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.

Keywords:

• Low vision
• neuropsychological assessment
• validity
• aging
• diagnostics

Acknowledgments

The authors gratefully acknowledge all participants, as well as the psychology students involved in participant recruitment and data collection. We thank orthoptist Nadine Naumann and clinical physicist visual system Bart Melis-Dankers of Royal Dutch Visio, Haren, The Netherlands, for their help in creating the simulation glasses and further support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Programmaraad Visuele Sector (no grant number appointed). The data that support the findings of this study are available from the corresponding author, GH, upon reasonable request.