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A new focus for Alzheimer’s patients

Researchers finding disease is exacerbated by vision loss

Stephen Morse, 62, is in the early stages of Alzheimer’s. Stephen Morse, 62, is in the early stages of Alzheimer’s. (Pat Greenhouse/Globe Staff)
By Carolyn Y. Johnson
Globe Staff / August 10, 2009

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The devastating memory gaps of Alzheimer’s disease often conceal a less well known impairment: a type of vision loss that a growing body of research shows may make people seem less mentally competent than they actually are.

Scientists at Boston University and elsewhere are now testing whether they could improve the lives of people with Alzheimer’s by helping them see better, using low-tech interventions such as colored dinner plates, oversize change purses, and special bingo cards.

A vision deficit may seem trivial when the backdrop is a terrifying disease that alters people’s personalities, destroys their memory, and robs them of their independence. But researchers believe that small changes, such as making sure patients can see a light switch or the edge of a stair, could have important consequences for their independence and quality of life.

“Let’s say you put keys down on the counter and can’t find them. People say, ‘Of course she can’t find them - she has Alzheimer’s.’ Well, what if she can’t see them?’’ said Alice Cronin-Golomb, a BU psychology professor who has done leading work on vision in Alzheimer’s disease.

Alzheimer’s patients have difficulty picking up on certain kinds of visual contrast - one researcher compared it to wearing sunglasses indoors and squinting. The changes are thought to be related to the brain deterioration that robs people of their memories.

The vision loss does not show up on a typical eye exam, however, so when a patient can’t correctly name an object in a drawing or can’t follow a TV program, the problem may be blamed on memory, when it really is eyesight.

Stephen Morse, an ebullient 62-year-old in the early stages of Alzheimer’s, said he doesn’t know why he has begun having trouble reading.

A few years ago, when the Milton resident was fired from his job at an architectural firm, he wasn’t sure what was wrong. He was aware he had taken to writing down everything, and he knew he was making mistakes. When he once got on the highway going the wrong way, Morse recalled, “I just said, ‘Wrong exit! I’m stupid!’ I didn’t think anything of it.’’

Morse was eventually diagnosed with Alzheimer’s, and has been heavily involved with clinical trials, including the BU research. He is firmly committed to doing anything he can to understand the disease - whether it gives him a cure or just the ability to more easily read a menu.

In a series of experiments, researchers at BU and collaborators have looked at how cranking up contrast could enhance people’s perception. One study found that by serving dinner on a red plate - increasing the visual contrast between the food and the background - a small group of men with advanced Alzheimer’s disease ate more. Another found that increasing the contrast of a line drawing reduced the number of errors Alzheimer’s patients made when they named the picture.

Now, Cronin-Golomb is testing whether simple, cheap steps could improve a patient’s functioning. She is studying, for example, whether varying pill’s color against a particular floor helps patients pick it up.

“Baking, bingo, trying to pick out change out of a purse, trying to pick up a pill that dropped on the floor . . . they’re not essential to live, but they’re pretty essential to operate in society,’’ said Tracy Dunne, a lecturer in psychology at BU who hopes to take the findings out of the lab to help patients and caregivers.

One of the BU group’s collaborators, Grover C. Gilmore, dean of the Mandel School of Applied Social Sciences at Case Western Reserve University, has found that healthy adults were able to identify letters faster than Alzheimer’s patients. Normally, such a delay might be chalked up to memory problems. But when he increased the visual contrast, he found that the difference between the two groups disappeared.

“I remember coming out of my lab and saying, ‘I cured Alzheimer’s disease,’ ’’ Gilmore said. While such interventions would, of course, not reverse patients’ mental decline, he added, “It’s very important to draw a distinction between their competence and their performance.’’

The greater awareness of the ways in which vision deficits may exacerbate the memory loss of Alzheimer’s disease has also focused greater attention on problems that may have previously been overlooked in a patient population facing a much more dire prognosis.

This summer, Gilmore and colleagues received a $2.9 million grant from the National Institutes of Health to evaluate whether people with Alzheimer’s would benefit from cataract surgery, a procedure that is not always seen as necessary for a patient with memory problems.

“The phrase I’ve often heard is, ‘What’s the point?’ ’’ said Gilmore.

People have spent years working on understanding the visual deficits that Alzheimer’s patients have, but the studies ongoing today carry the hope of real-life interventions.

A rule of thumb may be that if you want a person to be able to see something, use bold contrasting colors. At a support group for Alzheimer’s patients, for example, Gilmore recalls a caretaker approaching him with a concern that his mother kept bumping into the dining room table. Gilmore offered a simple explanation: because of the disease, she didn’t remember bumping into the table, and because of the vision problems, she couldn’t distinguish between the edge of the dark wood table and the carpet beneath.

The answer Gilmore suggested was simple: a white tablecloth.

Carolyn Y. Johnson can be reached at cjohnson@globe.com.