Document Detail


A low-vision rehabilitation program for patients with mild cognitive deficits.
MedLine Citation:
PMID:  23619914     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
IMPORTANCE: We are unaware of any standardized protocols within low-vision rehabilitation (LVR) to address cognitive impairment.
OBJECTIVE: To design and pilot-test an LVR program for patients with macular disease and cognitive deficits.
DESIGN: The Memory or Reasoning Enhanced Low Vision Rehabilitation (MORE-LVR) program was created by a team representing optometry, occupational therapy, ophthalmology, neuropsychology, and geriatrics. This pilot study compares outcomes before and after participation in the MORE-LVR program.
SETTING: Eligible patients were recruited from an LVR clinic from October 1, 2010, through March 31, 2011.
PARTICIPANTS: Twelve patients completed the intervention, and 11 companions attended at least 1 training session.
INTERVENTION: Key components of the MORE-LVR intervention are as follows: (1) repetitive training with a therapist twice weekly during a 6-week period, (2) simplified training experience addressing no more than 3 individualized goals in a minimally distracting environment, and (3) involvement of an informal companion (friend or family member).
MAIN OUTCOME MEASURES: Version 2000 National Eye Institute Vision Function Questionnaire-25; timed performance measures, Telephone Interview for Cognitive Status-modified(TICS-m), Logical Memory tests, satisfaction with activities of daily living, and goal attainment scales.
RESULTS: Twelve patients without dementia (mean age, 84.5 years; 75% female) who screened positive for cognitive deficits completed the MORE-LVR program. Participants demonstrated improved mean (SD) scores on the National Eye Institute's Visual Function Questionnaire-25 composite score (47.2 [16.3] to 54.8 [13.8], P = .01) and near-activities score (21.5 [14.0] to 41.0 [23.1], P = .02), timed performance measures (writing a grocery list [P = .03], filling in a crossword puzzle answer [P = .003]), a score indicating satisfaction with independence (P = .05), and logical memory (P = .02). All patients and companions reported progress toward at least 1 individualized goal; more than 70% reported progress toward all 3 goals.
CONCLUSIONS AND RELEVANCE: This pilot study demonstrates feasibility of an LVR program for patients with macular disease and mild cognitive deficits. Participants demonstrated improvements in vision-related function and cognitive measures and expressed high satisfaction. Future work is needed to determine whether MORE-LVR is superior to usual outpatient LVR for persons with coexisting visual and cognitive impairments.
Authors:
Heather E Whitson; Diane Whitaker; Guy Potter; Eleanor McConnell; Fay Tripp; Linda L Sanders; Kelly W Muir; Harvey J Cohen; Scott W Cousins
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  JAMA ophthalmology     Volume:  131     ISSN:  2168-6173     ISO Abbreviation:  JAMA Ophthalmol     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-07-12     Completed Date:  2013-10-25     Revised Date:  2014-07-02    
Medline Journal Info:
Nlm Unique ID:  101589539     Medline TA:  JAMA Ophthalmol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  912-9     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living
Aged
Aged, 80 and over
Cognition Disorders / rehabilitation*
Education of Visually Disabled / organization & administration*
Female
Humans
Intelligence Tests
Male
Pilot Projects
Program Evaluation*
Retinal Diseases / rehabilitation
Sickness Impact Profile
Vision, Low / rehabilitation*
Visually Impaired Persons / rehabilitation*
Grant Support
ID/Acronym/Agency:
5P30AG028716/AG/NIA NIH HHS; K23 AG032867/AG/NIA NIH HHS; K23 AG032867/AG/NIA NIH HHS; K23 MH087741/MH/NIMH NIH HHS; MH087741/MH/NIMH NIH HHS; P30 AG028716/AG/NIA NIH HHS
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