Comorbid cognitive impairment and functional trajectories in low vision rehabilitation for macular disease

Abstract

Background and Aims Comorbid cognitive impairment is common among visually impaired older adults. This study investigated whether baseline cognitive status predicts functional trajectories among older adults in low vision rehabilitation (LVR) for macular disease. Methods The Telephone Interview for Cognitive Status – modified (TICS-m) was administered to macular disease patients aged ≥ 65 years receiving outpatient LVR. Mixed models assessed the rate of change in instrumental activities of daily living and visual function measures over a mean follow-up of 115 days. Results Of 91 participants, 17 (18.7%) had cognitive impairment (TICS-m score ≤ 27) and 23 (25.3%) had marginal impairment (TICS-m scores 28 to 30). Controlling for age and gender, baseline cognitive status did not predict most functional outcomes. However, participants with marginal cognitive impairment experienced worse functional trajectories in ability to prepare meals (p=0.03).and activities that require distance vision (p = 0.05). Conclusion Patients with mild to moderate cognitive impairment should not be excluded from LVR, but programs should be prepared to detect and accommodate a range of cognitive ability.

Rehabilitation Referral for Patients With Irreversible Vision Impairment Seen in a Public Safety-Net Eye Clinic

“…This level of cognitive status also enhances the likelihood that they could benefit from vision rehabilitation interventions if they had been referred. 60 Health literacy was limited in our sample, which was not surprising because lower educational attainment (66.4% of participants did not complete high school or were high school/General Education Development graduates) and African American race/ ethnicity (86.0%) are risk factors for lower health literacy. 61 Safety-net health centers 62 serve patients who are among the most vulnerable in our society because they are more likely to have lower income, be racial/ethnic minorities, lack health insurance, and have lower health literacy.…”

How can basic research on spatial cognition enhance the visual accessibility of architecture for people with low vision?

“…Future work in the design of visually accessible spaces must consider that visual impairment does not exist in isolation from other health problems. The prevalence of many eye diseases (e.g., age-related macular degeneration, glaucoma) is highly correlated with age, and there is evidence for comorbidities with cognitive impairments, hearing impairments, and depression (Whitson et al 2011). Other comorbidities exist with physical disabilities such as the peripheral neuropathies associated with diabetesrelated visual impairment (Tesfaye et al 2010) or the increased likelihood of requiring a walker or wheelchair with age.…”

Comorbidity of age-related macular degeneration with Alzheimer’s disease: A histopathologic case-control study

“…While an association between vision loss and cognitive impairment clearly exists, our current results and the two large case control studies cited above suggest a lack of a substantive co-prevalence between AD and AMD diagnoses [10, 11, 30]. Taken together, these findings support the notion that the epidemiological link between AMD and cognitive impairment arises because vision loss affects cognitive processes or the presentation of cognitive decline, rather than that the two diseases arise concurrently due to shared underlying pathology [31].…”