Association of Vision Impairment With Cognitive Decline Across Multiple Domains in Older Adults

Varadaraj, Varshini; Muñoz, Beatriz; Deal, Jennifer A.; An, Yang; Albert, Marilyn; Resnick, Susan M.; Ferrucci, Luigi; Swenor, Bonnielin K.

doi:10.1001/jamanetworkopen.2021.17416

Cited by 42 publications

(31 citation statements)

References 49 publications

(91 reference statements)

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“…Recent systematic reviews and meta-analyses found that VI was significantly associated with cognitive impairment in cross-sectional and longitudinal studies [ 16 , 17 ]. In a longitudinal cohort study, it was found that worse visual acuity at baseline was associated with greater declines in language and memory domains of cognitive function [ 18 ]. Although the causality between the VI and cognitive impairment remains to be investigated, the value of screening elders for visual impairment and optimizing their vision could potentially contribute to the prevention of cognitive decline.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of a community-based vision care programme for the elderly

et al. 2022

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Background This study evaluated the real-world effectiveness and potential cost-effectiveness of a community-based vision care programme for the elderly population aged 60 years or above. Methods Data from a total of 8899 subjects participating in a community-based comprehensive vision care programme from 2015 to 2019 were analysed to evaluate the effectiveness of the programme in terms of the prevalence of distance visual impairment (VI), the change in the prevalence of distance VI after refractive error correction, and the types of ocular disorders suspected. Distance VI was defined as a) visual acuity (VA) worse than 6/18 in any eye (worse eye) and b) VA worse than 6/18 in the better eye. The cost-effectiveness from the funder’s perspective was also estimated in terms of cost per distance VI avoided. Results Based on the presenting vision of the worse eye, the prevalence of distance VI was 39.1% (3482/8899, 95% CI: 38.1%-40.1%) and reduced to 13.8% (1227/8899, 95% CI: 13.1%-14.5%) based on best-corrected VA. Referenced to the presenting vision of the better eye, the prevalence of distance VI was 17.3% (1539/8899, 95% CI: 16.5%-18.1%) and decreased to 4.2% (373/8899, 95% CI: 3.8%-4.6%) with best optical correction. Uncorrected refractive error was the major cause of presenting distance VI. From the funder’s perspective, the cost per distance VI case prevented was HK$1921 based on VA in the worse eye and HK$3715 based on the better eye. Conclusion This community-based programme identified distance VI in the best eye of 17 out of every 100 subjects. With appropriate new or updated distance optical corrections, distance VI was reduced to about 4 in 100 subjects. Visual impairment in the elderly is common even in a relatively affluent city. A model of care which could minimise avoidable distance VI would bring benefits at individual and societal levels.

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Section: Discussionmentioning

confidence: 99%

An evaluation of a community-based vision care programme for the elderly

et al. 2022

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“…This is in contrast to 4 longitudinal studies and one meta-analysis that have found a relationship between VI and cognitive function [12][13][14]53,54 and 1 study that found a relationship between visual acuity, used as a continuous variable, and cognitive decline. 55 Furthermore, several studies have found a relationship between VI and dementia or cognitive impairment [56][57][58][59][60] although not all. 61 Of note, some of these studies used cognitive tests that relied on vision without removing the visual items (MMSE, 3 MS).…”

Section: Discussionmentioning

confidence: 99%

Visual Impairment, Eye Disease, and 3-Year Cognitive Decline: The Canadian Longitudinal Study on Aging

Grant

Aubin

Buhrmann

et al. 2021

Ophthalmic Epidemiology

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Purpose: To examine the longitudinal association between vision-related variables and the 3-year change in cognitive test scores in a community-dwelling sample of adults and to explore whether sex, education, or hearing loss act as effect modifiers. Methods: Data came from two waves of a 3-year population-based prospective cohort study (Canadian Longitudinal Study on Aging), which consisted of 30,097 randomly selected people aged 45-85 years from 7 Canadian provinces. Visual impairment (VI) was defined as binocular presenting visual acuity worse than 20/40. Participants were asked if they had ever had a diagnosis of age-related macular degeneration (AMD), glaucoma, or cataract. Cognitive change over 3 years was examined by calculating the difference between baseline and follow-up scores for the Rey Auditory Verbal Learning Test (RAVLT) and the RAVLT delayed test (memory tests), the Controlled Oral Word Association Test (COWAT) and the Animal Naming Test (ANT) (verbal fluency tests), and the Mental Alternation Test (MAT) (processing speed test). Multiple linear regression was used. Results: VI, AMD, and cataract were not associated with 3-year changes on any of the 5 cognitive tests after adjusting for age, sex, ethnicity, education, income, smoking, diabetes, stroke, heart disease, and province. A report of glaucoma was associated with greater declines in MAT scores (β = -0.60, 95% CI -1.03, -0.18). No effect modification was detected. Conclusions: Glaucoma was associated with worsening processing speed. Further research to confirm this finding and to understand the possible reason is necessary.

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“…Just to provide an example, it was demonstrated that sensory functions impairments have a direct role in cognitive aging, since good sensory functions, with particular regard to visual task, were found strongly predictive of the cognitive performance (Glass, 2007). Interestingly, each visual function has a different impact on cognitive impairment, with contrast sensitivity seeming to have the strongest relationship with cognitive tests scores (Varadaraj et al, 2021). It is worth of notice that glaucomatous patients are characterized by significantly higher impairment of contrast sensitivity, with respect to normal aging (McKendrick et al, 2007).…”

Section: Cognitive Impairment In Glaucomamentioning

confidence: 99%

Cognitive Dysfunctions in Glaucoma: An Overview of Morpho-Functional Mechanisms and the Impact on Higher-Order Visual Function

Arrigo

Aragona

Saladino

et al. 2021

Front. Aging Neurosci.

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Background: Glaucoma is a chronic, vision-threatening disease, and a major cause of legal blindness. The current view is no longer limited to the progressive optic nerve injury, since growing evidence strongly support the interpretation of glaucoma as a complex neurodegenerative disease. However, the precise pathogenic mechanisms leading to the onset and progression of central nervous system (CNS) impairment, and the functional consequences of this damage, are still partially understood. The main aim of this review is to provide a complete and updated overview of the current knowledge regarding the CNS involvement in glaucoma, and the possible therapeutic perspectives.Methods: We made a careful survey of the current literature reporting all the relevant findings related to the cognitive dysfunctions occurring in glaucoma, with specific remarks dedicated on the higher-order visual function impairment and the possible employment of neuroprotective agents.Results: The current literature strongly support the interpretation of glaucoma as a multifaceted chronic neurodegenerative disease, widely affecting the CNS. The cognitive impairment may vary in terms of higher-order functions involvement and in the severity of the degeneration. Although several neuroprotective agents are currently available, the development of new molecules represents a major topic of investigation for future clinical trials.Conclusions: Glaucoma earned the right to be fully considered a neurodegenerative disease. Glaucomatous patients may experience a heterogeneous set of visual and cognitive symptoms, progressively deteriorating the quality of life. Neuroprotection is nowadays a necessary therapeutic goal and a future promising way to preserve visual and cognitive functions, thus improving patients’ quality of life.

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Association of Vision Impairment With Cognitive Decline Across Multiple Domains in Older Adults

Cited by 42 publications

References 49 publications

An evaluation of a community-based vision care programme for the elderly

An evaluation of a community-based vision care programme for the elderly

Visual Impairment, Eye Disease, and 3-Year Cognitive Decline: The Canadian Longitudinal Study on Aging

Cognitive Dysfunctions in Glaucoma: An Overview of Morpho-Functional Mechanisms and the Impact on Higher-Order Visual Function

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