P1‐388: Visual and Cognitive Improvement Following Cataract Surgery in Subjects With Dementia

Lerner, Alan J.; Debanne, Sara M.; Belkin, Julie; Lass, Jon; Riedel, Tatiana M.; Steinemann, Thomas L.; Sami, Susie A.; Gilmore, Grover C.

doi:10.1016/j.jalz.2014.05.630

Cited by 8 publications

(18 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Three studies reported on the impact of cataract surgery intervention (Lerner et al , 2014; Girard et al , 2016; Payal et al , 2016), one on rehabilitation training (Whitson et al , 2013) and one on use of prism lenses (Izzo et al , 1986). There was limited and inconsistent evidence for the benefit of any vision intervention on any outcome measure.…”

Section: Discussionmentioning

confidence: 99%

“…Out of two studies that reported on behavioral and psychological outcomes following cataract surgery, Lerner et al . (2014) reported a reduction in behavioral and psychological symptoms of dementia, while Girard et al . (2016) reported an improvement in sleep problems but an increase in agitation, with no change in total symptoms overall.…”

Section: Discussionmentioning

confidence: 99%

“…Whitson et al 2013 et al, 1998) and improvement in activities of daily living (patient-reported satisfaction with ability to perform 8 instrumental activities of daily living) were found. Lerner et al (2014) reported the results of cataract surgery for patients with dementia compared to a control group with dementia. The control group had either declined cataract surgery or were on a waiting list.…”

Section: Vision Rehabilitation Trainingmentioning

confidence: 99%

“…There was limited and inconsistent evidence for the benefit of any vision intervention on any outcome measure. Out of two studies that reported on behavioural and psychological outcomes following cataract surgery, Lerner et al (2014) reported a reduction in behavioural and psychological symptoms of dementia, while Girard et al (2016) reported an improvement in sleep problems but an increase in agitation, with no change in total symptoms overall. A recent study reported that cataract was the primary cause of post-refraction vision impairment for 48% of people with dementia in the UK, while age-related macular degeneration was the primary cause for 36% (Bowen et al, 2016).…”

Section: Vision Interventionsmentioning

confidence: 99%

See 3 more Smart Citations

Interventions for hearing and vision impairment to improve outcomes for people with dementia: a scoping review

Dawes

Wolski

Himmelsbach

et al. 2019

International Psychogeriatrics

View full text Add to dashboard Cite

Background:Age-related hearing and vision problems are common among people with dementia and are associated with poorer function, reduced quality of life and increased caregiver burden. Addressing sensory impairments may offer an opportunity to improve various aspects of life for people with dementia.Methods:Electronic databases were searched using key terms dementia, hearing impairment, vision impairment, intervention, and management. Database searches were supplemented by hand searching bibliographies of papers and via consultation with a network of health professional experts. Studies were eligible for inclusion if they included adults aged over 50 with dementia with adult-onset hearing or vision impairment who had received a hearing or vision intervention in relation to cognitive function, rate of decline, psychiatric symptoms, hearing/vision-related disability, quality of life, and/or caregiver burden outcomes. A range of study designs were included. Results were summarized descriptively according to level of evidence and effect sizes calculated where possible. Risk of bias was assessed using Downs and Black's (1998) checklist. The development of the intervention was summarized according to the CReDECI2 scheme. PROSPERO review registration number 2016:CRD42016039737.Results:Twelve papers describing hearing interventions and five papers describing vision interventions were included. Most were of low to moderate quality. One high quality randomized controlled trial of a hearing aid intervention was identified. Hearing interventions included provision of hearing aids, assistive listening devices, communication strategies, hearing aid trouble shooting, and cochlear implantation. Vision interventions included prism lenses, rehabilitation training, and cataract surgery. There was no consistent evidence for the positive impact of hearing/vision interventions on cognitive function, rate of cognitive decline, quality of life, or caregiver burden.Conclusion:Sensory interventions may promote better outcomes, but there is a need for properly powered, controlled trials of hearing and vision interventions on outcomes relevant to people living with dementia.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Vision Rehabilitation Trainingmentioning

confidence: 99%

Section: Vision Interventionsmentioning

confidence: 99%

See 2 more Smart Citations

Interventions for hearing and vision impairment to improve outcomes for people with dementia: a scoping review

Dawes

Wolski

Himmelsbach

et al. 2019

International Psychogeriatrics

View full text Add to dashboard Cite

show abstract

“…81 Another small-scale study investigated the effects of expediting binocular cataract extraction by 6 months in the cognitively impaired. 149 Preliminary results suggested that expedited cataract surgery in people with dementia has the potential to improve behavioural measures while decreasing neuropsychiatric symptoms and carer distress. The intervention also reduced the decline of cognitive function as measured by sMMSE scores.…”

Section: Expedited Cataract Surgerymentioning

confidence: 99%

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

Bowen

Edgar

Hancock

et al. 2016

Health Serv Deliv Res

121

View full text Add to dashboard Cite

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.

show abstract

Association of Visual Impairment With Risk of Incident Dementia in a Women’s Health Initiative Population

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE Dementia affects a large and growing population of older adults. Although past studies suggest an association between vision and cognitive impairment, there are limited data regarding longitudinal associations of vision with dementia.OBJECTIVE To evaluate associations between visual impairment and risk of cognitive impairment. DESIGN, SETTING, AND PARTICIPANTSA secondary analysis of a prospective longitudinal cohort study compared the likelihood of incident dementia or mild cognitive impairment (MCI) among women with and without baseline visual impairment using multivariable Cox proportional hazards regression models adjusting for characteristics of participants enrolled in Women's Health Initiative (WHI) ancillary studies. The participants comprised community-dwelling older women (age, 66-84 years) concurrently enrolled in WHI Sight Examination (enrollment 2000 and WHI Memory Study (enrollment 1996-1998. The study was conducted from 2000 to the present. EXPOSURES Objectively measured visual impairment at 3 thresholds (visual acuity worse than 20/40, 20/80, or 20/100) and self-reported visual impairment (determined using composite survey responses). MAIN OUTCOMES AND MEASURESHazard ratios (HRs) and 95% CIs for incident cognitive impairment after baseline eye examination were determined. Cognitive impairment (probable dementia or MCI) was based on cognitive testing, clinical assessment, and centralized review and adjudication. Models for (1) probable dementia, (2) MCI, and (3) probable dementia or MCI were evaluated.RESULTS A total of 1061 women (mean [SD] age, 73.8 [3.7] years) were identified; 206 of these women (19.4%) had self-reported visual impairment and 183 women (17.2%) had objective visual impairment. Forty-two women (4.0%) were ultimately classified with probable dementia and 28 women (2.6%) with MCI that did not progress to dementia. Mean post-eye examination follow-up was 3.8 (1.8) years (range, 0-7 years). Women with vs without baseline objective visual impairment were more likely to develop dementia. Greatest risk for dementia was among women with visual acuity of 20/100 or worse at baseline (HR, 5.66; 95% CI, 1.75-18.37), followed by 20/80 or worse (HR, 5.20; 95% CI,, and 20/40 or worse (HR, 2.14; 95% CI, 1.08-4.21). Findings were similar for risk of MCI, with the greatest risk among women with baseline visual acuity of 20/100 or worse (HR, 6.43; 95% CI, 1.66-24.85). CONCLUSIONS AND RELEVANCEIn secondary analysis of a prospective longitudinal cohort study of older women with formal vision and cognitive function testing, objective visual impairment appears to be associated with an increased risk of incident dementia. However, incident cases of dementia and the proportion of those with visual impairment were low. Research is needed to evaluate the effect of specific ophthalmic interventions on dementia.

show abstract

P1‐388: Visual and Cognitive Improvement Following Cataract Surgery in Subjects With Dementia

Cited by 8 publications

References 0 publications

Interventions for hearing and vision impairment to improve outcomes for people with dementia: a scoping review

Interventions for hearing and vision impairment to improve outcomes for people with dementia: a scoping review

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

Association of Visual Impairment With Risk of Incident Dementia in a Women’s Health Initiative Population

Contact Info

Product

Resources

About