Research Tools That Can Improve The Lives Of Your Loved Ones
This includes magnifying glasses, audiobooks, large print or audio labels, audio or large print tags, and motion-activated lighting. You shouldnt be surprised if the person you care for is resistant to the use of technical assistance. Have patience and make it available, but dont pressure them to use the resources youve provided. When introduced in the early phases of vision loss, these aids prevent the frustration that might develop after a person is already having difficulty seeing clearly.
Early Warning Signs Of Alzheimers Disease
Some changes in your parents vision that may be an early warning sign of Alzheimers disease include:
- Difficulty reading, even when wearing vision aids such as glasses, reading glasses, or contacts
- Difficulty interpreting visual images
- Trouble judging distance or depth
- Trouble detecting differences in colors
- Difficulty with contrast
These changes can make regular daily activities more challenging and even dangerous. Driving, for example, can become much more hazardous when your parent is struggling with difficulties with depth, distance, and other interpretation. It is important to note that these changes are not always a sign of dementia. Instead, they could be related to many other changes that can come along with aging, including cataracts. This makes it extremely important to pay close attention to your parents abilities so that you can detect when they may need to see a doctor.
Bringing your parent to the eye doctor regularly can allow them to monitor your parents eye health, vision, and changes that might indicate other problems in their body.
If you notice that they are suddenly having these difficulties, do not hesitate to discuss them with your parents doctor so that they can get an accurate diagnosis and get started on the course of treatment and management that is right for them and their specific needs.
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What 16 Studies Suggest
The researchers searched for studies regarding vision loss and dementia published before 2020. Databases included PubMed, Web of Science, Embase, and PsycINFO.
From these sources, the authors of the study culled 4,580 records, eliminating duplicates and irrelevant research, eventually identifying 16 high quality studies encompassing 76,373 participants ages 50 and older.
The studies overall conclusions were that:
- Based on both objective and subjective vision assessments, people with visual impairments were at a roughly 60% higher risk of dementia or cognitive impairment.
- At the outset of the studies, the likelihood of having a cognitive impairment was 137% higher among people with vision impairment compared to those who did not.
- Compared to people without vision issues, those who were visually impaired at the start of the studies were at a 44% higher risk of incident dementia, with a 41% higher risk of incident cognitive impairment.
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Dont Overlook Alzheimers Affect On Eyesight
In understanding the changes that occur for a person living with Alzheimers disease, one that may be overlooked is what may be happening to eyesightthis is distinct to the changes in vision that occur as we age. Kendra Farrow, Research and Training Associate with the National Research and Training Center at Mississippi State University, discussed the vision deficits in an AFA webinar, Understanding Vision Impairments & How to Help.
Many individuals with Alzheimers disease may have a critical vision impairment where there may be nothing physically wrong with their eyes, but the brain is not fully processing visual information. The brain cannot interpret what is being seen, said Farrow, who is herself legally blind. Here are visual impairments for caregivers to watch for:
PERIPHERAL FIELD LOSS:Like looking through a tube, said Farrow, individuals are unable to see things that are on the side, top or bottom, making something as simple as moving around the home without tripping or bumping into things difficult. This deficit may contribute to an inability to detect motion as well.
HOW TO HELP:Place objects directly in front of the person. Eliminate clutter from floors and tabletops.
LOSS OF CONTRAST SENSITIVITY:Individuals may experience difficulty seeing objects of the same color .
HOW TO HELP:Use high contrast colors as much as possible .
HOW TO HELP:Keep areas well lit place brightly colored tape on the edge of stairs.
Visual Perception And Aging
As we age, we lose the ability to process visual information. Furthermore, medical conditions such as cataracts, glaucoma, macular degeneration, and diabetes may aggravate the visual-perceptual difficulties. The significant changes are:
- Reduced peripheral vision
- A decline in the ability to process distance and three-dimensional objects
Charles Bonnet Syndrome is one condition that may arise with losing vision as we age. Its characterized by having visual hallucinations that may include:
- Patterns of lines, dots, and/or geometric shapes
- Scenery, such as rivers, volcanoes, or mountains
- Insects, characters, creatures, or animals
- Characters draped in costume from an earlier time
Hallucinations are most commonly reported when people wake up and can persist for a few seconds, minutes, or hours. They may be of various forms, move or be still, and appear in black and white or color.
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What Alzheimers Has To Say About Your Eyesight
Alzheimers affects more than 40 million people worldwide and is one of the most common causes of dementia. However, finding a solution to this disease is still something that eludes researches today. Getting a yearly eye test can be a way to pick up early signs of Alzheimers and early involvement can be beneficial to family members and caregivers.
Scientists continue to learn more about Alzheimers and eyesight, but a cure still hasnt been found. However, it may be possible to screen patients with Alzheimers eyes in the future with a simple eye exam, researchers say.
What happens to the eyes due to Alzheimers?
4 Common Visual Deficits:
An Alzheimers brain typically has 4 areas of visual deficit that causes a patient to make mistakes in perceptions. Lets take a look at them:
Some patients are incompetent to detect motion. And instead of being able to see things as an ongoing video, they identify the world as a series of still photos. This makes patients feel lost even around close family members and friends. Activities involving fast motion and the ability to watch television comfortably become a challenge for patients.
Patients by mid-Alzheimers disease have to struggle with a 12-inch field of vision where they have lost the ability to see everything at the top, on the bottom, and on the sides.
Can Alzheimers Disease Affect Vision
- Problems with object recognition: People with dementia may see an object correctly with their eyes, but their brains may misinterpret what the eyes are seeing. As a result, people with Alzheimers may not be able to correctly or accurately name certain things or people they see.
- Poor color discrimination: There seems to be a connection between dementia and difficulties distinguishing between colors. People with Alzheimers disease may especially have problems recognizing colors in the blue-violet range.
- Its common for people with dementia to have decreased peripheral vision. Reduced side vision can lead to a variety of challenges for people with Alzheimers. For example, they may not notice objects to their side, leading them to bump into or trip over things as they walk.
- Loss of depth perception: People with Alzheimers disease may gradually lose their depth perception. They may have problems distinguishing between flat pictures and three-dimensional objects or trouble judging distances.
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Problems With Diagnosis Of Sight Loss
If the person has sight loss, it can make diagnosing dementia more difficult. They may have difficulties with some of the questions they are asked in the assessment, or their sight loss may mask the difficulties they are having.
It is often assumed that if a person has dementia they wont be able to manage a sight test, but this is not true. There are things that can help such as allowing more time, adapting the tests and someone going with them.
It may also be assumed that any problems the person is having are because of their dementia, and people may not think to check their sight.
Alzheimers Disease Dementia And The Connection To Eye Health
- Eye Health, Vision and Age
A visit to your eye care professional may give you clues about the health of your brain and reveal some early signs of various forms of dementia, including Alzheimers disease.
Alzheimers disease is a degenerative neural disease caused by an abnormal build-up of proteins in the brain that kills cells and damages connections between neurons. Common symptoms include memory loss, difficulty thinking, disorientation, and other kinds of cognitive decline. Symptoms can also include vision problems such as decreased peripheral vision and trouble with spatial relationships, object recognition, color discrimination, and depth perception.
Alzheimers also has a significant financial impact, leading the pack on Medicare reimbursement. One in every five Medicare dollars goes to someone with the disease.
In the U.S., an estimated 5.5 million people may be living with Alzheimers disease, according to the National Institute on Aging. By 2060, the number of Americans with Alzheimers is expected to nearly triple to 15 million. Currently, Alzheimers is typically only diagnosed during an autopsy. If a routine eye exam could help to predict Alzheimers long before a person shows symptoms, doctors would have more time to slow the progression of the disease.
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Ongoing Research To Further Treatment
UT Southwestern researchers and ophthalmologists regularly participate in national clinical trials as well as international research projects. For example, Vinod Mootha, M.D., a member of our research team, traveled to an area of India in which inbreeding is common. Data retrieved were analyzed in order to identify, characterize, and model genetic variations and mutations that alter specific genes and cause hereditary degenerative diseases that affect the eyes. Using this information and our relevant systems, we are working to identify prevention methods to reduce incidences of eye-related neurodegeneration symptoms around the world.
Among the most exciting accomplishments in vision research is gene therapy for the treatment of Leber congenital amaurosis , a rare retinal degenerative condition characterized by severe vision loss starting at birth. Today, using a benign adeno-associated virus , researchers can replace the defective copy of the gene that causes LCA with a fully functional copy, preventing the disease from progressing. Alternatively, in certain instances, harmful genes linked to ocular disorders can be reduced or silenced by the injection of antisense oligonucleotides into the eye.
Dementia And Eyesight: 3 Common Changes And Behaviors
1. Field of vision narrowsTeepa explains that by the time were 75 years old, the normal changes related to aging reduce our normal peripheral vision a little bit, so were not able to see and notice as much as we would when we were younger .
When someone has dementia, their field of vision narrows to about 12 inches around. As Teepa says, its like wearing binoculars .
If you were to use binoculars and try to move around normally, it would be very difficult.
2. The brain shuts down information, making it harder to see things right in front of themAs dementia advances, the brain may find that the information coming in through two eyes is too overwhelming.
So, it effectively shuts down the information coming from one eye at that point, your older adult could basically be seeing through one eye .
That means they lose depth perception and cant tell if something is two-dimensional or three-dimensional.
That makes it hard for your older adult to know if something is a pattern in the carpet or an object on the floor, a real apple or a picture of an apple, or what the chair seats height is .
3. Changes in vision cause behavior changes that dont make sense to usThese changes in vision can cause someone to do things that seem strange to us.
Teepa shows how someone might seem like theyre picking at the air, but theyre actually trying to turn off the ceiling light because it seems much closer than it really is .
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Inability To Recognize Objects
The eyes of a person diagnosed with dementia may see that object, but the persons brain may have a different interpretation of what the eyes are seeing. As a result, individuals with Alzheimers disease may not be able to precisely or accurately label some things or people they observe as a consequence of the disease.
Dementia And Vision Problems
Dementia and vision problems may occur for many reasons:
Normal aging
Other medical conditions of the eye
Damage to different parts of the visual system from different types of dementia
Are common causes that must be considered when working with a person with dementia.
The person with dementia and vision problems can present differently by each individual. These vision problems may include
- A person seeing illusions
- Misidentifications
- And even hallucinations.
The result of these vision problems can be more severe for a person suffering with dementia than for an individual without dementia. This is because a person with dementia may not understand.. or remember, that they are having vision problems. or have the ability or be a able to rationalize and test reality.
Dementia and vision problems have been reported for a number of types of dementias including:
Vascular dementia . With vascular dementia vision problems may occur if stroke-type damage occurs.. on or near the visual pathway in the brain.
Vision studies of Alzheimers dementia has had the research of all the dementias. To help you to better understand what may be occurring with your family member with dementia you must first understand the complex nature of visual perceptual issues.
What a person sees and then interprets they see can be very different from reality. However, it is their reality, and does affect a persons behavior.
What is accurate perception?
The eyes adjust to:
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Dementia And Vision Loss
A friend has told you they have dementia. Sometimes, they mistake a coat on a hook to be a person, or think a blue-colored floor is water. Is the dementia solely responsible for these errors? There may be more going on, as researchers have discovered a link between some forms of dementia and vision loss.
Discover how dementia and vision loss are interconnected, what you can do to help yourself or a loved one, and how the Council can assist.
What is Dementia?
According to the Alzheimers Association, dementia is an overall term for diseases and conditions characterized by a decline in memory, language, problem-solving and other thinking skills affecting a persons ability to perform everyday activities. It is not a typical part of aging.
How Might Vision Change Occur With and Without Dementia?
Vision loss in older adults can occur due to eye conditions such as macular degeneration, cataracts, or as part of other health conditions such as diabetes. In these conditions, vision loss results from changes in structures within the eye. People who have dementia can experience changes in vision not related to the eye itself. This is because the dementia affects parts of the brain that manage the visual input from the eyes. This means they might have visual problems but otherwise healthy eyes. Each type of dementia can affect the visual system in the brain in a different way.
If a person has dementia, they may find it challenging to:
Additional Resources:
Vision & Spatial Symptoms In Alzheimer’s
There are a variety of symptoms that are indicative of visuospatial difficulties, including1,2:
- Reduced visual acuity, or how clearly you can see
- Impairment in color vision
- Trouble identifying and naming objects
- Visual agnosia, where an individual can see things but not recognize or interpret them
All of these issues can have profound effects on ones life and daily activities. Identify this symptom early so you can get the assistance you need.
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Studies Link Vision Loss To Dementia
The idea of a sensory deficit contributing to dementia risk isnt new. Hearing loss, which has long been linked to cognitive problems, is the largest modifiable risk factor for dementia, according to a 2020 Lancet Commission report. Its estimated to account for about 9 percent of dementia cases, according to the report.
Its only in more recent years that researchers have discovered vision loss may have a similar association.
In 2021, several different large-scale analyses of observational studies where researchers observe individuals but dont give treatment or try to affect the outcome found that older adults with impaired vision were at increased risk of eventually developing cognitive problems. One review, published in the journal Ophthalmology, found that people with eyesight problems were 66 percent more likely to have cognitive impairment, and 109 percent more likely to have dementia, compared to those with no vision issues. A similar analysis found those odds to be 35 and 47 percent higher, respectively.
Meanwhile, a study published in JAMA Internal Medicine in December 2021 offered potential support for the idea that treating a vision problem could prevent cognitive decline. The study followed two groups of people age 65-plus with cataracts who did not have dementia. It found that those who had surgery to remove their cataracts were 30 percent less likely to be diagnosed with dementia in later years than those who didnt have the surgery.
Retinal Tauopathy In Alzheimers Patients
Another key characteristic sign of AD neuropathology that strongly reflects neuronal injury and cognitive decline is abnormal tau, specifically hyperphosphorylated tau and its inclusion in NFTs . The physiological distribution pattern of total non-phosphorylated tau expression in the human retina was first described in 1995 . According to this report and subsequent studies, tau is predominantly expressed in the inner retinal layers, most intensely along three distinct bands in the IPL, more diffusely in the OPL and somatodendritically in the INL . Tau is also localized, albeit weakly, in other inner retinal layers such as the GCL and NFL as well as in photoreceptors of the human retina .
Figure 4. Evidence of hyperphosphorylated pTau inclusions in AD retina. Representative micrograph images of retinal cross-sections from AD patients following immunostaining with AT8 mAb against phospho-tau , revealing intracellular pTau aggregates in both inner and outer nuclear layers , and plexiform layers . Scale bars: 10 m Higher magnification images of inner retina stained with Gallyas silver showing neurofibrillary tangle -like structures in ganglion cell layer . Immuofluorescence staining of AT100 mAb against phospho-tau showing punctate aggregates and intracellular inclusions in INL. Images and data of panels are adapted from Schön et al. . Images and data of panels c-d are reproduced from Koronyo et al. with permission of ASCI via Copyright Clearance Center.
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