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Maniarasu P, Kuzhuppilly NIR, Pai H V, Ve RS, Varadharajan S, Ganeshrao SB. Inhibitory control and working memory using saccadic eye movements in primary glaucoma. Atten Percept Psychophys 2024:10.3758/s13414-024-02961-z. [PMID: 39327360 DOI: 10.3758/s13414-024-02961-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2024] [Indexed: 09/28/2024]
Abstract
Glaucoma is a progressive optic neuropathic disorder that significantly impacts the activities of daily life (ADLs) of individuals. Emerging studies indicate degenerative changes in cortical and subcortical regions in individuals with glaucoma, which are associated with cognitive processes and oculomotor control. Cognitive processes involving top-down processes such as attention, planning, task management and execution, are crucial for meeting the demands of everyday tasks, and are affected in glaucoma. This study investigated the executive functions, specifically inhibitory control (IC) and working memory (WM), in individuals with glaucoma compared to age-matched controls, using eye movements. This was achieved through four tasks sensitive to executive functions, including antisaccade, memory-guided prosaccade and antisaccade, and the Go-NoGo tasks. Saccadic eye-movement parameters were also assessed in a prosaccade task, considered as a control condition with minimal IC and WM load. The results indicated that glaucoma is associated with changes in both IC and WM. Increased anticipatory saccadic errors might be linked to inhibitory deficiencies during the preparatory stage of the saccadic suppression mechanism. The increased omission errors in the antisaccade task might be due to the lack of regulation of the WM component. Taken together, these findings provide evidence for the involvement of cognitive deficits in individuals with glaucoma.
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Affiliation(s)
- Priyanka Maniarasu
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Neetha I R Kuzhuppilly
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vijaya Pai H
- Department of Ophthalmology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ramesh S Ve
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Srinivasa Varadharajan
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Artiq Insights Pvt Ltd, Chennai, Tamil Nadu, India
| | - Shonraj Ballae Ganeshrao
- Department of Optometry, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India.
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Yeo BSY, Ong RYX, Ganasekar P, Tan BKJ, Seow DCC, Tsai ASH. Cataract Surgery and Cognitive Benefits in the Older Person: A Systematic Review and Meta-analysis. Ophthalmology 2024; 131:975-984. [PMID: 38336283 DOI: 10.1016/j.ophtha.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/26/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
TOPIC This systematic review and meta-analysis aims to clarify the association of cataract surgery with cognitive impairment and dementia. CLINICAL RELEVANCE The association between vision impairment and cognitive decline is well-established. However, the cognitive benefits of cataract surgery are less clear. Given the lack of cure for dementia, identifying modifiable risk factors is key in caring for patients with cognitive deficits. METHODS The study was conducted following Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. PubMed, Embase, and Cochrane Library were searched from inception through October 11, 2022, for studies reporting the effect of cataract surgery on cognitive impairment and dementia. We pooled maximally adjusted hazard ratios (HRs) for dichotomous outcomes and ratio of means (RoM) for continuous outcomes using a random-effects model. Heterogeneity was examined using sensitivity and subgroup analyses. The quality of evidence was evaluated using the Newcastle-Ottawa scale, Cochrane risk-of-bias tool for randomized trials, and Grading of Recommendations, Assessment, Development and Evaluations (GRADE) guidelines. RESULTS This review included 24 articles comprising 558 276 participants, of which 19 articles were analyzed qualitatively. The bias of studies ranged from low to moderate, and GRADE extended from very low to low. Cataract surgery was associated with a 25% reduced risk of long-term cognitive decline compared with those with uncorrected cataracts (HR, 0.75; 95% confidence interval [CI], 0.72-0.78). This cognitive benefit was seen across various cognitive outcomes and remained robust to sensitivity analyses. Participants who underwent cataract surgery showed a similar risk of long-term cognitive decline as healthy controls without cataracts (HR, 0.84; 95% CI, 0.66-1.06). Additionally, cataract surgery was associated with a 4% improvement in short-term cognitive test scores among participants with normal cognition (RoM, 0.96; 95% CI, 0.94-0.99), but no significant association was observed among participants with preexisting cognitive impairment. DISCUSSION Cataract surgery may be associated with a lower risk of cognitive impairment and dementia, and cataract-associated vision impairment may be a modifiable risk factor for cognitive decline. Physicians should be aware of the cognitive sequelae of cataracts and the possible benefits of surgery. The cognitive benefits of cataract surgery should be investigated further in randomized trials. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Brian Sheng Yep Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Rebecca Yi Xuan Ong
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Republic of Singapore
| | - Pooja Ganasekar
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Benjamin Kye Jyn Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Dennis Chuen Chai Seow
- Department of Geriatric Medicine, Singapore General Hospital, Singapore, Republic of Singapore; SingHealth Duke-NUS Centre of Memory and Cognitive Disorders, Singapore, Republic of Singapore
| | - Andrew S H Tsai
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore.
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Seo JH, Lee Y. Causal Associations of Glaucoma and Age-Related Macular Degeneration with Cataract: A Bidirectional Two-Sample Mendelian Randomisation Study. Genes (Basel) 2024; 15:413. [PMID: 38674349 PMCID: PMC11049509 DOI: 10.3390/genes15040413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 03/21/2024] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
Common age-related eye disorders include glaucoma, cataract, and age-related macular degeneration (AMD); however, little is known about their relationship with age. This study investigated the potential causal relationship between glaucoma and AMD with cataract using genetic data from multi-ethnic populations. Single-nucleotide polymorphisms (SNPs) associated with exposure to cataract were selected as instrumental variables (IVs) from genome-wide association studies using meta-analysis data from BioBank Japan and UK Biobank. A bidirectional two-sample Mendelian randomisation (MR) study was conducted to assess the causal estimates using inverse variance weighted, MR-Egger, and MR pleiotropy residual sum and outlier tests. SNPs with (p < 5.0 × 10-8) were selected as IVs for cataract, primary open-angle glaucoma, and AMD. We found no causal effects of cataract on glaucoma or AMD (all p > 0.05). Furthermore, there were no causal effects of AMD on cataract (odds ratio [OR] = 1.02, p = 0.400). However, glaucoma had a substantial causal effect on cataract (OR = 1.14, p = 0.020). Our study found no evidence for a causal relationship of cataract on glaucoma or AMD and a casual effect of AMD on cataract. Nonetheless, glaucoma demonstrates a causal link with cataract formation, indicating the need for future investigations of age-related eye diseases.
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Affiliation(s)
- Je Hyun Seo
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea;
| | - Young Lee
- Veterans Medical Research Institute, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea;
- Department of Applied Statistics, Chung-Ang University, Seoul 06974, Republic of Korea
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Wang L, Sang B, Zheng Z. The risk of dementia or cognitive impairment in patients with cataracts: a systematic review and meta-analysis. Aging Ment Health 2024; 28:11-22. [PMID: 37416949 DOI: 10.1080/13607863.2023.2226616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/04/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES The aim of this study was to investigate whether cataract disease is associated with the risk of developing dementia or cognitive impairment. METHODS A systematic search of the literature in PubMed, the Extracts Database (Embase), the Cochrane Library and the Web of Science databases was performed from the inception data of each database until 1 September 2022. Sensitivity analyses were performed to assess the robustness and reliability of the overall findings. All extracted data were statistically analyzed using Stata software v.16.0. Publication bias was assessed using funnel plots and the Egger test. RESULTS There were 11 publications included in this study, which consisted of 489,211participants, spanning 10 countries from 2012 to 2022. Aggregation suggested that cataracts were associated with cognitive impairment (odds ratio [OR] = 1.32; 95% CI: 1.21-1.43; I 2 = 45.4.%; p = 0.000). The presence of cataracts is significantly associated with an increased risk of developing all-cause dementia (relative risk [RR] = 1.17; 95% CI: 1.08-1.26; I2 = 0.0%; p = 0.000). In subgroup analyses, having cataracts may increase the risk of Alzheimer's disease (hazard ratio [HR] = 1.28; 95% CI: 1.13-1.45; I2 = 0.0%; p = 0.000) and vascular dementia (HR = 1.35; 95% CI = 1.06-1.73; I2 = 0.0%, p = 0.015). The data from the Egger's test showed no significant evidence of publication bias. CONCLUSIONS Cataracts are associated with the risk of cognitive impairment and dementia, including Alzheimer's disease, and vascular dementia.
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Affiliation(s)
- Luping Wang
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Bowen Sang
- Heilongjiang University of Traditional Chinese Medicine, Harbin, China
| | - Zuyan Zheng
- Department of Acupuncture, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
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Nagarajan N, Assi L, Varadaraj V, Motaghi M, Sun Y, Couser E, Ehrlich JR, Whitson H, Swenor BK. Vision impairment and cognitive decline among older adults: a systematic review. BMJ Open 2022; 12:e047929. [PMID: 34992100 PMCID: PMC8739068 DOI: 10.1136/bmjopen-2020-047929] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/03/2021] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES There has been increasing epidemiological research examining the association between vision impairment (VI) and cognitive impairment and how poor vision may be a modifiable risk factor for cognitive decline. The objective of this systematic review is to synthesise the published literature on the association of VI with cognitive decline, cognitive impairment or dementia, to aid the development of interventions and guide public policies pertaining to the relationship between vision and cognition. METHODS A literature search was performed with Embase, Medline and Cochrane library databases from inception to March 2020, and included abstracts and articles published in peer-reviewed journals in English. Our inclusion criteria included publications that contained subjective/objective measures of vision and cognition, or a diagnosis of VI, cognitive impairment or dementia. Longitudinal or cross-sectional studies with ≥100 participants aged >50 years were included. The search identified 11 805 articles whose abstracts underwent screening by three teams of study authors. Data abstraction and quality assessment using the Effective Public Health Practice Project Quality Assessment Tool were performed by one author (NN). 10% of the articles underwent abstraction and appraisal by a second author (LA/VV), results were compared between both and were in agreement. RESULTS 110 full-text articles were selected for data extraction, of which 53 were cross-sectional, 43 longitudinal and 14 were case-control studies. The mean age of participants was 73.0 years (range 50-93.1). Ninety-one (83%) of these studies reported that VI was associated with cognitive impairment. CONCLUSION Our systematic review indicates that a majority of studies examining the vision-cognition relationship report that VI is associated with more cognitive decline, cognitive impairment or dementia among older adults. This synthesis supports the need for additional research to understand the mechanisms underlying the association between VI and cognitive impairment and to test interventions that mitigate the cognitive consequences of VI.
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Affiliation(s)
- Niranjani Nagarajan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lama Assi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - V Varadaraj
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mina Motaghi
- Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Yi Sun
- Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Elizabeth Couser
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua R Ehrlich
- Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Institute for healthcare policy and innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Heather Whitson
- Department of Medicine, Geriatrics, Duke University, Durham, North Carolina, USA
| | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Zheng C, Liu S, Zhang X, Hu Y, Shang X, Zhu Z, Huang Y, Wu G, Xiao Y, Du Z, Liang Y, Chen D, Zang S, Hu Y, He M, Zhang X, Yu H. Shared genetic architecture between the two neurodegenerative diseases: Alzheimer's disease and glaucoma. Front Aging Neurosci 2022; 14:880576. [PMID: 36118709 PMCID: PMC9476600 DOI: 10.3389/fnagi.2022.880576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/13/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Considered as the representatives of neurodegenerative diseases, Alzheimer's disease (AD) and glaucoma are complex progressive neuropathies affected by both genetic and environmental risk factors and cause irreversible damages. Current research indicates that there are common features between AD and glaucoma in terms of epidemiology and pathophysiology. However, the understandings and explanations of their comorbidity and potential genetic overlaps are still limited and insufficient. METHOD Genetic pleiotropy analysis was performed using large genome-wide association studies summary statistics of AD and glaucoma, with an independent cohort of glaucoma for replication. Conditional and conjunctional false discovery rate methods were applied to identify the shared loci. Biological function and network analysis, as well as the expression level analysis were performed to investigate the significance of the shared genes. RESULTS A significant positive genetic correlation between AD and glaucoma was identified, indicating that there were significant polygenetic overlaps. Forty-nine shared loci were identified and mapped to 11 shared protein-coding genes. Functional genomic analyses of the shared genes indicate their modulation of critical physiological processes in human cells, including those occurring in the mitochondria, nucleus, and cellular membranes. Most of the shared genes indicated a potential modulation of metabolic processes in human cells and tissues. Furthermore, human protein-protein interaction network analyses revealed that some of the shared genes, especially MTCH2, NDUFS3, and PTPMT1, as well as SPI1 and MYBPC3, may function concordantly. The modulation of their expressions may be related to metabolic dysfunction and pathogenic processes. CONCLUSION Our study identified a shared genetic architecture between AD and glaucoma, which may explain their shared features in epidemiology and pathophysiology. The potential involvement of these shared genes in molecular and cellular processes reflects the "inter-organ crosstalk" between AD and glaucoma. These results may serve as a genetic basis for the development of innovative and effective therapeutics for AD, glaucoma, and other neurodegenerative diseases.
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Affiliation(s)
- Chunwen Zheng
- Shantou University Medical College, Shantou, China
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shunming Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiayin Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunyan Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhuoting Zhu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guanrong Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Xiao
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zijing Du
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yingying Liang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Daiyu Chen
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Siwen Zang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
| | - Xueli Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Medical Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Cui QN, Green D, Jethi M, Driver T, Porco TC, Kuo J, Lin SC, Stamper RL, Han Y, Chiu CS, Ramanathan S, Ward ME, Possin K, Ou Y. Individuals with and without normal tension glaucoma exhibit comparable performance on tests of cognitive function. Int J Ophthalmol 2021; 14:1721-1728. [PMID: 34804862 PMCID: PMC8569564 DOI: 10.18240/ijo.2021.11.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 03/16/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate aspects of cognition impacted by individuals with and without normal tension glaucoma. METHODS Fifty normal tension glaucoma (NTG) and 50 control patients ≥50y of age were recruited from the UCSF Department of Ophthalmology. Demographic data and glaucoma parameters were extracted from electronic medical records for both groups. Tests of executive function [Executive Abilities: Measures and Instruments for Neurobehavioral Evaluation and Research (EXAMINER)] and learning and memory [California Verbal Learning Test-Second Edition (CVLT-II)] were administered to both NTG and controls. Race, handedness, best-corrected visual acuity, maximum intraocular pressure, optic nerve cup-to-disc ratio, visual field and optic nerve optical coherence tomography parameters, and a measure of general health (Charlson Comorbidity Index) were compared between NTG and controls as well as within NTG subgroups. Multivariate linear regression was used to compare group performances on the EXAMINER battery and CVLT-II while controlling for age, sex, and years of education. RESULTS NTG and controls were comparable with respect to age, sex, race, education, handedness, and the Charlson Comorbidity Index (P>0.05 for all). Performance on the EXAMINER composite score and the CVLT-II did not differ between NTG and controls (P>0.05 for both). CONCLUSION This is the first prospective study in which the cognitive function of subject with NTG were evaluated using a comprehensive, computerized neurocognitive battery. Subjects with NTG do not perform worse than unaffected controls on tests of executive function, learning, and memory. Results do not support the hypothesis that individuals with NTG are at higher risk for cognitive dysfunction and/or dementia.
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Affiliation(s)
- Qi N. Cui
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
- University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - David Green
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
| | - Mohit Jethi
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
| | - Todd Driver
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
| | - Travis C. Porco
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
- Francis I. Proctor Foundation, University of California San Francisco, San Francisco, California 94143, USA
| | - Jane Kuo
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
| | - Shan C. Lin
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
- Glaucoma Center of San Francisco, San Francisco, California 94105, USA
| | - Robert L. Stamper
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
| | - Ying Han
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
| | - Cynthia S. Chiu
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
| | - Saras Ramanathan
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
| | - Michael E. Ward
- Department of Neurology, University of California San Francisco, San Francisco, California 94143, USA
- Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
| | - Katherine Possin
- Department of Neurology, University of California San Francisco, San Francisco, California 94143, USA
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, San Francisco, California 94143, USA
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Swenor BK, Lee MJ, Varadaraj V, Whitson HE, Ramulu PY. Aging With Vision Loss: A Framework for Assessing the Impact of Visual Impairment on Older Adults. THE GERONTOLOGIST 2021; 60:989-995. [PMID: 31504483 DOI: 10.1093/geront/gnz117] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Indexed: 12/26/2022] Open
Abstract
There is limited research examining the impact of visual impairment (VI) on older adults while considering the complexities of aging, leaving gaps in our understanding of how health consequences of VI might be averted. We created a framework integrating concepts from disability, geriatrics, and ophthalmology that conceptualizes how VI challenges successful aging. Here, VI influences multiple functional domains, and increases the risk of negative health outcomes. This model acknowledges that common causes, such as risk factors that affect eyes and other systems simultaneously, may also drive the relationship between VI and health outcomes. Finally, the model highlights how the impact of VI on aging outcomes can be addressed at multiple intervention points.
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Affiliation(s)
- Bonnielin K Swenor
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
| | - Moon J Lee
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
| | - Varshini Varadaraj
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
| | - Heather E Whitson
- Department of Medicine (Geriatrics), Duke University Medical Center, Durham, North Carolina.,Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.,Duke Aging Center, Duke University Medical Center, Durham, North Carolina.,Geriatrics Research, Education and Clinical Center, Durham VA Medical Center, North Carolina
| | - Pradeep Y Ramulu
- Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Baltimore, Maryland
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Xiao Z, Wu W, Zhao Q, Zhang J, Hong Z, Ding D. Sensory impairments and cognitive decline in older adults: A review from a population-based perspective. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2020.100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Vidal KS, Suemoto CK, Moreno AB, Duncan B, Schmidt MI, Maestri M, Barreto SM, Lotufo PA, Bertola L, Bensenor IM, Brunoni AR. Association between cognitive performance and self-reported glaucoma in middle-aged and older adults: a cross-sectional analysis of ELSA-Brasil. ACTA ACUST UNITED AC 2020; 53:e10347. [PMID: 33146284 PMCID: PMC7643934 DOI: 10.1590/1414-431x202010347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022]
Abstract
Recent evidence suggests that glaucoma and Alzheimer's disease are neurodegenerative diseases sharing common pathophysiological and etiological features, although findings are inconclusive. We sought to investigate whether self-reported glaucoma patients without dementia present poorer cognitive performance, an issue that has been less investigated. We employed cross-sectional data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and included participants ≥50 years of age without a known diagnosis of dementia and a self-reported glaucoma diagnosis. We excluded those with previous stroke, other eye conditions, and using drugs that could impair cognition. We evaluated cognition using delayed word recall, phonemic verbal fluency, and trail making (version B) tests. We used multinomial linear regression models to investigate associations between self-reported glaucoma with cognition, adjusted by several sociodemographic and clinical variables. Out of 4,331 participants, 139 reported glaucoma. Fully-adjusted models showed that self-reported glaucoma patients presented poorer performance in the verbal fluency test (β=-0.39, 95%CI=-0.64 to -0.14, P=0.002), but not in the other cognitive assessments. Thus, our results support the hypothesis that self-reported glaucoma is associated with poor cognitive performance; however, longitudinal data are necessary to corroborate our findings.
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Affiliation(s)
- K S Vidal
- Laboratório da Visão, Instituto de Psicologia, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C K Suemoto
- Divisão de Geriatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A B Moreno
- Departamento de Epidemiologia e Métodos Quantitativos na Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - B Duncan
- Departamento de Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - M I Schmidt
- Departamento de Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - M Maestri
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina, Universidade do Rio Grande do Sul, Porto Alegre, RS, Brasil
| | - S M Barreto
- Faculdade de Medicina e Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - P A Lotufo
- Departamento de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Medicina Interna, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L Bertola
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I M Bensenor
- Departamento de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Medicina Interna, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A R Brunoni
- Departamento de Clínica Médica, Hospital Universitário, Universidade de São Paulo, São Paulo, SP, Brasil.,Departamento de Medicina Interna, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.,Laboratório de Neurociências, Departamento e Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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11
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Anderson DE, Bader JP, Boes EA, Gagrani M, Smith LM, Ndulue JK, Kedar S, Gulati V, Ghate DA, Rizzo M. Glaucomatous visual fields and neurocognitive function are independently associated with poor lane maintenance during driving simulation. BMC Ophthalmol 2020; 20:419. [PMID: 33081721 PMCID: PMC7574483 DOI: 10.1186/s12886-020-01682-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Driving simulators are a safe alternative to on-road vehicles for studying driving behavior in glaucoma drivers. Visual field (VF) loss severity is associated with higher driving simulator crash risk, though mechanisms explaining this relationship remain unknown. Furthermore, associations between driving behavior and neurocognitive performance in glaucoma are unexplored. Here, we evaluated the hypothesis that VF loss severity and neurocognitive performance interact to influence simulated vehicle control in glaucoma drivers. METHODS Glaucoma patients (n = 25) and suspects (n = 18) were recruited into the study. All had > 20/40 corrected visual acuity in each eye and were experienced field takers with at least three stable (reliability > 20%) fields over the last 2 years. Diagnosis of neurological disorder or cognitive impairment were exclusion criteria. Binocular VFs were derived from monocular Humphrey VFs to estimate a binocular VF index (OU-VFI). Montreal Cognitive Assessment (MoCA) was administered to assess global and sub-domain neurocognitive performance. National Eye Institute Visual Function Questionnaire (NEI-VFQ) was administered to assess peripheral vision and driving difficulties sub-scores. Driving performance was evaluated using a driving simulator with a 290° panoramic field of view constructed around a full-sized automotive cab. Vehicle control metrics, such as lateral acceleration variability and steering wheel variability, were calculated from vehicle sensor data while patients drove on a straight two-lane rural road. Linear mixed models were constructed to evaluate associations between driving performance and clinical characteristics. RESULTS Patients were 9.5 years older than suspects (p = 0.015). OU-VFI in the glaucoma group ranged from 24 to 98% (85.6 ± 18.3; M ± SD). OU-VFI (p = .0066) was associated with MoCA total (p = .0066) and visuo-spatial and executive function sub-domain scores (p = .012). During driving simulation, patients showed greater steering wheel variability (p = 0.0001) and lateral acceleration variability (p < .0001) relative to suspects. Greater steering wheel variability was independently associated with OU-VFI (p = .0069), MoCA total scores (p = 0.028), and VFQ driving sub-scores (p = 0.0087), but not age (p = 0.61). CONCLUSIONS Poor vehicle control was independently associated with greater VF loss and worse neurocognitive performance, suggesting both factors contribute to information processing models of driving performance in glaucoma. Future research must demonstrate the external validity of current findings to on-road performance in glaucoma.
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Affiliation(s)
- David E Anderson
- Department of Ophthalmology & Visual Science, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE, 68198-5540, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - John P Bader
- Department of Ophthalmology, University of Kentucky College of Medicine, Lexington, USA
| | - Emily A Boes
- College of Medicine, University of Nebraska Medical Center, Omaha, USA
| | - Meghal Gagrani
- Department of Ophthalmology & Visual Science, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE, 68198-5540, USA
| | - Lynette M Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, USA
| | - Jideofor K Ndulue
- Department of Ophthalmology & Visual Science, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE, 68198-5540, USA
| | - Sachin Kedar
- Department of Ophthalmology & Visual Science, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE, 68198-5540, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Vikas Gulati
- Department of Ophthalmology & Visual Science, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE, 68198-5540, USA
| | - Deepta A Ghate
- Department of Ophthalmology & Visual Science, University of Nebraska Medical Center, 985540 Nebraska Medical Center, Omaha, NE, 68198-5540, USA.
| | - Matthew Rizzo
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
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12
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Vidal KSM, Bertola L, Suemoto CK, Moreno AB, Duncan B, Schmidt MI, Maestri M, Barreto SM, Lotufo PA, Benseñor IM, Brunoni AR. Glaucoma, but not cataracts, predicts lower verbal fluency performance: 3.8-year follow-up from the ELSA-Brasil study. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:871-883. [PMID: 33073671 DOI: 10.1080/13825585.2020.1837723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Glaucoma, cataracts, and cognitive decline are most common in older ages. Although cross-sectional studies showed that these disorders are associated, follow-up studies are lacking. To investigate this issue, baseline and follow-up data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were employed. We evaluated participants ≥ 55 years-old at follow-up without diagnosis of dementia, stroke, and other eye conditions except for glaucoma and cataracts. Cognition was evaluated using delayed word recall, verbal fluency, and trail making (version B) tests. Regression models were employed to investigate associations between glaucoma and cognition, adjusted by several confounders. Out of 3,867 participants, 379 and 118 presented cataracts and glaucoma, respectively. Only glaucoma was apredictor of lower verbal fluency (B = -0.23, 95% CI -035 to -012, p< 0.001). Other associations were not significant (ps>0.57). Our results suggest that glaucoma may be related to declining cognition.
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Affiliation(s)
| | - Laiss Bertola
- Department of Internal Medicine, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil
| | - Claudia K Suemoto
- Division of Geriatrics, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil
| | - Arlinda B Moreno
- Department of Epidemiology and Quantitative Methods in Health, National School of Public Health, Fundação Oswaldo Cruz, Rio De Janeiro, Brazil
| | - Bruce Duncan
- Postgraduate Studies Program in Epidemiology and Hospital De Clínicas De Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Maria Inês Schmidt
- Postgraduate Studies Program in Epidemiology and Hospital De Clínicas De Porto Alegre, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Marcelo Maestri
- Department of Ophthalmology and Otorhinolaryngology, Faculdade De Medicina Da Universidade Do Rio Grande Do Sul, Porto Alegre, Brazil
| | - Sandhi M Barreto
- Faculdade De Medicina & Hospital Das Clínicas, Universidade Federal De Minas Gerais, Minas Gerais, Brazil
| | - Paulo A Lotufo
- Department of Internal Medicine, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade De São Paulo, São Paulo, Brazil
| | - Isabela M Benseñor
- Department of Internal Medicine, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade De São Paulo, São Paulo, Brazil
| | - Andre R Brunoni
- Department of Internal Medicine, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil.,Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade De São Paulo, São Paulo, Brazil.,Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry, Faculdade De Medicina Da Universidade De São Paulo, São Paulo, Brazil
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13
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Xiao Z, Wu W, Zhao Q, Liang X, Luo J, Ding D. Association of Glaucoma and Cataract with Incident Dementia: A 5-Year Follow-Up in the Shanghai Aging Study. J Alzheimers Dis 2020; 76:529-537. [PMID: 32538850 DOI: 10.3233/jad-200295] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Zhenxu Xiao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Wanqing Wu
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Qianhua Zhao
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoniu Liang
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianfeng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Lab of Public Health Safety of the Ministry of Education, Fudan University, Shanghai, China
| | - Ding Ding
- Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
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14
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Lee SSY, Wood JM, Black AA. Impact of glaucoma on executive function and visual search. Ophthalmic Physiol Opt 2020; 40:333-342. [PMID: 32189400 DOI: 10.1111/opo.12679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Executive function and visual search are linked to a number of activities of daily living including driving and mobility. Using a computerised version of the Trail Making Test B (TMT-B), we compared the executive function and visual search ability of older adults with glaucoma to age-similar controls and identified which visual function tests best predict TMT-B performance. Novel low-contrast and shifting-target variations of the test were incorporated to explore the effects of different levels of test complexity. METHODS Thirty-one older adults with mild to moderate glaucoma (mean age = 71.2 years [SD 6.9]; better-eye mean deviation [MD]: median = -1.9 dB [IQR = -1.2 to 0.4], worse-eye MD: median = -11.1 dB [IQR = -14.0 to -7.7]) and 24 age-similar controls (mean age = 71.9 years [SD 6.6]) with normal vision participated. The groups were matched in age, sex, and cognitive status (mini-mental state examination [MMSE]). Participants underwent measurements of visual acuity, contrast sensitivity (CS), visual fields, and visual processing speeds using the useful field-of-view (UFoV). Participants then completed four variations of a computerised TMT-B test, with different levels of complexity based on target contrast (high/low-contrast) and shifts in target position (fixed/shifting locations). Linear mixed-effect models were used to explore the effects of group, target contrast and shift on TMT-B completion time. RESULTS The glaucoma group took 17.3s longer than controls to complete the TMT-B (P = 0.028). All participants took 6.5s longer to complete the low- compared to the high-contrast tests (P = 0.012), and 10.6s longer for the shifting TMT-B compared to the fixed version (P < 0.001). There was no interaction effect between group, contrast, or target shift on completion time. Across all tests and participant groups, longer completion time was associated with slower UFoV processing speeds (divided attention: P = 0.003; selective attention: P = 0.006). Poorer CS was associated with longer completion times for the low (P = 0.007), but not the high-contrast tests. CONCLUSIONS Our findings suggest that older adults with mild to moderate glaucoma have poorer visual search ability and executive function relative to controls. However, decreasing target contrast or shifting target position did not exacerbate the effects of glaucomatous visual impairment on performance. The UFoV was a strong predictor of TMT-B performance.
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Affiliation(s)
- Samantha Sze-Yee Lee
- School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.,Lions Eye Institute, Centre for Ophthalmology and Visual Sciences, University of Western Australia, Perth, Australia
| | - Joanne M Wood
- School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Alexander A Black
- School of Optometry and Vision Science, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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15
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Raman P, Khy Ching Y, Sivagurunathan PD, Ramli N, Mohd. Khalid KH. The Association Between Visual Field Reliability Indices and Cognitive Impairment in Glaucoma Patients. J Glaucoma 2019; 28:685-690. [DOI: 10.1097/ijg.0000000000001269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Legdeur N, Badissi M, Carter SF, de Crom S, van de Kreeke A, Vreeswijk R, Trappenburg MC, Oudega ML, Koek HL, van Campen JP, Keijsers CJPW, Amadi C, Hinz R, Gordon MF, Novak G, Podhorna J, Serné E, Verbraak F, Yaqub M, Hillebrand A, Griffa A, Pendleton N, Kramer SE, Teunissen CE, Lammertsma A, Barkhof F, van Berckel BNM, Scheltens P, Muller M, Maier AB, Herholz K, Visser PJ. Resilience to cognitive impairment in the oldest-old: design of the EMIF-AD 90+ study. BMC Geriatr 2018; 18:289. [PMID: 30477432 PMCID: PMC6258163 DOI: 10.1186/s12877-018-0984-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 11/15/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The oldest-old (subjects aged 90 years and older) population represents the fastest growing segment of society and shows a high dementia prevalence rate of up to 40%. Only a few studies have investigated protective factors for cognitive impairment in the oldest-old. The EMIF-AD 90+ Study aims to identify factors associated with resilience to cognitive impairment in the oldest-old. In this paper we reviewed previous studies on cognitive resilience in the oldest-old and described the design of the EMIF-AD 90+ Study. METHODS The EMIF-AD 90+ Study aimed to enroll 80 cognitively normal subjects and 40 subjects with cognitive impairment aged 90 years or older. Cognitive impairment was operationalized as amnestic mild cognitive impairment (aMCI), or possible or probable Alzheimer's Disease (AD). The study was part of the European Medical Information Framework for AD (EMIF-AD) and was conducted at the Amsterdam University Medical Centers (UMC) and at the University of Manchester. We will test whether cognitive resilience is associated with cognitive reserve, vascular comorbidities, mood, sleep, sensory system capacity, physical performance and capacity, genetic risk factors, hallmarks of ageing, and markers of neurodegeneration. Markers of neurodegeneration included an amyloid positron emission tomography, amyloid β and tau in cerebrospinal fluid/blood and neurophysiological measures. DISCUSSION The EMIF-AD 90+ Study will extend our knowledge on resilience to cognitive impairment in the oldest-old by extensive phenotyping of the subjects and the measurement of a wide range of potential protective factors, hallmarks of aging and markers of neurodegeneration. TRIAL REGISTRATION Nederlands Trial Register NTR5867 . Registered 20 May 2016.
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Affiliation(s)
- Nienke Legdeur
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Maryam Badissi
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Stephen F. Carter
- Wolfson Molecular Imaging Centre, Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | - Sophie de Crom
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Aleid van de Kreeke
- Department of Ophthalmology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ralph Vreeswijk
- Department of Geriatric Medicine, Spaarne Gasthuis, Haarlem, The Netherlands
| | | | - Mardien L. Oudega
- Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Huiberdina L. Koek
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jos P. van Campen
- Department of Geriatric Medicine, MC Slotervaart Hospital, Amsterdam, The Netherlands
| | | | - Chinenye Amadi
- Wolfson Molecular Imaging Centre, Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | - Rainer Hinz
- Wolfson Molecular Imaging Centre, Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | | | - Gerald Novak
- Janssen Pharmaceutical Research and Development, Titusville, NJ USA
| | - Jana Podhorna
- Boehringer Ingelheim International GmbH, Ingelheim/Rhein, Germany
| | - Erik Serné
- Department of Internal Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frank Verbraak
- Department of Ophthalmology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and MEG Center, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Alessandra Griffa
- Dutch Connectome Lab, Department of Complex Trait Genetics, Center for Neuroscience and Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Neil Pendleton
- Wolfson Molecular Imaging Centre, Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | - Sophia E. Kramer
- Department of Otolaryngology-Head and Neck Surgery, Section Ear & Hearing, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Adriaan Lammertsma
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Bart N. M. van Berckel
- Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Majon Muller
- Department of Internal Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Andrea B. Maier
- Department of Medicine and Aged Care, @AgeMelbourne, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Human Movement Sciences, @AgeAmsterdam, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Karl Herholz
- Wolfson Molecular Imaging Centre, Division of Neuroscience & Experimental Psychology, University of Manchester, Manchester, UK
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, PO Box 7057, 1007 MB Amsterdam, the Netherlands
- Department of Psychiatry & Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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17
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Stephan BCM, Muniz‐Terrera G, Granic A, Collerton J, Davies K, Saxby BK, Wesnes KA, Kirkwood TB, Jagger C. Longitudinal changes in global and domain specific cognitive function in the very-old: findings from the Newcastle 85+ Study. Int J Geriatr Psychiatry 2018; 33. [PMID: 28639724 PMCID: PMC5811803 DOI: 10.1002/gps.4743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Ageing is associated with changes in cognition in some, but not all domains. In young-old adults, defined as persons aged 65-84 years, baseline cognitive function has been shown to impact on cognitive trajectories. Whether similar patterns occur in the very-old, defined as persons aged 85 years and over, is not known. METHODS Longitudinal changes (5 years' follow-up) in global and domain specific cognitive function including memory, attention and speed were investigated in participants from the Newcastle 85+ Study (n = 845). At baseline, participants were grouped using Mini-Mental State Examination cut-off scores and dementia status into the following: not impaired, mildly impaired or severely impaired/dementia groups. RESULTS Only a limited number of cognitive measures showed significant decline in performance over time. Where observed, change generally occurred only in the severely impaired group. In the severely impaired group, small differences in baseline age were associated with poorer performance over time on most measures. Education was not protective against cognitive decline in any group. CONCLUSIONS There are individuals who maintain a high level of cognitive function or only show mild impairments even into their ninth decade of life. This group of successful cognitive agers may provide insight for identifying predictors of cognitive integrity in later life. In individuals with severe impairment, cognitive performance shows significant decline over time, especially in measures of attention and speed. Further work to identify those individuals at highest risk of cognitive decline is necessary to implement early support and intervention strategies in this rapidly expanding age group. © 2017 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd.
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Affiliation(s)
- Blossom C. M. Stephan
- Institute of Health and SocietyNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - Graciela Muniz‐Terrera
- Centre for Dementia PreventionUniversity of Edinburgh, Royal Edinburgh HospitalEdinburghUK
| | - Antoneta Granic
- AGE Research Group, Institute of NeuroscienceNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK,NIHR Newcastle Biomedical Research Centre, and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Joanna Collerton
- Institute of Health and SocietyNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - Karen Davies
- AGE Research Group, Institute of NeuroscienceNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK,NIHR Newcastle Biomedical Research Centre, and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Brian K. Saxby
- Institute for AgeingNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
| | - Keith A. Wesnes
- Department of PsychologyNorthumbria UniversityNewcastle upon TyneUK,Wesnes Cognition LimitedStreatley‐on‐ThamesUK
| | - Thomas B.L. Kirkwood
- Institute for Cell and Molecular Biosciences and Institute for AgeingNewcastle UniversityNewcastle upon TyneUK
| | - Carol Jagger
- Institute of Health and SocietyNewcastle University, Campus for Ageing and VitalityNewcastle upon TyneUK
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18
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Daveckaite A, Grusauskiene E, Petrikonis K, Vaitkus A, Siaudvytyte L, Januleviciene I. Cognitive functions and normal tension glaucoma. Indian J Ophthalmol 2017; 65:974-978. [PMID: 29044063 PMCID: PMC5678334 DOI: 10.4103/ijo.ijo_756_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: Only a few studies have analyzed the potential link between glaucoma and cognitive function impairment. They have found controversial results. This study aims to perform quick cognitive function assessment with clock drawing test (CDT) using two different scoring systems and compare between normal tension glaucoma (NTG) and cataract patients. Methods: Totally, 30 NTG and 30 patients with cataracts were included in a prospective, pilot study. The predrawn circle was given, and patients were asked to draw the clock showing a time of 11:10. The test was evaluated using two methods – Freund method using a 7-point scoring scale (optimal cutoff ≤4) and Rakusa using a 4-point scoring scale (optimal cutoff ≤3). The level of significance was set at P < 0.05. Results: CDT result was significantly better in cataract group than in NTG group: 3.5 (2) versus 2 (2) by Freund, (P = 0.003) and 6.5 (1) versus 4.5 (2.75) by Rakusa, respectively (P = 0.004). Sixty percent (n = 18) of NTG group and 10% (n = 3) of cataract group patients completed the CDT in the specific picture manner (the short hand on 11 and the long hand between 11 and 12), (P = 0.001). Conclusions: Lower CDT results were seen in NTG patients according to two different scoring systems. NTG patients showed a specific manner of drawing. Further prospective studies are needed to investigate the CDT reliability as fast screening test of cognitive function impairment in glaucoma patients.
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Affiliation(s)
- Akvile Daveckaite
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Evelina Grusauskiene
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Kestutis Petrikonis
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Antanas Vaitkus
- Department of Neurology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Lina Siaudvytyte
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
| | - Ingrida Januleviciene
- Department of Ophthalmology, Lithuanian University of Health Sciences, Kaunas 50009, Lithuania
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19
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Criscuolo C, Fabiani C, Cerri E, Domenici L. Synaptic Dysfunction in Alzheimer's Disease and Glaucoma: From Common Degenerative Mechanisms Toward Neuroprotection. Front Cell Neurosci 2017; 11:53. [PMID: 28289378 PMCID: PMC5326746 DOI: 10.3389/fncel.2017.00053] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 02/14/2017] [Indexed: 01/24/2023] Open
Abstract
Alzheimer’s disease (AD) and glaucoma are two distinct multifactorial neurodegenerative diseases, primarily affecting the elderly. Common pathophysiological mechanisms have been elucidated in the past decades. First of all both diseases are progressive, with AD leading to dementia and glaucoma inducing blindness. Pathologically, they all feature synaptic dysfunction with changes of neuronal circuitry, progressive accumulation of protein aggregates such as the beta amyloid (Aβ) and intracellular microtubule inclusions containing hyperphosphorylated tau, which belongs to microtubule associated protein family. During an early phase of degeneration, both diseases are characterized by synaptic dysfunction and changes of mitogen-activated protein kinases (MAPK). Common degenerative mechanisms underlying both diseases are discussed here, along with recent results on the potential use of the visual system as a biomarker for diagnosis and progression of AD. Common neuropathological changes and mechanisms in AD and glaucoma have facilitated the transfer of therapeutic strategies between diseases. In particular, we discuss past and present evidence for neuroprotective effects of brain-derived neurotrophic factor (BDNF).
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Affiliation(s)
- Chiara Criscuolo
- Neuroscience Institute of the National Council of Research (CNR) Pisa, Italy
| | - Carlotta Fabiani
- Neuroscience Institute of the National Council of Research (CNR) Pisa, Italy
| | - Elisa Cerri
- Neuroscience Institute of the National Council of Research (CNR) Pisa, Italy
| | - Luciano Domenici
- Neuroscience Institute of the National Council of Research (CNR)Pisa, Italy; Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'AquilaL'Aquila, Italy
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20
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Hwang S, Shin YU, Kang MH, Cho HY, Seong M. The Correlation between Cognitive Function and Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.8.968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sunjin Hwang
- Department of Ophthalmology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Yong Un Shin
- Department of Ophthalmology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Ho Kang
- Department of Ophthalmology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hee Yoon Cho
- Department of Ophthalmology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Mincheol Seong
- Department of Ophthalmology, Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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21
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Lenoble Q, Lek JJ, McKendrick AM. Visual object categorisation in people with glaucoma. Br J Ophthalmol 2016; 100:1585-1590. [DOI: 10.1136/bjophthalmol-2015-308289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 06/14/2016] [Accepted: 07/18/2016] [Indexed: 11/03/2022]
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22
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Wen YH, Wu SS, Lin CHR, Tsai JH, Yang P, Chang YP, Tseng KH. A Bayesian Approach to Identifying New Risk Factors for Dementia: A Nationwide Population-Based Study. Medicine (Baltimore) 2016; 95:e3658. [PMID: 27227925 PMCID: PMC4902349 DOI: 10.1097/md.0000000000003658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dementia is one of the most disabling and burdensome health conditions worldwide. In this study, we identified new potential risk factors for dementia from nationwide longitudinal population-based data by using Bayesian statistics.We first tested the consistency of the results obtained using Bayesian statistics with those obtained using classical frequentist probability for 4 recognized risk factors for dementia, namely severe head injury, depression, diabetes mellitus, and vascular diseases. Then, we used Bayesian statistics to verify 2 new potential risk factors for dementia, namely hearing loss and senile cataract, determined from the Taiwan's National Health Insurance Research Database.We included a total of 6546 (6.0%) patients diagnosed with dementia. We observed older age, female sex, and lower income as independent risk factors for dementia. Moreover, we verified the 4 recognized risk factors for dementia in the older Taiwanese population; their odds ratios (ORs) ranged from 3.469 to 1.207. Furthermore, we observed that hearing loss (OR = 1.577) and senile cataract (OR = 1.549) were associated with an increased risk of dementia.We found that the results obtained using Bayesian statistics for assessing risk factors for dementia, such as head injury, depression, DM, and vascular diseases, were consistent with those obtained using classical frequentist probability. Moreover, hearing loss and senile cataract were found to be potential risk factors for dementia in the older Taiwanese population. Bayesian statistics could help clinicians explore other potential risk factors for dementia and for developing appropriate treatment strategies for these patients.
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Affiliation(s)
- Yen-Hsia Wen
- From the School of Pharmacy, College of Pharmacy, Kaohsiung Medical University (Y-HW, S-SW); Department of Psychiatry (J-HT) and Department of Neurology (Y-PC), Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University (PY); and Department of Computer Science and Engineering, National Sun Yat-sen University (C-HRL, K-HT), Kaohsiung, Taiwan
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23
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Rascón-Martínez DM, Fresán-Orellana A, Ocharán-Hernández ME, Genis-Zarate JH, Castellanos-Olivares A. The Effects of Ketamine on Cognitive Function in Elderly Patients Undergoing Ophthalmic Surgery. Anesth Analg 2016; 122:969-75. [DOI: 10.1213/ane.0000000000001153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Miyata K, Obayashi K, Saeki K, Tone N, Tanaka K, Nishi T, Morikawa M, Kurumatani N, Ogata N. Higher Cognitive Function in Elderly Individuals with Previous Cataract Surgery: Cross-Sectional Association Independent of Visual Acuity in the HEIJO-KYO Cohort. Rejuvenation Res 2016; 19:239-43. [PMID: 26414122 DOI: 10.1089/rej.2015.1718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Cataract surgery improves visual acuity and drastically increases the capacity for light reception to the retina. Although previous studies suggested that both light exposure and visual acuity were associated with cognitive function, the relationships between cataract surgery, visual acuity, and cognitive function have not been evaluated in large populations. In this cross-sectional study, we measured cognitive function using the Mini-Mental State Examination and best-corrected visual acuity in pseudophakic (previous cataract surgery) and phakic (no previous cataract surgery) elderly individuals. Of 945 participants (mean age 71.7 years), 166 (17.6%) had pseudophakia and 317 (33.5%) had impaired cognitive function (score ≤26). The pseudophakic group showed significantly better visual acuity than the phakic group (p = 0.003) and lower age-adjusted odds ratio (ORs) for cognitive impairment (OR 0.66; p = 0.038). Consistently, in multivariate logistic regression models, after adjusting for confounding factors, including visual acuity and socioeconomic status, ORs for cognitive impairment were significantly lower in the pseudophakic group than in the phakic group (OR 0.64; 95% confidence interval 0.43-0.96; p = 0.031). This association remained significant in sensitivity analysis, excluding participants with low cognitive score ≤23 (n = 36). In conclusion, in a general elderly population, prevalence of cognitive impairment was significantly lower in pseudophakic individuals independently of visual acuity. The association was also independent of several major causes of cognitive impairment such as aging, gender, obesity, socioeconomic status, hypertension, diabetes, sleep disturbances, depressive symptoms, and physical inactivity.
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Affiliation(s)
- Kimie Miyata
- 1 Department of Ophthalmology, Nara Medical University School of Medicine , Nara, Japan
| | - Kenji Obayashi
- 2 Department of Community Health and Epidemiology, Nara Medical University School of Medicine , Nara, Japan
| | - Keigo Saeki
- 2 Department of Community Health and Epidemiology, Nara Medical University School of Medicine , Nara, Japan
| | - Nobuhiro Tone
- 3 Center for Academic Industrial and Governmental Relations, Nara Medical University School of Medicine , Nara, Japan
| | - Kunihiko Tanaka
- 4 Osaka City University , Graduate School of Medicine, Osaka, Japan
| | - Tomo Nishi
- 1 Department of Ophthalmology, Nara Medical University School of Medicine , Nara, Japan
| | - Masayuki Morikawa
- 5 Mie Prefectural Mental Care Center , Mie, Japan .,6 Department of Psychiatry, Nara Medical University School of Medicine , Nara, Japan
| | - Norio Kurumatani
- 2 Department of Community Health and Epidemiology, Nara Medical University School of Medicine , Nara, Japan
| | - Nahoko Ogata
- 1 Department of Ophthalmology, Nara Medical University School of Medicine , Nara, Japan
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25
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Hamagishi T, Inagawa T, Kambayashi Y, Tsujiguchi H, Kitaoka M, Mitoma J, Asakura H, Suzuki F, Hori D, Anyenda EO, Thao NTT, Hibino Y, Hayashi K, Shibata A, Sagara T, Okochi J, Takamoku K, Hatta K, Konoshita T, Nakamura H. The Association between Activity of Daily Living and the Combination of Alzheimer’s Disease and Cataract in Elderly Requiring Nursing Care. Health (London) 2016. [DOI: 10.4236/health.2016.810103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Frampton G, Harris P, Cooper K, Lotery A, Shepherd J. The clinical effectiveness and cost-effectiveness of second-eye cataract surgery: a systematic review and economic evaluation. Health Technol Assess 2015; 18:1-205, v-vi. [PMID: 25405576 DOI: 10.3310/hta18680] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Elective cataract surgery is the most commonly performed surgical procedure in the NHS. In bilateral cataracts, the eye with greatest vision impairment from cataract is operated on first. First-eye surgery can improve vision and quality of life. However, it is unclear whether or not cataract surgery on the second eye provides enough incremental benefit to be considered clinically effective and cost-effective. OBJECTIVE To conduct a systematic review of clinical effectiveness and analysis of cost-effectiveness of second-eye cataract surgery in England and Wales, based on an economic model informed by systematic reviews of cost-effectiveness and quality of life. DATA SOURCES Twelve electronic bibliographic databases, including MEDLINE, EMBASE, Web of Science, The Cochrane Library and the Centre for Reviews and Dissemination databases were searched from database inception to April 2013, with searches updated in July 2013. Reference lists of relevant publications were also checked and experts consulted. REVIEW METHODS Two reviewers independently screened references, extracted and checked data from the included studies and appraised their risk of bias. Based on the review of cost-effectiveness, a de novo economic model was developed to estimate the cost-effectiveness of second-eye surgery in bilateral cataract patients. The model is based on changes in quality of life following second-eye surgery and includes post-surgical complications. RESULTS Three randomised controlled trials (RCTs) of clinical effectiveness, three studies of cost-effectiveness and 10 studies of health-related quality of life (HRQoL) met the inclusion criteria for the systematic reviews and, where possible, were used to inform the economic analysis. Heterogeneity of studies precluded meta-analyses, and instead data were synthesised narratively. The RCTs assessed visual acuity, contrast sensitivity, stereopsis and several measures of HRQoL. Improvements in binocular visual acuity and contrast sensitivity were small and unlikely to be of clinical significance, but stereopsis was improved to a clinically meaningful extent following second-eye surgery. Studies did not provide evidence that second-eye surgery significantly affected HRQoL, apart from an improvement in the mental health component of HRQoL in one RCT. In the model, second-eye surgery generated 0.68 incremental quality-adjusted life-years with an incremental cost-effectiveness ratio of £1964. Model results were most sensitive to changes in the utility gain associated with second-eye surgery, but otherwise robust to changes in parameter values. The probability that second-eye surgery is cost-effective at willingness-to-pay thresholds of £10,000 and £20,000 is 100%. LIMITATIONS Clinical effectiveness studies were all conducted more than 9 years ago. Patients had good vision pre surgery which may not represent all patients eligible for second-eye surgery. For some vision-related patient-reported outcomes and HRQoL measures, thresholds for determining important clinical effects are either unclear or have not been determined. CONCLUSIONS Second-eye cataract surgery is generally cost-effective based on the best available data and under most assumptions. However, more up-to-date data are needed. A well-conducted RCT that reflects current populations and enables the estimation of health state utility values would be appropriate. Guidance is required on which vision-related, patient-reported outcomes are suitable for assessing effects of cataract surgery in the NHS and how these measures should be interpreted clinically. STUDY REGISTRATION This project is registered as PROSPERO CRD42013004211. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Geoff Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Petra Harris
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Keith Cooper
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Andrew Lotery
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Keenan TDL, Goldacre R, Goldacre MJ. Associations between primary open angle glaucoma, Alzheimer's disease and vascular dementia: record linkage study. Br J Ophthalmol 2014; 99:524-7. [PMID: 25370081 DOI: 10.1136/bjophthalmol-2014-305863] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS The potential association between primary open angle glaucoma (POAG) and Alzheimer's disease (AD) is uncertain and has implications for understanding disease pathogenesis, referral and treatments. The aim was to determine whether individuals diagnosed with POAG are at higher risk of subsequently developing AD or vascular dementia. METHODS A POAG cohort of 87 658 people was constructed from English National Health Service linked hospital episode statistics from 1999 to 2011. An AD cohort (251 703 people), vascular dementia cohort (217 302 people) and reference cohort (>2.5 million people) were constructed in similar ways. Risk of dementia following POAG was determined: rate ratios were calculated based on standardised rates of dementia in the POAG cohort. RESULTS The risk of AD following a diagnosis of POAG was not elevated: the rate ratio was 1.01 (95% CI 0.96 to 1.06). The risk of vascular dementia after POAG was modestly elevated, with rate ratio 1.10 (1.05 to 1.16). The likelihood of a hospital record of POAG following AD or vascular dementia was very low, with rate ratios 0.28 (0.24 to 0.31) and 0.32 (0.28 to 0.37), respectively. CONCLUSIONS POAG and AD are neurodegenerative conditions that share some pathological features. However, considering AD after POAG, their coexistence at the individual level is no different from that expected by chance. By contrast, a diagnosis of POAG is modestly associated with later development of vascular dementia, presumably owing to shared vascular risk factors. People with dementia in England are much less likely to be admitted subsequently with POAG, perhaps through poor access to hospital eye services and diagnostic challenges.
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Affiliation(s)
- Tiarnan D L Keenan
- Faculty of Medical and Human Sciences, Institute of Human Development, University of Manchester, Manchester, UK Manchester Royal Eye Hospital, Manchester, UK
| | - Raph Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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28
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Elyashiv SM, Shabtai EL, Belkin M. Correlation between visual acuity and cognitive functions. Br J Ophthalmol 2013; 98:129-32. [PMID: 24169658 DOI: 10.1136/bjophthalmol-2013-304149] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A possible association between visual acuity (VA) and dementia was investigated in 2716 subjects who were aged between 53 and 102 at first visit and had varying degrees of dementia. Better VA was found to be significantly correlated with a lower dementia level (person coefficient range 0.146-0.261 over 10 years of follow-up, all correlations are significant, p<0.0001) as well as with a higher global cognitive score (person coefficient range -0.254 to -0.318 over 10 years of follow-up, all correlations are significant, p<0.0001), a grade encompassing 19 different cognitive tests. This correlation remained significant after adjustment for age, years of education, gender, use of ophthalmic drugs and years of follow-up.
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Affiliation(s)
- Sivan M Elyashiv
- Sackler Faculty of Medicine, Goldschleger Eye institute, Sheba Medical Center, Tel Aviv University, , Tel Hashomer, Israel
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