Zheng D Diane, Lee David J, Rundek Tatjana, Lam Byron L, Gregori Ninel Z, Curiel Rosie E, Loewenstein David A
Center for Cognitive Neurosciences & Aging (D.D.Z., R.E.C., D.A.L.), Department of Psychiatry and Behavioral Science, University of Miami Miller School of Medicine, Miami, Florida, USA.
Department of Public Health Sciences (D.J.E.), University of Miami Miller School of Medicine, Miami, Florida, USA.
Am J Ophthalmol. 2025 Jun;274:196-208. doi: 10.1016/j.ajo.2025.02.043. Epub 2025 Mar 5.
Visual impairment (VI) is prevalent in older adults and associated with cognitive decline. However, the mechanisms through which visual impairment affects cognitive functioning during the aging process are poorly understood. Our study aims to estimate the direct effect of visual acuity on cognitive function and its indirect effect through social isolation and depressive symptoms by sex and age.
Cross-sectional study.
117,231 individuals aged 40-70 participated in the UK Biobank baseline and ocular assessment. Of these, 81% were white, 54% were female, and 45.6% were aged 60-70. The mean age was 56.8 (SD 8.1) years.
Path analyses with multiple equations were conducted to examine the direct and indirect effects of visual acuity (VA). Stratified analyses by gender and age were performed.
LogMAR VA was the exposure, with social isolation and depressive symptoms as mediators. Cognitive functions, including visual memory, verbal-numerical reasoning, processing speed, and prospective memory, were the outcomes.
VA had a direct effect on cognitive function (β = -0.979 for reasoning and OR = 0.67 for prospective memory). VA also influenced cognition indirectly through social isolation and depressive symptoms. The direct effect of VA on cognitive function was similar in men vs. women and middle-aged vs. older. However, there is a marked difference in the mediating effect via social isolation and depressive symptoms by age and sex. The mediating effect of VI on cognition via social isolation was stronger in older adults than middle-aged and in men than women; while the mediating effect via depressive symptoms was stronger in women and middle-aged individuals. VI had the largest mediating effect via social isolation in older males.
Vision, social isolation, and depressive symptoms are modifiable factors and can be treated to preserve cognition. Encouraging social engagement among male and older adults with VI and promoting mental health awareness in women and middle-aged individuals with VI will reduce the negative impact of VI on cognition, lower dementia risk, and improve the well-being of aging adults.
视力损害（VI）在老年人中普遍存在且与认知衰退相关。然而，视力损害在衰老过程中影响认知功能的机制尚不清楚。我们的研究旨在按性别和年龄估计视力对认知功能的直接影响及其通过社会隔离和抑郁症状产生的间接影响。
横断面研究。
117231名年龄在40 - 70岁之间的个体参与了英国生物银行的基线和眼部评估。其中，81%为白人，54%为女性，45.6%年龄在60 - 70岁之间。平均年龄为56.8（标准差8.1）岁。
进行多方程路径分析以检验视力（VA）的直接和间接影响。按性别和年龄进行分层分析。
以LogMAR视力为暴露因素，社会隔离和抑郁症状作为中介变量。认知功能，包括视觉记忆、言语数字推理、处理速度和前瞻性记忆，作为结果变量。
视力对认知功能有直接影响（推理方面β = -0.979，前瞻性记忆方面OR = 0.67）。视力还通过社会隔离和抑郁症状间接影响认知。视力对认知功能的直接影响在男性与女性以及中年人与老年人中相似。然而，在通过社会隔离和抑郁症状产生的中介效应方面，存在年龄和性别的显著差异。视力损害通过社会隔离对认知的中介效应在老年人中比中年人更强，在男性中比女性更强；而通过抑郁症状产生的中介效应在女性和中年个体中更强。视力损害在老年男性中通过社会隔离产生的中介效应最大。
视力、社会隔离和抑郁症状是可改变的因素，可以通过治疗来维持认知。鼓励患有视力损害的男性和老年人进行社交活动，并提高患有视力损害的女性和中年个体的心理健康意识，将减少视力损害对认知的负面影响，降低痴呆风险，并改善老年人的幸福感。
