June 04, 2018
By Lorraine L. Janeczko
NEW YORK (Reuters Health) - Subjective memory complaints (SMCs) can help doctors assess cognitive impairment in elderly patients who have vision problems and can't see vision-based tests, according to new research.
"Our study found a high prevalence of subjective memory complaints in older adults with visual impairment and an increased likelihood of reporting subjective memory complaints in individuals with visual impairment compared to individuals without visual impairment," said Dr. Bonnielin K. Swenor of Johns Hopkins University School of Medicine in Baltimore, Maryland.
"However, assessing cognitive function in individuals with vision loss may be difficult due to inability to see cognitive tests and due to constraints in clinical settings," she told Reuters Health by email. "Inquiring about subjective memory complaints may give clinicians insight into a patient’s awareness and perception of cognitive health, allowing ophthalmologists and other providers to give more individualized advice regarding health promotion and medication adherence."
The findings were presented in a poster May 2 at ARVO 2018, the annual meeting of the Association for Research in Vision and Ophthalmology, in Honolulu, Hawaii.
Dr. Swenor and her colleagues used the National Health and Nutrition Examination Survey (NHANES) to examine the prevalence of SMC in older adults with visual impairment (VI).
They analyzed data from nearly 5,800 individuals who were between 60 and 90 years of age in the 1999-2006 NHANES cycles to explore the link between corrected visual acuity worse than 20/40 in the better-seeing eye and self-reported limitation due to confusion or memory problems.
The VI group was older on average than the non-VI group (77.8 years vs. 70.3 years); more people in the VI group were women (61% vs. 55%) and fewer were Caucasian (79% vs. 83%).
Of those 60 and older, 22% in the VI group reported SMCs compared to 11% in the non-VI group (P<0.001).
Those between 60 and 79 reported similar rates of SMC in both groups, but among those who were 80 and above, 30% with VI reported SMCs compared to 19% of those without VI (P=0.003).
After adjustments for age, sex, race, depression, education and marital status, visually impaired individuals were more likely to report SMCs than those who were not impaired (risk ratio, 1.33; P=0.004).
Co-author Dr. Varshini Varadaraj, also at Hopkins, told Reuters Health by email, "Evaluation of cognitive function in older adults with visual impairment is challenging with the large majority of cognitive tests currently in practice comprising at least some visually demanding tasks."
"To give one example of where these findings may prove useful, prior research has shown that medication non-adherence is an issue among patients with chronic conditions such as glaucoma," she explained. "Clinicians may ask such patients about subjective memory complaints to get an idea about how their cognitive health may be impacting their medication adherence and refer them to the resources they may need so they can better follow clinical orders and protect their vision."
"It is important to keep in mind that there still exist challenges in assessing cognitive function among patients with visual impairment, and results should be interpreted with caution as it is possible that test results are influenced by an inability to see portions of the test," Dr. Varadaraj advised. "Further research is required to determine how to optimally ascertain cognitive function among older adults with visual impairment and to develop innovative ascertainment methods."
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