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 Vision, Hearing Loss, And Anticholinergics May Pass As Cognitive Decline, Researchers Say

Early screening to detect and treat vision and hearing problems, and  jettisoning anticholinergic drugs, may help protect seniors from false diagnoses of pre-dementia cognitive impairment, St. Louis University researchers are claiming.

Researchers at St. Louis University and St. Louis’ Veterans Affairs hospital looked at two sets of cognitive function tests of 223 elderly veterans, one set taken in 2003 and the other set in 2010-11. Of those men whose cognitive functions improved from the 2003 test, the decisive factors seemed to be having been treated for vision problems and having ended anticholinergic medication courses, the researchers found.

Anticholinergic drugs are nerve agents used to treat an array of problems from the gastrointestinal to urinary tracts. Among their myriad side effects, however, are confusion, disorientation, and memory problems.

“This study provides significant evidence supporting the importance of evaluating medical causes in persons who screen positive for mild cognitive deficits…” corresponding author Dulce Cruz-Oliver writes for the team in the September issue of the Journal of the American Medical Directors Association. “The ability to significantly improve early detection rates will help formulate the treatment plans and approaches to patients with mild cognitive deficit.” 

For many experts, mild cognitive deficit can be an early warning of ongoing dementia, usually Alzheimer’s disease. Cruz-Oliver’s findings suggest that some of her colleagues may be ringing alarm bells too soon. 

Among those men whose test scores receded from “severe” impairment to “mild,” half had received dementia therapy, one-third had some kind of hearing loss correction, and one-third had dropped anticholinergic drugs, Cruz-Oliver says. Of those who went from “mild” to “no” impairment, nearly 31 percent had dropped the drugs, almost 28 percent had some kind of hearing loss correction, and more than 22 percent had some kind of visual impairment corrected, Cruz-Oliver says. 

“The ability to significantly improve early detection rates will help formulate the treatment plans and approaches to patients with mild cognitive deficit,” Cruz-Oliver says. 

Cruz-Oliver’s findings are likely to add weight to the work of German cognitive scientist Michael Ramscar. Earlier this year, Ramscar and his colleagues denounced as “a myth” the idea that seniors’ brains slow down as they age. Without a diagnosed pathology (such as Alzheimer’s), Ramscar’s team argued, doctors should be careful about assuming cognitive decline. 

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.

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