09:30-11:10 | Room 707 Saturday Onsite Presentation Session 1

Vision and Hearing Health

Session Chair: Tai Anh Vu

09:30-09:55

69202 | The Effectiveness of Auditory Rehabilitation in the Elderly: A Case Report

Chun-yi Lin, Asia University, Taiwan

Natalie Yu-Hsien Wang, Asia University, Taiwan

Pei-Chen (Peggy) Liu, Asia University, Taiwan

Background and Aims: Cognitive decline in the elderly has been linked to age-related hearing loss. This case study investigated whether auditory rehabilitation might improve auditory performance as well as cognitive functioning in the elderly with age-related hearing loss who did not wear hearing aids. Methods: The participant, LHL, was an 89-year-old female with mild bilateral hearing loss between 1000Hz – 4000Hz at 46.7 dB HL. She did not wear hearing aids and had no diagnosis of cognitive impairment. LHL took part in a four-week auditory rehabilitation program, which consisted of a one-hour training session per week. LHL received training for auditory discrimination and auditory memory. Prior to and by the end of the program, pure-tone audiometry, auditory discrimination and memory, and cognitive functioning were evaluated. For the assessment of cognition, the Mandarin Chinese version of Montreal Cognitive Assessment (MoCA) was used. Results: LHL’s hearing thresholds remained the same, and the auditory memory did not benefit from the program. However, auditory discrimination performance improved significantly, from 10% to 60% of accuracy. In terms of cognition, the MOCA score improved from 6 to 11. Conclusions and Recommendations: This study demonstrates the potential benefit of auditory rehabilitation for the elderly with mild age-related hearing loss who have not worn hearing aids. Moreover, cognitive performance is likely to be compromised by hearing loss. Based on this case, we encourage audiologists to provide aural rehabilitation for cases with mild age-related hearing loss soon after identifying hearing loss to postpone the decline of cognition.

09:55-10:20

67462 | Content Development of the VISION-Cog: A Novel Tool To Assess Cognitive Impairment in Visually Impaired Older Adults

Tai Anh Vu, Duke-NUS Medical School, Singapore

Eva Fenwick, Duke-NUS Medical School, Singapore

Kinjal Doshi, National University Hospital, Singapore

Preeti Gupta, Singapore Eye Research Institute, Singapore

Ecosse Lamoureux, Duke-NUS Medical School, Singapore

Objective: We describe the content development of the VISually Independent test battery Of NeuroCOGnition (VISION-Cog)–a new diagnostic tool to evaluate cognitive impairment (CI) in visually impaired older Asian adults.

Method: The qualitative content development phase consisted of 2 iterative stages: a neuropsychological consultation and literature review (Stage 1) and an expert-panel discussion (Stage 2). In Stage 1, we investigated currently available test batteries for CI in visually impaired and their limitations, and construct our preliminary test battery. We then deliberated this battery during an expert-panel discussion (Stage 2) to decide, via agreement of the experts, the content of a pilot neuropsychological battery.

Result: The two-stage process resulted in a pilot VISION-Cog consisting of 9 vision-independent neuropsychological tests, including the Modified Spatial Memory Test, List Learning, List Recall & List Recognition, Adapted Token Test, Semantic Fluency, Modified Spatial Analysis, Verbal Subtests of the Frontal Battery Assessment, Digit Symbol, Digit Span Forwards, and Digit Span Backwards. These tests encompassed 5 cognitive domains–memory and learning, language, executive function, complex attention, and perceptual-motor. The expert panel made suggestions to improve the clarity of test instructions and ensure culturally relevant test content. These suggestions were incorporated and iteratively pilot-tested by the study team until no further issues emerged.

Conclusion: We have developed a 5-domain and 9-test VISION-Cog pilot instrument capable of replacing vision-dependent diagnostic batteries and aiding the clinician-based diagnosis of CI in visually impaired older adults. Subsequent phases will examine the VISION-Cog’s feasibility, comprehensibility, and acceptability; and evaluate its diagnostic performance.

10:20-10:45

67463 | Pilot Testing of the VISION-Cog: A Novel Tool to Diagnose Cognitive Impairment in Visually Impaired Older Adults

Tai Anh Vu, Duke-NUS Medical School, Singapore

Eva Fenwick, Duke-NUS Medical School, Singapore

Kinjal Doshi, National University Hospital, Singapore

Preeti Gupta, Singapore Eye Research Institute, Singapore

Ecosse Lamoureux, Duke-NUS Medical School, Singapore

Objective: We pilot-tested the VISually Independent test battery Of NeuroCOGnition (VISION-Cog) to determine its feasibility, comprehensibility, and acceptability in evaluating cognitive impairment (CI) in visually impaired older Asian adults.

Method: The VISION-Cog was iteratively fine-tuned through pilot studies and expert-panel discussion. In the first pilot study (Stage 1), we recruited 15 visually impaired and cognitively normal participants aged ≥ 60 years to examine the pilot VISION-Cog’s feasibility (length of time to administer), comprehensibility (clarity of instructions), and acceptability (participant burden). We then presented the pilot results to the expert panel (Stage 2) who decided via agreement on a revised version of the VISION-Cog. Subsequently, we conducted a second pilot study (Stage 3) to ascertain improvement in feasibility, comprehensibility, and acceptability of the revised version.

Result: The VISION-Cog was deemed feasible, taking approximately 60 minutes to complete. All participants agreed that the test instructions were clear and the battery did not cause undue discomfort or frustration. The data collector rated all tests as very user-friendly. Minor modifications to the pilot VISION-Cog were suggested by the panel to improve its safety, clarity of instructions, and cultural relevance. These suggestions were incorporated and iteratively tested in the second pilot study until no further issues emerged.

Conclusion: Using an iterative mixed-methods process, we have developed a feasible, comprehensible, and acceptable 5-domain and 9-item visually independent VISION-Cog test battery suitable to assist CI diagnosis in older adults with visual impairment. We will assess its diagnostic potential against clinician-based assessment of CI in subsequent phases.

10:45-11:10

68099 | Psychiatric Problems in

Impaired Vision in Elderly Patient

Andri Andri, Krida Wacana Christian University, Indonesia

Impaired vision in elderly patients does have an extraordinary psychological impact. Losing sight for some patients is frightening and often triggers psychiatric problems. Several cases of visual impairment in practice are associated with the onset of symptoms of severe mental disorders such as depressive disorders and anxiety disorders. We found several cases of visual disturbances such as glaucoma and retinal disorders which often lead to sleep problems, anxiety disorders and depression. A 75 years old male patient with glaucoma and difficulty in sleeping that made him more anxious and a 67 year old female patient with retinopathic diabetic with declining of vision after surgery. Both patients complained about how they were not satisfied with their opthamologist and felt so much regret about the operation. The male patient was treated with Ativan 1mg (lorazepam) since he felt much worry initiating sleeping. It worked for him. He did not stand for the side effects of antidepressant and refused to use it.The female patients had persistent symptoms of anxiety. She was given Escitalopram 5mg and Clobazam 5mg twice a day to relieve the symptoms and it worked for her. Both patients still continued the medications until this report was made. They rejected the psychological intervention and just wanted to do the medication.

11:25-12:15 | Room 707