Cognitive impairment in age-related macular degeneration and geographic atrophy.
OBJECTIVE
To investigate cognitive function in patients with early and late age-related macular degeneration (AMD) compared with an elderly, community-dwelling Korean population without AMD.


METHODS
Case-control study.


METHODS
We enrolled 170 AMD patients and 190 non-AMD community-based controls.


METHODS
A comprehensive battery for cognitive function evaluation consisting of 15 psychological tests, including a depression evaluation test, was used. Cognitive function scores were adjusted for age, gender, education, and visual acuity (VA). We categorized AMD as early AMD, exudative AMD, or geographic atrophy.


METHODS
The primary outcome measure was the degree of cognitive impairment, as assessed by the Korean versions of the Consortium to Establish a Registry for Alzheimer's Disease Neuropsychological Assessment Battery, Benton Visual Retention Test, and Digit Span Test Forward and Backward.


RESULTS
Patients with AMD showed lower global cognition scores than did normal controls (mean Mini-Mental State Examination [MMSE] score, 24.97 vs 25.99; P<0.001). Among cognitive functions, visuospatial function, verbal memory, visual memory, and frontal function were impaired in AMD patients relative to normal controls. The rate of mild cognitive impairment (MCI) was higher in AMD patients than in controls (52.4% vs 26.8%; P<0.001), with an odds ratio (OR) of 3.127 (95% confidence interval, 1.855-5.271) after adjustment for age, education, and VA. Geographic atrophy was associated with the highest risk of MCI (OR, 4.431; 95% confidence interval, 1.413-13.898) and a clinically significant reduction in MMSE scores (23.42) relative to the controls. There was a trend of worsening cognitive function test scores from the controls to the early AMD, then the exudative AMD, and finally the geographic atrophy patients, after adjustment for covariates. AMD patients with poor VA (≤20/100) had 6 times the risk of MCI as AMD patients with good or moderate VA (>20/100).


CONCLUSIONS
Patients with AMD, especially those with the geographic atrophy subtype, are at greater risk for cognitive impairment than are non-AMD control subjects. In the visual rehabilitation of AMD patients, potential cognitive impairment should be taken into consideration.
Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Korea.
Se Joon
SJ
Woo
Kyu Hyung
KH
Park
Jeeyun
J
Ahn
Jin Yeong
JY
Choe
Hyeon
H
Jeong
Ji Won
JW
Han
Tae Hui
TH
Kim
Ki Woong
KW
Kim
D000368:Aged; D016022:Case-Control Studies; D003071:Cognition / Q000502:physiology; D060825:Cognitive Dysfunction / Q000209:etiology* / Q000503:physiopathology; D004522:Educational Status; D005260:Female; D057092:Geographic Atrophy / Q000150:complications* / Q000503:physiopathology; D015577:Geriatric Assessment; D006801:Humans; D007223:Infant; D007361:Intelligence Tests; D008268:Macular Degeneration / Q000150:complications* / Q000503:physiopathology; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors; D014792:Visual Acuity / Q000502:physiology