Uhlmann R F, Larson E B, Koepsell T D, Rees T S, Duckert L G
Department of Medicine, University of Washington, Seattle.
J Gen Intern Med. 1991 Mar-Apr;6(2):126-32. doi: 10.1007/BF02598307.
To determine whether impaired visual acuity is associated with dementia and cognitive dysfunction in older adults.
Paired case-control comparisons of the relative frequencies of visual impairment in demented cases and nondemented controls. Cohort analyses of correlation between visual acuity and cognitive functioning in demented cases.
Internal medicine clinics at two academically affiliated medical centers.
Eighty-seven consecutively selected patients greater than or equal to 65 years of age with mild-to-moderate, clinically diagnosed Alzheimer's disease (cases) and 87 nondemented controls matched to the cases by age, sex, and education.
The prevalence of visual impairment was higher in cases than in controls [unadjusted odds ratio for near-vision impairment = 2.7 (95% CI = 1.4, 5.2); unadjusted odds ratio for far-vision impairment = 2.1 (95% CI = 1.02, 4.3); odds ratios adjusted for family history of dementia, depression, number of medications, and hearing loss were 2.5 (95% CI = 1.1, 10.5) for near-vision impairment and 1.9 (95% CI = 0.8, 4.6) for far-vision impairment]. When further stratified by quartiles of visual acuity, no statistically significant "dose-response" relationship between vision impairment and dementia risk was observed. Among cases, the degree of visual impairment was significantly correlated with the severity of cognitive dysfunction for both near and far vision (adjusted ps less than 0.001).
Visual impairment is associated with both an increased risk and an increased clinical severity of Alzheimer's disease, but the increased risk may not be consistent with a progressive dose-response relationship. Further studies are needed to determine whether visual impairment unmasks and exacerbates the symptoms of dementia or is a marker of disease severity.
确定视力受损是否与老年人的痴呆症和认知功能障碍相关。
对痴呆病例和非痴呆对照中视力损害相对频率进行配对病例对照比较。对痴呆病例中视力与认知功能之间的相关性进行队列分析。
两个学术附属医疗中心的内科诊所。
连续选取87例年龄大于或等于65岁、临床诊断为轻度至中度阿尔茨海默病的患者（病例组），以及87名在年龄、性别和教育程度上与病例组匹配的非痴呆对照。
病例组视力损害的患病率高于对照组[近视力损害的未调整比值比 = 2.7（95%可信区间 = 1.4, 5.2）；远视力损害的未调整比值比 = 2.1（95%可信区间 = 1.02, 4.3）；针对痴呆家族史、抑郁症、用药数量和听力损失进行调整后的近视力损害比值比为2.5（95%可信区间 = 1.1, 10.5），远视力损害比值比为1.9（95%可信区间 = 0.8, 4.6）]。当按视力四分位数进一步分层时，未观察到视力损害与痴呆风险之间有统计学意义的“剂量反应”关系。在病例组中，近视力和远视力的视力损害程度均与认知功能障碍的严重程度显著相关（调整后p值小于0.001）。
视力损害与阿尔茨海默病的风险增加和临床严重程度增加均相关，但风险增加可能与渐进性剂量反应关系不一致。需要进一步研究以确定视力损害是掩盖并加重了痴呆症状还是疾病严重程度的一个标志物。
