Charles Bonnet syndrome in older adults with age-related macular degeneration: Its relationship to depression and mild cognitive impairment

Abstract

Older adults are prone to have multiple chronic health conditions. The purpose of this study was to investigate whether older adults with age-related macular degeneration (AMD) who experience Charles Bonnet syndrome (CBS) are at a higher risk of developing depression and mild cognitive impairment (MCI).A total of 42 participants (31 females, 11 males; age: 68-99 years, M = 85.5 years; visual acuity [VA] in the better eye ranging from 20/70 to 20/1200) diagnosed with AMD were recruited in a vision rehabilitation center. They completed the Montreal Cognitive Assessment (MoCA) in its blind version, the Geriatric Depression Scale, and responded to questions designed to determine whether they experienced visual hallucinations consistent with CBS. Participants were then categorized into whether or not they experienced CBS, were at risk of depression or were at risk of MCI.Participants in the group experiencing CBS did not statistically show a higher likelihood of developing depression and/or MCI than those without CBS. Overall, the risk of depression (30%) was consistent with previous studies. In our sample of 42 older adults with visual impairment, 62% failed the MoCA suggesting they were at risk of cognitive decline.Our study was not able to replicate previous reports of a possible relationship between CBS and MCI in older adults with AMD; however, the observed level of possible cognitive impairment warrants further investigation. Future studies should include participants with other ocular pathologies to investigate whether a relationship among CBS, MCI, and/or depression may exist independently of AMD.

Prevalence of Charles Bonnet syndrome in patients with age‐related macular degeneration: systematic review and meta‐analysis

“…(), Boxerman et al. (), Gordon (), and Roh et al. () recruited patients with AMD from vision rehabilitation centres and found that CBS was rather prevalent.…”

“…Vojnikovi c et al (2010) The participants were asked if they had CBS or any visual hallucinations. Methodological approach or definition of CBS was not described in detail Boxerman et al (2014) Patients were asked a series of questions regarding the presence of unusual visual experiences, and if they said yes, additional questions were asked to describe the visual experiences, whether the image was static or dynamic, how the individual felt about the visions, and whether they had disclosed having hallucinations to others. Depending on how the patients answered to the questions, they were categorized into group of CBS or non-CBS Brown & Murphy (1992) Patients were asked of descriptions of visual experiences and specifically whether patients saw formed visual images that were not present.…”

“…The authors also investigated prevalence of CBS and found no significant relationship between the presence of CBS and difference in visionrelated quality of life (Roh et al 2018). Lannon et al (2006), Gilmour et al (2009), Boxerman et al (2014, Gordon (2016), and Roh et al (2018) recruited patients with AMD from vision rehabilitation centres and found that CBS was rather prevalent. Those with CBS had lower BCVA (Gilmour et al 2009).…”

Cognitive impairment and Charles Bonnet syndrome: a prospective study

“…Thus, this outcome was also not met. This is in keeping with other studies in the condition (Schultz and Melzack, ; Holroyd and Rabins, ; Boxerman et al ., ) which also found no evidence of deteriorated cognitive performance among CBS patients. Only two studies have claimed to detect cognitive deficits in participants with CBS.…”

“…The principal limitation is the small sample size, something the study shares with previous work (Schultz and Melzack, 1993;Holroyd and Rabins, 1996;Pliskin et al, 1996;Graham et al, 2011;Boxerman et al, 2015). Recruitment to the study proved challenging; only 17% of those screening positive for complex hallucinations were recruited and completed all study measures.…”