Elaine M Tran1,2, Marcia L Stefanick3, Victor W Henderson4,5,6, Stephen R Rapp7, Jiu-Chiuan Chen8, Nicole M Armstrong9, Mark A Espeland10, Emily W Gower11,12, Aladdin H Shadyab13, Wenjun Li14, Katie L Stone15,16, Suzann Pershing1,2,17,18. 1. Byers Eye Institute at Stanford, Palo Alto, California. 2. Department of Ophthalmology, Stanford University School of Medicine, Palo Alto, California. 3. Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California. 4. Department of Epidemiology and Population Health, Stanford University, Palo Alto, California. 5. Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, California. 6. Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark. 7. Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina. 8. Department of Neurology, University of Southern California, Los Angeles. 9. Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, Maryland. 10. Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. 11. Gillings School of Global Public Health, Department of Epidemiology, University of North Carolina at Chapel Hill. 12. Department of Ophthalmology, School of Medicine, University of North Carolina at Chapel Hill. 13. Department of Family Medicine and Public Health, School of Medicine, University of California San Diego, La Jolla. 14. Department of Medicine, University of Massachusetts Medical School, Worcester. 15. California Pacific Medical Center Research Institute, San Francisco. 16. Department of Epidemiology and Biostatistics, University of California, San Francisco. 17. Veterans Affairs Palo Alto Health Care System, Palo Alto, California. 18. Department of Health Research and Policy (Health Services Research), Stanford University, Palo Alto, California.
Abstract
Importance: Dementia affects a large and growing population of older adults. Although past studies suggest an association between vision and cognitive impairment, there are limited data regarding longitudinal associations of vision with dementia. Objective: To evaluate associations between visual impairment and risk of cognitive impairment. Design, Setting, and Participants: A secondary analysis of a prospective longitudinal cohort study compared the likelihood of incident dementia or mild cognitive impairment (MCI) among women with and without baseline visual impairment using multivariable Cox proportional hazards regression models adjusting for characteristics of participants enrolled in Women's Health Initiative (WHI) ancillary studies. The participants comprised community-dwelling older women (age, 66-84 years) concurrently enrolled in WHI Sight Examination (enrollment 2000-2002) and WHI Memory Study (enrollment 1996-1998, ongoing). The study was conducted from 2000 to the present. Exposures: Objectively measured visual impairment at 3 thresholds (visual acuity worse than 20/40, 20/80, or 20/100) and self-reported visual impairment (determined using composite survey responses). Main Outcomes and Measures: Hazard ratios (HRs) and 95% CIs for incident cognitive impairment after baseline eye examination were determined. Cognitive impairment (probable dementia or MCI) was based on cognitive testing, clinical assessment, and centralized review and adjudication. Models for (1) probable dementia, (2) MCI, and (3) probable dementia or MCI were evaluated. Results: A total of 1061 women (mean [SD] age, 73.8 [3.7] years) were identified; 206 of these women (19.4%) had self-reported visual impairment and 183 women (17.2%) had objective visual impairment. Forty-two women (4.0%) were ultimately classified with probable dementia and 28 women (2.6%) with MCI that did not progress to dementia. Mean post-eye examination follow-up was 3.8 (1.8) years (range, 0-7 years). Women with vs without baseline objective visual impairment were more likely to develop dementia. Greatest risk for dementia was among women with visual acuity of 20/100 or worse at baseline (HR, 5.66; 95% CI, 1.75-18.37), followed by 20/80 or worse (HR, 5.20; 95% CI, 1.94-13.95), and 20/40 or worse (HR, 2.14; 95% CI, 1.08-4.21). Findings were similar for risk of MCI, with the greatest risk among women with baseline visual acuity of 20/100 or worse (HR, 6.43; 95% CI, 1.66-24.85). Conclusions and Relevance: In secondary analysis of a prospective longitudinal cohort study of older women with formal vision and cognitive function testing, objective visual impairment appears to be associated with an increased risk of incident dementia. However, incident cases of dementia and the proportion of those with visual impairment were low. Research is needed to evaluate the effect of specific ophthalmic interventions on dementia.
Importance: Dementia affects a large and growing population of older adults. Although past studies suggest an association between vision and cognitive impairment, there are limited data regarding longitudinal associations of vision with dementia. Objective: To evaluate associations between visual impairment and risk of cognitive impairment. Design, Setting, and Participants: A secondary analysis of a prospective longitudinal cohort study compared the likelihood of incident dementia or mild cognitive impairment (MCI) among women with and without baseline visual impairment using multivariable Cox proportional hazards regression models adjusting for characteristics of participants enrolled in Women's Health Initiative (WHI) ancillary studies. The participants comprised community-dwelling older women (age, 66-84 years) concurrently enrolled in WHI Sight Examination (enrollment 2000-2002) and WHI Memory Study (enrollment 1996-1998, ongoing). The study was conducted from 2000 to the present. Exposures: Objectively measured visual impairment at 3 thresholds (visual acuity worse than 20/40, 20/80, or 20/100) and self-reported visual impairment (determined using composite survey responses). Main Outcomes and Measures: Hazard ratios (HRs) and 95% CIs for incident cognitive impairment after baseline eye examination were determined. Cognitive impairment (probable dementia or MCI) was based on cognitive testing, clinical assessment, and centralized review and adjudication. Models for (1) probable dementia, (2) MCI, and (3) probable dementia or MCI were evaluated. Results: A total of 1061 women (mean [SD] age, 73.8 [3.7] years) were identified; 206 of these women (19.4%) had self-reported visual impairment and 183 women (17.2%) had objective visual impairment. Forty-two women (4.0%) were ultimately classified with probable dementia and 28 women (2.6%) with MCI that did not progress to dementia. Mean post-eye examination follow-up was 3.8 (1.8) years (range, 0-7 years). Women with vs without baseline objective visual impairment were more likely to develop dementia. Greatest risk for dementia was among women with visual acuity of 20/100 or worse at baseline (HR, 5.66; 95% CI, 1.75-18.37), followed by 20/80 or worse (HR, 5.20; 95% CI, 1.94-13.95), and 20/40 or worse (HR, 2.14; 95% CI, 1.08-4.21). Findings were similar for risk of MCI, with the greatest risk among women with baseline visual acuity of 20/100 or worse (HR, 6.43; 95% CI, 1.66-24.85). Conclusions and Relevance: In secondary analysis of a prospective longitudinal cohort study of older women with formal vision and cognitive function testing, objective visual impairment appears to be associated with an increased risk of incident dementia. However, incident cases of dementia and the proportion of those with visual impairment were low. Research is needed to evaluate the effect of specific ophthalmic interventions on dementia.
Authors: Aimee Teo Broman; Beatriz Munoz; Jorge Rodriguez; Rosario Sanchez; Harry A Quigley; Ronald Klein; Robert Snyder; Sheila K West Journal: Invest Ophthalmol Vis Sci Date: 2002-11 Impact factor: 4.799
Authors: Se Joon Woo; Kyu Hyung Park; Jeeyun Ahn; Jin Yeong Choe; Hyeon Jeong; Ji Won Han; Tae Hui Kim; Ki Woong Kim Journal: Ophthalmology Date: 2012-06-15 Impact factor: 12.079
Authors: Kate Dupuis; M Kathleen Pichora-Fuller; Alison L Chasteen; Veronica Marchuk; Gurjit Singh; Sherri L Smith Journal: Neuropsychol Dev Cogn B Aging Neuropsychol Cogn Date: 2014-10-17
Authors: Michael Y Lin; Peter R Gutierrez; Katie L Stone; Kristine Yaffe; Kristine E Ensrud; Howard A Fink; Catherine A Sarkisian; Anne L Coleman; Carol M Mangione Journal: J Am Geriatr Soc Date: 2004-12 Impact factor: 5.562
Authors: C M Mangione; J M Seddon; E F Cook; J H Krug; C R Sahagian; E W Campion; R J Glynn Journal: J Am Geriatr Soc Date: 1993-05 Impact factor: 5.562
Authors: J R Evans; A E Fletcher; R P L Wormald; E Siu-Woon Ng; S Stirling; L Smeeth; E Breeze; C J Bulpitt; M Nunes; D Jones; A Tulloch Journal: Br J Ophthalmol Date: 2002-07 Impact factor: 4.638
Authors: Ajay Kolli; Kristian Seiler; Neil Kamdar; Lindsey B De Lott; Mark D Peterson; Michelle A Meade; Joshua R Ehrlich Journal: Am J Ophthalmol Date: 2021-09-20 Impact factor: 5.258
Authors: Thomas J Littlejohns; Shabina Hayat; Robert Luben; Carol Brayne; Megan Conroy; Paul J Foster; Anthony P Khawaja; Elżbieta Kuźma Journal: J Gerontol A Biol Sci Med Sci Date: 2022-04-01 Impact factor: 6.591
Authors: Ajay Kolli; Michelle M Hood; Carrie Karvonen-Gutierrez; Sayoko E Moroi; Joshua R Ehrlich; Brenda W Gillespie; Sarah Dougherty Wood; David C Musch Journal: J Gerontol A Biol Sci Med Sci Date: 2021-11-15 Impact factor: 6.591
Authors: Joshua R Ehrlich; Bonnielin K Swenor; Yunshu Zhou; Kenneth M Langa Journal: J Gerontol A Biol Sci Med Sci Date: 2021-11-15 Impact factor: 6.591
Authors: Ane Murueta-Goyena; Rocío Del Pino; Marta Galdós; Begoña Arana; Marian Acera; Mar Carmona-Abellán; Tamara Fernández-Valle; Beatriz Tijero; Olaia Lucas-Jiménez; Natalia Ojeda; Naroa Ibarretxe-Bilbao; Javier Peña; Jesus Cortes; Unai Ayala; Maitane Barrenechea; Juan Carlos Gómez-Esteban; Iñigo Gabilondo Journal: Ann Neurol Date: 2020-11-09 Impact factor: 10.422