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Dementia and Eye Health - Causes, Diagnosis, and Precautions

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Dementia is associated with age-related macular degeneration, cataracts, and diabetes. Read to know more in-depth.

Written by

Dr. Anjali

Medically reviewed by

Dr. Asha Juliet Barboza

Published At December 16, 2022
Reviewed AtFebruary 24, 2023

Introduction

Dementia is considered a major neurocognitive disorder, which means there is decreased mental function due to medical diseases other than psychiatric illness. It is characterized by a decrease in multiple cognitive abilities, such as learning, thinking, reasoning, problem-solving, and decision-making capability, which is acquired rather than developmental.

All types of dementia have the exact molecular mechanisms responsible for the cause and progression of things like:

  1. Hypoxia (inability to deliver oxygen to tissues either due to low blood supply or because of low oxygen amount in the blood).

  2. Oxidative stress (imbalance between free radicals and antioxidants).

  3. Neuroinflammation (inflammatory response within the brain and spinal cord).

  4. Mitochondrial bioenergetics and neurodegeneration.

  5. Blood-brain barrier permeability.

Dementia is most commonly seen in elderly individuals. Advancing age is a risk factor for dementia. Comorbidity can further lead to the condition. Statistics depict that almost 47 million people live with dementia all over the world, and by 2050 there will be a threefold increase, and the number will turn to 131 million. Vision problems, vision loss, and blindness can be one of the first signs of dementia. When the visual pathways are not stimulated, dementia can progress more rapidly and lead to more troubles. Dementia often causes vision problems and can interfere with daily living and activities, including:

  • Reading will be difficult.

  • There will be difficulty with facial recognition.

  • Patients develop disinterest in hobbies and daily activities.

  • Difficulty locating and finding objects.

  • There will be uncoordinated body movements seen in patients who have dementia.

If any of these behaviors are noticed, it is advised to consult a physician for treatment and to have a good outcome.

What Are the Causes Associated With Dementia and Eye Health?

  • Cataracts (clouding of the lens) are almost 11 % higher in cataract patients.

  • Macular degeneration can also lead to dementia.

  • Other health conditions include stroke (when the blood supply to the brain is reduced).

  • Normal aging of the eye can also impact the condition.

  • It is seen with patients suffering from ophthalmic and systemic conditions such as diabetes, heart disease, and depression.

  • It is also observed that patients with at least two ophthalmic conditions were at higher risk for dementia than those with one ophthalmic disease. Patients with at least two ophthalmic and at least two systemic conditions were almost three times more likely to develop dementia.

Could Dementia Affect the Eyes?

Alzheimer's disease is a disease caused by the death of brain cells. It causes dementia, and the abnormal building of proteins in the brain kills cells called neurons. It also deteriorates connections between the neurons. It is characterized by loss of memory, difficulty in thinking, disorientation, and other kinds of cognitive decline (normal aging that causes dementia). In addition, patients may present with symptoms such as problems in vision, especially trouble with spatial relationships (understanding how objects move towards one another) and depth perception. There are also problems related to difficulty in reading, following moving objects, and contrast issues.

There are different types of dementia.

  1. Alzheimer's Disease: Alzheimer's disease is the most common one. 60 to 80 % of dementia is because of Alzheimer's disease. There are other types as well that include vascular dementia, which is associated with stroke (when the blood supply to the brain is compromised), dementia associated with Lewy bodies (a disease associated with abnormal deposits of proteins), and frontal lobe dementia (a progressive brain disease).

  2. Parkinson's Disease and Huntington's Disease: Parkinson's disease and Huntington's disease (the degeneration of nerve cells in the brain) can also lead to dementia. There is mild cognitive impairment in older age, which worsens with time. It can be seen in the early stages of Alzheimer's disease.

Alzheimer's disease is diagnosed after a proper assessment and ophthalmic examination. These tests include cognitive testing for memory and thinking, talking to family members, physical examination, and brain imaging scans.

How to Diagnose Dementia and Eye Health?

  • Changes are associated with the retina in people with Alzheimer's or other forms of dementia. There is a change in individual layers of the retina or blood flow within the eye.

  • Optical coherence tomography (OCT) is a quick and standard test to see changes in the retina.OCT is also used to see other eye conditions as well.

  • A new imaging technique called fluorescence lifetime imaging ophthalmoscopy (FLIO) is also used to diagnose the condition. FLIP helps in the measurement of a protein called beta-amyloid in the retina. This is a protein that gets built up in people who have Alzheimer's disease. Studies also indicate eye tissue changes in people with other brain diseases such as Creutzfeldt-Jakob (mad cow disease). It is a degenerative brain disease that leads to dementia and Parkinson's disease (a brain disorder that causes uncontrollable body movements).

What Are the Precautions to be Taken to Prevent the Condition?

Many precautions are required for someone living with both sight loss and dementia. These include:

  • Good eye care is essential that is done by having regular eye tests and also the use of correct glasses that are clean and correct.

  • Improve the lighting, using contrasting colors and keeping areas clutter-free.

  • Encourage patients with dementia to communicate with body language and physical contact.

  • Technology and equipment can also help, such as automatic lights or audio labels. Automatic lights and audio labels increase safety and reduce the risks of accidents and falls.

  • Seeking support from ophthalmologists and health care workers.

  • Develop strategies and also ensure the optical prescription is up-to-date.

Conclusion

As visual loss is concerned, cataracts and diabetic retinopathy are associated with an increased risk of dementia. Early diagnosis and management may help in identifying dementia. Most of the causes are treatable or preventable in the case of visual dementia. Proper investigation and tests are required to diagnose dementia. The relationship between brain tissue and eyes is an area of interest for ophthalmologists and neurologists. The brain plays an essential role in taking visual information, the eyes put it together into a picture, and the optic nerve connects the brain to the back of the eye.

Frequently Asked Questions

1.

Can Dementia Cause Eyesight Problems?

 
Alzheimer's disease can result in dementia. Patients suffering from dementia may have problems with vision and trouble with spatial relationships. Spatial relationship refers to the ability of an individual to understand how objects are aligned. They also exhibit problems in reading, following moving objects, and identifying contrast differences.

2.

Are Dementia and Alzheimer's Considered Hereditary Disorders?

Alzheimer's disease is not always hereditary, but if the gene carrying the mutation for Alzheimer's is passed from the parent to their children, then there are chances of developing early-onset Alzheimer's disease.

3.

Does Alzheimer's and Dementia Denote the Same?

Dementia is a general term whereas Alzheimer’s denotes a particular type of brain disease. Dementia refers to a group of symptoms that is associated with cognitive decline. Alzheimer's disease is a degenerative brain disorder that is caused due to brain cell damage that will result in complex brain changes.

4.

Are Dementia and Alzheimer's Considered Genetic Disorders?

Yes, Alzheimer's disease can occur in individuals with a specific gene mutation responsible for the same. A risk factor gene, APOE4 is responsible for causing late-onset Alzheimer's disease and three single gene mutations in amyloid precursor protein (APP) on chromosome 21, oresenilin 1 (PSEN1) on chromosome 14, and presenilin 2 (PSEN2) on chromosome 1 are responsible for causing early-onset Alzheimer's disease.

5.

Is There a Cure for Dementia?

As such, there is no single cure for dementia, as different underlying diseases can cause it, and treating them can result in complete resolution. However, medication and therapy put together can help manage the symptoms of Alzheimer's and dementia.

6.

From Which Part Does Alzheimer's Start in the Brain?

 
Alzheimer's disease starts affecting the neurons and their interconnections in the entorhinal cortex and hippocampus and in brain parts that are responsible for memory. Later it affects the cerebral cortex, which is responsible for reasoning, language, and social behavior.

7.

When Does Dementia Turn Into Alzheimer's Disease?

Alzheimer's disease is one of the reasons for dementia in about 60 to 80 % of the cases. Alzheimer's can be identified in the mild dementia stage itself when there are problems associated with thinking and memory. Early-onset dementia affects people in their 30s or 40s.

8.

When Is Hospice Required for Patients With Dementia?

Hospice is required in patients with dementia when there is a decline in patients' physical and mental conditions. Some of the important signs that may require hospice care:
- Inability to sit, walk or stand without assistance. 
- Difficulty swallowing foods and choking.
- Urine and fecal incontinence.
- The inability to smile and limited speech capabilities with less than five words per day.
- Other coexisting conditions such as cancer, congenital heart disease, pneumonia, or sepsis

9.

When Is Sleep Disturbed for Dementia Patients?

About one-quarter of patients suffering from dementia complain of sleep disturbances. Patients suffering from dementia usually experience fragmented sleep at night and excessive daytime sleepiness. So they take short naps during the day to compensate for the lost sleep at night.

10.

When Do Patients Suffering From Dementia Turn Violent?

 
Patients suffering from dementia may show physical aggression and violent behavior when the disease is in the advanced stage. They usually exhibit such behaviors when they are facing challenges with communication and in the presence of triggers like pain, reduced vision, excessive noise, or change in the environment.

11.

Which Type of Dementia Is Reversible?

Most dementia cases are irreversible. Reversible dementia can be caused by the following:
- Drug effects and interaction.
- Excessive alcohol consumption.
- Sleep problems.
- Stress.
- Inflammation and other metabolic diseases or abnormalities.
- Depression.
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Dr. Asha Juliet Barboza
Dr. Asha Juliet Barboza

Ophthalmology (Eye Care)

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