Copenhagen, Denmark – Cataract surgery is effective in delaying cognitive decline and improving vision, cognition and quality of life in patients with dementia, according to a study presented at the 2014 Alzheimer’s Association International Conference (AAIC). Preliminary results from this prospective study suggest that for cataract patients with clinically significant dementia co-morbidities, immediate cataract surgery may not only improve visual acuity and vision-related quality of life and reduce behavioral problems, but may also slow the rate of cognitive decline, reduce neuropsychiatric symptoms and reduce caregiver stress. “MMSE scores were maintained in dementia patients who underwent cataract surgery immediately, while those who delayed surgery experienced a 2.5-point drop in scores; a difference equal to or greater than that seen in any current trial of anti-Alzheimer’s disease drugs.” Principal investigator Alan J. Lerner, MD, of Case Western Reserve University, noted. Reluctance to operate Despite the fact that Alzheimer’s disease patients often have co-morbid cataracts, doctors are often reluctant to operate on these patients. “These patients often cannot undergo surgery for one simple reason: because they also have dementia. Families often don’t want them to undergo surgery, and even doctors don’t recommend it, whether it’s geriatrics, internal medicine or ophthalmology.” To evaluate the impact of cataract surgery on vision, cognition and quality of life in this group, the researchers noted that subjects with a concurrent diagnosis of dementia and cataracts that had reached a level that affected their vision were recruited from dementia and ophthalmology clinics. The study included two cohorts: the intervention group (n=28) underwent cataract surgery immediately after recruitment, while the control group (n=14) refused surgery or underwent surgery 6 months later. In addition to visual acuity and cataract severity, the investigators assessed the subjects’ cognitive status using the MMSE and the Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS-Cog). In addition, the Neuropsychiatric Inventory (NPI) was used to detect psychiatric symptoms, including anxiety, disorganized thinking, depression, and hallucinations, while the Neuropsychiatric Inventory Caregiver Distress subscale (NPI-Distress) was used to measure caregiver mental distress. Subjects were assessed by the investigators at study baseline and after 6 months of treatment. The mean age of the subjects in the intervention and control groups was 80 and 83.6 years, respectively. In addition, Dr. Lerner noted that these subjects already had considerable cognitive impairment, with mean MMSE scores of only 18.75 and 16.93 in the two groups, respectively. The analysis showed, first, that all patients in the intervention group had significantly improved vision. This finding may seem unquestionable, but Dr. Lerner specifically noted that cataract surgery is not always a sure thing, so “it is reassuring to know that the patients’ vision did improve. Second, according to Dr. Lerner, the MMSE scores of patients who underwent immediate surgery increased rather than decreased, improving by 0.39 points compared to the pre-treatment scores, while the control group decreased by 2.31 points. The striking findings also showed a 4.71-point decrease in the NPI score in the intervention group, compared with a 3.92-point increase in the intervention group. For caregivers, the NPI-Distress scale score decreased by 2.00 points in the intervention group, while it increased by 0.93 points in the control group. “As for the most impressive findings, the reduction in neuropsychiatric symptoms and caregiver burden and stress were also in the mix.” Dr. Lerner stated. Although the mechanism for the correlation between improved vision and reduced cognitive decline remains unclear, Dr. Lerner speculates that indirect causes may be at play. He noted that sensory deprivation is associated with hallucinations, anxiety and other psychiatric symptoms, while poorer vision and secondary cognitive decline are the result of an inability to interact with the outside environment. Although these findings are only preliminary, Dr. Lerner said the findings send a strong message that may apply not only to dementia patients with the co-morbid cataract, but also to dementia patients with other co-morbidities. “I think there are a lot of conflicting treatment claims for dementia, and there are conflicting opinions about the scale for dealing with co-morbidities. This study suggests that if we really want to improve something, then we really should be more aggressive, because these treatments have bottom-line effects: improved behavior, quality of life, slowing of potential cognitive decline, and reduced caregiver stress. Finally, we need to keep in mind that effective help doesn’t always come in the form of a pill.” Expert Insight: Social Isolation As a commentary on the above study, Dr. Maria Carrillo, vice president of medical and scientific relations for the Alzheimer’s Association, said this study highlights the importance of optimizing medical care for people with dementia. While it may be true that family members or physicians are reluctant to perform surgery or other invasive treatments on people with dementia, the lack of vision and hearing screening for people with dementia is equally problematic and may be even more so than the previous fact. “If a patient with dementia falls and is admitted to the hospital with a hip injury because they can’t see, there’s a chance they may never recover from their pre-injury state. In addition, visual loss can lead to severe social isolation. I don’t think people really understand the importance of medical care for people with dementia to the quality of life of this population: not only does it help the patient, but it helps the family.”