Dinarvand Daniel, Panthakey Johann, Hassan Ahmed, Ahmed Mohamed H
Department of Medicine, Ashford and St. Peter's Hospital NHS Foundation Trust, Surrey KT16 0PZ, UK.
Department of Medicine, Royal Surrey County Hospital NHS Foundation Trust, Surrey GU2 7XX, UK.
Diseases. 2024 Nov 1;12(11):273. doi: 10.3390/diseases12110273.
: As life expectancy increases, the prevalence of frailty and eye diseases (cataracts, glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy) in the elderly global population is rising. Eye diseases and visual impairment not only contribute to a high incidence of falls, fractures, depression, and social isolation but they also herald cognitive decline and frailty (vision-cognitive impairment). : This narrative review explores the relationship between eye diseases, visual impairment, and frailty, their association with cognitive decline, the current approaches in identifying and managing these conditions and the potential role of interdisciplinary care models. Relevant articles were identified by searching the major databases. : Eye diseases are common in elderly individuals and can lead to visual impairment and subsequently contribute to falls, fractures, depression, and social isolation. Visual impairment is strongly linked to cognitive decline, which is a key component of frailty. Reduced sensory input from vision loss leads to decreased cognitive stimulation, reduced engagement in activities such as reading, problem-solving, executive function, attention, and social interactions, which are crucial for maintaining cognitive health. This can lead to a form of "sensory deprivation", which accelerates neurodegenerative processes. As cognitive decline progresses, it creates a feedback loop where individuals may struggle to manage their health, adhere to treatment regimens, or seek timely medical care, exacerbating both cognitive impairment and frailty. Additionally, subjective cognitive decline (SCD) is common in older adults with vision loss and may precede clinical dementia. This sense of declining cognitive ability can worsen anxiety and depression, further contributing to frailty. Early intervention has the potential to mitigate the cognitive effects of vision loss (vision-cognitive impairment). : Ophthalmologists should play an important role in detecting frailty associated with vision loss. Incorporating frailty assessments into ophthalmic practice can facilitate referrals to geriatric care and early interventions, improving patient outcomes. Geriatricians should be vigilant in identifying visual impairment and referring patients for appropriate ophthalmic investigation and management. Regular vision assessments should be part of comprehensive geriatric evaluations. Future research will assess the beneficial role of community geriatricians in detecting frailty and vision-cognitive impairment. An interdisciplinary and collaborative approach between ophthalmologists and geriatricians can lead to earlier detection, comprehensive management, and improved outcomes in frailty, eye diseases, and cognitive function.
随着预期寿命的增加，全球老年人口中衰弱和眼部疾病（白内障、青光眼、年龄相关性黄斑变性（AMD）和糖尿病视网膜病变）的患病率正在上升。眼部疾病和视力障碍不仅导致跌倒、骨折、抑郁和社会隔离的高发生率，还预示着认知能力下降和衰弱（视力-认知障碍）。 本叙述性综述探讨了眼部疾病、视力障碍和衰弱之间的关系，它们与认知能力下降的关联，目前识别和管理这些情况的方法以及跨学科护理模式的潜在作用。通过搜索主要数据库确定了相关文章。 眼部疾病在老年人中很常见，可导致视力障碍，进而导致跌倒、骨折、抑郁和社会隔离。视力障碍与认知能力下降密切相关，而认知能力下降是衰弱的关键组成部分。视力丧失导致的感觉输入减少会导致认知刺激减少，减少参与阅读、解决问题、执行功能、注意力和社交互动等对维持认知健康至关重要的活动。这可能导致一种“感觉剥夺”形式，加速神经退行性过程。随着认知能力下降的进展，会形成一个反馈循环，个体可能难以管理自己的健康、坚持治疗方案或及时寻求医疗护理，从而加剧认知障碍和衰弱。此外，主观认知下降（SCD）在视力丧失的老年人中很常见，可能先于临床痴呆出现。这种认知能力下降的感觉会加重焦虑和抑郁，进一步导致衰弱。早期干预有可能减轻视力丧失的认知影响（视力-认知障碍）。 眼科医生在检测与视力丧失相关的衰弱方面应发挥重要作用。将衰弱评估纳入眼科实践可以促进转介至老年护理和早期干预，改善患者预后。老年病医生应警惕识别视力障碍，并将患者转介进行适当的眼科检查和管理。定期视力评估应成为综合老年评估的一部分。未来的研究将评估社区老年病医生在检测衰弱和视力-认知障碍方面的有益作用。眼科医生和老年病医生之间的跨学科协作方法可以导致衰弱、眼部疾病和认知功能的更早检测、全面管理和改善预后。
