Joshua R Ehrlich1,2, Jenna Goldstein3, Bonnie K Swenor4,5,6, Heather Whitson7,8, Kenneth M Langa2,9,10,11, Phillip Veliz2,12. 1. Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor. 2. Institute for Social Research, University of Michigan, Ann Arbor. 3. University of Michigan Medical School, Ann Arbor. 4. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland. 5. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. 6. Disability Health Research Center, Johns Hopkins University, Baltimore, Maryland. 7. Geriatric Medicine Division, Duke University School of Medicine, Durham, North Carolina. 8. Geriatric Research Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina. 9. Department of Internal Medicine, University of Michigan, Ann Arbor. 10. Department of Health Management and Policy, University of Michigan, Ann Arbor. 11. Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan. 12. University of Michigan School of Nursing, Ann Arbor.
Abstract
Importance: Dementia prevention is a high priority, given the large impact of dementia on the well-being of individuals and society. The number of older adults with dementia in the US and globally is projected to increase as a result of population aging and growth. Thus, it is vital to identify potentially modifiable dementia risk factors. Vision impairment has been identified as a risk factor for accelerated cognitive decline and incident dementia. An estimated 90% of vision impairment is preventable or has yet to be treated. Nevertheless, vision impairment has not been included in the dominant life-course models of dementia risk factors used to shape public health policy and research priorities. Objective: To strengthen an existing model of potentially modifiable dementia risk factors through the inclusion of vision impairment and to estimate the contributions of those risk factors in the US population. Design, Setting, and Participants: Population-based, cross-sectional study using data from the 2018 round of the Health and Retirement Study. Analyses were conducted from March 11 through September 24, 2021. The study population was a probability sample of US adults aged 50 years and older. Exposures: Potentially modifiable dementia risk factors, including vision impairment. Main Outcomes and Measures: The estimated population attributable fractions (PAFs) of dementia associated with vision impairment and other dementia risk factors were calculated. The PAF represents the number of cases of dementia that would potentially be prevented if a risk factor were eliminated. Results: The probability sample from the Health and Retirement Study included 16 690 participants (weighted demographic characteristics: 54.0% female, 52.0% age ≥65, 10.6% Black, 80% White, and 9.2% identified as other [including American Indian or Alaska Native, Asian, and Hawiian Native or Pacific Islander, although specific data were not available]). The 12 dementia risk factors in the PAF model were associated with an estimated 62.4% of dementia cases in the US. The risk factor with the highest weighted PAF for dementia was hypertension (12.4%). The PAF of vision impairment was 1.8%, suggesting that more than 100 000 prevalent dementia cases in the US could potentially have been prevented through healthy vision. Conclusions and Relevance: Existing life-course models of potentially modifiable dementia risk factors may consider including vision impairment. Since a large majority of vision impairment can be treated with cost-effective but underused interventions, this may represent a viable target for future interventional research that aims to slow cognitive decline and prevent incident dementia.
Importance: Dementia prevention is a high priority, given the large impact of dementia on the well-being of individuals and society. The number of older adults with dementia in the US and globally is projected to increase as a result of population aging and growth. Thus, it is vital to identify potentially modifiable dementia risk factors. Vision impairment has been identified as a risk factor for accelerated cognitive decline and incident dementia. An estimated 90% of vision impairment is preventable or has yet to be treated. Nevertheless, vision impairment has not been included in the dominant life-course models of dementia risk factors used to shape public health policy and research priorities. Objective: To strengthen an existing model of potentially modifiable dementia risk factors through the inclusion of vision impairment and to estimate the contributions of those risk factors in the US population. Design, Setting, and Participants: Population-based, cross-sectional study using data from the 2018 round of the Health and Retirement Study. Analyses were conducted from March 11 through September 24, 2021. The study population was a probability sample of US adults aged 50 years and older. Exposures: Potentially modifiable dementia risk factors, including vision impairment. Main Outcomes and Measures: The estimated population attributable fractions (PAFs) of dementia associated with vision impairment and other dementia risk factors were calculated. The PAF represents the number of cases of dementia that would potentially be prevented if a risk factor were eliminated. Results: The probability sample from the Health and Retirement Study included 16 690 participants (weighted demographic characteristics: 54.0% female, 52.0% age ≥65, 10.6% Black, 80% White, and 9.2% identified as other [including American Indian or Alaska Native, Asian, and Hawiian Native or Pacific Islander, although specific data were not available]). The 12 dementia risk factors in the PAF model were associated with an estimated 62.4% of dementia cases in the US. The risk factor with the highest weighted PAF for dementia was hypertension (12.4%). The PAF of vision impairment was 1.8%, suggesting that more than 100 000 prevalent dementia cases in the US could potentially have been prevented through healthy vision. Conclusions and Relevance: Existing life-course models of potentially modifiable dementia risk factors may consider including vision impairment. Since a large majority of vision impairment can be treated with cost-effective but underused interventions, this may represent a viable target for future interventional research that aims to slow cognitive decline and prevent incident dementia.
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