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Older adults with glaucoma more prone to cognitive impairment, depression
Study underscores impact cognitive impairment may have on glaucoma treatment adherence.
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Older adults with glaucoma have higher rates of cognitive impairment and depression compared with healthy counterparts, according to a study.
“In my clinical work, I evaluate people to determine if they have dementia. I’m struck by the number of these patients who have visual impairment,” study author Brian P. Yochim, PhD, ABPP, told Ocular Surgery News.
Study design, findings
The study included 41 glaucoma patients with a mean age of 70 years treated at the Glaucoma Service at the University of Colorado. Approximately 22% of the patients had some degree of cognitive impairment, compared with roughly 16% of American older adults in general.
The study was published in the Journal of Glaucoma.
“We were surprised by this high rate of cognitive impairment,” Yochim said. “We thought there might be a high rate of depression, considering that people are losing their vision, and obviously that is a difficult thing to adjust to, but we assumed that their memory would be similar to that of healthy, older adults of the same age.”
Cognitive functioning was measured by two popular tests for detecting dementia: the California Verbal Learning Test, Second Edition, Short Form, for memory; and the verbal fluency subtest of the Delis-Kaplan Executive Functioning System.
There were also two self-report measures: the 15-item Geriatric Depression Scale and the Geriatric Anxiety Inventory. Even though the 12% rate of depression found in the study was much higher than the 1% to 5% rate reported in the general older population in the U.S., Yochim and colleagues expected an even higher rate.
“Perhaps people are more resilient than we think in the face of having a disease like glaucoma that robs them of their vision,” Yochim said.
Implications
An older adult in a vision clinic is more likely to have some cognitive impairment than depression, and an important implication of the study is that poor adherence to a treatment regimen may be due to memory impairment that is interfering with the patient’s ability to follow the regimen, Yochim said.
Patients who exhibit these kinds of problems may need a memory screening and may need referral to a neuropsychologist for further evaluation, Yochim said.
“[Patients] may have difficulty organizing their treatment regimen and when to take a particular medication at which time,” Yochim said. “[Depressed patients] may have less interest in following their treatment regimen.”
Only one patient in the study reported symptoms of anxiety.
The study was unable to confirm a direct connection between glaucoma and cognitive impairment.
“However, it is certainly an interesting area to explore,” Yochim said. “If there is a pathological process occurring in the eyes, it might increase the chances of a pathological process occurring in the brain as well. I believe our study is just a start at looking at this area.”
Yochim is developing measures of cognitive functioning that could be used specifically on people with visual impairment.
“A lot of the tests that we use to assess cognitive functioning in older adults require intact vision,” he said. – by Bob Kronemyer
Reference:
- Yochim BP, Mueller AE, Kane KD, Kahook MY. Prevalence of cognitive impairment, depression, and anxiety symptoms among older adults with glaucoma. J Glaucoma. 2012;21(4):250-254.
For more information:
- Brian P. Yochim, PhD, ABPP, can be reached at MIRECC 151Y, VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA 94304; email: byochim@stanford.edu.
- Disclosure: Yochim has no relevant financial disclosures.