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Researchers suggest assessing cognitive impairment of elderly glaucoma patients
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Researchers found that glaucoma patients older than 65 years were four times more likely to have cognitive impairment than younger patients.
This suggests that older glaucoma patients have a higher prevalence for undiagnosed cognitive impairment (CI), according to the authors of a study published in the Journal of Glaucoma.
Primary open angle glaucoma patients have been found to have an increased risk for developing Alzheimer’s disease. Additionally, CI is reported to be more prevalent in patients with visual impairment, the authors said.
Therefore, researchers aimed to study the link between CI and visual field progression in Malaysian glaucoma patients.
In this prospective, cross sectional study, researchers assessed the CI of 60 glaucoma patients receiving treatment at the Hospital Kuala Pilah. They monitored the patients’ visual field using a Humphrey visual field analyzer (Carl Zeiss Meditec) and tracked CI using the clock drawing test (CDT).
CDT score, mean deviation, pattern standard deviation, visual field index, fixation loss, false positive and false negative values were all analyzed using an ordinal regression model, according to the study.
Researchers found a statistically significant association between CDT scores and the patients’ glaucoma severity, fixation loss, false negative (FN) and visual field index values. With a model adjusted for age and glaucoma severity, patients with lower FN values were less likely to have CI.
They also found that glaucoma patients with higher mean deviation were more likely to have CI. Additionally, they concluded that patients older than 65 years had an increased incidence of CI.
The researchers stated that their findings suggest glaucoma patients should receive CI screening and monitoring during assessment for visual progression caused by glaucoma. – by Scott Buzby
Disclosure: The authors report no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Visual field testing is a difficult and universally hated task. Unlike other glaucoma tests, it is entirely subjective, and obtaining reliable results is difficult.
Why do it? Well, it’s an important measure of functional loss, and patients can relate to the results. I routinely use visual field test results as a way educate patients on their glaucoma. Also, as glaucoma progresses, it may be the only way we can monitor disease progression, as anatomic measures may no longer be accurate. As important as visual field testing may be, many patients produce questionable results, and some are simply unable to perform the threshold visual field. Why is this?
Raman and colleagues help answer this question in their prospective, cross-sectional study of CI in glaucoma patients. They found a higher rate of CI in glaucoma patients compared to healthy age-matched controls. Perhaps glaucoma leads to CI due to limits on cognition-improving visual activities such as games and reading? Are CI and glaucoma related disease conditions? They do share similar epidemiology.
We don’t know, but next time I have a poor performing patient I’m going to take a moment to investigate the possibility of CI.
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