The Evolving Role of Ophthalmology Clinics in Screening for Early Alzheimer’s Disease: A Review

Abstract

Alzheimer’s disease (AD) is the leading cause of dementia, which is a growing public health concern. Although there is no curative treatment for established AD, early recognition and modification of the known risk factors can reduce both severity and the rate of progression. Currently, an early diagnosis of AD is rarely achieved, as there is no screening for AD. The cognitive decline in AD is gradual and often goes unnoticed by patients and caregivers, resulting in patients presenting at later stages of the disease. Primary care physicians (general practitioners in the UK) can administer a battery of tests for patients presenting with memory problems and cognitive impairment, however final diagnosis of AD is usually made by specialised tertiary level clinics. Recent studies suggest that in AD, visuospatial difficulties develop prior to the development of memory problems and screening for visuospatial difficulties may offer a tool to screen for early stage AD. AD and cataracts share common risk and predisposing factors, and the stage of cataract presentation for intervention has shifted dramatically with early cataract referral and surgical intervention becoming the norm. This presentation offers an ideal opportunity to administer a screening test for AD, and visuospatial tools can be administered at post-operative visits by eye clinics. Abnormal findings can be communicated to primary care physicians for further follow up and assessment, or possible interventions which modify risk factors such as diabetes, hypertension and obesity can be undertaken. We propose that eye clinics and ophthalmology facilities have a role to play in the early diagnosis of AD and reducing the burdens arising from severe dementia.

Glaucoma Is Not Associated With Alzheimer's Disease or Dementia: A Meta-Analysis of Cohort Studies

“…It has to be mentioned that although our findings did not support that glaucoma is an independent risk factor for subsequent development of AD, in view of the lack of effective strategies for early screening of AD before the occurrence of memory dysfunction ( 41 ), ophthalmologic examinations remain of potential as early screening tools for AD. With the development of novel techniques such as retinal optical coherence tomography ( 42 , 43 ) and nanomaterial biosensors ( 44 ), it could be expected that eye clinics and ophthalmology facilities may play important roles in the early diagnosis of AD and subsequent reducing the burdens arising from severe dementia ( 45 ).…”

Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis

“…We included six reviews 10,[35][36][37][38][39] and 12 primary studies [40][41][42][43][44][45][46][47][48][49][50][51] in this section.…”

“…46 Although the common model in the UK is for people with memory problems to be identified in primary care and referred to a memory clinic for more detailed assessment, primary care-led services are available in some areas. Three included studies [47][48][49] focused on screening and diagnosis, and the topic of different service models is discussed in more detail below (see Chapter 8). An evaluation of primary care-led services in Bristol found that, in practice, GPs rarely made independent diagnoses of dementia.…”

“…48 A need for specialist support with diagnosis was also identified in a study aimed at developing a multidisciplinary memory clinic in south-western Sydney, NSW, Australia. 49 Eye clinics have been suggested as an alternative setting for screening, 47 but this approach does not appear to have been tested.…”

“…Four studies 33,47,112,113 researched the role of other services in early or increasing diagnosis of people with MCI. These studies included primary care services, such as cancer clinics and an ophthalmology clinic.…”