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T.Q. Pham, J.J. Wang, A. Kifley, P. Mitchell, Blue Mountains Eye Study; Age–Related Maculopathy and Cognitive Impairment in an Older Population . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3312.
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Purpose: Age–related maculopathy (ARM) and Alzheimer’s disease have been hypothesized to share a common pathogenesis. We aimed to assess the cross–sectional association between ARM and mini–mental state examination (MMSE) scores in an older Australian population. Methods:In the second cross–sectional survey of the Blue Mountains Eye Study (BMES), we examined 3509 persons (75.1% of survivors from the original study and 85.2% of newly eligible residents) aged 49+ years during 1997–2000. ARM lesions were assessed from retinal photographs using the Wisconsin ARM Grading System. Folstein’s mini–mental state examination (MMSE) was conducted. MMSE score was categorized as high normal (28–30, reference group), low normal (24–27) and cognitively impaired (<24). A modified MMSE was also used for analysis without vision related items and was dichotomised as normal (18–22) and cognitively impaired (0–17). Demographic, lifestyle factors and past medical histories were collected during an interview. Logistic regression models were used to assess the association between presence of ARM and cognitive impairment, adjusting for age, sex, current smoking and factors associated with cognitive impairment. Results: The prevalence (numbers with) of late ARM, early ARM, soft drusen and retinal pigment epithelial (RPE) abnormalities was 1.5% (52), 8.3% (283), 12.2% (412) and 14.5% (488), respectively. The prevalence of cognitive impairment was 18.0% in persons with late ARM and 8.4% in those with early ARM, compared to 3.0% in persons without late ARM and 2.6% in those without either early or late ARM. After adjusting for age, sex, current smoking, post–high–school qualification and alcohol consumption, persons with late ARM were more likely to have low normal MMSE scores (odds ratio, OR 2.2, 95% confidence interval, CI 1.1–4.4) and cognitive impairment (OR 4.7, CI 1.9–11.7). Using the modified MMSE, the association between late ARM and cognitive impairment remained in multivariate models (OR 2.2, CI 1.0–4.9). No significant association was found between cognitive impairment and early ARM or its component lesions (soft drusen and RPE abnormalities). Conclusions: We found a significant, cross–sectional association between late ARM and cognitive impairment among older Australians. This was weaker, but remained statistically significant, after excluding vision–related items from the MMSE instrument. Longitudinal data are needed to confirm this association.
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