COGNITIVE STATUS IN ELDERLY PATIENTS WITH CATARACT, GLAUCOMA AND MACULAR DEGENERATION: NOSOLOGY-SPECIFIC PATTERNS AND PREDICTORS OF MILD COGNITIVE IMPAIRMENT

Introduction. Elderly ophthalmic patients are increasingly recognised as a cognitively vulnerable population, yet the mechanisms linking specific eye diseases to cognitive decline remain insufficiently characterised. This study compared cognitive profiles in elderly patients with age-related cataract, primary open-angle glaucoma (POAG) and age-related macular degeneration (AMD), and identified independent predictors of mild cognitive impairment (MCI).

Methods. Prospective parallel-group study (2024–2025; n=263, age ≥60): cataract (n=125), POAG (n=52), AMD (n=36), controls (n=50). Nosology-adapted instruments: full MoCA for cataract and controls; T-MoCA (telephone version, no visuospatial tasks) for POAG and AMD. Additional tools: MMSE, FAB, HADS. Statistics: Spearman correlation, Baron–Kenny mediation analysis (bootstrap 5,000 iterations), multivariate logistic regression with ROC analysis.

Results. MCI was found in 69.6% (cataract), 75.0% (POAG) and 80.6% (AMD) vs 24.0% in controls (p<0.001). Three nosology-specific patterns emerged: a reversible sensory pattern in cataract (ρ BCVA↔MoCA=+0.41; p<0.001); a neurodegenerative pattern in POAG with stage-related decline (T-MoCA: stage I 20.4±2.1 → stage III 17.2±2.7; p=0.031), stable over 12 months; and a psycho-emotional pattern in AMD, where depression (HADS-D) fully mediated the BCVA→T-MoCA association (bootstrap 95% CI excludes 0; ρ=−0.51). In the neovascular AMD subgroup, HADS-D reduction on anti-VEGF therapy correlated with T-MoCA improvement (+1.1 points; p=0.031). An MCI prediction model (AUC=0.79) included BCVA, POAG stage, HADS-D, age and education.

Conclusions. Cognitive decline in elderly ophthalmic patients follows distinct, nosology-specific pathways requiring differentiated clinical management. Routine cognitive screening adapted to visual status should be integrated into geriatric ophthalmic practice, with depression correction prioritised in AMD and neurocognitive monitoring in POAG.