User:Eg2619/Alzheimer's disease

Outline:

1. Introduction to Visual Impairment in Dementia Patients

• Describe risk of visual impairment in those with dementia
• Reference the prevalence of visual impairments
• Describe the negative impacts of this on those affected and caregivers

2. Screening tools/Diagnosis

• Why screening tools are important for diagnosing visual impairments
• Review screening tools for visual impairments in those with dementia

3. Types of Visual Impairments

• Review types of visual impairments that are potentially found in those with dementia

4. Conclusion

• Summarize diagnostic tools and types of visual impairments, emphasize importance of awareness and tools to ease the impact on patients and their caregivers

Article Draft

Visual Impairments in Dementia

Dementia is a progressively debilitating disease. In addition to age, dementia creates greater risk for visual impairments. Visual impairments can manifest as alterations in visual acuity, contrast sensitivity, color vision, and more. The prevalence of those with vision alterations and eye specific diseases varies depending on the measurement of visual impairment. These impairments can lead to significant negative impacts on dementia patients with visual impairments and their caregivers. These impacts include a higher risk of inpatient admission and hospice use. 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. Additionally, vision impairments are associated with greater incidence of loneliness, anxiety, depression, and lower quality of life. 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. However, the caregivers that spent significantly more time caregiving were compared to those who were caregiving for those without dementia or visual impairments. The impacts of visual impairments on dementia patients and their caregivers create an incentive for proper diagnoses and awareness of the ways that these impairments can manifest.

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. There are factors for screening for sensory impairments, such as speaking clearly, using concise instructions, and limiting time required to complete the test. One review of screening tests included those over 65 with neurodegenerative impairment and only included visual assessments. 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. 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. The Pupil Reflex measures anatomical changes by seeing if the pupils constrict equally and examines cranial nerve II. The Neuro-opthalmic Assessment examines ocular movements, ductions, and pupils, as well as cranial nerve III, IV, VI. The Counting Finges and Hand Motion measure near visual acuity through cranial nerve II and macular function. The Acuity card with letters also assesses near vision, but preferable with habitual refraction with glasses on and no-glare. The Snellen chart and Feinbloom examines visual acuity for distance with habitual refraction under good lighting and no glare conditions. Confrontation fields measures visual field face to face using objects as well as hands. Ishihara plates measures color vision with the presence of congenital (binocular testing) or acquired (monocular testing) color impairments.

In Alzheimer's disease, the sensory system is affected negatively. The olfactory, vision, and auditory system can become impaired over time. 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. It may also be associated with tau and amyloid deposition according to florbetapir and flortaucipir PET scans. Those with Alzheimer's disease can also exhibit abnormal pupillary responses. Interestingly, a potential biomarker of Alzheimer's disease involves the sensitivity of administering topicamide, an acetylcholine-blocker. Additionally, those with mild cognitive impairment show changes in pupillary response compared to healthy controls. 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. There are many studies which have also reported retinal thinning in Alzheimer's disease.

Overall, visual impairments in those with dementia can lead to increase risk in depression, anxiety, and lower quality of life. It can negatively impact caregivers due to safety concerns, physical exhaustion, and increasing dependency. Visual impairments can impact those directly suffering from dementia given the increased risk for inpatient admission and hospice use. There are potential screening tests for visual impairments that measure visual field, near and distance acuity, and color vision. While all senses are affected, the visual impairments in those with Alzheimer's include contrast sensitivity and pupillary responses. However, it is important to further investigate sensory impairments in order to determine biomarkers, diagnoses, and potential treatments.