Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Social Environment and Health Program, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
Int J Geriatr Psychiatry. 2024 Jul;39(7):e6123. doi: 10.1002/gps.6123.
Sensory impairment is a hypothesized risk factor for cognitive decline; however, the psychosocial pathways are not well understood. We evaluated whether the association between visual impairment (VI) and cognitive decline was partially mediated via depressive symptoms, loneliness, or social activity.
We used data from 2601 older adults enrolled in the Memory and Aging Project in 1997 and the Minority Aging Research Study in 2004 with neuropsychological tests across five domains measured annually for up to 16 years. VI was assessed with the Rosenbaum Pocket Vision Screener. Depressive symptoms, loneliness, and social activity were self-reported using validated scales. We used structural equation models to estimate the associations of VI with baseline and change in cognitive function, directly and indirectly through each mediator (depressive symptoms, loneliness, and social activity). We evaluated mediation via "psychological distress" using a latent variable combining depressive symptoms and loneliness.
The association between VI and global cognitive decline was mediated via lower social activity (indirect effect) [95% confidence interval (CI)] of linear slope: -0.025 (-0.048, -0.011), via loneliness (-0.011 [95% CI: -0.028, -0.002]), and via psychological distress (-0.017 [95% CI: -0.042, -0.003]). We did not find sufficient evidence for mediation via depressive symptoms alone.
The harmful effect of VI on cognitive decline may be partially mediated through loneliness and lower social activity.
感觉障碍是认知能力下降的一个假设风险因素；然而，其心理社会途径尚不清楚。我们评估了视力障碍（VI）与认知能力下降之间的关联是否部分通过抑郁症状、孤独感或社会活动来介导。
我们使用了 1997 年参加记忆与衰老项目和 2004 年参加少数族裔衰老研究的 2601 名老年人的数据，这些老年人每年接受五个领域的神经心理学测试，最长可达 16 年。使用 Rosenbaum 口袋视力筛查器评估 VI。使用经过验证的量表评估抑郁症状、孤独感和社会活动。我们使用结构方程模型来估计 VI 与认知功能基线和变化之间的直接和间接关联，通过每个中介物（抑郁症状、孤独感和社会活动）来间接关联。我们使用结合抑郁症状和孤独感的潜在变量来评估“心理困扰”的中介作用。
VI 与整体认知能力下降的关联通过较低的社会活动（间接效应）[95%置信区间（CI）]呈线性斜率介导：-0.025（-0.048，-0.011），通过孤独感（-0.011 [95% CI：-0.028，-0.002]）和心理困扰（-0.017 [95% CI：-0.042，-0.003]）。我们没有发现充分的证据表明仅通过抑郁症状来介导。
VI 对认知能力下降的有害影响可能部分通过孤独感和较低的社会活动来介导。
