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Consider link between poor vision, cognitive function in elderly patients
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I recently had the pleasure of seeing an 84-year-old woman who has been a patient for the past 20 years. While she was calm and well oriented, her cognitive status seemed diminished relative to her last visit 1 year ago. For the first time, she was accompanied by her daughter.
She had no complaints, and her examination was unremarkable with the exception of moderately advanced cataract and best corrected visual acuity of 20/50 in each eye. Even though she was fairly asymptomatic, I presented the option of cataract surgery – its benefits, inherent risks and logistical considerations. My patient – and her daughter – did not really see any reason for surgery. After all, she was no longer driving and seemed to be getting along with daily life tasks. In short, they both felt she was doing fine. But was she really?
The aforementioned scenario is one that plays out in each of our offices on a daily basis. On one hand, cataract surgery is an incredibly efficient procedure, offering our patients a dramatic improvement in vision with very little risk of complication. On the other hand, it is a surgical procedure, and an elective one at that. So, we oft times defer to the patient’s wishes. However, is this really the best approach, especially for our patients with early cognitive dysfunction, dementia or Alzheimer’s?
While the link between poor vision and cognitive dysfunction has always been speculative, there is an increasing body of literature implicating more than a casual relationship between the two. In their work published in the American Journal of Epidemiology, Rogers and Langa analyzed data from the Aging, Demographics and Memory Study (ADAMS), a prospective population-based study of dementia. The results were staggering.
Seniors with poor vision were five times more likely to develop cognitive decline without dementia than their peers with very good or excellent vision. In addition, seniors with poor vision without intervention (visits to the eye doctor and, when indicated, cataract surgery) were almost 10 times more likely to develop Alzheimer’s disease.
In their conclusion, the authors wrote, “Our study results suggest that treatment of visual disorders may delay the diagnosis of dementia, particularly Alzheimer’s disease.”
Granted, it is still unclear whether treating visual problems in those with dementia will actually slow cognitive decline. However, it is imperative we consider the link between poor vision and cognitive function when consulting – and making recommendations for – our seniors contemplating cataract surgery. Indeed, for certain patients it may no longer be advisable to take a “wait and see” approach to cataract surgery. While they might feel as though they are doing well now, this approach may well put them at risk for more significant health issues down the road.
Reference:
- Rogers MAM, Langa KM. Untreated poor vision: a contributing factor to late-life dementia. Am J Epidemiol. 2010;171(6):728-735.