Effects of low visual acuity on neuropsychological test scores: A simulation study

Abstract

Objective: To systematically examine the effect of low visual acuity (LVA) on a number of commonly used neuropsychological tests. Method: In this study, the influence of LVA on a number of commonly used neuropsychological tests was examined in 238 healthy older adults (aged 50-80) without visual or neurological impairment. LVA was simulated using simulation glasses. Results: It was found that a simulated LVA of $0.2 (decimal acuity; Snellen 6/30 or 20/100, LogMAR 0.7) had a negative impact on test performance for the Trail Making Test, Complex Figure of Rey (copy score), and Visual Object and Space Perception battery subtest 3, but not for the Mini Mental State Examination and Balloons test. For some tests, the negative impact of LVA increased with age. Conclusions: These results have important implications for the use of neuropsychological tests in the visually impaired population. More specifically, when administering the Trail Making Test, Complex Figure of Rey (copy score), and Visual Object and Space Perception Battery subtest 3 to older people with LVA, low test scores should be interpreted with great caution. Low test scores on the Mini Mental State Examination and Balloons Test are not likely to be caused by LVA and are more likely to reflect actual cognitive impairment. The results contribute to the validity of neuropsychological assessment of older people with visual impairment, leading to more effective and more patient-based rehabilitation.

The effect of age-related macular degeneration on cognitive test performance

“…For example, screening participants with mobile vision charts (e.g., Snellen) 30 prior to participation, or administering vision-friendly variations of standard cognitive assessments (e.g., blind MOCA) 31 . While our findings specifically relate to AMD, the differences between normal and simulated conditions corroborate previous studies using paper-and-pencil tests under low visual acuity or cataract simulations 10 , 11 , 32 . The findings also align with studies assessing cognition in older clinical populations, indicating that this problem is systematic across a range of visual impairments 33 , 34 .…”

“…Since older adults with visual impairments are significantly more vulnerable to physical and mental comorbidities (i.e., Parkinson’s disease, dementia, hearing loss), a vision loss simulation with healthy, normally-sighted participants can more easily isolate vision-related effects on behaviour 8 , 9 . While simulations may never wholly replicate a visual impairment (e.g., due to patient variability in symptom presentation; underdeveloped compensatory strategies; and lack of progressive visual decline) 9 , thus far simulating vision loss has been a simple, yet valid approach to investigate the effects of visual impairments on cognition 10 , 11 . Furthermore, AMD simulations have replicated patterns of behaviour and difficulties experienced by AMD patients 9 .…”

Exploring the effect of glaucomatous visual field defects of current drivers on a neuropsychological test battery

“…This corresponds to a visual angle of at least 29°by 41°degrees, and more when the participant is leaning closer towards the paper. Research on the effects of simulated low visual acuity and cataract on TMT performance have demonstrated a negative impact on performance (Wood et al 2010;de Haan et al 2019), and the TMT has been associated scores in an on-road driving study in glaucoma patients (Bhorade et al 2016). Glaucoma patients are significantly slower on the TMT-B compared with controls (Gangeddula et al 2017).…”

“…2010; de Haan et al. 2019), and the TMT has been associated scores in an on‐road driving study in glaucoma patients (Bhorade et al. 2016).…”

Simulating Macular Degeneration to Investigate Activities of Daily Living: A Systematic Review

“…Simulation experiments have provided insights into people's behaviors and capabilities with visual impairments (Wood et al, 2010;Lehsing et al, 2019). These experiments have also been used as models for diagnostic visual assessments (de Haan et al, 2020), pilot experiments prior to testing in actual patients (Hwang et al, 2018), and as educational tools for the wider community (Juniat et al, 2019). Critically, simulations can contribute to understanding the effects of eye conditions without subjecting a person to potential risks.…”