Dual Sensory Impairment and Cognitive Decline: The Results From the Shelter Study

The association between dual sensory impairment and dementia: A systematic review and meta-analysis

BACKGROUND

Sensory impairments have been linked to dementia. However, the impact of dual sensory impairment (DSI), combining both vision impairment and hearing impairment, on dementia has shown inconsistent results.

OBJECTIVE

To systematically review the evidence on the association DSI and dementia.

METHODS

A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library databases. Included studies were prospective or retrospective cohort studies and a case-control study. The primary outcome was the onset of dementia or its various subtypes, including Alzheimer's disease (AD) and vascular dementia (VaD). Effect sizes, including hazard ratios (HRs), were pooled through a random-effects model.

RESULTS

A total of 11 observational studies with 346,659 participants were included. DSI was significantly associated with the incidence of dementia compared to no sensory impairment (9 studies; HR: 1.46; 95% confidence interval [CI]: 1.29-1.65). Among subtypes of dementia, DSI was associated with AD onset (4 studies; HR: 2.07; 95% CI: 1.45-2.94); however, this association was not found in VaD (2 studies; HR: 1.65; 95% CI: 0.96-2.85).

CONCLUSIONS

These findings suggest that DSI is significantly associated with an increased risk of dementia. Further research is required to identify preventive strategies to decrease the incidence of dementia in individuals with sensory impairment.

Dual sensory loss and cognitive impairment: A study in elderly users of gerontological centers in a Galician urban area

SIGNIFICANCE

Several studies indicate that dual sensory loss (DSL) is related to cognitive impairment. However, there are still no conclusive data on the role of each individual deficit on cognitive performance when both co-occur in the same person.

PURPOSE

This study aimed to analyze the possible association between sensory deficit and cognitive impairment in a sample of older adults and whether this association differs in subjects with DSL compared with those with single or no sensory impairment.

METHODS

Participants of this study were older adult users of gerontological centers in an urban area of Galicia (Spain). All subjects underwent visual and auditory screening tests to detect the presence of DSL. The Spanish version of the Mini-Mental State Examination test was used to identify cognitive impairment. Hearing loss was defined according to Ventry and Weinstein's criteria. Visual impairment was defined as a binocular presenting visual acuity <0.5 (20/40). The presence of DSL was established on the basis of the definitions of the single deficits.

RESULTS

A total of 534 subjects were examined. Older adults with DSL had the worst results in the Mini-Mental test, and those without sensory impairment had the best. The likelihood of cognitive impairment was greater in older adults with DSL than in those without sensory impairment (odds ratio, 6.06 [3.14 to 11.65]). When only visual impairment was present, the likelihood of cognitive impairment was 3.73 times higher (0.95 to 3.09) than that of subjects with no sensory impairment. Hearing loss alone seems not to be significantly associated with a higher risk of cognitive impairment.

CONCLUSIONS

The results of this study highlight the importance of continuing research in DSL for the prevention of cognitive impairment, the design of intervention plans, and the optimization of health resources.

Dual sensory impairment: Global prevalence, future projections, and its association with cognitive decline

There is rising public health concern surrounding dual sensory impairment (DSI), or comorbid hearing and vision impairments. Its global prevalence and the magnitude of its association with cognitive decline (CD) is unclear. Three databases were searched for epidemiological studies examining DSI prevalence or its association with CD. Independent reviewers selected studies, extracted data, and evaluated bias. Random-effects meta-analyses were performed. Projections were estimated using United Nations data. The population attributable fraction of DSI-associated CD was calculated. Among 43 studies with 5,246,796 participants, clinically assessed DSI prevalence was 5.50% (95% confidence interval [CI] = 2.88%-10.26%), with regional/ethnic/age variations. DSI prevalence is projected to increase by 27.2% from 2025 to 2050. Approximately 59.83% (95%CI = 41.03-76.12) of DSI patients had cognitive impairment. Baseline DSI was associated with incident CD (odds ratio [OR] = 1.72, 95%CI = 1.37-2.15). Globally, 3.81% (95%CI = 1.05-10.55) of incident CD may be attributed to DSI. DSI is globally prevalent, growing, and associated with CD, highlighting the need for better health policy and resource allocation. HIGHLIGHTS: The global prevalence of DSI is 5.50%, with geographical, ethnical and age variations. The prevalence of DSI rises with age and is projected to increase by 27.2% by 2050. Approximately 60% of individuals with DSI may have measurable cognitive impairment. DSI was associated with a 72% greater longitudinal risk of incident CD. Globally, 3.81% of CD cases may be attributable to DSI.

Association of hearing loss with cognitive function and mental health in Africa: A systematic review

OBJECTIVE

To summarize the evidence for the associations between hearing loss and mental health and cognitive function in Africa.

METHODS

This systematic review was prepared following the PRISMA guidelines. Cohort, case‒control and cross-sectional studies were considered for inclusion if they reported the prevalence of any mental health conditions or levels of cognitive functioning among persons with hearing loss/deafness in comparison to those without hearing loss. No age restriction was applied. Articles not published in English or not from the African subcontinent were excluded. The initial search yielded a total of 2,822 articles from electronic databases. After title, abstract and full-text screening, seven articles were found to be eligible, with a total of 2,761 participants across Africa.

RESULTS

Five studies reported that hearing difficulties were significantly associated with an increased prevalence of poor mental health. Two studies reported on cognition, one on higher odds (2.22; 95%CI) of developing cognitive decline among persons with hearing difficulties than among those with normal hearing. The majority of studies were conducted among special populations (i.e., retirement homes and special schools), with most participants being female.

CONCLUSION

This study revealed an increased risk of mental health disorders and/or cognitive decline for people with hearing impairment in African populations. However, the number of relevant studies is small, and more research is needed to provide evidence for public health interventions across the continent.

TRIAL REGISTRATION

PROSPERO-CRD42024520957.

Association of cumulative average sensory impairments with cognitive function and depressive symptoms: Two prospective cohort studies

BACKGROUND

Globally, over 2.2 billion people have a vision impairment and over 1.5 billion live with hearing impairment, which are significant public health concerns given the meaningful impacts on individual and society. We aimed to investigate whether long-term average visual, hearing, and dual sensory impairment was independently associated with cognitive impairment, incident dementia, and incident depressive symptoms.

METHODS

We used data from the Health and Retirement Study (HRS) and the China Health and Retirement Longitudinal Study (CHARLS), two nationally representative and prospective cohorts of community middle aged and older adults. Average sensory impairment was calculated using the area under the curve divided by follow-up time from wave 3 (1996) to wave 15 (2020) in HRS and wave 1 (2011) to wave 4 (2018) in CHARLS. Cox regression models adjusted for multiple covariates were used to estimate adjusted hazard ratios (HRs) and 95 % confidence intervals (95 % CIs).

RESULTS

For each one standard deviation (SD) increment in average visual impairment, the risk of developing cognitive impairment, incident dementia, and incident depressive symptoms increased by 12 %, 34 %, and 39 % in CHARLS and 11 %, 14 % and 10 % in HRS. Similar results were found for each SD increment in average hearing impairment and dual sensory impairment. Nonlinear dose-response relationships were identified between visual impairment and dementia, as well as dual sensory impairment and dementia in both cohorts.

LIMITATIONS

The diagnosis of cognitive impairment, dementia, and depression were based on subjective assessment.

CONCLUSION

Multi-level approaches aimed at improving access to sensory care are needed to improve middle-aged and older adults' visual and auditory functions.

A Prospective Association Between Sensory Impairment and Cognitive Performance Among Older Community-Dwelling Adults: The Role of Depressive Symptoms

We examined whether vision impairment (VI) and hearing impairment (HI) and dual sensory impairment (DSI) affect cognitive performance and whether depression mediates that effect. We examined 55,340 participants from the Survey of Health, Aging and Retirement in Europe, which assessed 32,325 participants in 2011 (baseline, Time 1), 2015 (follow-up, Time 2), sociodemographic data and health factors, self-reported VI, HI, and DSI at baseline, depression, and cognitive performance after four years. A multiple mediator model was tested using bootstrapping and resampling. At baseline, 22.9% had VI, 10.2% HI, and 10.4% had DSI. We found a significant negative association between VI (b = -0.023, p = .001) and DSI (b = -0.083, p = .001) and cognitive performance; both were also associated with depression, which was linked with poor cognition. VI or DSI among older adults are associated with poor cognitive function directly and indirectly by increasing depression symptoms.

Sensory impairments and the risk of cognitive decline and dementia across sex, age, and regions: Longitudinal insights from Europe

BACKGROUND

In aging populations, understanding predictors of cognitive decline is essential. We aimed to investigate the risk of cognitive decline and dementia by sensory impairments across sex, age, and European regions, and examined the mediating role of activities of daily living (ADL), physical activity, and depressive symptoms.

METHODS

A cohort study of 72,287 Europeans aged 50+ participating in at least two waves of the Survey of Health, Ageing and Retirement in Europe. We employed mixed-effects and time-to-event models, incorporating sex interactions, and adjusting for socio-demographic factors and medical history.

RESULTS

Compared to individuals with good vision and hearing, lower cognitive function was found for people with vision impairment (VI) (males: coef. -0.70, 95 % CI -0.95; -0.46; females: coef. -1.12, 95 % CI -1.33; -0.92), hearing impairment (HI) (males: coef. -0.64, 95 % CI -0.93; -0.35; females: coef. -0.96, 95 % CI -1.27; -0.65) and dual sensory impairment (DSI, i.e. VI and HI) (males: coef. -1.81, 95 % CI -2.16; -1.46; females: coef. -2.71, 95 % CI -3.05; -2.38), particularly among females. Moreover, higher dementia risk was observed among participants with VI (hazard ratio (HR) 1.29, 95 % CI 1.17; 1.43), HI (HR 1.18, 95 % CI 1.05; 1.34), and DSI (HR 1.62, 95 % CI 1.45; 1.81) with no sex-interactions. Findings were overall consistent across age and European regions.

CONCLUSION

The results suggest the necessity of preventing sensory impairments to maintain good cognitive function. Mitigating depressive symptoms, ADL limitations, and physical inactivity could potentially reduce a significant portion of the total effect of sensory impairments on cognitive decline.

Dual sensory impairments in companion dogs: Prevalence and relationship to cognitive impairment

PURPOSE

Many older dogs (Canis lupus familiaris) develop cognitive impairment. Dog owners often describe impairments in multiple sensory functions, yet the relationships between sensory and cognitive function in older dogs is not well understood.

METHODS

We performed assessments of dog vision and hearing, both clinically (n = 91, electroretinography and brainstem auditory evoked potential) and via validated questionnaire (n = 238). We determined prevalence of sole and dual hearing/vision impairments in younger (<8 years) and older (≥8 years) dogs. Impairment cutoffs were determined using data from young dogs. We assessed the relationships between questionnaire-assessed vision and/or hearing impairments and cognitive impairment using logistic regression.

RESULTS

Younger and older dog groups had similar distributions of sex and purebred/mixed breed status. Sex had no relationship to prevalence of sensory impairments. Older dogs had higher prevalence of hearing, vision, and dual sensory impairments, assessed both clinically and by questionnaire (P<0.001), and cognitive impairment assessed by questionnaire (P<0.001). Dogs had higher prevalence of reported cognitive impairment when owners reported dual vision and hearing impairments (79-94%, versus 25-27% in dogs with no sensory impairments), which was most consistent in dogs aged ≥8 years. In these older dogs, dual vision/hearing impairments were associated with a significantly increased risk of cognitive impairment (1.8-2.0 odds ratio).

CONCLUSION

Dogs aged ≥8 years are at higher risk for dual hearing/vision impairments and associated cognitive impairments. The causal relationship between these impairments is not defined, but clinical consideration of these multimorbidity risks should be made in older dogs.

Associations between sensory impairment and functional limitations among older Chinese adults: mediating roles of social isolation and cognition

BACKGROUND

The high prevalence of sensory impairment and functional limitations in older adults is a significant concern, yet there is limited understanding of the relationship between these two conditions. Therefore, the objective of this study was to investigate the pathways connecting sensory impairment and functional limitations by examining serial multiple mediating effects of social isolation and cognition in older adults.

METHODS

Using the China Health and Retirement Longitudinal Study dataset, a sample of 4871 older adults was selected. The study variables included sensory impairment, functional limitations, social isolation and cognition, and other covariates. A hierarchical multiple linear regression model was used to assess the association between sensory impairment and functional limitations. Mediation analysis was conducted to explore the sequential multiple mediating effects of social isolation and cognitive function in the relationship between sensory impairment and functional limitations.

RESULTS

Our findings revealed a significant and positive association between sensory impairment and functional limitations (B = 0.615, 95% CI: 0.397, 0.834). After adjusting for social isolation and cognitive function, the impact of sensory impairment on functional limitations accounted for 87.19% of the total effect. Additionally, approximately 12.81% of the significant relationship between dual sensory impairment and functional limitations was mediated by social isolation and cognitive function. A serial multiple mediating pathway (sensory impairment → social isolation → cognition → functional limitations) was identified, with a coefficient of 0.013 (95% CI: 0.006, 0.020).

CONCLUSIONS

Our study provides evidence for the mediating effects of social isolation and cognition in the relationship between sensory impairment and functional limitations. Given the prevalence of functional limitations among older adults with sensory impairment, it is crucial to consider social isolation and cognitive function in efforts to reduce the burden of disability care. Future validation of these findings through longitudinal studies is necessary.

Hidden dangers: Does multisensory impairments accompanying visual impairment increase dementia risk

BACKGROUND

Growing evidence suggests that sensory impairment, particularly in the form of visual impairment, may contribute to the development of dementia. However, it remains unclear whether experiencing concurrent visual impairment in combination with other types of multisensory impairments may further increase this risk.

METHODS

The study used data from the UK Biobank cohort study, which recruited 500,000 adults. With meticulous screening procedures in place, individuals with visual impairment, hearing impairment, and oral health issues were identified for further follow-up evaluations. A multivariable regression analysis was conducted to investigate the relationship between multisensory impairments concurrent with visual impairment and cognitive function. Cox proportional hazard models were used to estimate hazard ratios and 95% confidence intervals to evaluate the association between multisensory impairments concurrent with visual impairment and dementia risk.

RESULTS

Subjects experiencing multisensory impairments concurrent with visual impairment demonstrated a negative association with cognitive function. Notably, individuals who have both vision and hearing impairments had a significantly higher risk of developing dementia (HR 1.28, 95% CI [1.01-1.63]). Additionally, individuals who experience vision impairment and oral health issues simultaneously were also at higher risk for dementia (HR 1.61, 95% CI [1.32-1.97]). Furthermore, the risk of dementia among individuals with vision impairment, hearing impairment, and oral health issues further escalated to an even higher level (HR 1.63, 95% CI [1.19-2.24]).

CONCLUSIONS

The correlation between the presence of multisensory impairments concurrent with visual impairment and cognitive decline is highly significant. Those with multisensory impairments concurrent with visual impairment are at a significantly increased risk of developing dementia.

Long-term cognitive impairment after probable delirium in long-term care residents: A population-based retrospective cohort study

BACKGROUND

The impact of delirium on cognition has not been well-studied in long-term care (LTC) residents. This study examined changes in cognition 1 year after a probable delirium episode among LTC residents, compared to LTC residents without probable delirium. We also evaluated whether the relationship between probable delirium and cognitive change differed according to a diagnosis of dementia.

METHODS

We conducted a population-based retrospective cohort study using linked health administrative data. The study population included adults aged 65+ residing in LTC in Ontario, Canada and assessed via the Resident Assessment Instrument-Minimum Dataset between January 1, 2016 and December 31, 2018. Probable delirium was ascertained via the delirium Clinical Assessment Protocol on the index assessment. Cognition was measured quarterly using the Cognitive Performance Scale (range 0-6, higher values indicate greater impairment). Cognitive decline up to 1 year after index was evaluated using multivariable proportional odds regression models.

RESULTS

Of 92,005 LTC residents, 2816 (3.1%) had probable delirium at index. Residents with probable delirium had an increased odds of cognitive decline compared to those without probable delirium, with adjusted odds ratios of 1.64 (95% confidence interval [CI] 1.35-1.99), 1.56 (95% CI 1.34-1.85), 1.57 (95% CI 1.32-1.86) and 1.50 (95% CI 1.25-1.80) after 1-3, 4-6, 7-9, and 10-12 months of follow-up. Residents with probable delirium and a comorbid dementia diagnosis had the highest adjusted odds of cognitive decline (adjusted odds ratio 5.57, 95% CI 4.79-6.48) compared to those without probable delirium or dementia. Residents with probable delirium were also more likely to die within 1 year than those without probable delirium (52.5% vs. 23.4%).

CONCLUSIONS

Probable delirium is associated with increased mortality and worsened cognition in LTC residents that is sustained months after the probable delirium episode. Efforts to prevent delirium in this population may help limit these adverse effects.

[Interventions for functionally dependent adults and their caregivers during the COVID-19 pandemic]

The COVID-19 pandemic has affected the world population, especially people from social groups in a situation of greater vulnerability among people with some functional dependency. Therefore, the aim of this review was to describe interventions during the pandemic to preserve general health, maintain function and independence, and prevent COVID-19 infection for functionally dependent adults (FDA). A systematic search in databases was carried out. Titles and abstracts of each publication were reviewed for relevance. Full-text articles were accessed by two independent reviewers. The information found was classified into three categories: 1) FDA during the COVID-19 pandemic, 2) FDA during the COVID-19 pandemic according to a specific condition (neurological conditions, sensory disabilities/impairments, and cognitive impairment), and 3) Older adults with functional dependence. The FDAs have faced difficulties and barriers during the COVID-19 pandemic. Strengthening strategies such as telerehabilitation is suggested to avoid deterioration or aggravation of the functionality of dependent people.

Strategies used during the cognitive evaluation of older adults with dual sensory impairment: a scoping review

BACKGROUND

Dual sensory impairment (DSI), the combination of visual and hearing impairments, is associated with increased risk for age-related cognitive decline and dementia. Administering cognitive tests to individuals with sensory impairment is challenging because most cognitive measures require sufficient hearing and vision. Considering sensory limitations during cognitive test administration is necessary so that the effects of sensory and cognitive abilities on test performance can be differentiated and the validity of test results optimized.

OBJECTIVE

To review empirical strategies that researchers have employed to accommodate DSI during cognitive testing of older adults.

METHODS

Seven databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, Global Health and the Evidence-Based Medicine Reviews databases) were searched for relevant articles integrating the three concepts of cognitive evaluation, aging, and DSI. Given the inclusion criteria, this scoping review included a total of 67 papers.

RESULTS

Twenty-eight studies reported five categories of strategies for cognitive testing of older adult participants with DSI: the assistance of experts, the modification of standardized test scoring procedures, the use of communication strategies, environmental modifications, and the use of cognitive tests without visual and/or auditory items.

CONCLUSIONS

The most used strategy reported in the included studies was drawing on the assistance of team members from related fields during the administration and interpretation of cognitive screening measures. Alternative strategies were rarely employed. Future research is needed to explore the knowledge-to-practice gap between research and current clinical practice, and to develop standardized testing strategies.

Health effects of social connectedness in older adults living in congregate long-term care settings: A systematic review of quantitative and qualitative evidence

BACKGROUND

The overall impact of social connectedness on health outcomes in older adults living in nursing homes and assisted living settings is unknown. Given the unclear health impact of social connectedness for older adults in congregate long-term care settings worldwide, a comprehensive systematic review is required to evaluate the overall relationship between social connectedness and health outcomes for them.

OBJECTIVES

The purpose of this article was to synthesize the literature regarding the health impact of social connectedness among older adults living in nursing homes or assisted living settings.

METHODS

Using PRISMA guidelines, we identified eligible studies from Scopus, MEDLINE, PsycINFO, CINAHL and Cochrane databases (1990-2021). Bias and quality reporting assessment was performed using standardized criteria for cohort, cross sectional and qualitative studies. At each stage, ≥ 2 researchers conducted independent evaluations.

RESULTS

Of the 7350 articles identified, 25 cohort (follow-up range: 1 month-11 years; with two also contributing to cross sectional), 86 cross sectional, eight qualitative and two mixed methods were eligible. Despite different instruments used, many residents living in nursing homes and assisted living settings had reduced social engagement. Quantitative evidence supports a link between higher social engagement and health outcomes most studied (e.g. depression, quality of life). Few studies evaluated important health outcomes (e.g. cognitive and functional decline). Most cohort studies showed that lack of social connectedness accelerated time to death.

CONCLUSIONS

Social connectedness may be an important modifiable risk factor for adverse health outcomes for older adults living in nursing homes and assisted living facilities. Most studies were cross sectional and focused on quality of life and mental health outcomes. Longitudinal studies suggest that higher social engagement delays time to death. Evidence regarding other health outcomes important to older adults was scant and requires further longitudinal studies.

Prevalence of depression, anxiety and suicidal ideas and associated factors, in particular sensory impairments, in a population of Bashkortostan in Russia

To assess prevalence and associated factors of depression, anxiety and suicidal ideas in populations from Russia, we conducted in rural and urban regions in Bashkortostan/Russia two population-based studies (Ural Eye and Medical Study (UEMS), performed from 2015 to 2017; Ural Very Old Study (UVOS), performed from 2017 to 2020) which included participants aged 40 + years and 85 + years, respectively. Depression was assessed using the questionnaire of the Center for Epidemiologic Studies Depression Scale Scoresheet, and anxiety was examined applying the State Trait Inventory Anxiety Test. Suicidal ideas were explored by the question whether suicide had previously been thought of or attempted (and if yes, for what reasons). In the statistical analysis we assessed the mean of the main outcome parameter (depression score and anxiety score) and searched for associations between these parameters and other parameters in univariable and multivariable regression analyses. In the UEMS with 5893 individuals (age: 59.0 ± 10.7 years; range 40-94 years), higher depression score and anxiety score were associated (multivariable analysis) with more marked hearing loss (beta: 0.07; P < 0.001, and beta: 0.07; P < 0.0012, respectively) and worse visual acuity (beta: 0.04; P = 0.02; and beta: 0.03; P = 0.03, resp.), in addition to female sex, Russian ethnicity, lower educational level, less alcohol consumption, weaker hand grip strength, less physical activity, and higher prevalence of dry eye disease. Attempted suicide was reported by 88 (1.5%; 95% CI 1.2, 1.8) participants. Having thought of suicide within the last 6 months was reported by 63 (1.1%) individuals. Out of 1491 UVOS participants (age: 88.2 ± 2.8 years; range 85-100 years) with a mean depression score of 20.0 ± 10.3 (median 18; range 0-58), 916 (61.4%; 95% CI 59.0, 63.9) fulfilled the definition of depression (depressions core ≥ 16). Higher depression score and higher anxiety score correlated (multivariable analysis) with higher hearing loss score (beta: 0.07; P = 0.02, and beta: 0.08; P = 0.009, resp.) and worse visual acuity (beta: 0.13; P < 0.001, and beta: 0.09; P = 0.007, resp.), in addition to female sex, urban region, less physical activity, less fruit intake, and lower cognitive function. Overall, 15 (1.0%; 95% CI 0.50, 1.50) individuals had attempted or thought of suicide. In conclusion, the findings suggest that besides female sex, lower level of education and lower cognitive function, it was sensory impairment, namely vision and hearing impairment, which belonged to the determinants of depression and anxiety in these populations from Russia.

Identifying predictors of cognitive decline in long-term care: a scoping review

BACKGROUND

Cognitive impairment can cause social, emotional, and financial burdens on individuals, caregivers, and healthcare providers. This is especially important in settings such as long-term care (LTC) homes which largely consist of vulnerable older adults. Thus, the objective of this study is to review and summarize current research examining risk factors of cognitive decline in older adults within LTC.

METHODS

This scoping review includes primary observational research studies assessing within-person change in cognition over time in LTC or equivalent settings in high resource countries. A mean participant age of ≥ 65 years was required. Searches were conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PyscInfo on June 27th, 2022 and included articles published during or after the year 2000. Title, abstract, and full-text screening was performed by two independent reviewers using Covidence. Specific predictors along with their associated relation with cognitive decline were extracted by a team of reviewers into a spreadsheet.

RESULTS

Thirty-eight studies were included in this review. The mean sample size was 14 620. Eighty-seven unique predictors were examined in relation to cognitive decline. Dementia was the most studied predictor (examined by 9 of 38 studies), and the most conclusive, with eight of those studies identifying it as a risk factor for cognitive decline. Other predictors that were identified as risk factors included arterial stiffness (identified by 2 of 2 studies), physical frailty (2 of 2 studies), sub-syndromal delirium (2 of 2 studies), and undergoing the first wave of COVID-19 lockdowns (2 of 2 studies). ADL independence was the most conclusive protective factor (3 of 4 studies), followed by social engagement (2 of 3 studies). Many remaining predictors showed no association and/or conflicting results.

CONCLUSIONS

Dementia was the most common risk factor, while ADL independence was the most common protective factor associated with cognitive decline in LTC residents. This information can be used to stratify residents by risk severity and provide better personalized care for older adults through the targeted management of cognitive decline.

Association of Hearing Status and Cognition With Fall Among the Oldest-Old Chinese: A Nationally Representative Cohort Study

OBJECTIVES

The oldest-old (aged ≥80 years) are the most rapidly growing population and age is related to hearing impairment (HI) and cognitive decline. We aimed to estimate the association between HI and fall, and the effect of different cognitive states on this association among the oldest-old Chinese population.

DESIGN

A total of 6931 Chinese oldest-old were included in the 2018 cross-cohort from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The presence of HI was identified by using a dichotomized metric of self-reported hearing status. Cognitive function was evaluated by using the modified Mini-Mental State Examination (MMSE). Cognitive impairment was defined as the MMSE score below 24 points. Data on fall history were collected by questionnaires survey from the participants or their relatives. We studied the association of hearing status and cognitive function with fall by using multivariable logistic regressions, upon adjustment of sociodemographic characteristics, lifestyles, and health conditions.

RESULTS

Our participants were aged 92 (range 80 to 117) on average, with 60.1% being women. In total, 39.1% of the participants had reported HI, 50.1% had cognitive impairment, and 26.2% had a history of falling. Participants with HI had a higher incidence of cognitive impairment (79.4%), as compared with their counterparts without HI (31.3%). Compared with those without HI, HI patients had a higher risk of falling after full adjustment for potential confounders (OR = 1.16 [95% confidence interval, CI, 1.01, 1.32], p = 0.031). In comparison with HI participants without cognitive impairment, HI patients with cognitive impairment had a higher fall risk (OR = 1.45 [95% CI = 1.23, 1.72], p < 0.001).

CONCLUSIONS

Association of hearing status and cognition with fall was, for the first time, examined on the basis of a nationally-representative oldest-old Chinese population. Poor cognitive performance was common in individuals with HI, and those with HI and cognitive impairment further increased the risk of falling.

Concurrent hearing and vision impairment and 8-year memory decline in community-dwelling older adults

BACKGROUND

Hearing and vision impairments are risk factors for cognitive decline; less is known about dual sensory impairment. This study quantifies the association between dual sensory impairment and 8-year change in memory among older adults.

METHODS

Data (N = 5552) were from the National Health and Aging Trends Study. Memory (immediate/delayed word recall, subjective memory) was measured annually (2011 to 2019). Hearing and vision impairments were measured by self-report. Association between dual sensory impairment and 8-year change in memory was assessed using multivariate linear mixed effect models and generalized logistic mixed models.

RESULTS

Rate of memory decline was most accelerated among participants with dual sensory impairment. For example, 8-year decline in delayed word recall was -1.03 (95% confidene interval: -1.29, -0.77) for dual sensory impairment versus -0.79 (-0.92, -0.67) for single and -0.56 (-0.63, -0.48) for no impairment.

CONCLUSION

Older adults with dual sensory impairment may be at particularly higher risk for cognitive decline.

Gender differences in the association between sensory function and CIND among Chinese elderly: Based on CLHLS

OBJECTIVE

To explore the gender differences of the association between sensory impairment (SI) and the risk of cognitive decline and possible cognitive impairment, no dementia (CIND).

METHOD

Data were drawn from three waves of the nationally representative survey of China Longitudinal Healthy Longevity Survey (CLHLS) between 2011/12-2018 surveys, involving 6138 participants aged 65 or older who had no CIND at the baseline. Multivariate linear or logistic regression models were employed to examine the effect of SI on cognitive decline and CIND risk by gender stratification, respectively.

RESULTS

Hearing impairment and visual impairment were associated with lower MMSE scores, and the strength of the association was stronger in men than in women. Hearing impairment was related to an elevated risk of CIND both in men and women (Men: OR=2.46; 95% CI=1.81, 3.35; Women: OR=1.43; 95% CI=1.09, 1.88). However, the effect of visual impairment on CIND was statistically significant only in men (OR=1.43; 95% CI=1.09, 1.88). The risk of cognitive decline and CIND were significantly higher with single and dual SI than those without SI, except for women with single visual impairment.

CONCLUSION

SI is independently associated with cognitive decline and CIND risk, and the association differed by gender. Further researches should clarify the mechanism between SI and cognitive function among older adults, especially for gender differences.

Sensory impairment and algorithmic classification of early cognitive impairment

INTRODUCTION

Sensory impairment (SI) is linked to cognitive decline, but its association with early cognitive impairment (ECI) is unclear.

METHODS

Sensory functions (vision, hearing, vestibular function, proprioception, and olfaction) were measured between 2012 and 2018 in 414 Baltimore Longitudinal Study of Aging (BLSA) participants (age 74 ± 9 years; 55% women). ECI was defined as 1 standard deviation below age-, sex-, race-, and education-specific mean performance in Card Rotations or California Verbal Learning Test immediate recall. Log binomial models (cross-sectional analysis) and Cox regression models (time-to-event analysis) were used to examine the association between SI and ECI.

RESULTS

Cross-sectionally, participants with ≥3 SI had twice the prevalence of ECI (prevalence ratio = 2.10, p = 0.02). Longitudinally, there was no significant association between SI and incident ECI over up to 6 years of follow-up.

DISCUSSION

SI is associated with higher prevalence, but not incident ECI. Future studies with large sample sizes need to further elucidate the relationship between SI and ECI.

Highlights

Sensory impairment is associated with high prevalence of early cognitive impairmentMultisensory impairment may pose a strong risk of early changes in cognitive functionIdentifying multisensory impairment may help early detection of dementia.

Is there a correlation between sensory impairments and social isolation in middle-aged and older Chinese population? Cross-sectional and longitudinal evidence from a nationally representative survey

Purpose

The aim of this study is to investigate the cross-sectional and longitudinal associations between sensory impairments (SIs) including single vision impairment (SVI), single hearing impairment (SHI), and dual sensory impairments (DSI) with social isolation in the middle-aged and older Chinese population.

Methods

Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 11,674 Chinese older adults aged over 45 were included at baseline 2011, and 6,859 participants who accomplished all four interviews from 2011 to 2018 were adapted for longitudinal analyses. Sensory status and social isolation measurements including social disconnectedness and self-perceived loneliness were collected. Assessment of social disconnectedness included the number of types of social activities in which they participated and the frequency of such participation. Loneliness referred to the subjective perception of loneliness. Other covariates included socio-demographic characteristics, medical conditions, and lifestyle-related factors. The impacts of baseline sensory status on social disconnectedness and loneliness were assessed using univariate and multivariate generalized linear models. A generalized linear model with generalized estimation equations (GEE) was used to assess the association between time-varying sensory statuses with social disconnectedness or loneliness over 8 years after being adjusted with multi-confounding factors.

Results

Participants with SIs had significantly higher levels of social disconnectedness and self-perceived loneliness, compared to those who were free of SI. All kinds of SIs were significantly associated with loneliness according to both cross-sectional and longitudinal data. The correlations between DSI and social disconnectedness or loneliness at baseline and over 8 years were also noticed. SHI was found to be significantly associated with both frequency and types of social activities according to cross-sectional data and with the frequency of social activity participation in longitudinal analysis. SVI was only associated with the types of social activities at baseline (all p-values &lt; 0.05).

Conclusion

Sensory impairments, especially dual sensory impairments, have explicitly detrimental effects on social isolation among the older Chinese population. Over time, single hearing impairment specifically jeopardizes their frequency rather than types of social activities participation.

Sensory impairments and subjective well-being status in middle-aged and older Chinese population: Cross-sectional and longitudinal analyses of a nationally representative survey

Purpose

To investigate the impacts of sensory impairments (SIs) including single vision impairment (SVI), single hearing impairment (SHI) and dual sensory impairment (DSI) on subjective wellbeing measurements including life expectancy (LE), life satisfaction (LS) and self-rated health (SRH) in middle-aged and older Chinese population.

Methods

We obtained data from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 9,293 Chinese middle-aged and older adults aging over 45 were included at baseline 2011 in this study, and 3,932 participants who accomplished all 4 interviews from 2011 to 2018 were adapted for longitudinal analyses. Sensory status and subjective wellbeing measurements were collected. Other covariates included socio-demographic characteristics, medical condition and lifestyle-related factors. The impacts of baseline sensory status on LE, LS and SRH were assessed using univariate and multivariate logistic regression analyses. A linear regression analysis with generalized estimating equations (GEE) was used to assess the association between time-varying sensory statuses with LE, LS and SRH over 8 years after being adjusted with multi-confounding factors.

Results

Participants with SIs had significantly lower level of LE, LS, and SRH, compared to those who were free of SI. All kinds of SIs were significantly associated with LE, LS, and SRH according to cross-sectional data. The correlations between SIs and LE or SRH over 8 years were also noticed. However, only SHI and DSI were found to be significantly associated with LS according to longitudinal data (all p values &lt; 0.05).

Conclusion

Sensory impairments had explicitly detrimental effects on subjective wellbeing status over time among middle-aged and older Chinese population.

Associations between Visual Acuity and Cognitive Decline in Older Adulthood: A 9-Year Longitudinal Study

OBJECTIVE

Emerging evidence suggests low vision may be a modifiable risk factor for cognitive decline. We examined effects of baseline visual acuity (VA) on level of, and change in, cognitive test performance over 9 years.

METHOD

A population-based sample of 1,621 participants (average age 77 years) completed a comprehensive neuropsychological evaluation and VA testing at baseline and reassessed at nine subsequent annual visits. Linear regression modeled the association between baseline VA and concurrent cognitive test performance. Joint modeling of a longitudinal sub-model and a survival sub-model to adjust for attrition were used to examine associations between baseline VA and repeated cognitive test performance over time.

RESULTS

Better baseline VA was associated cross-sectionally with younger age, male sex, greater than high school education, and higher baseline neuropsychological test scores on both vision-dependent (B coefficient range -0.163 to -0.375, p = .006 to <.001) and vision-independent tests (-0.187 to -0.215, p = .003 to .002). In longitudinal modeling, better baseline VA was associated with slower decline in vision-dependent tests (B coefficient range -0.092 to 0.111, p = .005 to <.001) and vision-independent tests (-0.107 to 0.067, p = .007 to <.001).

CONCLUSIONS

Higher VA is associated with higher concurrent cognitive abilities and slower rates of decline over 9 years in both vision-dependent and vision-independent tests of memory, language, and executive functioning. Findings are consistent with emerging literature supporting vision impairment in aging as a potentially modifiable risk factor for cognitive decline. Clinicians should encourage patient utilization of vision assessment and correction with the added aim of protecting cognition.

Hearing and vision difficulty and sequential treatment among older adults in India

Aging not only affect biomarker-related processes, but it also affects the physiological processes of the human body. Of all the physiological processes, hearing and vision are of utmost importance to a human. Therefore, this study examines the prevalence and factors associated with hearing and vision difficulty and their sequential treatment among older adults in India. Utilizing data from Building a Knowledge Base on Population Aging in India, study used two sets of outcome variables; firstly, self-reported hearing and vision difficulty and secondly, treatment-seeking for hearing and vision difficulty. A total of 9541 older adults aged 60+ years from seven major regionally representative states were selected. Descriptive statistics were used to perform preliminary analysis. Additionally, the study employed the Heckprobit selection model. It is a two-equation model. This model is used in order to accommodate the heterogeneity (i.e., shared unobserved factors) among older adults and then address the endogeneity (between hearing and vision loss problems and their treatment-seeking behaviour) for older adults in India, the model offers a two-step analysis and deals with the zero-sample issue. Around 59% and 21% of older adults reported vision and hearing difficulty, respectively. Only 5% of older adults suffering from hearing difficulty reported utilizing hearing aids. Lifestyle factors (smoking tobacco and chewing tobacco) significantly affect hearing and vision difficulty; various chronic diseases were also found to be associated with high levels of hearing and vision difficulty among older adults. Results from Heckprobit model shows that older adults with 11+ years of education had higher probability to use visual [β = 0.54, 95% confidence interval (CI): 0.37, 0.70] and hearing aids [β = 0.6, 95% CI: 0.18, 1.02]. The use of hearing and vision aids was lower among poor older adults, older adults from Scheduled Caste, and older adults in rural areas. The study indicates that more than half of older adults face vision difficulty and almost one-fourth face hearing difficulty in rural India, education and lifestyle appear to be the main driver of health-seeking behaviour. Additional attention shall be given to understand the strategies that may advocate a higher use for hearing aids among older adults.

Changes in sensory, postural stability and gait functions depending on cognitive decline, and possible markers for detection of cognitive status

Background

Numerous people never receive a formal dementia diagnosis. This issue can be addressed by early detection systems that utilize alternative forms of classification, such as gait, balance, and sensory function parameters. In the present study, said functions were compared between older adults with healthy cognition, older adults with low executive function, and older adults with cognitive impairment, to determine which parameters can be used to distinguish these groups.

Results

A group of cognitively healthy older men was found to have a significantly greater gait cadence than both the low executive function group (113.1 ± 6.8 vs. 108.0 ± 6.3 steps/min, p = 0.032) and the cognitively impaired group (113.1 ± 6.8 vs. 107.1 ± 7.4 steps/min, p = 0.009). The group with low executive function was found to have more gait stability than the impaired cognition group, represented by the single limb support phase (39.7 ± 1.2 vs. 38.6 ± 1.3%, p = 0.027). Additionally, the healthy cognition group had significantly greater overall postural stability than the impaired cognition group (0.6 ± 0.1 vs. 1.1 ± 0.1, p = 0.003), and the low executive function group had significantly greater mediolateral postural stability than the impaired cognition group (0.2 ± 0.1 vs. 0.6 ± 0.6, p = 0.012). The low executive function group had fewer mistakes on the sentence recognition test than the cognitively impaired (2.2 ± 3.6 vs. 5.9 ± 6.4, p = 0.005). There were no significant differences in visual capacity, however, the low executive function group displayed an overall greatest ability.

Conclusions

Older adults with low executive function showcased a lower walking pace, but their postural stability and sensory functions did not differ from those of the older adults with healthy cognition. The variables concluded as good cognitive status markers were (1) gait cadence for dividing cognitively healthy from the rest and (2) single limb support portion, mediolateral stability index, and the number of mistakes on the sentence recognition test for discerning between the low executive function and cognitive impairment groups.

Increased probability of mood disorders after age-related macular degeneration: a population-based cohort study

We aim to investigate the association of mood disorders with age-related macular degeneration (AMD). This retrospective cohort study used data from 2000 and 2016 from National Health Insurance Research Database (NHIRD) in Taiwan. Patients with AMD diagnosis formed the exposed group, and an age- and sex-matched group without AMD served as the nonexposed group. Main outcomes were the incidence of mood disorders including psychological counseling, behavior therapy, sleep or anxiety-related disorders, and major depressive disorders (MDDs) in the exposed and non-exposed groups. The Cox proportional hazard regression analysis was used to evaluate the incidence and adjusted hazard ratio (aHR) of mood disorders. A total of 5916 and 11,832 individuals with and without AMD were enrolled into the exposed and nonexposed groups. There were 1017 (17.19%) and 1366 (11.54%) episodes of mood disorders occurred in the exposed and nonexposed groups, respectively. The aHRs of any psychological counseling, behavioral therapy, sleep or anxiety-related disorders, and MDD were significantly higher in patients with AMD than in those without AMD (all P < 0.05). Besides, patients with dry-AMD, participants aged 50-70 years, and women with AMD had a higher incidence of mood disorders (all P < 0.05) than did non-AMD individuals, patients > 70 years, and women without AMD. In conclusion, AMD occurrence leads to an increased rate of mood disorders, particularly among those with dry-AMD, middle aged participants (aged 50-70), and women.

Hearing Impairment With Cognitive Decline Increases All-Cause Mortality Risk in Chinese Adults Aged 65 Years or Older: A Population-Based Longitudinal Study

Background

Hearing impairment (HI), a highly prevalent sensory impairment affecting older adults, is a risk factor for cognitive decline. However, few studies examined the association between HI and all-cause mortality, and the role of different cognitive states on this relationship in Chinese older adults is poorly understood.

Methods

A total of 10,744 Chinese older adults aged 65 years or older were included in the 2011/2012 and 2014 cohorts from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with the longest follow-up period lasting for up to 8 years. The presence of HI was identified by using a dichotomized metric of self-reported hearing status. All-cause mortality data were ascertained from interviews with family members or relatives of the participants. Cognitive function was evaluated by employing the modified Mini-Mental State Examination (MMSE), which consisted of seven subdomains (orientation, naming foods, registration, attention and calculation, copy figure, delayed recall, and speech and language). Kaplan–Meier survival curves were constructed to evaluate the different hearing states on overall survival. The risk of mortality over the follow-up period was estimated by using Cox proportional hazard ratios (HRs) models.

Results

A conspicuous probability was revealed in the survival relationship between hearing status and all-cause mortality for the total population (p < 0.001). Participants with HI had a higher risk of all-cause mortality (HR = 2.29, 95% CI: 2.16, 2.42), as compared with their counterparts without HI. The association was robust upon fully adjustment for potential confounders (HR = 1.07, 95% CI: 1.00, 1.14). Compared to HI participants with no cognitive impairment, HI patients with cognitive impairment had a higher mortality risk (HR = 2.31, 95% CI: 2.13, 2.51). Impairment in the subdomains of cognitive function were independently associated with elevated mortality risk in the participants with HI, with an HR ranging from 1.28 (copy figure) to 1.46 (speech and language).

Conclusions

Cognitive decline was common in individuals with HI, and those with HI and cognitive impairment further increased mortality risk. Our findings prompt a call for actions to improve the hearing status and cognitive function of older people to minimize health risks and improve longevity.

Association of Visual, Hearing, and Dual Sensory Impairment With Incident Dementia

Introduction

The relationship between sensory impairments and the risk of dementia is inconclusive. We aim to investigate the association of visual impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI) with incident dementia.

Methods

The UK Biobank study recruited more than 500,000 participants aged 40-69 years across the United Kingdom. Participants with available visual acuity (VA) measurements and speech-reception-threshold (SRT) information and free of dementia at the baseline assessment were included in the analysis. VI was defined as VA worse than 0.3 LogMAR units and HI were defined as an SRT of -5.5 dB or over. DSI was defined as the presence of both VI and HI. Incident dementia was identified through linked data to primary care or hospital admission records and death registries. Multivariable Cox proportional hazard regression models were used to examine the association of VI, HI, and DSI with incident dementia.

Results

Among 113,511 participants (mean age: 56.8 ± 8.09 years, female: 54.4%), a total number of 1,135 (1.00%) cases of incident dementia were identified during a median follow up period of 11.1 years [interquartile range (IQR): 10.9-11.4 years]. The incidence of dementia showed significant differences among the non-sensory impairment (NSI) group, VI-only group, HI-only group, and DSI group (p < 0.001). After adjusting for demographic, lifestyle, health, and genetic factors, isolated VI (HR = 1.50, 95% CI: 1.06-2.12, p = 0.023), isolated HI (HR = 1.42, 95% CI:1.20-1.69, p < 0.001), and DSI (HR = 1.82, 95% CI: 1.10-3.00, p = 0.020) were independently associated with higher risks of incident dementia.

Conclusions

Visual, hearing, and dual sensory impairments were associated with an increased risk of developing dementia, suggesting that visual and hearing impairments are modifiable risk factors that can be targeted to prevent dementia.

Is Hearing Impairment Causally Associated With Falls? Evidence From a Two-Sample Mendelian Randomization Study

Background

Observational studies have suggested that hearing impairment (HI) was associated with the risk of falls, but it remains unclear if this association is of causal nature.

Methods

A two-sample Mendelian randomization (MR) study was conducted to investigate the causal association between HI and falls in individuals of European descent. Summary data on the association of single nucleotide polymorphisms (SNPs) with HI were obtained from the hitherto largest genome-wide association study (GWAS) (n = 323,978), and statistics on the association of SNPs with falls were extracted from another recently published GWAS (n = 461,725). MR Steiger filtering method was applied to determine the causal direction between HI and falls. Inverse-variance weighted (IVW) method was employed as the main approach to analyze the causal association between HI and falls, whereas weighted median, simple mode, weighted mode, and MR-Egger methods were used as complementary analyses. The MR-Egger intercept test, the MR-PRESSO test, and Cochran's Q statistic were performed to detect the potential directional pleiotropy and heterogeneity, respectively. The odds ratio (OR) with 95% confidence intervals (CIs) was used to evaluate this association.

Results

A total of 18 SNPs were identified as valid instrumental variables in our two-sample MR analysis. The positive causality between HI and risk of falls was indicated by IVW [OR 1.108 (95% CI 1.028, 1.194), p = 0.007]. The sensitivity analyses yielded comparable results. The “leave-one-out” analysis proved that lack of a single SNP did not affect the robustness of our results. The MR-Egger intercept test exhibited that genetic pleiotropy did not bias the results [intercept = −2.4E−04, SE = 0.001, p = 0.832]. Cochran's Q test revealed no heterogeneity.

Conclusion

Our MR study revealed a causal association between genetically predicted HI and falls. These results provide further evidence supporting the need to effectively manage HI to minimize fall risks and improve quality of life.

Alterations to cognitive abilities and functional networks in rats post broad-band intense noise exposure

This study aimed to investigate the alterations of cognition and functional connectivity post noise, and find the progress and neural substrates of noise induced hearing loss (NIHL)-associated cognitive impairment. We exposed rats to 122 dB broad-band noise for 2 h to induce hearing loss and the auditory function was assessed by measuring auditory brainstem response thresholds. Morris water maze test and resting state MRI were computed at 0 day, 1, 3, 6 months post noise to reveal cognitive ability and neural substrate. The interregional connections in the auditory network and default mode network, as well as the connections using the auditory cortex and cingulate cortex as seeds were also examined addtionally. The deficit in spatial learning/memory was only observed at 6 months after noise exposure. The internal connections in the auditory network and default mode network were enhanced at 0 day and decreased at 6 months post noise. The connectivity using the auditory cortex and cingulate cortex as seeds generally followed the rule of "enhancement-normal-decrease-widely decrease". A new model accounting for arousal, dementia, motor control of NIHL in is proposed. Our study highlights the fundamental flexibility of neural systems, and may also point toward novel therapeutic strategies for treating sensory disorders.

Longitudinal Changes in Hearing and Visual Impairments and Risk of Dementia in Older Adults in the United States

Importance

Hearing and vision problems are individually associated with increased dementia risk, but the impact of having concurrent hearing and vision deficits, ie, dual sensory impairment (DSI), on risk of dementia, including its major subtypes Alzheimer disease (AD) and vascular dementia (VaD), is not well known.

Objective

To evaluate whether DSI is associated with incident dementia in older adults.

Design, Setting, and Participants

This prospective cohort study from the Cardiovascular Health Study (CHS) was conducted between 1992 and 1999, with as many as 8 years of follow-up. The multicenter, population-based sample was recruited from Medicare eligibility files in 4 US communities with academic medical centers. Of 5888 participants aged 65 years and older in CHS, 3602 underwent cranial magnetic resonance imaging and completed the modified Mini-Mental State Examination in 1992 to 1994 as part of the CHS Cognition Study. A total of 227 participants were excluded due to prevalent dementia, leaving a total of 3375 participants without dementia at study baseline. The study hypothesis was that DSI would be associated with increased risk of dementia compared with no sensory impairment. The association between the duration of DSI with risk of dementia was also evaluated. Data analysis was conducted from November 2019 to February 2020.

Exposures

Hearing and vision impairments were collected via self-report at baseline and as many as 5 follow-up visits.

Main Outcomes and Measures

All-cause dementia, AD, and VaD, classified by a multidisciplinary committee using standardized criteria.

Results

A total of 2927 participants with information on hearing and vision at all available study visits were included in the analysis (mean [SD] age, 74.6 [4.8] years; 1704 [58.2%] women; 455 [15.5%] African American or Black; 2472 [85.5%] White). Compared with no sensory impairment, DSI was associated with increased risk of all-cause dementia (hazard ratio [HR], 2.60; 95% CI, 1.66-2.06; P < .001), AD (HR, 3.67; 95% CI, 2.04-6.60; P < .001) but not VaD (HR, 2.03; 95% CI, 1.00-4.09; P = .05).

Conclusions and Relevance

In this cohort study, DSI was associated with increased risk of dementia, particularly AD. Evaluation of hearing and vision in older adults may help to identify those at high risk of developing dementia.

The Association Between Hearing Impairment, Vision Impairment, Dual Sensory Impairment, and Serious Cognitive Impairment: Findings from a Population-Based Study of 5.4 million Older Adults

Background:

Sensory impairments and cognitive impairment are increasing in scope due to the aging population.

Objective:

To investigate the association between hearing impairment, vision impairment, and dual sensory impairment with cognitive impairment among older adults.

Methods:

Secondary analysis of a combination of ten consecutive waves (2008–2017) of the nationally representative American Community Survey. The sample included 5.4 million community-dwelling and institutionalized older adults aged 65 and older. Bivariate and logistic regression models were conducted to examine the association hearing impairment, vision impairment, and dual sensory impairment with cognitive impairment.

Results:

After controlling for age, race, education, and income, older adults with only hearing impairment had more than double the odds of cognitive impairment (OR = 2.66, 95% CI = 2.64, 2.68), while older adults with only vision impairment had more than triple the odds of cognitive impairment (OR = 3.63; 95% CI = 3.59, 3.67). For older adults with dual sensory impairment, the odds of cognitive impairment were eight-fold (OR = 8.16; 95% CI = 8.07, 8.25). Similar trends were apparent in each sex and age cohort.

Conclusion:

Hearing and vision impairment are both independently associated with cognitive impairment. However, dual sensory impairment is associated with substantially higher odds of cognitive impairment, even after controlling for sociodemographic characteristics. Practitioners working with older adults may consider treatment for sensory impairments and cognitive impairment concurrently. Future research is needed to determine if the association is causal, and to investigate the effectiveness of common methods of treatment for sensory impairment for reducing the prevalence of cognitive impairment.

Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents

BACKGROUND

Hearing and vision impairments and the use of audio-visual aids are associated with cognitive decline in community-dwelling older people, but effects in long-term care facilities (LFCF) are unclear. We hypothesize that visual and hearing impairment are associated with cognitive decline and these relationships are mediated by using visual and hearing aids.

METHODS

Secondary data analysis of a longitudinal study was conducted in the 7 government-subsidized LTCF operated by one of the largest non-governmental organizations in Hong Kong using data between 2005 and 2016. Eligible residents were ≥ 60 years of age without severe cognitive impairment at baseline who had stayed in the facilities for more than 3 years. All variables were measured by using the Minimum Data Set-Resident Assessment Instrument Version 2.0, Hong Kong version. The outcome was cognitive decline. Predictors were visual and hearing impairments. Mediators were the use of visual and hearing aids. General linear models were employed to test the hypotheses.

RESULTS

Results for 2,233 residents were analyzed, with a mean age of 82.1 ± 8.2 years and a mean follow-up period of 4.4 ± 0.8 years. Results showed that those who had visual impairment (p = 0.004) and hearing impairments (p = 0.022) had a higher risk of cognitive decline. Using hearing aids (coefficient = 0.0186, p < 0.05) positively mediates the effect of hearing impairment on cognitive decline. Using visual aids (coefficient = -0.0881, p < 0.05) negatively mediates the effects of visual impairment on cognitive decline.

CONCLUSION

In LTCF, hearing and visual impairments are associated with a higher risk of cognitive decline. Hearing aids often-users were associated with a higher risk of cognitive decline. LTCF residents with visual impairment did not use visual aids. Use of visual aids demonstrated potential effects in slowing cognitive decline. A future study with a larger and more diverse sample with attention to quality of devices is proposed to confirm its effects.

Longitudinal association between visual disability and cognitive function among middle-aged and older adults in China

BACKGROUND/AIMS

To determine the associations between visual disability and cognitive decline in Chinese middle-aged and older adults.

METHODS

A total of 6748 subjects were enrolled into this longitudinal, population-based, nationally representative study from two waves of the China Health and Retirement Longitudinal Study. Lagged dependent variable regression was used to model the independent associations between self-reported visual disability and cognitive function including memory and mental status.

RESULTS

The mean age of the 6748 individuals was 56.33 years, and 3350 (49.6%) were women. The prevalence of visual disability was 3.8%, which increased with age (p<0.001). Both memory and mental status score worsened over time (all p<0.001). After controlling for covariates, lagged dependent variable regression models showed that visual disability at baseline was significantly associated with memory decline after 7 years (β=-0.252, p=0.046). After stratifying by age groups, this association was only significant in the 55-64 age group (β=-0.372, p=0.033). In addition, both memory and mental status in 2011 predicted memory decline over 7 years (p=0.024 and p=0.045, respectively).

CONCLUSIONS

Our results suggest that visual disability may be a risk factor of memory decline, but not mental status among middle-aged and elderly adults in China. Future studies are needed to further corroborate the association between visual disability and cognitive decline and to determine whether interventions to preserve good visual function can prevent cognitive decline.

Visual Impairment and Risk of Dementia: The UK Biobank Study

PURPOSE

To investigate the relationship between visual impairment (VI) and dementia in the UK Biobank Study.

DESIGN

Prospective cohort study.

METHODS

A total of 117,187 volunteers (aged 40-69 years) deemed free of dementia at baseline were included. Habitual distance visual acuity worse than 0.3 logMAR units in the better-seeing eye was used to define VI. The incident dementia was based on electronically linked hospital inpatient and death records.

RESULTS

During a median follow-up of 5.96 years, the presence of VI was significantly associated with incident dementia (hazard ratio: 1.78; 95% confidence interval: 1.18-2.68; P = .006). There was a clear trend between the severity of VI and risk of dementia (P for trend = .002).

CONCLUSIONS

We found VI was associated with increased risk of dementia, with a progressively greater risk among those with worse visual acuity. Our findings suggested that VI might be a modifiable risk factor for dementia and highlighted the potential value of VI elimination to delay the manifestation of dementia.

The revised index for social engagement (RISE) in long-term care facilities: reliability and validity in Japan

BACKGROUND

This study aimed to establish the validity and reliability of a revised index for social engagement (RISE) in the Japanese context.

METHODS

We analysed the data of 1377 participants over 65 years of age who had been admitted to two types of long-term care facilities (LTCF) in Japan: four health facilities for older adults and eight nursing homes. Resident level data based on the Japanese version of the interRAI assessment instrument were collected from 623 residents in the former and 754 in the latter. From these data, we calculated RISE by adding six dichotomous items on social engagement in the assessment form. Factorial validity was evaluated by exploratory factorial analysis and confirmatory factor analysis, convergent validity by the correlation between average activity time and the RISE score, and discriminant validity by the correlation between cognitive levels and the RISE scores. Lastly, we assessed internal consistency using Cronbach's alpha.

RESULTS

We identified a two-factor model in the exploratory factorial analysis with a factor loading >0.40, except for one RISE item. The confirmatory factor analysis confirmed that the two-factor model had appropriate model fits. The correlation between time involved in activities and the RISE score was r = 0.45, while the correlation between cognitive function and the RISE score was r = -0.32. The convergent and discriminant validities supported the use of Japanese LTCF. Cronbach's alpha ranged 0.70-0.72.

CONCLUSIONS

Although further revision may be needed to improve factorial validity, RISE is reliable and valid for assessing social engagement of older adults admitted to LTCF in Japan. By using the Japanese version of RISE, the positive aspects of social functioning can be appropriately assessed and provide more evidence for improving the quality of care in LTCF.

A Newly Identified Impairment in Both Vision and Hearing Increases the Risk of Deterioration in Both Communication and Cognitive Performance

Vision and hearing impairments are highly prevalent in adults 65 years of age and older. There is a need to understand their association with multiple health-related outcomes. We analyzed data from the Resident Assessment Instrument for Home Care (RAI-HC). Home care clients were followed for up to 5 years and categorized into seven unique cohorts based on whether or not they developed new vision and/or hearing impairments. An absolute standardized difference (stdiff) of at least 0.2 was considered statistically meaningful. Most clients (at least 60%) were female and 34.9 per cent developed a new sensory impairment. Those with a new concurrent vison and hearing impairment were more likely than those with no sensory impairments to experience a deterioration in receptive communication (stdiff = 0.68) and in cognitive performance (stdiff = 0.49). After multivariate adjustment, they had a twofold increased odds (adjusted odds ratio [OR] = 2.1; 95% confidence interval [CI]:1,87, 2.35) of deterioration in cognitive performance. Changes in sensory functioning are common and have important effects on multiple health-related outcomes.

Self-reported dual sensory impairment, dementia, and functional limitations in Medicare beneficiaries

BACKGROUND

Vision and hearing impairments often co-exist with dementia, and all are independently associated with limitations in daily activities. Our aim was to examine the association of dual sensory impairment with functional limitations, and further examine the combined estimated association of sensory impairment and dementia with these functional limitations.

METHODS

Cross-sectional analysis of the National Health and Aging Trends Study (NHATS), a population-based cohort of Medicare beneficiaries, was performed. Participants were selected from the 2015 round. Survey weighted Poisson regression models adjusted for dementia, demographics, and health status variables examined the association of self-reported dual sensory impairment (no sensory impairment, single sensory impairment, dual sensory impairment) with scores of limitations in mobility, self-care, and household activities. Models were repeated to take into account the combined effects of dual sensory impairment and dementia.

RESULTS

Overall, 7124 participants representative of Medicare beneficiaries 65 years or older were included. Of them, 43.9% were 75 years or older and 55.3% were female. Older adults with dual sensory impairment had greater limitations with mobility (prevalence rate ratio [PRR] = 1.45, 95% CI = 1.28-1.63), self-care (PRR = 1.41, 95% CI = 1.25-1.59), and household activities (PRR = 1.54, 95% CI = 1.37-1.72) compared with those without sensory impairment. They also had greater limitations than those with a single sensory impairment across the different activity categories. In models taking into account the combined estimated effect of both sensory impairment and dementia, those with dual sensory impairment and dementia had greater limitations than those without sensory impairment or dementia in each category (mobility: PRR = 1.85, 95% CI = 1.59-2.14, self-care: PRR = 1.86, 95% CI = 1.59-2.18, household: PRR = 2.41, 95% CI = 2.09-2.77).

CONCLUSIONS

Older adults with dual sensory impairment had greater functional limitations compared with those without sensory impairment and those with a single sensory impairment. Strategies to improve visual and/or hearing function (e.g., sensory aids, rehabilitation) could potentially help prevent or minimize disability, even among those with dementia.

Bidirectional Association between Visual Impairment and Dementia Among Older Adults in the United States Over Time

PURPOSE

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.

DESIGN

Retrospective, time-to-event study.

PARTICIPANTS

National Health and Aging Trends Study (NHATS) participants from 2011 to 2018 cycles.

METHODS

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.

MAIN OUTCOME MEASURES

Hazard ratio (HR) for incident dementia among participants with baseline self-reported VI and HR for incident VI among participants with baseline dementia.

RESULTS

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).

CONCLUSIONS

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.

Cognitive Impairment in Older Adults With Concurrent Hearing and Vision Impairment: A Systematic Scoping Review Protocol

Introduction: As the prevalence of age-related sensory impairment increases, more evidence emerges on the association between uni-sensory and cognitive impairment (CI) in older adults. However, the link between CI and concurrent hearing and vision impairment (referred to as dual sensory impairment/DSI) is not well-understood, and this combined effect may be additive or multiplicative. Moreover, the existing evidence on CI in older adults with DSI is scattered and limited. Through this systematic scoping review, we aim to map existing evidence on CI in older adults with DSI, and to summarize what is known about the prevalence, incidence and risk factors of CI, and tools used to screen or assess CI in older adults with DSI. Methods and Analysis: We will use the Joanna Briggs Institute framework to perform the review. Eleven databases [MEDLINE, CINAHL/EBSCO, EMBASE, Mednar, WorldWideScience, PsycEXTRA, OAIster, OpenGrey (SIGLE), Global Health, PsycINFO, and Web of Science] and clinical trial registries (ISRCTN Registry, WHO ICTRP, and ClinicalTrials.gov) will be searched. Study selection will be completed using Covidence, and data will be extracted using an a priori data extraction tool. To be included, studies had to be peer-reviewed, had older adults with DSI as the focal population, and are related to CI. Data will be presented using a narrative summary with emphasis on implications for future research and practice. Discussion: Reliable cognitive screening is of the utmost importance for prevention and treatment of CI within DSI population. The study findings will have significant implications for health services delivery and policy research. The summarized findings on the prevalence, incidence, associated risk factors, and CI screening and assessment tools will inform geriatric care. The review will also document knowledge gaps on CI in the DSI population and identify areas of interest for future studies. Ethics and Dissemination: The scoping study, being a review of existing documents, does not require ethics approval. The findings will be disseminated with relevant stakeholders using knowledge translation activities such as scientific presentations and publications. We intend to use the findings to conduct a Delphi study to evaluate which CI tools are suitable for older population with DSI.

Visual and Hearing Impairment Are Associated With Delirium in Hospitalized Patients: Results of a Multisite Prevalence Study

OBJECTIVE

Sensory deficits are important risk factors for delirium but have been investigated in single-center studies and single clinical settings. This multicenter study aims to evaluate the association between hearing and visual impairment or bi-sensory impairment (visual and hearing impairment) and delirium.

DESIGN

Cross-sectional study nested in the 2017 "Delirium Day" project.

SETTING AND PARTICIPANTS

Patients 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes, and hospices in Italy.

METHODS

Delirium was assessed with the 4AT (a short tool for delirium assessment) and sensory deficits with a clinical evaluation. We assessed the association between delirium, hearing and visual impairment in multivariable logistic regression models, adjusting for: Model 1, we included predisposing factors for delirium (ie, dementia, weight loss and autonomy in the activities of daily living); Model 2, we added to Model 1 variables, which could be considered precipitating factors for delirium (ie, psychoactive drugs and urinary catheters).

RESULTS

A total of 3038 patients were included; delirium prevalence was 25%. Patients with delirium had a higher prevalence of hearing impairment (30.5% vs 18%; P < .001), visual impairment (24.2% vs 15.7%; P < .01) and bi-sensory impairment (16.2% vs 7.5%) compared with those without delirium. In the multivariable logistic regression analysis, the presence of bi-sensory impairment was associated with delirium in Model 1 [odds ratio (OR) 1.5, confidence interval (CI) 1.2-2.1; P = .00] and in Model 2 (OR 1.4; CI 1.1-1.9; P = .02), whereas the presence of visual and hearing impairment alone was not associated with delirium either in Model 1 (OR 0.8; CI 0.6-1.2, P = .36; OR 1.1; CI 0.8-1.4; P = .42) or in Model 2 (OR 0.8, CI 0.6-1.2, P = .27; OR 1.1, CI 0.8-1.4, P = .63).

CONCLUSIONS AND IMPLICATIONS

Our findings support the importance of routine screening and specific interventions by a multidisciplinary team to implement optimal management of sensory impairments and hence prevention and the management of the patients with delirium.

Informed Consent or Assent Strategies for Research With Individuals With Deafblindness or Dual Sensory Impairment: A Scoping Review

OBJECTIVE

To synthesize evidence on existing informed consent/assent strategies and processes that enable the participation of individuazls with deafblindness or dual sensory impairment in research.

DATA SOURCES

Five scientific databases (PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health, Web of Science, and PsycINFO) and other sources such as Google Scholar, Journal of Visual Impairment and Blindness, and British Journal of Visual Impairment were hand-searched from January 2015 until July 2020.

STUDY SELECTION

Studies were selected using a priori inclusion criteria of sensory and cognitive disabilities and focused on consent/assent strategies and processes in research within this population. Articles related to the medical or sexual consent processes were excluded.

DATA EXTRACTION

An Excel spreadsheet was used to extract data from the eligible sources. Discrepancies were resolved in discussion with team members.

DATA SYNTHESIS

A total of 2163 sources were screened, and 16 articles were included in the review. Seven sources only examined consent strategies, whereas the remaining 8 included a combination of consent/assent and dissent strategies. Using thematic analysis, 3 key themes emerged: consent/assent strategies, researcher capacity, and capacity to consent tools. Key identified strategies included the accessibility of the consent/assent process, building relationships with participants and caregivers, identifying behavioral cues, and communication training for researchers.

CONCLUSIONS

Despite the absence of literature on consent/assent strategies within the population with deafblindness, the review found promising strategies applied to individuals with other cognitive or sensory disabilities that researchers can adopt. Researchers are encouraged to use best practices in creating an inclusive research environment to include individuals with deafblindness.

Dual Sensory Impairment and Cognitive Impairment in the Korean Longitudinal Elderly Cohort

OBJECTIVE

To investigate the effects of single sensory impairment (SSI; visual or auditory) or dual sensory impairment (DSI; visual and auditory) on dementia and longitudinal changes of neuropsychological test scores.

METHODS

In this nationwide, prospective, community-based elderly cohort study, KLOSCAD (the Korean Longitudinal Study on Cognitive Aging and Dementia), 6,520 elderly individuals (58-101 years) representing the general population were included. We defined visual and auditory sensory impairment via self-report questionnaire: 932 had normal sensory function, 2,957 had an SSI, and 2,631 had a DSI. Demographic and clinical variables including cognitive outcomes were evaluated every 2 years over 6 years. Through logistic regression, Cox regression, and linear mixed model analysis, the relationship between SSI or DSI and dementia prevalence, dementia incidence, and change in neuropsychological scores were evaluated.

RESULTS

At baseline, DSI was significantly associated with increased dementia prevalence compared to normal sensory function (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.17-4.02), but SSI was not (OR 1.27, 95% CI 0.66-2.41). During the 6-year follow-up, the incidence of dementia was significantly higher in the DSI group than in the normal sensory function group (hazard ratio 1.9, 95% CI 1.04-3.46) and neuropsychological scores significantly decreased (β -0.87, 95% CI [-1.17 to -0.58]).

CONCLUSIONS

Our results suggest that coexisting visual and hearing impairments facilitate dementia prevalence, dementia incidence, and cognitive decline, but visual or hearing impairment alone do not. Visual and hearing impairment may lead to dementia or cognitive decline independent of Alzheimer pathology.

Prevalence of Concurrent Functional Vision and Hearing Impairment and Association With Dementia in Community-Dwelling Medicare Beneficiaries

IMPORTANCE

Impairments in vision or hearing are common and have been independently linked to higher risk of dementia in older adults. There is a limited understanding of the prevalence of concurrent functional vision and hearing impairment (dual sensory impairment) and its contribution to dementia risk.

OBJECTIVE

To examine the age-specific prevalence of functional dual sensory impairment among older adults, and to investigate the cross-sectional and 7-year longitudinal associations between functional dual sensory impairment and dementia.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study of 7562 older adults used data from the US National Health and Aging Trends Study (NHATS), a nationally representative cohort study of community-dwelling, Medicare beneficiaries aged 65 years and older in the US. Participants in the study with complete data on hearing, vision, and dementia were included in analysis. Data were collected between 2011 and 2018, and between March 2018 and May 2020.

EXPOSURES

Self-reported functional sensory impairments (ie, no sensory impairment, functional vision impairment only, functional hearing impairment only, and functional dual sensory impairment).

MAIN OUTCOMES AND MEASURES

Age-specific prevalence of functional sensory impairments was calculated. Generalized linear regression with a complementary log-log link and a discrete time proportional hazards model with a complementary log-log link were used to assess the cross-sectional and 7-year longitudinal hazard of dementia.

RESULTS

Of 7562 participants, 3073 (40.7%) were ages 80 years or older and 4411 (58.3%) were women. Overall, 5.4% (95% CI, 4.7%-6.1%) of participants reported functional vision impairment only, 18.9% (95% CI, 18.9%-17.8%) reported functional hearing impairment only, and 3.1% (95% CI, 2.7%-3.5%) reported functional dual sensory impairment (prevalence estimates are weighted). Participants reporting sensory impairments were older (no impairment: age ≥90 years, 2.12% [95% CI, 1.79%-2.46%] vs functional dual sensory impairment: age ≥90 years, 20.06% [95% CI, 16.02%-24.10%]), had lower education (no impairment: <high school, 19.05% [95% CI, 17.27%-20.83%] vs functional dual sensory impairment: <high school, 46.15% [95% CI, 38.38%-53.92%]), and greater disease burden (eg, heart disease: no impairment, 15.30% [95% CI, 14.04%-16.55%] vs functional dual sensory impairment, 25.49% [95% CI, 19.96%-31.02%]). Compared with no impairment, functional vision impairment (adjusted hazard ratio [aHR], 1.89; 95% CI, 1.57-2.28), functional hearing impairment (aHR, 1.14; 95% CI, 1.00-1.31), and functional dual sensory impairment (aHR, 2.00; 95% CI, 1.57-2.53) were associated with a higher cross-sectional hazard of dementia. Over 7 years, functional vision impairment (aHR, 1.40; 95% CI, 1.12-1.74), functional hearing impairment (aHR, 1.09; 95% CI, 0.95-1.24), and functional dual sensory impairment (aHR, 1.50; 95% CI, 1.12-2.02) were associated with a higher hazard of incident dementia compared with no impairment.

CONCLUSIONS AND RELEVANCE

In this cohort study of US Medicare beneficiaries, dual sensory impairment was prevalent in older adults and associated with increased risk of dementia. These findings suggest that sensory rehabilitative interventions for multiple impairments may be an additional resource in efforts to reduce dementia risk.

Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19

OBJECTIVES

Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19.

DESIGN

Scoping review.

SETTINGS AND PARTICIPANTS

Residents of LTC homes, care homes, and nursing homes.

METHODS

We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies.

RESULTS

We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents.

CONCLUSIONS AND IMPLICATIONS

Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.

Association of Visual Impairment With Risk of Incident Dementia in a Women's Health Initiative Population

Importance

Dementia affects a large and growing population of older adults. Although past studies suggest an association between vision and cognitive impairment, there are limited data regarding longitudinal associations of vision with dementia.

Objective

To evaluate associations between visual impairment and risk of cognitive impairment.

Design, Setting, and Participants

A secondary analysis of a prospective longitudinal cohort study compared the likelihood of incident dementia or mild cognitive impairment (MCI) among women with and without baseline visual impairment using multivariable Cox proportional hazards regression models adjusting for characteristics of participants enrolled in Women's Health Initiative (WHI) ancillary studies. The participants comprised community-dwelling older women (age, 66-84 years) concurrently enrolled in WHI Sight Examination (enrollment 2000-2002) and WHI Memory Study (enrollment 1996-1998, ongoing). The study was conducted from 2000 to the present.

Exposures

Objectively measured visual impairment at 3 thresholds (visual acuity worse than 20/40, 20/80, or 20/100) and self-reported visual impairment (determined using composite survey responses).

Main Outcomes and Measures

Hazard ratios (HRs) and 95% CIs for incident cognitive impairment after baseline eye examination were determined. Cognitive impairment (probable dementia or MCI) was based on cognitive testing, clinical assessment, and centralized review and adjudication. Models for (1) probable dementia, (2) MCI, and (3) probable dementia or MCI were evaluated.

Results

A total of 1061 women (mean [SD] age, 73.8 [3.7] years) were identified; 206 of these women (19.4%) had self-reported visual impairment and 183 women (17.2%) had objective visual impairment. Forty-two women (4.0%) were ultimately classified with probable dementia and 28 women (2.6%) with MCI that did not progress to dementia. Mean post-eye examination follow-up was 3.8 (1.8) years (range, 0-7 years). Women with vs without baseline objective visual impairment were more likely to develop dementia. Greatest risk for dementia was among women with visual acuity of 20/100 or worse at baseline (HR, 5.66; 95% CI, 1.75-18.37), followed by 20/80 or worse (HR, 5.20; 95% CI, 1.94-13.95), and 20/40 or worse (HR, 2.14; 95% CI, 1.08-4.21). Findings were similar for risk of MCI, with the greatest risk among women with baseline visual acuity of 20/100 or worse (HR, 6.43; 95% CI, 1.66-24.85).

Conclusions and Relevance

In secondary analysis of a prospective longitudinal cohort study of older women with formal vision and cognitive function testing, objective visual impairment appears to be associated with an increased risk of incident dementia. However, incident cases of dementia and the proportion of those with visual impairment were low. Research is needed to evaluate the effect of specific ophthalmic interventions on dementia.