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Systematic Diagnostic Error of Dementia in Old Age through Cataract-caused losses of Intelligence?
1Lehrl S., 2Gerstmeyer K.,
1Friedrich-Alexander-Universität, Klinik für Psychiatrie und Psychotherapie, Bereich Medizinische Psychologie und Medizinische Soziologie (Erlangen)
2Augenklinik Minden (Minden)
Purpose: Several clinical investigations comprising many thousand persons suggest a reduced intelligence level in seniors with diagnostically unspecified visual problems. In particular fluid intelligence is concerned reflecting the actual mental efficiency. Less affected is the stored experience, the acquired knowledge (= crystallized intelligence). We had measured directly the fluid intelligence in seniors with cataract. Pre-operatively their intelligence was considerably reduced and post-operatively improved. These intelligence changes reach such a degree that there emerged the suspicion that not seldom cataract-caused intelligence losses might be confounded with the cognitive impairment, the guiding symptom of dementia in old age (multiinfarction type, Alzheimer´s type, and mixed type). At last many a patient could be assessed falsely in neuropsychiatry. Because of its importance this suspicion is to be examined more profoundly.
Method: Comparisons of the judged and psychometrically measured symptoms and searches in literature by means of Medline and SCI.
Results: Essential features of dementia in old age found in ICD 10 overlap with the psychic properties of cataract-patients. In the guiding feature nowadays frequently measured by the test MMSE the IQ losses caused by cataract according to our findings are interpreted as dementia of medium severeness. This facilitates false allocations to dementia. In given dementias the severeness will considerably be overestimated. The found publications did not report those confusions. However, in comparison to controls they substantiated statistical associations between prevalence of cataract and dementia in seniors.
Conclusions: The cognitive impairments in lately acquired cataract and its related losses in everyday activities and social contacts favour the false diagnosis "dementia in old age" and the overestimation of the degree of severeness. Because of the high frequency of senile cataract and dementia in age (about 25 % of 80 years old persons) the false assessments might be frequent. In those cases successful cataract-surgery may lower or even abolish the demential symptoms within a few weeks.