University of California San Francisco, Department of Ophthalmology, San Francisco, California; Stanford University School of Medicine, Stanford, California.
Stanford University School of Medicine, Stanford, California.
Ophthalmology. 2021 Sep;128(9):1276-1283. doi: 10.1016/j.ophtha.2021.02.021. Epub 2021 Feb 27.
Although visual impairment (VI) has been associated with worse cognitive performance among older adults, the temporal relationship between the 2 remains subject to debate. Our objective was to investigate the longitudinal impact of VI on cognitive function and vice versa.
Retrospective, time-to-event study.
National Health and Aging Trends Study (NHATS) participants from 2011 to 2018 cycles.
A total of 10 676 participants aged 65 years and older were included. Cox proportional hazards regression models evaluated the impact of baseline VI on subsequent dementia and impact of baseline dementia on subsequent VI. Models were adjusted for potential confounding variables, including demographics, clinical comorbidities, and hearing and physical function limitations.
Hazard ratio (HR) for incident dementia among participants with baseline self-reported VI and HR for incident VI among participants with baseline dementia.
Of the 10 676 participants included in the analysis, approximately 40% were aged 65-74 years, 40% were aged 75-84 years, and the remaining 20% were aged 85 years and older. The majority were female (59%), and 68% self-identified as non-Hispanic White. Among participants with normal cognitive status at baseline, subsequent dementia was observed in 1753 (16%), and among participants with normal self-reported vision at baseline, subsequent VI was reported in 2371 (22%). In adjusted regression models, participants with baseline VI had higher likelihood of developing dementia over subsequent follow-up (HR, 2.3; 95% confidence interval [CI], 2.0-2.6; P < 0.001). Likewise, participants with baseline dementia had a higher likelihood of developing self-reported VI over time (HR, 2.5; 95% CI, 2.2-2.8; P < 0.001).
Self-reported VI in the US Medicare population is associated with greater dementia likelihood over time, and dementia is similarly associated with greater VI likelihood over time. Associations are likely multifactorial and bidirectional and could be explained by intervening variables in the path from VI to dementia, or vice versa, or by common risk factors for pathological processes in both eyes and brain. These findings suggest the need for early identification of older adults with visual compromise and consideration of visual disability in the cognitively impaired.
尽管视力障碍（VI）与老年人认知表现较差有关，但两者之间的时间关系仍存在争议。我们的目的是研究 VI 对认知功能的纵向影响，反之亦然。
回顾性、事件时间研究。
来自 2011 年至 2018 年周期的国家健康老龄化趋势研究（NHATS）参与者。
共纳入 10676 名 65 岁及以上的参与者。Cox 比例风险回归模型评估了基线 VI 对随后发生痴呆的影响，以及基线痴呆对随后发生 VI 的影响。模型调整了潜在的混杂变量，包括人口统计学、临床合并症以及听力和身体功能限制。
基线自我报告 VI 的参与者中发生痴呆的风险比（HR），以及基线痴呆的参与者中发生 VI 的 HR。
在纳入分析的 10676 名参与者中，约 40%的年龄在 65-74 岁之间，40%的年龄在 75-84 岁之间，其余 20%的年龄在 85 岁及以上。大多数参与者为女性（59%），68%自我认定为非西班牙裔白人。在基线认知状态正常的参与者中，随后有 1753 人（16%）发生痴呆，在基线自我报告视力正常的参与者中，随后有 2371 人（22%）出现 VI。在调整后的回归模型中，基线 VI 的参与者在随后的随访中更有可能发生痴呆（HR，2.3；95%置信区间[CI]，2.0-2.6；P<0.001）。同样，基线痴呆的参与者随着时间的推移更有可能出现自我报告的 VI（HR，2.5；95%CI，2.2-2.8；P<0.001）。
美国医疗保险人群中自我报告的 VI 与较长时间内更高的痴呆可能性相关，而痴呆也与较长时间内更高的 VI 可能性相关。这些关联可能是多因素的、双向的，可能是 VI 向痴呆发展或反之的中间变量所解释，或者是眼睛和大脑中病理过程的共同危险因素所解释。这些发现表明需要早期识别视力受损的老年人，并在认知受损的老年人中考虑视力障碍。
