Dickens Paris, Ramaesh Kanna
Avon and Wiltshire Mental Health Partnership NHS Trust, Petherton Resource Centre, 3 Petherton Road, Hengrove, Bristol BS14 9BP, UK.
Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, UK.
Vision (Basel). 2020 Oct 29;4(4):46. doi: 10.3390/vision4040046.
Alzheimer's disease (AD) is the leading cause of dementia, which is a growing public health concern. Although there is no curative treatment for established AD, early recognition and modification of the known risk factors can reduce both severity and the rate of progression. Currently, an early diagnosis of AD is rarely achieved, as there is no screening for AD. The cognitive decline in AD is gradual and often goes unnoticed by patients and caregivers, resulting in patients presenting at later stages of the disease. Primary care physicians (general practitioners in the UK) can administer a battery of tests for patients presenting with memory problems and cognitive impairment, however final diagnosis of AD is usually made by specialised tertiary level clinics. Recent studies suggest that in AD, visuospatial difficulties develop prior to the development of memory problems and screening for visuospatial difficulties may offer a tool to screen for early stage AD. AD and cataracts share common risk and predisposing factors, and the stage of cataract presentation for intervention has shifted dramatically with early cataract referral and surgical intervention becoming the norm. This presentation offers an ideal opportunity to administer a screening test for AD, and visuospatial tools can be administered at post-operative visits by eye clinics. Abnormal findings can be communicated to primary care physicians for further follow up and assessment, or possible interventions which modify risk factors such as diabetes, hypertension and obesity can be undertaken. We propose that eye clinics and ophthalmology facilities have a role to play in the early diagnosis of AD and reducing the burdens arising from severe dementia.
阿尔茨海默病（AD）是痴呆症的主要病因，这一问题日益引起公共卫生领域的关注。尽管对于已确诊的AD尚无治愈性疗法，但尽早识别并改变已知风险因素可减轻病情严重程度并减缓疾病进展速度。目前，由于缺乏针对AD的筛查手段，AD很少能得到早期诊断。AD导致的认知衰退是渐进性的，患者和照料者往往难以察觉，结果患者往往在疾病后期才前来就诊。初级保健医生（英国的全科医生）可以为有记忆问题和认知障碍的患者进行一系列检查，不过AD的最终诊断通常由专业的三级诊所做出。最近的研究表明，在AD患者中，视觉空间障碍在记忆问题出现之前就已出现，对视觉空间障碍进行筛查可能为早期AD筛查提供一种手段。AD和白内障有共同的风险因素和易感因素，随着早期转诊和手术干预成为常态，白内障进行干预的时机已发生了巨大变化。此次报告提供了一个为AD进行筛查测试的理想机会，视觉空间检测工具可由眼科诊所在术后随访时使用。异常结果可告知初级保健医生以便进一步跟进和评估，或者可以采取可能的干预措施来改变糖尿病、高血压和肥胖等风险因素。我们建议眼科诊所和眼科机构在AD的早期诊断以及减轻严重痴呆症带来的负担方面发挥作用。
