Cataract surgery for people with Alzheimer's disease and other dementias not only improves vision but can slow decline in cognition and improve quality of life for both people with the disease and their caregivers, according to clinical trial results reported today at the Alzheimer's Association International Conference® 2014 (AAIC® 2014) in Copenhagen.
"This study supports the Alzheimer's Association view that people with dementia retain, and benefit from, full healthcare treatment," said Maria Carrillo, Ph.D., Alzheimer's Association vice president of Medical and Scientific Relations. "Too common attitudes such as, 'There's no need for extra care' or 'Why put them through all of that' are not justified and are bad medical practice."
"Appropriate thoughtfulness and restraint are necessary when considering surgery or other procedures for people with Alzheimer's or another dementia. However, we should not assume that medical procedures cannot be pursued or are too risky. As these new results show, improving sensory abilities, for example, can provide benefits in a variety of ways – for people with Alzheimer's and also for their caregivers from whom unnecessary burden can be lifted," Carrillo said.
At AAIC 2014, Alan J. Lerner, M.D. of Case Western Reserve University and University Hospitals Case Medical Center and colleagues reported interim results from an ongoing clinical trial to determine the effects of cataract removal on several measures of visual ability, cognitive measures, and quality of life in people with dementia. Study participants are recruited from dementia and ophthalmology clinics at University Hospitals Case Medical Center and MetroHealth Medical Center in Cleveland, Ohio, and are divided into two groups: (1) immediate surgery following recruitment and (2) delayed or refused surgery. Vision and cognitive status, mood, and capability to complete daily activities are evaluated at baseline and six months after recruitment, or six months after surgery.
Preliminary analysis of results from 20 surgical and eight non-surgical participants showed that the surgical group had significantly improved visual acuity and quality of life, reduced decline in memory and executive functioning, and improvements in behavioral measures compared with the non-surgical group. Levels of perceived burden for caregivers of people in the surgical group also showed improvement.
"These preliminary results indicate that improved vision can have a variety of benefits for people with dementia and their loved ones, both visual and non-visual," said Lerner. "Our findings need to be verified in a larger study, but they suggest the need to aggressively address dementia co-morbidities such as vision-impairing cataracts, while balancing safety and medical risks."
"If the results hold up, it will significantly affect how we treat cataracts in individuals with dementia. Other interventions to offset sensory loss – including vision and hearing – may help improve quality of life for people with dementia and their caregivers," Lerner added.
According to the Alzheimer's Association, a person with dementia has the right to any medical treatment available. People with the disease may require longer courses of some treatments such as rehabilitative therapies compared to people with intact cognition. Therapies that may be of benefit should not be discontinued because a person with Alzheimer's has failed to make progress as the same rate as someone without the disease.
Making medical decisions about treatment remains the right of the person with Alzheimer's until he or she no longer has the cognitive capacity to understand the decision. At that time, medical decisions are made by the person's surrogate. The Alzheimer's Association recommends that preferences about medical treatment and decisions should be addressed early in the disease process through the execution of advance directives. Absent an advance directive, the surrogate decision maker should be guided by the values and any expressed wishes of the person with Alzheimer's disease.
With the support of the Alzheimer's Association and the Alzheimer's community, the United States created its first National Plan to Address Alzheimer's Disease in 2012. The plan includes the critical goal, which was adopted by the G8 at the Dementia Summit in 2013, of preventing and effectively treating Alzheimer's by 2025. It is only through strong implementation and adequate funding of the plan, including an additional $200 million in fiscal year 2015 for Alzheimer's research, that we'll meet that goal.