Abstract
Purpose :
Previous studies have reported an association between vision impairment (VI) and cognitive health. Specifically, VI is associated with the development of cognitive impairment, a clinical precursor to dementia. However, most older adults with VI will not develop cognitive impairment or dementia. This study sought to determine whether the association of VI with incident cognitive impairment varies by ε4 carrier status of the Apolipoprotein E gene, a strong genetic risk factor for cognitive decline and dementia.
Methods :
We used data from the population-based Aging, Demographics and Memory Study (ADAMS), which included adults aged 70 years and older. Vision impairment was defined as vision worse than 20/40 in the better seeing eye. Participants underwent a consensus panel assessment of cognitive function and were categorized as cognitively normal, cognitive impairment no dementia (CIND), or dementia. We constructed a Cox proportional hazards model to estimate the joint effects of VI and APOE-ε4 on the development of CIND among participants who were cognitively normal at baseline. Models were adjusted for age, sex, education, medical comorbidities, and for the competing risk of death.
Results :
There were 196 participants included in this analysis. Both VI (HR=2.0, 95% CI 1.3-3.2) and APOE-ε4 (HR=1.7, 95% CI 1.2-2.6) were independently associated with incident CIND. The joint effect of VI and APOE-ε4 on incident CIND (HR=5.7, 95% CI 2.8-11.6) was significantly elevated compared to having no VI and no APOE-ε4 allele. However, there was no increase in the hazard of CIND among those with only VI or the APOE-ε4 allele (Figure).
Conclusions :
The hazard of incident CIND among older adults with VI was elevated only among those who were carriers of the APOE-ε4 gene variant. These findings may be important for risk stratification and for targeting interventions to those at greatest risk.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.