Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0429, USA.
Am J Epidemiol. 2010 Mar 15;171(6):728-35. doi: 10.1093/aje/kwp453. Epub 2010 Feb 11.
Ophthalmologic abnormalities have been described in patients with dementia, but the extent to which poor vision and treatment for visual disorders affect cognitive decline is not well defined. Linked data from the Health and Retirement Study and Medicare files (1992-2005) were used to follow the experiences of 625 elderly US study participants with normal cognition at baseline. The outcome was a diagnosis of dementia, cognitively impaired but no dementia, or normal cognition. Poor vision was associated with development of dementia (P = 0.0048); individuals with very good or excellent vision at baseline had a 63% reduced risk of dementia (95% confidence interval (CI): 20, 82) over a mean follow-up period of 8.5 years. Participants with poorer vision who did not visit an ophthalmologist had a 9.5-fold increased risk of Alzheimer disease (95% CI: 2.3, 39.5) and a 5-fold increased risk of cognitively impaired but no dementia (95% CI: 1.6, 15.9). Poorer vision without a previous eye procedure increased the risk of Alzheimer disease 5-fold (95% CI: 1.5, 18.8). For Americans aged 90 years or older, 77.9% who maintained normal cognition had received at least one previous eye procedure compared with 51.7% of those with Alzheimer disease. Untreated poor vision is associated with cognitive decline, particularly Alzheimer disease.
眼科异常已在痴呆患者中被描述，但视力不佳和视觉障碍治疗对认知能力下降的影响程度尚不清楚。使用来自健康与退休研究和医疗保险文件（1992-2005 年）的关联数据，对 625 名基线时认知正常的美国研究参与者的经历进行了随访。结局是痴呆、认知障碍但无痴呆或认知正常的诊断。视力不佳与痴呆的发生相关（P = 0.0048）；在平均 8.5 年的随访期间，基线时视力非常好或极好的个体患痴呆的风险降低了 63%（95%置信区间：20，82）。未就诊于眼科医生的视力较差的参与者患阿尔茨海默病的风险增加了 9.5 倍（95%置信区间：2.3，39.5），认知障碍但无痴呆的风险增加了 5 倍（95%置信区间：1.6，15.9）。未经治疗的视力不佳且无先前眼部手术增加了 5 倍患阿尔茨海默病的风险（95%置信区间：1.5，18.8）。在 90 岁或以上的美国人中，77.9%保持认知正常的人至少接受过一次先前的眼部手术，而患有阿尔茨海默病的人中这一比例为 51.7%。未经治疗的视力不佳与认知能力下降有关，尤其是阿尔茨海默病。
