Li Melissa, Hamedani Ali G
Departments of Neurology, Ophthalmology, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
J Neuroophthalmol. 2025 Jun 1;45(2):131-136. doi: 10.1097/WNO.0000000000002235. Epub 2024 Aug 16.
Visual impairment is a risk factor for cognitive impairment and hallucinations in older adults, but associations with other neuropsychiatric symptoms (NPS) of dementia have not been examined.
We analyzed cross-sectional data from the Aging, Demographics, and Memory Study (ADAMS), a nationally representative sample of the US population aged 70+ years. Vision was measured by self-report and using a near card. Dementia was ascertained through cognitive testing with expert consensus, and NPS were screened using the Neuropsychiatric Inventory. We used logistic regression to measure the association between visual impairment and prevalent NPS adjusting for sociodemographic factors and comorbidities. Analyses incorporated sample weights to account for the complex survey design of ADAMS.
Of 624 participants with dementia, 332 (53%) had self-reported visual impairment and 193 (31%) had best-corrected acuity of 20/40 or worse. In unadjusted models, self-reported visual impairment was significantly associated with hallucinations (OR 2.88; 95% CI 1.12-7.44), depression (OR 2.79; 95% CI 1.7-4.57), and agitation (OR 1.61; 95% CI 1.05-2.48). Reduced visual acuity was associated with hallucinations (OR 10.13; 95% CI 2.93-34.98), psychosis (OR 6.69, 95% CI 2.53-17.7), and mania (OR 5.92, 95% CI 1.77-19.82). However, these associations did not remain significant after covariate adjustment.
Visual impairment was associated with hallucinations, depression, agitation, psychosis, and mania in patients with dementia, but at least some of this relationship is explained by age, comorbidities, and other factors.
视力障碍是老年人认知障碍和幻觉的一个风险因素，但与痴呆症的其他神经精神症状（NPS）之间的关联尚未得到研究。
我们分析了来自老龄化、人口统计学和记忆研究（ADAMS）的横断面数据，该研究是美国70岁及以上人群具有全国代表性的样本。视力通过自我报告和使用近视力卡片进行测量。通过认知测试并经专家共识确定痴呆症，使用神经精神科问卷筛查NPS。我们使用逻辑回归来测量视力障碍与常见NPS之间的关联，并对社会人口学因素和合并症进行了调整。分析纳入了样本权重以考虑ADAMS复杂的调查设计。
在624名痴呆症患者中，332名（53%）自我报告有视力障碍，193名（31%）最佳矫正视力为20/40或更差。在未调整的模型中，自我报告的视力障碍与幻觉（比值比2.88；95%置信区间1.12 - 7.44）、抑郁（比值比2.79；95%置信区间1.7 - 4.57）和激越（比值比1.61；95%置信区间1.05 - 2.48）显著相关。视力下降与幻觉（比值比10.13；95%置信区间2.93 - 34.98）、精神病（比值比6.69，95%置信区间2.53 - 17.7）和躁狂（比值比5.92，95%置信区间1.77 - 19.82）相关。然而，在进行协变量调整后，这些关联不再显著。
视力障碍与痴呆症患者的幻觉、抑郁、激越、精神病和躁狂相关，但这种关系至少部分可由年龄、合并症和其他因素来解释。
