the drug has been released, it almost recovers its initial optical properties.
Collapse
Affiliation(s)
- José M. Artigas
- Fisabio Oftalmología Médica (FOM), Bifurcación Pío Baroja-General Avilés s/n, 46015 Valencia, Spain
- Depto de Óptica, Facultad de Física, Universitat de València, C/Dr Moliner, 50, 46100 Burjassot (Valencia), Spain
| | - M. Carmen García-Domene
- Fisabio Oftalmología Médica (FOM), Bifurcación Pío Baroja-General Avilés s/n, 46015 Valencia, Spain
- Depto de Óptica, Facultad de Física, Universitat de València, C/Dr Moliner, 50, 46100 Burjassot (Valencia), Spain
| | - Amparo Navea
- Fisabio Oftalmología Médica (FOM), Bifurcación Pío Baroja-General Avilés s/n, 46015 Valencia, Spain
- Universidad Cardenal Herrera-CEU, Castellón, Spain
| | - Pablo Botella
- Instituto de Tecnología Química (ITQ), Universitat Politècnica de València-Consejo Superior de Investigaciones Científicas, Avenida de los Naranjos s/n, 46022 Valencia, Spain
| | - Eduardo Fernández
- Instituto de Bioingeniería, Universidad Miguel Hernández and CIBER BBN, Elche, Spain
| |
Collapse
|
25
|
Girard B, Chouard B, Hardy F. [Cataract surgery among 50 Alzheimer's patient (55 eyes)]. J Fr Ophtalmol 2017; 40:487-498. [PMID: 28571835 DOI: 10.1016/j.jfo.2017.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Cataract surgery for 50 Alzheimer patients (55 eyes). METHODS Cinquante Alzheimer's patients with 0≤MMS≤25, with bilateral disabling cataracts were included for surgery. The surgical technique is analyzed. RESULTS AND CONCLUSION The preoperative examination of Alzheimer's patients is time consuming and requires experience in this area, which is important to integrate into the practice of ophthalmology. The type of cataract is unusual, with a predilection for pseudoexfoliation syndrome and zonular fragility that has to be managed during surgery. The procedure may be performed under local anesthesia. Three months after surgery, Alzheimer's patients demonstrated improved visual acuity (P<0.001) with no worsening of their dementia.
Collapse
Affiliation(s)
- B Girard
- Service d'ophtalmologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France; Service d'ophtalmologie V, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France.
| | - B Chouard
- Service d'ophtalmologie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - F Hardy
- Service d'anesthésie, centre hospitalier national d'ophtalmologie des Quinze-Vingts, 28, rue de Charenton, 75012 Paris, France
| |
Collapse
|
26
|
Wongrakpanich S, Petchlorlian A, Rosenzweig A. Sensorineural Organs Dysfunction and Cognitive Decline: A Review Article. Aging Dis 2016; 7:763-769. [PMID: 28053826 PMCID: PMC5198866 DOI: 10.14336/ad.2016.0515] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/15/2016] [Indexed: 11/17/2022] Open
Abstract
Vision, hearing, olfaction, and cognitive function are essential components of healthy and successful aging. Multiple studies demonstrate relationship between these conditions with cognitive function. The present article focuses on hearing loss, visual impairment, olfactory loss, and dual sensory impairments in relation to cognitive declination and neurodegenerative disorders. Sensorineural organ impairment is a predictive factor for mild cognitive impairment and neurodegenerative disorders in the elderly. We recommend early detection of sensorineural dysfunction by history, physical examination, and screening tests. Assisted device and early cognitive rehabilitation may be beneficial. Future research is warranted in order to explore advanced treatment options and method to slow progression for cognitive declination and sensorineural organ impairment.
Collapse
Affiliation(s)
- Supakanya Wongrakpanich
- 1Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA and Department of Medicine, Chulalongkorn University, Thailand
| | - Aisawan Petchlorlian
- 2Division of Geriatric, Department of Medicine, Chulalongkorn University, Thailand
| | - Andrew Rosenzweig
- 3Division of Geriatric, Department of Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| |
Collapse
|
27
|
Kumar CM, Seet E. Cataract surgery in dementia patients—time to reconsider anaesthetic options. Br J Anaesth 2016; 117:421-425. [DOI: 10.1093/bja/aew301] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
28
|
Girard B, Chouard B, Levy P, Luquel L, Seux ML, Drunat O. Modifications des troubles du comportement après l’opération de la cataracte chez les patients Alzheimer. J Fr Ophtalmol 2016; 39:675-686. [DOI: 10.1016/j.jfo.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/17/2016] [Accepted: 05/25/2016] [Indexed: 11/26/2022]
|
29
|
Mine M, Miyata K, Morikawa M, Nishi T, Okamoto N, Kawasaki R, Yamashita H, Kurumatani N, Ogata N. Association of Visual Acuity and Cognitive Impairment in Older Individuals: Fujiwara-kyo Eye Study. Biores Open Access 2016; 5:228-34. [PMID: 27610269 PMCID: PMC5003003 DOI: 10.1089/biores.2016.0023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Both visual impairment and cognitive impairment are essential factors that determine the quality of life in the aged population. The aim of this study was to determine if a correlation existed between visual acuity and cognitive impairment in an elderly Japanese population. The Fujiwara-kyo Eye Study was a cross-sectional study of individuals aged ≥68 years who lived in Nara Prefecture of Japan. Participants underwent ophthalmological examinations and cognitive function test. A mild visual impairment was defined as having a best corrected visual acuity (BCVA) >0.2 logarithm of the minimum angle of resolution (logMAR) units in the better eye. Cognitive impairment was defined as having a Mini-Mental State Examination (MMSE) score of ≤23 points. A total to 2818 individuals completed the examinations. The mean age of the participants was 76.3 ± 4.8 years (mean ± standard deviation). The mean BCVA of the better eye was −0.02 ± 0.13 logMAR units and 6.6% subjects were classified as being mildly visually impaired. The mean MMSE score was 27.3 ± 2.3 and 5.7% subjects were classified as being cognitively impaired. The proportion of subjects with cognitive or moderate visual impairment increased with age, and there was a significant correlation between the visual acuity and MMSE score (r = −0.10, p < 0.0001). Subjects with mild visual impairments had 2.4 times higher odds of having cognitive impairment than those without visual impairment (odds ratio 2.4, 95% confidence interval, 1.5–3.8, p < 0.001) after adjusting for age, sex, and length of education. We conclude that it may be important to maintain good visual acuity to reduce the risk of having cognitive impairment.
Collapse
Affiliation(s)
- Masashi Mine
- Department of Ophthalmology, Nara Medical University , Kashihara, Nara, Japan
| | - Kimie Miyata
- Department of Ophthalmology, Nara Medical University , Kashihara, Nara, Japan
| | | | - Tomo Nishi
- Department of Ophthalmology, Nara Medical University , Kashihara, Nara, Japan
| | - Nozomi Okamoto
- Department of Community Health and Epidemiology, Nara Medical University , Kashihara, Nara, Japan
| | - Ryo Kawasaki
- Department of Public Health, Graduate School of Medical Science, Yamagata University , Yamagata, Japan
| | - Hidetoshi Yamashita
- Department of Ophthalmology and Visual Science, Yamagata University Faculty of Medicine , Yamagata, Japan
| | - Norio Kurumatani
- Department of Community Health and Epidemiology, Nara Medical University , Kashihara, Nara, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University , Kashihara, Nara, Japan
| |
Collapse
|
30
|
Bowen M, Edgar DF, Hancock B, Haque S, Shah R, Buchanan S, Iliffe S, Maskell S, Pickett J, Taylor JP, O’Leary N. The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60–89 years with dementia and qualitative exploration of individual, carer and professional perspectives. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04210] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BackgroundThe prevalence of visual impairment (VI) and dementia increases with age and these conditions may coexist, but few UK data exist on VI among people with dementia.ObjectivesTo measure the prevalence of eye conditions causing VI in people with dementia and to identify/describe reasons for underdetection or inappropriate management.DesignStage 1 – cross-sectional prevalence study. Stage 2 – qualitative research exploring participant, carer and professional perspectives of eye care.SettingStage 1 – 20 NHS sites in six English regions. Stage 2 – six English regions.ParticipantsStage 1 – 708 participants with dementia (aged 60–89 years): 389 lived in the community (group 1) and 319 lived in care homes (group 2). Stage 2 – 119 participants.InterventionsStage 1 gathered eye examination data following domiciliary sight tests complying with General Ophthalmic Services requirements and professional guidelines. Cognitive impairment was assessed using the Standardised Mini-Mental State Examination (sMMSE) test, and functional ability and behaviour were assessed using the Bristol Activities of Daily Living Scale and Cambridge Behavioural Inventory – Revised. Stage 2 involved individual interviews (36 people with dementia and 11 care workers); and separate focus groups (34 optometrists; 38 family and professional carers).Main outcome measures.VI defined by visual acuity (VA) worse than 6/12 or worse than 6/18 measured before and after refraction.ResultsStage 1 – when participants wore their current spectacles, VI prevalence was 32.5% [95% confidence interval (CI) 28.7% to 36.5%] and 16.3% (95% CI 13.5% to 19.6%) for commonly used criteria for VI of VA worse than 6/12 and 6/18, respectively. Of those with VI, 44% (VA < 6/12) and 47% (VA < 6/18) were correctable with new spectacles. Almost 50% of remaining uncorrectable VI (VA < 6/12) was associated with cataract, and was, therefore, potentially remediable, and one-third was associated with macular degeneration. Uncorrected/undercorrected VI prevalence (VA < 6/12) was significantly higher in participants in care homes (odds ratio 2.19, 95% CI 1.30 to 3.73;p < 0.01) when adjusted for age, sex and sMMSE score. VA could not be measured in 2.6% of group 1 and 34.2% of group 2 participants (p < 0.01). The main eye examination elements (excluding visual fields) could be performed in > 80% of participants. There was no evidence that the management of VI in people with dementia differed from that in older people in general. Exploratory analysis suggested significant deficits in some vision-related aspects of function and behaviour in participants with VI. Stage 2 key messages – carers and care workers underestimated how much can be achieved in an eye examination. People with dementia and carers were unaware of domiciliary sight test availability. Improved communication is needed between optometrists and carers; optometrists should be informed of the person’s dementia. Tailoring eye examinations to individual needs includes allowing extra time. Optometrists wanted training and guidance about dementia. Correcting VI may improve the quality of life of people with dementia but should be weighed against the risks and burdens of undergoing examinations and cataract surgery on an individual basis.LimitationsSampling bias is possible owing to quota-sampling and response bias.ConclusionsThe prevalence of VI is disproportionately higher in people with dementia living in care homes. Almost 50% of presenting VI is correctable with spectacles, and more with cataract surgery. Areas for future research are the development of an eye-care pathway for people with dementia; assessment of the benefits of early cataract surgery; and research into the feasibility of specialist optometrists for older people.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Michael Bowen
- Research Department, College of Optometrists, London, UK
| | - David F Edgar
- Division of Optometry and Visual Science, City University London, London, UK
| | | | - Sayeed Haque
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Rakhee Shah
- Research Department, College of Optometrists, London, UK
- The Outside Clinic, Swindon, UK
| | - Sarah Buchanan
- Research Department, Thomas Pocklington Trust, London, UK
| | - Steve Iliffe
- Department of Primary Care and Population Health, University College London, London, UK
| | - Susan Maskell
- Public and participant involvement representative, Alzheimer’s Society Research Network, London, UK
| | - James Pickett
- Research Department, Alzheimer’s Society, London, UK
| | - John-Paul Taylor
- Institute for Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil O’Leary
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Republic of Ireland
| |
Collapse
|
31
|
Chen Y, Hahn P, Sloan FA. Changes in Visual Function in the Elderly Population in the United States: 1995-2010. Ophthalmic Epidemiol 2016; 23:137-44. [PMID: 27142717 DOI: 10.3109/09286586.2015.1057603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To document recent trends in visual function among the United States population aged 70+ years and investigate how the trends can be explained by inter-temporal changes in: (1) population sociodemographic characteristics, and chronic disease prevalence, including eye diseases (compositional changes); and (2) effects of the above factors on visual function (structural changes). METHODS Data from the 1995 Asset and Health Dynamics among the Oldest Old (AHEAD) and the 2010 Health and Retirement Study (HRS) were merged with Medicare Part B claims in the interview years and the 2 previous years. Decomposition analysis was performed. Respondents from both studies were aged 70+ years. The outcome measure was respondent self-reported visual function on a 6-point scale (from 6 = blind to 1 = excellent). RESULTS Overall, visual function improved from slightly worse than good (3.14) in 1995 to slightly better than good (2.98) in 2010. A decline in adverse effects of aging on vision was found. Among the compositional changes were higher educational attainment leading to improved vision, and higher prevalence of such diseases as diabetes mellitus, which tended to lower visual function. However, compared to compositional changes, structural changes were far more important, including decreased adverse effects of aging, diabetes mellitus (when not controlling for eye diseases), and diagnosed glaucoma. CONCLUSION Although the US population has aged and is expected to age further, visual function improved among elderly persons, especially among persons 80+ years, likely reflecting a favorable role of structural changes identified in this study in mitigating the adverse effect of ongoing aging on vision.
Collapse
Affiliation(s)
- Yiqun Chen
- a Department of Economics , Duke University , Durham , NC , USA
| | - Paul Hahn
- b Department of Ophthalmology , Duke University School of Medicine , Durham , NC , USA
| | - Frank A Sloan
- a Department of Economics , Duke University , Durham , NC , USA
| |
Collapse
|
32
|
Javaid FZ, Brenton J, Guo L, Cordeiro MF. Visual and Ocular Manifestations of Alzheimer's Disease and Their Use as Biomarkers for Diagnosis and Progression. Front Neurol 2016; 7:55. [PMID: 27148157 PMCID: PMC4836138 DOI: 10.3389/fneur.2016.00055] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/29/2016] [Indexed: 12/21/2022] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia affecting the growing aging population today, with prevalence expected to rise over the next 35 years. Clinically, patients exhibit a progressive decline in cognition, memory, and social functioning due to deposition of amyloid β (Aβ) protein and intracellular hyperphosphorylated tau protein. These pathological hallmarks of AD are measured either through neuroimaging, cerebrospinal fluid analysis, or diagnosed post-mortem. Importantly, neuropathological progression occurs in the eye as well as the brain, and multiple visual changes have been noted in both human and animal models of AD. The eye offers itself as a transparent medium to cerebral pathology and has thus potentiated the development of ocular biomarkers for AD. The use of non-invasive screening, such as retinal imaging and visual testing, may enable earlier diagnosis in the clinical setting, minimizing invasive and expensive investigations. It also potentially improves disease management and quality of life for AD patients, as an earlier diagnosis allows initiation of medication and treatment. In this review, we explore the evidence surrounding ocular changes in AD and consider the biomarkers currently in development for early diagnosis.
Collapse
Affiliation(s)
- Fatimah Zara Javaid
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Jonathan Brenton
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Li Guo
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Maria F. Cordeiro
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
33
|
Miyata K, Obayashi K, Saeki K, Tone N, Tanaka K, Nishi T, Morikawa M, Kurumatani N, Ogata N. Higher Cognitive Function in Elderly Individuals with Previous Cataract Surgery: Cross-Sectional Association Independent of Visual Acuity in the HEIJO-KYO Cohort. Rejuvenation Res 2016; 19:239-43. [PMID: 26414122 DOI: 10.1089/rej.2015.1718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cataract surgery improves visual acuity and drastically increases the capacity for light reception to the retina. Although previous studies suggested that both light exposure and visual acuity were associated with cognitive function, the relationships between cataract surgery, visual acuity, and cognitive function have not been evaluated in large populations. In this cross-sectional study, we measured cognitive function using the Mini-Mental State Examination and best-corrected visual acuity in pseudophakic (previous cataract surgery) and phakic (no previous cataract surgery) elderly individuals. Of 945 participants (mean age 71.7 years), 166 (17.6%) had pseudophakia and 317 (33.5%) had impaired cognitive function (score ≤26). The pseudophakic group showed significantly better visual acuity than the phakic group (p = 0.003) and lower age-adjusted odds ratio (ORs) for cognitive impairment (OR 0.66; p = 0.038). Consistently, in multivariate logistic regression models, after adjusting for confounding factors, including visual acuity and socioeconomic status, ORs for cognitive impairment were significantly lower in the pseudophakic group than in the phakic group (OR 0.64; 95% confidence interval 0.43-0.96; p = 0.031). This association remained significant in sensitivity analysis, excluding participants with low cognitive score ≤23 (n = 36). In conclusion, in a general elderly population, prevalence of cognitive impairment was significantly lower in pseudophakic individuals independently of visual acuity. The association was also independent of several major causes of cognitive impairment such as aging, gender, obesity, socioeconomic status, hypertension, diabetes, sleep disturbances, depressive symptoms, and physical inactivity.
Collapse
Affiliation(s)
- Kimie Miyata
- 1 Department of Ophthalmology, Nara Medical University School of Medicine , Nara, Japan
| | - Kenji Obayashi
- 2 Department of Community Health and Epidemiology, Nara Medical University School of Medicine , Nara, Japan
| | - Keigo Saeki
- 2 Department of Community Health and Epidemiology, Nara Medical University School of Medicine , Nara, Japan
| | - Nobuhiro Tone
- 3 Center for Academic Industrial and Governmental Relations, Nara Medical University School of Medicine , Nara, Japan
| | - Kunihiko Tanaka
- 4 Osaka City University , Graduate School of Medicine, Osaka, Japan
| | - Tomo Nishi
- 1 Department of Ophthalmology, Nara Medical University School of Medicine , Nara, Japan
| | - Masayuki Morikawa
- 5 Mie Prefectural Mental Care Center , Mie, Japan .,6 Department of Psychiatry, Nara Medical University School of Medicine , Nara, Japan
| | - Norio Kurumatani
- 2 Department of Community Health and Epidemiology, Nara Medical University School of Medicine , Nara, Japan
| | - Nahoko Ogata
- 1 Department of Ophthalmology, Nara Medical University School of Medicine , Nara, Japan
| |
Collapse
|
34
|
Bunn F, Burn AM, Goodman C, Robinson L, Rait G, Norton S, Bennett H, Poole M, Schoeman J, Brayne C. Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem). HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04080] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Anne-Marie Burn
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK
| | - Louise Robinson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Rait
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London Medical School, London, UK
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Holly Bennett
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marie Poole
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
35
|
Hamagishi T, Inagawa T, Kambayashi Y, Tsujiguchi H, Kitaoka M, Mitoma J, Asakura H, Suzuki F, Hori D, Anyenda EO, Thao NTT, Hibino Y, Hayashi K, Shibata A, Sagara T, Okochi J, Takamoku K, Hatta K, Konoshita T, Nakamura H. The Association between Activity of Daily Living and the Combination of Alzheimer’s Disease and Cataract in Elderly Requiring Nursing Care. Health (London) 2016. [DOI: 10.4236/health.2016.810103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
36
|
Jefferis JM, Taylor JP, Clarke MP. Does cognitive impairment influence outcomes from cataract surgery? Results from a 1-year follow-up cohort study. Br J Ophthalmol 2015; 99:412-7. [PMID: 25287367 PMCID: PMC4345983 DOI: 10.1136/bjophthalmol-2014-305657] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/04/2014] [Accepted: 08/25/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIMS To assess the impact of impaired cognition on visual outcomes 1 year following cataract surgery in a cohort of older people. METHODS Participants aged 75 years or more with bilateral cataract and scheduled for cataract surgery were recruited consecutively. Cognition was assessed using the revised Addenbrooke's cognitive examination (ACE-R). Participants were divided into two groups: normal (ACE-R ≥88) and impaired cognition (ACE-R <88). Visual quality of life (VQOL) and logarithm of minimum angle of resolution visual acuity (VA) were assessed at baseline and 1 year following cataract surgery. RESULTS Of 112 participants, 48 (43%) had normal cognition and 64 (57%) had impaired cognition. One year following cataract surgery participants in both groups had significant improvements in VQOL and VA. Visual outcomes at 1 year were significantly better in participants with normal cognition than in those with impaired cognition (95% CIs for difference 0.4-7.0 and 0.02-0.1, for VQOL and VA, respectively). Regression analyses correcting for potential confounders showed a relationship between baseline cognition and VA at 1 year (R(2)=0.30, p=0.001) and a possible relationship between baseline cognition and VQOL at 1 year (R(2)=0.41, p=0.01, this became insignificant after removal of outliers). CONCLUSIONS Patients with impaired cognition benefit from cataract surgery, but not to the same extent as patients with normal cognition.
Collapse
Affiliation(s)
| | - John-Paul Taylor
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | | |
Collapse
|
37
|
Bunn F, Burn AM, Goodman C, Rait G, Norton S, Robinson L, Schoeman J, Brayne C. Comorbidity and dementia: a scoping review of the literature. BMC Med 2014; 12:192. [PMID: 25358236 PMCID: PMC4229610 DOI: 10.1186/s12916-014-0192-4] [Citation(s) in RCA: 259] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 09/26/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Evidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. The presence of dementia may complicate clinical care for other conditions and undermine a patient's ability to manage a chronic condition. The aim of this study was to scope the extent, range and nature of research activity around dementia and comorbidity. METHODS We undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers. We searched AMED, Cochrane Library, CINAHL, PubMed, NHS Evidence, Scopus, Google Scholar (searched 2012, Pubmed updated 2013), checked reference lists and performed citation searches on PubMed and Google Scholar (ongoing to February 2014). RESULTS We included 54 primary studies, eight reviews and three guidelines. Much of the available literature relates to the prevalence of comorbidities in people with dementia or issues around quality of care. Less is known about service organisation and delivery or the views and experiences of people with dementia and their family carers. There is some evidence that people with dementia did not have the same access to treatment and monitoring for conditions such as visual impairment and diabetes as those with similar comorbidities but without dementia. CONCLUSIONS The prevalence of comorbid conditions in people with dementia is high. Whilst current evidence suggests that people with dementia may have poorer access to services the reasons for this are not clear. There is a need for more research looking at the ways in which having dementia impacts on clinical care for other conditions and how the process of care and different services are adapting to the needs of people with dementia and comorbidity. People with dementia should be included in the debate about the management of comorbidities in older populations and there needs to be greater consideration given to including them in studies that focus on age-related healthcare issues.
Collapse
Affiliation(s)
- Frances Bunn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Anne-Marie Burn
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Claire Goodman
- Centre for Research in Primary and Community Care, University of Hertfordshire, College Lane, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Greta Rait
- Research Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK.
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, King's College London, Guy's Hospital Campus, London, SE1 9RT, UK.
| | - Louise Robinson
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
| | | | - Carol Brayne
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK.
| |
Collapse
|
38
|
Jefferis JM, Clarke MP, Taylor JP, Brittain KR. Challenges for the cataract surgeon treating people with dementia: a qualitative study exploring anesthetic choices. Clin Ophthalmol 2014; 8:1993-9. [PMID: 25328382 PMCID: PMC4196883 DOI: 10.2147/opth.s69388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In light of the growing number of people with dementia and age-related cataract, as well as changing anesthetic practices for cataract surgery, this study aimed to explore the experiences of cataract surgeons in managing patients with dementia and making anesthetic decisions. METHODS This was a qualitative study using semistructured interviews with senior cataract surgeons from two centers in England. Fourteen surgeons were interviewed, and a thematic approach informed by grounded theory was used for the analysis. RESULTS Choice of anesthesia for people with dementia was a central theme arising from the data. Surgeons varied in their thresholds for using general anesthesia. Decisions about suitability for local anesthesia were limited by time constraints and generally made rapidly and based on instinct; dementia was not always apparent at the point of preassessment. Surgeons used a variety of topical, sub-Tenon's, and sharp needle blocks for people with dementia. Surgeons discussed techniques to help patients tolerate local anesthesia, such as clear communication, a primary nurse, hand-holding, and support from an anesthetist. However, within our sample, some surgeons had had negative experiences of operating on people with dementia, where an incorrect judgment had been made that they could tolerate local anesthetic cataract surgery. CONCLUSION This study highlights the differing practices of cataract surgeons when making anesthetic choices for people with dementia and the challenges they face. In order to avoid the situation of a patient with dementia becoming distressed during awake surgery, increased time at preassessment and anesthetic support may be beneficial.
Collapse
Affiliation(s)
- Joanna Mary Jefferis
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
- Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - Michael Patrick Clarke
- Newcastle Eye Centre, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, UK
- Institute of Neurosciences, Newcastle University, Newcastle upon Tyne, UK
| | - John-Paul Taylor
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | | |
Collapse
|
39
|
Yu WK, Chen YT, Wang SJ, Kuo SC, Shia BC, Liu CJL. Cataract surgery is associated with a reduced risk of dementia: a nationwide population-based cohort study. Eur J Neurol 2014; 22:1370-7, e79-80. [PMID: 25196252 DOI: 10.1111/ene.12561] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 07/25/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Our purpose was to determine the association of cataract surgery with subsequent development of dementia in older adults with newly diagnosed cataract. METHODS By using data from Taiwan National Health Insurance Research Database (NHIRD), a population-based cohort study including 491 226 subjects aged 70 or older with first-time diagnosis of cataract coded from 2000 to 2009 was conducted. After matching cataract patients receiving cataract surgery with cataract patients without receiving cataract surgery for age, sex, index date, Charlson Comorbidity Index score, interval between first coding of cataract diagnosis and index date, hypertension and diabetes mellitus, 113 123 patients in each cohort were enrolled. The main outcome measure was newly diagnosed dementia coded by neurologists or psychiatrists more than 365 days after cataract surgery. Incidence rate and hazard ratio of dementia were compared between the cataract surgery and cataract diagnosis cohorts. RESULTS The incidence rate of dementia was 22.40 per 1000 person-years in the cataract surgery cohort and 28.87 per 1000 person-years in the cataract diagnosis cohort. The rate of dementia was significantly lower in the cataract surgery group (hazard ratio 0.77, 95% confidence interval 0.75-0.79, P < 0.001). Female gender (P < 0.001) and a shorter interval between the date of first coding of a cataract diagnosis and the date of cataract surgery (P = 0.009) were significantly associated with a lower incidence rate of dementia. CONCLUSION In an NHIRD cohort of Taiwanese aged 70 years and older with a diagnosis of cataract, patients undergoing cataract surgery were associated with a reduced risk of subsequent dementia compared with those without cataract surgery.
Collapse
Affiliation(s)
- W-K Yu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Y-T Chen
- Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - S-J Wang
- Faculty of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - S-C Kuo
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli, Taiwan
| | - B-C Shia
- Graduate School of Business Administration, Fu Jen Catholic University, Taipei, Taiwan.,Department of Statistics and Information Science and Applied Statistics, Fu Jen Catholic University, Taipei, Taiwan
| | - C J-L Liu
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| |
Collapse
|
40
|
Vision function abnormalities in Alzheimer disease. Surv Ophthalmol 2014; 59:414-33. [DOI: 10.1016/j.survophthal.2013.10.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Revised: 09/28/2013] [Accepted: 10/01/2013] [Indexed: 12/16/2022]
|
41
|
Jefferis JM, Taylor JP, Collerton J, Jagger C, Kingston A, Davies K, Kirkwood T, Clarke MP. The association between diagnosed glaucoma and cataract and cognitive performance in very old people: cross-sectional findings from the newcastle 85+ study. Ophthalmic Epidemiol 2013; 20:82-8. [PMID: 23510311 DOI: 10.3109/09286586.2012.757626] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Common age-related eye diseases including glaucoma, cataract and age-related macular degeneration (AMD) have been proposed to be associated with dementia. Few studies have examined the relationship between cognition and cataract or glaucoma. We explored the association between cognition and cataract and glaucoma diagnoses in community-dwelling 85-year-olds. METHODS Cross-sectional analysis of data from the Newcastle 85+ Study. Diagnoses of eye disease were extracted from family practice records. Cognitive performance was assessed by the standardized mini-mental state examination (sMMSE) and the sMMSE-blind (MMblind). Relationships between glaucoma diagnosis or cataract diagnosis and lower cognition were examined using ordinal logistic regression. RESULTS Complete data were available for 839 participants. Of these, 36.0% (302/839) had recorded previous cataract surgery, 11.2% (94/839) untreated cataract and 7.9% (66/839) diagnosed glaucoma. Glaucoma diagnosis was associated with lower sMMSE results (odds ratio [OR] 1.76, 95% confidence interval [CI] 1.05-2.95); but not lower MMblind (OR 1.17, 95% CI 0.65-2.12). When compared to no cataract, cataract diagnosis (treated and untreated combined) was associated with higher sMMSE (OR 0.55, 95% CI 0.38-0.79) and MMblind (OR 0.51, 95% CI 0.34-0.76). Previously treated cataract was associated with higher sMMSE (OR 0.72, 95% CI 0.59-0.88) and MMblind (OR 0.68, 95% CI 0.55-0.85). Untreated cataract was not significantly associated with sMMSE (OR 0.65, 95% CI 0.36-1.19) or MMblind (OR 0.73, 95% CI 0.39-1.36). CONCLUSIONS This large epidemiological study of 85-year-olds found that lower sMMSE but not MMblind was associated with glaucoma diagnosis, suggesting the association may be driven by poor vision. Cataract diagnosis was associated with higher sMMSE and MMblind. Reasons for this observation are unclear but may relate to enhanced help-seeking behavior in people with diagnosed cataract.
Collapse
|
42
|
Killen A, Firbank MJ, Collerton D, Clarke M, Jefferis JM, Taylor JP, McKeith IG, Mosimann UP. The assessment of cognition in visually impaired older adults. Age Ageing 2013; 42:98-102. [PMID: 23108164 DOI: 10.1093/ageing/afs157] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND visual and cognitive impairments are common in later life. Yet there are very few cognitive screening tests for the visually impaired. OBJECTIVE to screen for cognitive impairment in the visually impaired. METHODS case-control study including 150 elderly participants with visual impairment (n = 74) and a control group without visual impairment (n = 76) using vision-independent cognitive tests and cognitive screening tests (MMSE and clock drawing tests (CDT)) which are in part vision dependent. RESULTS the scoring of the two groups did not differ in the vision-independent cognitive tests. Visually impaired patients performed poorer than controls in the vision-dependent items of the MMSE (T = 7.3; df: 148; P < 0.001) and in CDT (T = 3.1; df: 145; P = 0.003). No group difference was found when vision-independent items were added to MMSE and CDT. The test score gain by the use of vision-independent items correlated with the severity of visual impairment (P < 0.002). CONCLUSION visually impaired patients benefit from cognitive tests, which do not rely on vision. The more visually impaired the greater the benefit.
Collapse
Affiliation(s)
- Alison Killen
- Newcastle University - Institute for Ageing and Health, Newcastle upon Tyne, United Kingdom
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Gruber N, Mosimann UP, Müri RM, Nef T. Vision and night driving abilities of elderly drivers. TRAFFIC INJURY PREVENTION 2013; 14:477-485. [PMID: 23683029 DOI: 10.1080/15389588.2012.727510] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE In this article, we review the impact of vision on older people's night driving abilities. Driving is the preferred and primary mode of transport for older people. It is a complex activity where intact vision is seminal for road safety. Night driving requires mesopic rather than scotopic vision, because there is always some light available when driving at night. Scotopic refers to night vision, photopic refers to vision under well-lit conditions, and mesopic vision is a combination of photopic and scotopic vision in low but not quite dark lighting situations. With increasing age, mesopic vision decreases and glare sensitivity increases, even in the absence of ocular diseases. Because of the increasing number of elderly drivers, more drivers are affected by night vision difficulties. Vision tests, which accurately predict night driving ability, are therefore of great interest. METHODS We reviewed existing literature on age-related influences on vision and vision tests that correlate or predict night driving ability. RESULTS We identified several studies that investigated the relationship between vision tests and night driving. These studies found correlations between impaired mesopic vision or increased glare sensitivity and impaired night driving, but no correlation was found among other tests; for example, useful field of view or visual field. The correlation between photopic visual acuity, the most commonly used test when assessing elderly drivers, and night driving ability has not yet been fully clarified. CONCLUSIONS Photopic visual acuity alone is not a good predictor of night driving ability. Mesopic visual acuity and glare sensitivity seem relevant for night driving. Due to the small number of studies evaluating predictors for night driving ability, further research is needed.
Collapse
Affiliation(s)
- Nicole Gruber
- Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
| | | | | | | |
Collapse
|
44
|
A novel, multidisciplinary clinic for complex visual problems in older people. Eye (Lond) 2012; 26:1536-41. [PMID: 23060021 DOI: 10.1038/eye.2012.205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Visual symptoms in older people can be complex and inadequately explained by eye pathology alone. Psychological and neurodegenerative processes may manifest as complex visual symptoms, and thus some patients may be poorly served by a purely ophthalmic approach. We have developed a novel multidisciplinary clinic with input from neurology, ophthalmology, and psychiatric specialists. Here, we describe the patient population, disease prevalence, and potential impact of this new clinic. METHODS A retrospective audit of paper and electronic records from June 2010 to February 2012 and selected case reports. RESULTS Between June 2010 and February 2012 48 patients attended the clinic. Notes were available for 47 (98%). Mean age was 76.2 (range 48-92). The main presenting complaints were hallucinations, followed by nonspecific visual deficit, double vision, blurred vision, and visuospatial deficit. Cognitive impairment was noted in 68% (32/47) of patients, of which 16/32 (50%) were new diagnoses. We were able to give a diagnosis to 98% (46/47) of patients; of these, 74% (35/46) were new diagnoses. A total of 6% (3/47) were felt to have presentations attributable to eye pathology alone, whereas 89% (42/47) were felt to have a neuropsychiatric component. Management included referral to other clinics for continuing care in 43% (20/47) and initiation of therapy in 36% (17/47). The three case reports demonstrate cases, where our multidisciplinary approach aided diagnosis and management of patients with complex visual symptoms. CONCLUSION A combined clinic with neurological, ophthalmic, and psychiatric input is an effective way to diagnose and manage complex visual problems in older people.
Collapse
|