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Stephanie Chen, Suzann Pershing; Longitudinal impact of visual impairment on cognitive function in the US. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5167.
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While visual impairment has been shown to be associated with worse cognitive performance in the US population of older adults, the temporal relationship between the two remains unclear. We performed a time-to-event study of Medicare beneficiaries to investigate the longitudinal impact of visual impairment on cognitive function.
We used the National Health and Aging Trends Study (NHATS), 2011-2015 cycles. A total of 7,075 participants aged 65 years and older were included. Cox proportional hazards models with time-varying covariates were constructed to evaluate the impact of self-reported visual impairment on probable or possible dementia, as classified per NHATS protocol. Regression models were adjusted for potential confounding variables, including demographics, clinical risk factors, and hearing and physical function impairments; p<0.05 was considered statistically significant.
At the initial survey, of the 7,075 participants included in the analysis, the largest proportion (39%) were between 75-84 years of age (Table 1). The majority were female (60%) and 69% self-identified as non-Hispanic White. Dementia was observed in 1,114 (16%) respondents. In the crude regression analysis, participants with self-reported visual impairment were at significantly higher risk of developing probable or possible dementia over subsequent followup (HR=4.4, CI: 3.9-5.0, p<0.001), compared to those without visual impairment. This association persisted after full adjustments for covariates (HR=2.1, CI: 1.8-2.5, p<0.001). Similar results were found for distance as well as near vision.
Using time-to-event analysis, self-reported visual impairment in the US Medicare population may be associated with greater risk of cognitive decline, suggesting a need for early identification of older adults with visual compromise.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
Table 1. Baseline Demographic Characteristics of Participants (2011), n=7,075 * Percentages may not equal 100% due to missing values
Table 2. Cox Proportional Hazards Models of Self-Reported Visual Impairment for Dementia Status †Models sequentially adjusted for demographics (age, gender, race/ethnicity, education level, and annual household income); clinical risk factors (diabetes, hypertension, coronary heart disease, myocardial infarction, and stroke); and hearing and physical function impairments ‡HR: hazards ratios for dementia vs. no dementia; HRs are reported with 95% confidence intervals (CI)
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