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Seniors with Macular Degeneration More Likely to Have
Cognitive Problems
AMD, reduced vision associated with thinking,
memory problems
April 11, 2006 - Older patients with advanced
age-related macular degeneration and reduced vision may be more likely
to also have cognitive impairment, or problems with thinking, learning
and memory, according to a study in the April issue of the Archives of
Ophthalmology, one of the JAMA/Archives journals.
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Health & Medicine |
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Age-related macular degeneration (AMD) develops
when the macula, the portion of the eye that allows people to see in
detail, deteriorates. AMD is a leading cause of irreversible vision loss
in elderly Americans, according to background information in the
article. Cognitive impairment also affects many older adults, reducing
their ability to function independently.
The Age-Related Eye Disease Study (AREDS) Research
Group examined the relationship between vision problems and cognitive
impairment in 2,946 patients enrolled in AREDS, an 11-center study of
AMD and age-related cataracts.
Between July 2000 and March 2004, the patients took
a series of six tests to gauge their cognitive function. Participants'
visual acuity (sharpness) was measured every year, and the progression
of AMD was assessed and categorized at regular intervals throughout the
study using photographs of the retina. Category 1 indicates no AMD and
Category 4 is the most advanced stage.
At the time they took the test, 23 percent of the
participants were classified as AMD Category 1, 29 percent Category 2,
26 percent Category 3 and 22 percent Category 4. In addition, 72 percent
had 20/40 vision or better, 18 percent had worse than 20/40 vision in
one eye and 10 percent had an overall visual acuity of less than 20/40.
Those who had more severe AMD had poorer average
scores on the cognitive tests, an association that remained even after
researchers considered other factors, including age, sex, race,
education, smoking, diabetes, use of cholesterol-lowering medications
and high blood pressure. Average scores also decreased as vision
decreased.
There are several possible explanations for these
associations, the researchers write. "Age-related macular degeneration
and cognitive impairment are both chronic neurodegenerative disorders
affecting an increasing number of persons as they age," the authors
write. AMD and cognitive impairment also may develop along similar
pathways. "For example, the main common characteristic of these diseases
is the loss in cells of the nervous system," they continue. Degeneration
of the optic nerve and the retina may lead to problems with both vision
and cognition.
"In addition, it has been hypothesized that the
relationship between visual and cognitive impairment is based on the
influence of visual impairment on the level and quality of interactive
experiences of older adults, thus reducing their capacity to develop and
maintain relationships and to participate in activities that may improve
their physical, mental and psychosocial well-being," the authors write.
"It has been postulated that vision impairment affects cognitive
performance by reducing the level of participation in these types of
stimulating activities and thus leads to a decrease in brain reserve.
The lack of activity may exacerbate cognitive impairment indirectly if
it predisposes a person to depression and social isolation."
This study was supported by contracts from the
National Eye Institute, the National Institute on Aging and the National
Institute of Neurological Disorders and Stroke, National Institutes of
Health, Department of Health and Human Services, Bethesda, Md.
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