visual impairment

Variations in eye structure and function seen early in Alzheimer's

More evidence for early changes in the eye in Alzheimer’s disease comes from a study involving both rats and postmortem human retinas. Changes were found in the retinal pigment epithelial layer (which harbors the supportive cells located in the back of the eye) and in the thickness of the choroidal layer that has blood vessels providing nutrients to the retina.

The finding is consistent with growing evidence that glaucoma is a neurodegenerative disorder similar to Alzheimer’s.

It’s not the noise in the brain; it’s the noise in the input

noise on TV screen

A new study has found that errors in perceptual decisions occurred only when there was confused sensory input, not because of any ‘noise’ or randomness in the cognitive processing. The finding, if replicated across broader contexts, will change some of our fundamental assumptions about how the brain works.

Eye health related to brain health in older adults

A large, long-running study has found cognitive decline and brain lesions are linked to mild retinal damage in older women.

Damage to the retina (retinopathy) doesn’t produce noticeable symptoms in the early stages, but a new study indicates it may be a symptom of more widespread damage. In the ten-year study, involving 511 older women (average age 69), 7.6% (39) were found to have retinopathy. These women tended to have lower cognitive performance, and brain scans revealed that they had more areas of small vascular damage within the brain — 47% more overall, and 68% more in the parietal lobe specifically. They also had more white matter damage. They did not have any more brain atrophy.

These correlations remained after high blood pressure and diabetes (the two major risk factors for retinopathy) were taken into account. It’s estimated that 40-45% of those with diabetes have retinopathy.

Those with retinopathy performed similarly to those without on a visual acuity test. However, testing for retinopathy is a simple test that should routinely be carried out by an optometrist in older adults, or those with diabetes or hypertension.

The findings suggest that eye screening could identify developing vascular damage in the brain, enabling lifestyle or drug interventions to begin earlier, when they could do most good. The findings also add to the reasons why you shouldn’t ignore pre-hypertensive and pre-diabetic conditions.

Aging successfully

In a recent news report, I talked about a study of older adults that found that their sense of control over their lives fluctuates significantly over the course of a day, and that this impacts on their cognitive abilities, including reasoning and memory.

Neglect your senses at your cognitive peril!

Untreated visual impairment significantly increases your risk of developing Alzheimer's or mild cognitive impairment.

Sensitivity to contrast appears to be an important factor underlying some instances of impaired cognitive function in older adults, adults with Parkinson's disease, and adults with Alzheimer's disease.

Contrast can be improved not only in reading material, but in living environments, and this produces significant benefits for all these groups.

Appropriate training may also help.

Other sensory impairments - hearing loss and failing sense of smell - have similarly been associated with greater risk of dementia.

Music training helps protect against age-related hearing problems.

Neglect (e.g. ignoring the messages from your senses) can be a factor in bringing about sensory deficits, and here training is particularly likely to be useful.

Impaired vision is common in old age and even more so in Alzheimer’s disease, and this results not only from damage in the association areas of the brain but also from problems in lower-level areas. A major factor in whether visual impairment impacts everyday function is contrast sensitivity.

Common health complaints increase Alzheimer's risk

Two large studies respectively find that common health complaints and irregular heartbeat are associated with an increased risk of developing Alzheimer’s, while a rat study adds to evidence that stress is also a risk factor.

A ten-year study involving 7,239 older adults (65+) has found that each common health complaint increased dementia risk by an average of about 3%, and that these individual risks compounded. Thus, while a healthy older adult had about an 18% chance of developing dementia after 10 years, those with a dozen of these health complaints had, on average, closer to a 40% chance.

It’s important to note that these complaints were not for serious disorders that have been implicated in Alzheimer’s. The researchers constructed a ‘frailty’ index, involving 19 different health and wellbeing factors: overall health, eyesight, hearing, denture fit, arthritis/rheumatism, eye trouble, ear trouble, stomach trouble, kidney trouble, bladder control, bowel control, feet/ankle trouble, stuffy nose/sneezing, bone fractures, chest problems, cough, skin problems, dental problems, other problems.

Not all complaints are created equal. The most common complaint — arthritis/rheumatism —was only slightly higher among those with dementia. Two of the largest differences were poor eyesight (3% of the non-demented group vs 9% of those with dementia) and poor hearing (3% and 6%).

At the end of the study, 4,324 (60%) were still alive, and of these, 416 (9.6%) had Alzheimer's disease, 191 (4.4%) had another sort of dementia and 677 (15.7%) had other cognitive problems (but note that 1,023 were of uncertain cognitive ability).

While these results need to be confirmed in other research — the study used data from broader health surveys that weren’t specifically designed for this purpose, and many of those who died during the study will have probably had dementia — they do suggest the importance of maintaining good general health.

Common irregular heartbeat raises risk of dementia

In another study, which ran from 1994 to 2008 and followed 3,045 older adults (mean age 74 at study start), those with atrial fibrillation were found to have a significantly greater risk of developing Alzheimer’s.

At the beginning of the study, 4.3% of the participants had atrial fibrillation (the most common kind of chronically irregular heartbeat); a further 12.2% developed it during the study. Participants were followed for an average of seven years. Over this time, those with atrial fibrillation had a 40-50% higher risk of developing dementia of any type, including probable Alzheimer's disease. Overall, 18.8% of the participants developed some type of dementia during the course of the study.

While atrial fibrillation is associated with other cardiovascular risk factors and disease, this study shows that atrial fibrillation increases dementia risk more than just through this association. Possible mechanisms for this increased risk include:

  • weakening the heart's pumping ability, leading to less oxygen going to the brain;
  • increasing the chance of tiny blood clots going to the brain, causing small, clinically undetected strokes;
  • a combination of these plus other factors that contribute to dementia such as inflammation.

The next step is to see whether any treatments for atrial fibrillation reduce the risk of developing dementia.

Stress may increase risk for Alzheimer's disease

And a rat study has shown that increased release of stress hormones leads to cognitive impairment and that characteristic of Alzheimer’s disease, tau tangles. The rats were subjected to stress for an hour every day for a month, by such means as overcrowding or being placed on a vibrating platform. These rats developed increased hyperphosphorylation of tau protein in the hippocampus and prefrontal cortex, and these changes were associated with memory deficits and impaired behavioral flexibility.

Previous research has shown that stress leads to that other characteristic of Alzheimer’s disease: the formation of beta-amyloid.

Training improves visual perception

A month-long training program has enabled volunteers to instantly recognize very faint patterns.

In a study in which 14 volunteers were trained to recognize a faint pattern of bars on a computer screen that continuously decreased in faintness, the volunteers became able to recognize fainter and fainter patterns over some 24 days of training, and this correlated with stronger EEG signals from their brains as soon as the pattern flashed on the screen. The findings indicate that learning modified the very earliest stage of visual processing.

The findings could help shape training programs for people who must learn to detect subtle patterns quickly, such as doctors reading X-rays or air traffic controllers monitoring radars, and may also help improve training for adults with visual deficits such as lazy eye.

The findings are also noteworthy for showing that learning is not confined to ‘higher-order’ processes, but can occur at even the most basic, unconscious and automatic, level of processing.

Reference: 

How the deaf have better vision; the blind better hearing

Two recent studies point to how those lacking one sense might acquire enhanced other senses, and what limits this ability.

An experiment with congenitally deaf cats has revealed how deaf or blind people might acquire other enhanced senses. The deaf cats showed only two specific enhanced visual abilities: visual localization in the peripheral field and visual motion detection. This was associated with the parts of the auditory cortex that would normally be used to pick up peripheral and moving sound (posterior auditory cortex for localization; dorsal auditory cortex for motion detection) being switched to processing this information for vision.

This suggests that only those abilities that have a counterpart in the unused part of the brain (auditory cortex for the deaf; visual cortex for the blind) can be enhanced. The findings also point to the plasticity of the brain. (As a side-note, did you know that apparently cats are the only animal besides humans that can be born deaf?)

The findings (and their broader implications) receive support from an imaging study involving 12 blind and 12 sighted people, who carried out an auditory localization task and a tactile localization task (reporting which finger was being gently stimulated). While the visual cortex was mostly inactive when the sighted people performed these tasks, parts of the visual cortex were strongly activated in the blind. Moreover, the accuracy of the blind participants directly correlated to the strength of the activation in the spatial-processing region of the visual cortex (right middle occipital gyrus). This region was also activated in the sighted for spatial visual tasks.

Learning how to hear shapes

Researchers trained blindfolded people to recognize shapes through coded sounds, demonstrating the abstract nature of perception.

We can see shapes and we can feel them, but we can’t hear a shape. However, in a dramatic demonstration of just how flexible our brain is, researchers have devised a way of coding spatial relations in terms of sound properties such as frequency, and trained blindfolded people to recognize shapes by their sounds. They could then match what they heard to shapes they felt. Furthermore, they were able to generalize from their training to novel shapes.

The findings not only offer new possibilities for helping blind people, but also emphasize that sensory representations simply require systematic coding of some kind. This provides more evidence for the hypothesis that our perception of a coherent object ultimately occurs at an abstract level beyond the sensory input modes in which it is presented.

Reference: 

[1921] Kim, J. - K., & Zatorre R. J. (2010).  Can you hear shapes you touch?. Experimental Brain Research. 202(4), 747 - 754.

Untreated vision problems linked to dementia in the elderly

Data from over 600 older adults has revealed that those with very good or excellent vision had a 63% reduced risk of dementia over the 8.5-year study period, while those with poorer vision who did not visit an ophthalmologist had a 9.5-fold increased risk of Alzheimer disease. The findings point to the need for older adults to seek treatment for their eye problems.

Data from 625 elderly Americans, followed for an average of 8.5 years, has revealed that those with very good or excellent vision at the beginning of the study had a 63% reduced risk of dementia over the study period. Those with poorer vision who did not visit an ophthalmologist had a 9.5-fold increased risk of Alzheimer disease and a 5-fold increased risk of cognitively impaired but no dementia. For the very-old (90+), 78% who maintained normal cognition had received at least one previous eye procedure compared with 51.7% of those with Alzheimer disease. The findings point to the need for older adults to seek treatment for their eye problems. The study raises the possibility that poor vision is not simply a symptom of developing dementia, but a contributing factor — possibly through its effect on curtailing activities which would help prevent it.

Reference: 

[325] Rogers, M. A. M., & Langa K. M. (2010).  Untreated Poor Vision: A Contributing Factor to Late-Life Dementia. Am. J. Epidemiol.. 171(6), 728 - 735.

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