User:Eg2619/Alzheimer's disease: Difference between revisions
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== Outline: == |
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[[Dementia]] is a progressively debilitating disease. In addition to age, dementia creates greater risk for [[Visual impairment|visual impairments]].<ref name=":0">{{Cite journal |last1=Zhang |first1=Wanyu |last2=Roberts |first2=Timothy V. |last3=Poulos |first3=Christopher J. |last4=Stanaway |first4=Fiona F. |date=2023-02-01 |title=Prevalence of visual impairment in older people living with dementia and its impact: a scoping review |journal=BMC Geriatrics |language=en |volume=23 |issue=1 |page=63 |doi=10.1186/s12877-022-03581-8 |doi-access=free |pmid=36726055 |pmc=9890816 |issn=1471-2318}}</ref> These impairments can lead to significant negative impacts on dementia patients with visual impairments and their caregivers, such as a higher risk of inpatient admission and hospice use. There are multiple screening assessments that can be useful for diagnosing visual impairment such as the Pupil Reflex, [[Confrontation]] fields, and the [[Snellen]] chart. Visual impairments can manifest as alterations such as visual acuity, contrast sensitivity, and color vision.<ref>{{Cite journal |last1=Almario |first1=Gemma |last2=Piñero |first2=David P |date=2022-05-19 |title=Impact of Alzheimer's Disease in Ocular Motility and Visual Perception: A Narrative Review |url=https://www.tandfonline.com/doi/full/10.1080/08820538.2021.2002371 |journal=Seminars in Ophthalmology |language=en |volume=37 |issue=4 |pages=436–446 |doi=10.1080/08820538.2021.2002371 |pmid=34779338 |issn=0882-0538}}</ref> |
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== Caregiver Impact == |
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# Introduction to Visual Impairment in Dementia Patients |
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| ⚫ | Visual impairments can lead to significant negative impacts on dementia patients with visual impairments and their caregivers, including [[inpatient admission]] and [[hospice]] use.<ref name=":0" /> However, studies have found no significant difference in annual health costs and annual medical [[fee-for-service]] costs between those living with [[dementia]] with and without visual impairment.<ref name=":0" /> Additionally, [[Visual impairment|vision impairments]] are associated with greater incidence of loneliness, [[anxiety]], [[depression (mood)|depression]], and lower quality of life.<ref name=":1">{{Cite journal |last1=Campos |first1=Jennifer L. |last2=Höbler |first2=Fiona |last3=Bitton |first3=Etty |last4=Labreche |first4=Tammy |last5=McGilton |first5=Katherine S. |last6=Wittich |first6=Walter |date=2019-04-08 |editor-last=Montero-Odasso |editor-first=Manuel |title=Screening for Vision Impairments in Individuals with Dementia Living in Long-Term Care: A Scoping Review |journal=Journal of Alzheimer's Disease |volume=68 |issue=3 |pages=1039–1049 |doi=10.3233/JAD-181129|pmid=30909236 |pmc=6484267 }}</ref> Caregivers report conflict due to safety concerns, physical exhaustion from dependency, less time dedicated to activities such as visiting friends, and significant time taking care of loved ones.<ref name=":0" /> However, in one journal article, the caregivers that spent significantly more time caregiving were compared to those who were caregiving for those without [[dementia]] or visual impairments.<ref name=":0" /> |
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== Screening Assessments used for Visual Impairments == |
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* Describe risk of visual impairment in those with dementia |
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| ⚫ | Screening for visual impairments in [[dementia]] patients is crucial for potential treatments and reducing the impacts on [[caregivers]]. [[Dementia]] patients in long-term care are under-diagnosed.<ref name=":1" /> There are factors for screening for sensory impairments, such as speaking clearly, using concise instructions, and limiting time required to complete the test.<ref name=":1" /> One review of screening tests included those over 65 with [[neurodegenerative]] impairment and only included visual assessments.<ref name=":1" /> This review used certain criteria to which assessments would be most suitable for screening visual impairments. These tests involved measures for [[visual acuity]], [[visual field]], [[color vision]], and [[anatomy]].<ref name=":1" /> The screening tests that were suggested to be most promising were the Pupil Reflex, Neuro-ophthalmic Assessment, Counting Fingers, [[Handmation|Hand Motion]], Acuity card (letters), [[Snellen chart]], Feinbloom, Confrontation fields, [[Ishihara plates]], among others.<ref name=":1" /> |
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* Reference the prevalence of visual impairments |
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* Describe the negative impacts of this on those affected and caregivers |
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The Pupil Reflex measures [[anatomical]] changes by seeing if the pupils constrict equally and examines [[cranial nerve II]].<ref name=":1" /> The Neuro-opthalmic Assessment examines ocular movements, ductions, and pupils, as well as [[cranial nerve III]], [[IV]], [[VI]].<ref name=":1" /> The Counting Fingers and Hand Motion measure near visual acuity through cranial nerve II and macular function.<ref name=":1" /> The Acuity card with letters also assesses near vision, but preferable with habitual refraction with glasses on and no-glare.<ref name=":1" /> The Snellen chart and Feinbloom examines visual acuity for distance with [[habitual]] refraction under good lighting and no glare conditions.<ref name=":1" /> Confrontation fields measures visual field face to face using objects as well as hands.<ref name=":1" /> [[Ishihara test|Ishihara plates]] measures color vision with the presence of congenital (binocular testing) or acquired (monocular testing) color impairments.<ref name=":1" /> |
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2. Screening tools/Diagnosis |
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* Why screening tools are important for diagnosing visual impairments |
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* Review screening tools for visual impairments in those with dementia |
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=== Contrast Sensitivity === |
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| ⚫ | In [[Alzheimer's disease]], the [[sensory system]] is affected negatively. The [[olfactory]], [[vision]], and [[auditory system]] can become impaired over time.<ref name=":2">{{Cite journal |last=Murphy |first=Claire |date=January 2019 |title=Olfactory and other sensory impairments in Alzheimer disease |url=https://www.nature.com/articles/s41582-018-0097-5 |journal=Nature Reviews Neurology |language=en |volume=15 |issue=1 |pages=11–24 |doi=10.1038/s41582-018-0097-5 |pmid=30532084 |issn=1759-4758}}</ref> The visual impairments in those with [[dementia]] can manifest in [[numerous]] ways. Contrast sensitivity can be impaired in [[Alzheimer's disease]], mild cognitive impairment, and those with cognitive issues without performance issues.<ref name=":2" /> It may also be associated with [[Tau tangle|tau tangles]] and [[amyloid plaque]] deposition according to [[florbetapir]] and flortaucipir PET scans.<ref name=":2" /> |
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=== Abnormal Pupillary Responses === |
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* Review types of visual impairments that are potentially found in those with dementia |
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Those with [[Alzheimer's disease]] can have abnormal pupillary responses.<ref name=":2" /> Those with [[mild cognitive impairment]] show changes in pupillary response compared to healthy controls.<ref name=":2" /> There was also a study completed which suggested those with [[amnestic mild cognitive impairment]] had greater differences in pupil dilation than those with [[non-amnestic mild cognitive impairment]] and healthy individuals.<ref name=":2" /> |
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=== Retinal Thinning === |
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4. Conclusion |
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There are many studies which have also reported retinal thinning in [[Alzheimer's disease]].<ref name=":2" /> Retinal thinning has been found to be observed in [[mild cognitive impairment]] and found to be related to memory issues in [[amnestic mild cognitive impairment]].<ref name=":2" /> One study reported greater retinal thinning in the peripapillary [[Retinal nerve fiber layer|retinal nerve fibre layer]] compared with controls.<ref name=":2" /> However, another study found that there was no significant difference in the thickness of inner [[retinal layers]] between those with mild [[cognitive impairment]] and those with early to moderate [[Alzheimer's disease]].<ref name=":2" /> Given the mixed results, retinal thinning needs to be further investigated. |
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* Summarize diagnostic tools and types of visual impairments, emphasize importance of awareness and tools to ease the impact on patients and their caregivers |
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<references/> |
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== Article Draft == |
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=== Visual Impairments in Dementia === |
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| ⚫ | Screening for visual impairments in dementia patients is crucial for potential treatments and reducing the impacts on caregivers. Dementia patients in long-term care are under-diagnosed. |
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| ⚫ | In Alzheimer's disease, the sensory system is affected negatively. The olfactory, vision, and auditory system can become impaired over time. |
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Overall, visual impairments in those with dementia can lead to increase risk in depression, anxiety, and lower quality of life. <ref name=":1" /> It can negatively impact caregivers due to safety concerns, physical exhaustion, and increasing dependency. <ref name=":0" /> Visual impairments can impact those directly suffering from dementia given the increased risk for inpatient admission and hospice use. <ref name=":0" /> There are potential screening tests for visual impairments that measure visual field, near and distance acuity, and color vision. <ref name=":1" /> While all senses are affected, the visual impairments in those with Alzheimer's include contrast sensitivity and pupillary responses. <ref name=":2" /> However, it is important to further investigate sensory impairments in order to determine biomarkers, diagnoses, and potential treatments. |
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<references responsive="1"></references> |
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[[Category:Wikipedia Student Program]] |
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Latest revision as of 15:37, 13 May 2024
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Dementia is a progressively debilitating disease. In addition to age, dementia creates greater risk for visual impairments.[1] These impairments can lead to significant negative impacts on dementia patients with visual impairments and their caregivers, such as a higher risk of inpatient admission and hospice use. There are multiple screening assessments that can be useful for diagnosing visual impairment such as the Pupil Reflex, Confrontation fields, and the Snellen chart. Visual impairments can manifest as alterations such as visual acuity, contrast sensitivity, and color vision.[2]
Caregiver Impact
[edit]Visual impairments can lead to significant negative impacts on dementia patients with visual impairments and their caregivers, including inpatient admission and hospice use.[1] However, studies have found no significant difference in annual health costs and annual medical fee-for-service costs between those living with dementia with and without visual impairment.[1] Additionally, vision impairments are associated with greater incidence of loneliness, anxiety, depression, and lower quality of life.[3] Caregivers report conflict due to safety concerns, physical exhaustion from dependency, less time dedicated to activities such as visiting friends, and significant time taking care of loved ones.[1] However, in one journal article, the caregivers that spent significantly more time caregiving were compared to those who were caregiving for those without dementia or visual impairments.[1]
Screening Assessments used for Visual Impairments
[edit]Screening for visual impairments in dementia patients is crucial for potential treatments and reducing the impacts on caregivers. Dementia patients in long-term care are under-diagnosed.[3] There are factors for screening for sensory impairments, such as speaking clearly, using concise instructions, and limiting time required to complete the test.[3] One review of screening tests included those over 65 with neurodegenerative impairment and only included visual assessments.[3] This review used certain criteria to which assessments would be most suitable for screening visual impairments. These tests involved measures for visual acuity, visual field, color vision, and anatomy.[3] The screening tests that were suggested to be most promising were the Pupil Reflex, Neuro-ophthalmic Assessment, Counting Fingers, Hand Motion, Acuity card (letters), Snellen chart, Feinbloom, Confrontation fields, Ishihara plates, among others.[3]
The Pupil Reflex measures anatomical changes by seeing if the pupils constrict equally and examines cranial nerve II.[3] The Neuro-opthalmic Assessment examines ocular movements, ductions, and pupils, as well as cranial nerve III, IV, VI.[3] The Counting Fingers and Hand Motion measure near visual acuity through cranial nerve II and macular function.[3] The Acuity card with letters also assesses near vision, but preferable with habitual refraction with glasses on and no-glare.[3] The Snellen chart and Feinbloom examines visual acuity for distance with habitual refraction under good lighting and no glare conditions.[3] Confrontation fields measures visual field face to face using objects as well as hands.[3] Ishihara plates measures color vision with the presence of congenital (binocular testing) or acquired (monocular testing) color impairments.[3]
Types of Visual Impairments
[edit]Contrast Sensitivity
[edit]In Alzheimer's disease, the sensory system is affected negatively. The olfactory, vision, and auditory system can become impaired over time.[4] The visual impairments in those with dementia can manifest in numerous ways. Contrast sensitivity can be impaired in Alzheimer's disease, mild cognitive impairment, and those with cognitive issues without performance issues.[4] It may also be associated with tau tangles and amyloid plaque deposition according to florbetapir and flortaucipir PET scans.[4]
Abnormal Pupillary Responses
[edit]Those with Alzheimer's disease can have abnormal pupillary responses.[4] Those with mild cognitive impairment show changes in pupillary response compared to healthy controls.[4] There was also a study completed which suggested those with amnestic mild cognitive impairment had greater differences in pupil dilation than those with non-amnestic mild cognitive impairment and healthy individuals.[4]
Retinal Thinning
[edit]There are many studies which have also reported retinal thinning in Alzheimer's disease.[4] Retinal thinning has been found to be observed in mild cognitive impairment and found to be related to memory issues in amnestic mild cognitive impairment.[4] One study reported greater retinal thinning in the peripapillary retinal nerve fibre layer compared with controls.[4] However, another study found that there was no significant difference in the thickness of inner retinal layers between those with mild cognitive impairment and those with early to moderate Alzheimer's disease.[4] Given the mixed results, retinal thinning needs to be further investigated.
References
[edit]- ^ a b c d e Zhang, Wanyu; Roberts, Timothy V.; Poulos, Christopher J.; Stanaway, Fiona F. (2023-02-01). "Prevalence of visual impairment in older people living with dementia and its impact: a scoping review". BMC Geriatrics. 23 (1): 63. doi:10.1186/s12877-022-03581-8. ISSN 1471-2318. PMC 9890816. PMID 36726055.
- ^ Almario, Gemma; Piñero, David P (2022-05-19). "Impact of Alzheimer's Disease in Ocular Motility and Visual Perception: A Narrative Review". Seminars in Ophthalmology. 37 (4): 436–446. doi:10.1080/08820538.2021.2002371. ISSN 0882-0538. PMID 34779338.
- ^ a b c d e f g h i j k l m Campos, Jennifer L.; Höbler, Fiona; Bitton, Etty; Labreche, Tammy; McGilton, Katherine S.; Wittich, Walter (2019-04-08). Montero-Odasso, Manuel (ed.). "Screening for Vision Impairments in Individuals with Dementia Living in Long-Term Care: A Scoping Review". Journal of Alzheimer's Disease. 68 (3): 1039–1049. doi:10.3233/JAD-181129. PMC 6484267. PMID 30909236.
- ^ a b c d e f g h i j Murphy, Claire (January 2019). "Olfactory and other sensory impairments in Alzheimer disease". Nature Reviews Neurology. 15 (1): 11–24. doi:10.1038/s41582-018-0097-5. ISSN 1759-4758. PMID 30532084.