Shandong Provincial ENT Hospital, School of Public Health, Shandong University, Jinan, Shandong, China.
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
BMC Med. 2024 Nov 7;22(1):518. doi: 10.1186/s12916-024-03748-7.
Epidemiological studies show inconsistent links between hearing/vision impairment and dementia risk. Using multisource data, we investigated how single or combined sensory impairments relate to risks of all-cause and specific types of dementia.
We employed a triangulation approach combining three methodologies. We analyzed 90,893 UK Biobank (UKB) adults to explore single and joint effects of hearing and vision impairments on all-cause and Alzheimer's disease (AD), vascular dementia (VD) and non-AD non-VD (NAVD). A meta-analysis of prospective studies involving 937,908 participants provided stronger evidence. Finally, we conducted Mendelian randomization (MR) analysis using genome-wide association studies from UKB (361,194 participants) and FinnGen (412,181 participants) to validate relationships between sensory impairments and dementia occurrence.
In the UKB cohort study, compared to participants with normal hearing, those in the mild and severe hearing impairment groups had progressively and significantly higher risk of all-cause dementia (mild: HR1.52, 95%CI 1.31-1.77; severe: HR1.80, 95%CI 1.36-2.38), AD (mild: HR1.63, 95%CI 1.30-2.04; severe: HR2.18, 95%CI 1.45-3.27), VD (mild: HR1.68, 95%CI 1.19-2.37; severe: HR1.47, 95%CI 1.22-1.78), and NAVD (mild: HR1.47, 95%CI 1.22-1.78; severe: HR1.98, 95%CI 1.43-2.75). Besides, vision impairment was associated with an increased risk of all-cause dementia (HR1.55, 95%CI 1.18-2.04) and NAVD (HR1.51, 95%CI 1.07-2.13). Furthermore, dual sensory impairment was associated with stepwise increased risks of all-cause and cause-specific dementia than single hearing or vision impairment. In the meta-analysis of 31 prospective cohort studies, risks of all-cause dementia and AD were elevated in participants with single hearing impairment (all-cause dementia: HR1.30, 95%CI 1.21-1.40; AD: HR1.30, 95%CI 1.21-1.40) and dual sensory impairment (all-cause dementia: HR1.63, 95%CI1.14-2.12; AD: HR 2.55, 95%CI 1.19-3.91), while single vision impairment only associated with higher risk of all-cause dementia (HR1.43, 95%CI 1.16-1.71) but not AD. Finally, the MR analysis revealed a significant association between hearing impairment and all-cause dementia (OR1.74, 95%CI 1.01-2.99), AD (OR1.56, 95%CI 1.09-2.23), and NAVD (OR1.14, 1.02-1.26), as well as vision impairment and NAVD (OR1.62, 95%CI 1.13-2.33).
Our findings showed significant associations between hearing and vision impairments and increased risks of all-cause and cause-specific dementia. Standardized hearing and vision assessment and intervention should be emphasized in dementia prevention strategies.
流行病学研究表明，听力/视力障碍与痴呆风险之间的联系不一致。本研究使用多源数据，调查了单一或联合感官障碍与全因和特定类型痴呆的风险之间的关系。
我们采用了一种结合了三种方法的三角测量方法。我们分析了 90893 名英国生物库（UKB）成年人，以探讨听力和视力障碍对全因和阿尔茨海默病（AD）、血管性痴呆（VD）和非 AD 非 VD（NAVD）的单一和联合影响。对涉及 937908 名参与者的前瞻性研究的荟萃分析提供了更强的证据。最后，我们使用来自 UKB（361194 名参与者）和 FinnGen（412181 名参与者）的全基因组关联研究进行孟德尔随机化（MR）分析，以验证感官障碍与痴呆发生之间的关系。
在 UKB 队列研究中，与听力正常的参与者相比，轻度和重度听力障碍组的全因痴呆（轻度：HR1.52，95%CI 1.31-1.77；重度：HR1.80，95%CI 1.36-2.38）、AD（轻度：HR1.63，95%CI 1.30-2.04；重度：HR2.18，95%CI 1.45-3.27）、VD（轻度：HR1.68，95%CI 1.19-2.37；重度：HR1.47，95%CI 1.22-1.78）和 NAVD（轻度：HR1.47，95%CI 1.22-1.78；重度：HR1.98，95%CI 1.43-2.75）的风险逐渐显著升高。此外，视力障碍与全因痴呆（HR1.55，95%CI 1.18-2.04）和 NAVD（HR1.51，95%CI 1.07-2.13）的风险增加有关。此外，与单一听力或视力障碍相比，双重感官障碍与全因和特定病因痴呆的风险呈逐步增加趋势。在 31 项前瞻性队列研究的荟萃分析中，在单一听力障碍的参与者中，全因痴呆和 AD 的风险增加（全因痴呆：HR1.30，95%CI 1.21-1.40；AD：HR1.30，95%CI 1.21-1.40）和双重感官障碍（全因痴呆：HR1.63，95%CI1.14-2.12；AD：HR 2.55，95%CI 1.19-3.91），而单一视力障碍仅与全因痴呆的风险增加相关（HR1.43，95%CI 1.16-1.71），但与 AD 无关。最后，MR 分析显示听力障碍与全因痴呆（OR1.74，95%CI 1.01-2.99）、AD（OR1.56，95%CI 1.09-2.23）和 NAVD（OR1.14，1.02-1.26）以及视力障碍和 NAVD（OR1.62，95%CI 1.13-2.33）之间存在显著关联。
我们的研究结果表明，听力和视力障碍与全因和特定病因痴呆的风险增加显著相关。在痴呆症预防策略中，应强调标准化的听力和视力评估和干预。
