Joshua R Ehrlich1,2, Tochukwu Ndukwe3, Sandy Chien4, Jinkook Lee4,5,6. 1. Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA, joshre@med.umich.edu. 2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA, joshre@med.umich.edu. 3. University of Michigan Medical School, Ann Arbor, Michigan, USA. 4. Center for Economic & Social Research, University of Southern California, Los Angeles, California, USA. 5. Department of Economics, University of Southern California, Los Angeles, California, USA. 6. RAND Corporation, Santa Monica, California, USA.
Abstract
INTRODUCTION: Due to population aging, India is poised to experience a large increase in the burden of both dementia and vision impairment (VI). Prior studies from other settings suggest that VI may be a modifiable risk factor for cognitive decline and dementia. However, to date, no studies have examined the association of impaired visual acuity and cognition in India. METHODS: A total of 3,784 participants in wave 1 of the population-based Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India underwent visual acuity testing and a cognitive test battery. Multivariable linear regression was used to model the cross-sectional associations of mild (<6/12-6/16), moderate (<6/18-6/60), and severe visual acuity impairment/blindness (<6/60) with cognitive performance scores corresponding to total cognition, orientation, memory, language/fluency, executive function, and informant-reported cognitive status. Models were adjusted for demographic, socioeconomic, and health characteristics. RESULTS: The weighted percentage of participants with any VI was 52.6%. VI was independently associated with lower cognitive scores across all domains, even after adjustment for known dementia risk factors. In fully adjusted models of total cognition (mean score: 130.7), mild, moderate, and severe VI/blindness were associated with a significant change of -3.5 (95% CI: -6.3, -0.6), -8.2 (95% CI -10.5, -5.6), and -16.8 (95% CI -22.3, -11.3) units, respectively. A dose-response association between level of VI and cognitive function was observed for all cognitive outcomes except for language/fluency domain scores. Associations were robust when cognitive tests dependent on visual function were excluded. Across each fully adjusted model of total, domain-specific, and informant-reported cognitive performance, moderate VI was equivalent to 5-9 years of cognitive aging. DISCUSSION/ CONCLUSION: This study illustrates that VI is cross-sectionally associated with lower cognitive performance, largely in a dose-response pattern, across various cognitive domains in the Indian population. These findings are important for informing future longitudinal and interventional studies.
INTRODUCTION: Due to population aging, India is poised to experience a large increase in the burden of both dementia and vision impairment (VI). Prior studies from other settings suggest that VI may be a modifiable risk factor for cognitive decline and dementia. However, to date, no studies have examined the association of impaired visual acuity and cognition in India. METHODS: A total of 3,784 participants in wave 1 of the population-based Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India underwent visual acuity testing and a cognitive test battery. Multivariable linear regression was used to model the cross-sectional associations of mild (<6/12-6/16), moderate (<6/18-6/60), and severe visual acuity impairment/blindness (<6/60) with cognitive performance scores corresponding to total cognition, orientation, memory, language/fluency, executive function, and informant-reported cognitive status. Models were adjusted for demographic, socioeconomic, and health characteristics. RESULTS: The weighted percentage of participants with any VI was 52.6%. VI was independently associated with lower cognitive scores across all domains, even after adjustment for known dementia risk factors. In fully adjusted models of total cognition (mean score: 130.7), mild, moderate, and severe VI/blindness were associated with a significant change of -3.5 (95% CI: -6.3, -0.6), -8.2 (95% CI -10.5, -5.6), and -16.8 (95% CI -22.3, -11.3) units, respectively. A dose-response association between level of VI and cognitive function was observed for all cognitive outcomes except for language/fluency domain scores. Associations were robust when cognitive tests dependent on visual function were excluded. Across each fully adjusted model of total, domain-specific, and informant-reported cognitive performance, moderate VI was equivalent to 5-9 years of cognitive aging. DISCUSSION/ CONCLUSION: This study illustrates that VI is cross-sectionally associated with lower cognitive performance, largely in a dose-response pattern, across various cognitive domains in the Indian population. These findings are important for informing future longitudinal and interventional studies.
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