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Sara Dubuc, Walter Wittich, Julius E. Gomolin, Oscar Kasner, Olga Overbury; Mild Cognitive Impairment And Visual Impairment: Is There A Link?. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1890.
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Recent studies have suggested an association between a number of ocular diseases and pathological Cognitive Impairment (CI). Two ocular pathologies which become more common in older people, Age-related Macular Degeneration (AMD) and Glaucoma, have recently been proposed to be neurodegenerative in nature and, therefore, potentially indicative of Central Nervous System (CNS) dysfunction. CI is a potential complication of the neurodegeneration of the CNS when it is affected by a disease such as Alzheimer’s. The brief cognitive assessment used most often for both screening purposes to assess level of cognitive functioning with elderly individuals is the well known Mini Mental Status Exam (MMSE). Recently, however, the MoCA (Montreal Cognitive Assessment) has been developed as an alternative to the MMSE. Although highly correlated with the MMSE, the MoCA may be a more sensitive tool for detecting Mild Cognitive Impairment (MCI), which may precede AD. In the present study, the MMSE and the MoCA were compared among individuals with dry AMD, glaucoma, no visual pathology and mild CI.
The number of participants in each group and their respective mean ETDRS acuities OU were: 28 with AMD (20/27), 25 with glaucoma (20/36) 16 visually healthy people (20/23) and 15 with MCI (20/25). Participants ranged in age between 47 and 89, with a mean of 72 years. The MMSE and the MoCA were administered in random order to all participants.
A one-way ANOVA revealed a significant difference among groups on the MoCA, F(3,80)= 3.33, p=.03) and on the MMSE, F(3,76), =4.2, p=.01. However, post hoc analyses demonstrated that the difference on the MMSE was only between the visually-healthy and the MCI group, whereas differences on the MoCA were found between the normal group and each of the MCI, glaucoma and AMD groups.
Given the results of the ANOVA and post-hoc analysis, the MoCA (but not the MMSE) may be detecting the presence of subtle cognitive changes in a population with early progressive retinal disease. Along with other recent studies also indicating that there may be a link between cognitive impairment and certain visual disorders, this adds to the evidence that neurodegenerative visual diseases of the eye may be linked to CI. Additionally, tests such as the MoCA, which identify CI in the earliest stages, might be the best type of screening tools to use for early detection.
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