Assessment of Vision Function and Cognitive Dysfunction in Older Adults through Questionnaire Surveys

BACKGROUND: Visual impairment in older adults has been associated with increased risk and severity of Alzheimer's disease (AD) [Cronin-Golomb, 1995]. There is a great need to understand the relationship between these two disease processes in an effort to improve coordinated care for these patients. The purpose of the study is to determine the relationship between cognitive dysfunction and self-reported visual function using the National Eye Institute Visual Function Questionnaire (NEI-VFQ) and Mini-Mental Status Exam (MMSE). METHODS: Subjects for this investigation were enrolled from the Alzheimer's Disease in Primary Care (ADPC) study, in which each participant undergoes a medical exam, interview, neuropsychological testing, 3T MRI of the brain and PET amyloid scans. This study recruited 131 participants from the ADPC cohort to complete the NEI VFQ-25. The 25-item questionnaire consists of 12 subscales that measure the impact of ocular disease on several domains of health. To examine the relationship between cognition and self-reported visual function, we correlated mini-mental state exam (MMSE) scores with NEI-VFQ overall composite scores. RESULTS: We observed a significant association between overall NEI-VFQ composite score and MMSE score (p = 0.0359). On average, for every 1-point increase in MMSE total score, the overall composite score increases by 0.3992 units. CONCLUSIONS: The consideration of visual function and quality of life is an important component during the ophthalmic and neuropsychological evaluation of a patient with cognitive dysfunction. Vision tests, such as visual acuity, are not a comprehensive representation of visual impairment experienced by individuals [Cullinan, 1978, Genensky, 1976], and do not account for the influence of visual disability on health-related quality of life (HRQOL) such as emotional well-being or social function [Mangione, 2001]. The use of the NEI-VFQ in a primary care setting could help identify patients with reduced self-reported visual function, which could simultaneously identify those at increased risk for cognitive dysfunction.