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G.S. Rubin, A.T. Broman, B. Munoz, K.A. Turano, K. Bandeen-Roche, S.K. West, SEE Project Team; The Interaction of Vision and Cognition as Predictors of Self-Reported Disability: SEE Study . Invest. Ophthalmol. Vis. Sci. 2003;44(13):988.
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Purpose: Age-related vision loss is associated with increased self-reported disability. The purpose of this study is to determine the impact of concomitant changes in cognitive function and to investigate interactions between visual and cognitive deficits. Methods: A population-based sample of 1505 persons between the ages of 72 – 92 was enrolled in the third round of the Salisbury Eye Evaluation (SEE) study. Visual acuity, contrast sensitivity, and visual fields were measured with standardized procedures that have been described previously. Cognitive function was assessed with a standardized test battery that included the Useful Field of View, Trails A and B, Hopkins Verbal Learning Test, Boston Naming Test, and the Brief Test of Attention. Self-reported disability was assessed with the Activities of Daily Vision Scale (ADVS). Currently, 1025 participants have been enrolled in the fourth round of SEE, two years following round three. Cross sectional and longitudinal associations were tested with multiple regression analyses adjusted for age, race, and gender. Longitudinal analyses were also adjusted for baseline ADVS. Results: Eighty four percent of participants were able to complete all tests. Those without complete data were generally older, with worse visual and cognitive performance. Cross sectionally, the ADVS score was strongly associated with all three vision measures (p< .0001), and with the Trails tests of divided attention (p< .0001) and the Boston Naming test of verbal fluency (p< .0001). There was a significant interaction between the vision and verbal fluency tests (p< .001). Among those in the upper quartile on verbal fluency there was a substantial impact of poor vision on ADVS score (e.g. an 18 point ADVS difference between upper and lower quartile for contrast sensitivity). However among those in the lower quartile on fluency there was little additional impact of poor vision on disability (e.g. less than four points between upper and lower quartile for contrast sensitivity). Longitudinally, changes in overall ADVS score were associated with changes in all vision measures and with the Trails tests of divided attention. Conclusions: In an older population, poor vision and cognition are associated with self-reported disability. Furthermore, changes in vision and cognition over a two-year interval predict changes in disability. The data suggest that the impact of vision loss may be greater in those with higher levels of cognitive function.
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