Question: Should I really bother having my mother get her cataracts repaired if she isn’t able to read because of her Alzheimer’s disease?
Answer: Most definitely. Optimizing hearing and vision for the person with dementia is a valuable and important contribution to care. It makes obvious sense that if a person cannot see, or struggles to hear, they are less likely to attend to information or understand it, and as a result they are less likely to remember. There is good research to suggest that hearing and vision problems are common sources of “excess disability” – a term meant to describe worse cognitive and functional impairment as a result of causes beyond the degree of dementia pathology per se.
Ensuring vision and audiology assessments have been completed is a simple and relatively painless process for most patients and caregivers. Wearing appropriate eye glasses is also a fairly simple intervention with good compliance. Arranging for cataract surgery, may be more challenging, but given the increasing simplicity and excellent tolerability of the surgery, mild to moderate dementia should definitely not be seen as a barrier to improving vision through this procedure. Dealing with hearing loss can be more problematic. Not all types of hearing loss can be improved by hearing aids, and hearing aids can be very difficult to use, or can be poorly tolerated for some people with dementia. While I always recommend consultation with an audiologist, for some patients however, use of a “pocket talker” can be a simple and inexpensive alternative that might be better tolerated than traditional hearing aids.
Regardless of the difficulty involved in optimizing hearing and vision, these interventions are well worth the effort. For example, a recent study in elderly people suggested that wearing hearing aids improved performance on cognitive testing compared to people who didn’t wear hearing aids, even though the group who wore hearing aids had worse hearing. Sensory impairment has also been associated with emotional symptoms like depression in people with dementia. Perhaps even more surprising, psychotic symptoms such as visual hallucinations (seeing things that aren’t there) and auditory hallucinations (hearing imaginary voices) have been associated with vision and hearing problems in people with dementia. Most importantly, there are reports that some of these symptoms can be improved when hearing and vision are improved.