随着年龄的增长，听力和视力障碍越来越普遍。在70岁之后，超过三分之二的人有很大的听力和/或视力问题。痴呆症也与年龄密切相关；超过90年的人中有三分之一患有痴呆症。不幸的是，在痴呆症患者中，听力和视力障碍尚未得到识别，并且无法治疗。当感觉障碍与认知困难同时发生时，对个体的影响会放大：依赖性可能会增加，认知能力下降可能更快，沟通问题更大。这个increases the risk of social isolation以及发展ir妄（混乱状态）和具有挑战性的行为（例如躁动，侵略）。最终，痴呆症患者的生活质量下降，护理费用增加。尽管如此，还是将听力和视力障碍作为一种经济有效的方式解决的机会improve outcomes对于老年人来说很重要。改善感官障碍以改善心理健康是我们欧洲委员会资助的Horizo​​n 2020计划的关键目标。SENSE-Cog’.

What we did

Our journey with SENSE-Cog started in 2016 in the response to the call for proposals under the banner of ‘Mental Wellbeing for Older People.’ Based on this, we gathered 27 investigators from across Europe, representing a range of disciplines, including hearing, vision, and cognitive health, and the fields of epidemiology, health economics, biostatistics, and clinical trial design. Together,我们决定检查链接among hearing, vision, and cognitive health, with a view to clinical applications. Inour new studyinBMC老年人, we consulted with people living with dementia (n=18) and their care partners (n=15) in the UK, Cyprus, and France to determine the best approach to improving the lives of people with dementia with co-occurring hearing and vision problems. Several key themes emerged, including: (1) the need to improve our methods of assessment of cognition in people with hearing and vision problems and (2) the possibility of improving quality of life in dementia by improving hearing and vision health.

The lack of valid and reliable assessment tools … was a significant unmet need.

Challenges identified

Our qualitative data revealed three areas of difficulty for persons with dementia (PwD) and their care partners, illustrated here with quotations.

First, hearing, vision, and cognitive assessments were not appropriately addressed to the complex needs of PwD and sensory comorbidity:

I know what she got it wrong [in the assessment], I knew the ones she can’t do […], you’ve got to draw a diagram, which will be inside a box, and […] I know she can’t do it, she can’t. But I mean that’s it, I got nothing, I got nothing else. Just a score.(Care partner)

Second, PwD commonly experienced challenges in communication and conveying unmet needs and concerns to care partners and professionals, across domains:

[我的病]教会了我听人们的声音。如果他们在跟我说话，您知道，真正听他们说的话，我想有些人，我不会说普遍，但有些人不听你对他们说的话。因此，如果我想知道我必须听。（PWD）

第三，有关该疾病支持的信息和指导在评估中不足：

研究员：所以没有什么解释？

Care partner:[…] yes more explanatory, this might have happened because there are different doctors and they are very busy…

研究员：neither for how to take care…

Care partner:他们必须通知我们更多。

From our consultations, it was clear that the lack of valid and reliable assessment tools for assessing cognition in people with sensory impairments and for assessing hearing and vision in people with cognitive impairments was a significant unmet need.

有痴呆症或患有痴呆症的人通常不会报告听力和视力障碍。同样，有听力和视力问题的人通常很难完成认知评估测试，因为大多数这些测试依靠完整的听力和视野。

Responding to unmet needs

We then attempted to address these outstanding needs by (i) developing and validating new cognitive assessments specifically adapted for people with hearing or vision impairment and (ii) developing and evaluating a home-based ‘sensory support intervention’ to improve quality of life and other outcomes for people with dementia.

评估开发工作中心围绕蒙特利尔认知评估（MOCA）的替代形式被开发和验证对于有听力或视力障碍的人。基于家庭的干预涉及对痴呆症患者的个性化感官支持的听力和愿景的评估，并由感官支持者提供。治疗师的额外支持有助于助听器和眼镜的摄取，正确使用和维护。治疗师还提供有关改善人们家中感官环境的建议；这可能涉及更好的照明，降噪或解决声学问题。最后，治疗师还为护理伙伴教授沟通技巧，并在需要时将痴呆症患者指导到社区支持和服务。干预是通过几个利益相关者的投入而开发的，并在三个国家进行了现场审查。现在正在确定评估随机控制的临床在五个欧洲国家的审判。

在整个Sense-Cog计划中，患者及其护理伙伴的需求和观点一直是中心。所有工作的设计和行为都由五个欧洲城市的“研究用户团体”网络告知，包括患有痴呆症或感觉障碍的人及其护理伙伴.

下一步是什么？

Sense-COG将提供经过验证的认知评估，适用于听力和视力障碍，以提高诊断的可靠性。它还将为基于感觉的干预措施提供证据基础，以改善痴呆症患者的结局，并为临床医生和护理人员的临床实践指南提供听力，视力和认知健康的临床实践指南。此外，Sense-Cog项目正在对不断增长的感觉认知健康领域的全球研究和临床社区产生动力和兴趣。我们未来的工作包括将感官支持干预转化为其他环境，包括低收入和中等收入国家（Sense-Cog亚洲）和护理（护理）家庭环境（Sense-Cog护理）。