Association of Vision Loss With Cognition in Older Adults.
ABSTRACT: Visual dysfunction and poor cognition are highly prevalent among older adults; however, the relationship is not well defined.To evaluate the association of measured and self-reported visual impairment (VI) with cognition in older US adults.Cross-sectional analysis of 2 national data sets: the National Health and Nutrition Examination Survey (NHANES), 1999-2002, and the National Health and Aging Trends Study (NHATS), 2011-2015. The NHANES was composed of a civilian, noninstitutionalized community, and the NHATS comprised Medicare beneficiaries in the contiguous United States. Vision was measured at distance, near, and by self-report in the NHANES and by self-report alone in the NHATS. Sample weights were used to ensure result generalizability.The NHANES measured Digit Symbol Substitution Test (DSST) score and relative DSST impairment (DSST score ?28, lowest quartile in study cohort), and the NHATS measured probable or possible dementia, classified per NHATS protocol.The NHANES comprised 2975 respondents aged 60 years and older who completed the DSST measuring cognitive performance. Mean (SD) age was 72 (8) years, 52% of participants were women (n?=?1527), and 61% were non-Hispanic white (n?=?1818). The NHATS included 30?202 respondents aged 65 years and older with dementia status assessment. The largest proportion (40%; n?=?12?212) were between 75 and 84 years of age. Fifty-eight percent were women (n?=?17?659), and 69% were non-Hispanic white (n?=?20?842). In the NHANES, distance VI (??=?-5.1; 95% CI, -8.6 to -1.6; odds ratio [OR], 2.8; 95% CI, 1.1-6.7) and subjective VI (??=?-5.3; 95% CI, -8.0 to -2.6; OR, 2.7; 95% CI, 1.6-4.8) were both associated with lower DSST scores and higher odds of DSST impairment after full adjustment with covariates. Near VI was associated with lower DSST scores but not higher odds of DSST impairment. The NHATS data corroborated these results, with all vision variables associated with higher odds of dementia after full adjustment (distance VI: OR, 1.9; 95% CI, 1.6-2.2; near VI: OR, 2.6; 95% CI, 2.2-3.1; either distance or near VI: OR, 2.1; 95% CI, 1.8-2.4).In a nationally representative sample of older US adults, vision dysfunction at distance and based on self-reports was associated with poor cognitive function. This was substantiated by a representative sample of US Medicare beneficiaries using self-reported visual function, reinforcing the value of identifying patients with visual compromise. Further study of longitudinal interactions between vision and cognition is warranted.
Project description:Abstract Background and Objectives Dementia and vision impairment (VI) are common among older adults but little is known about caregiving in this context. Research Design and Methods We used data from the 2011 National Health and Aging Trends Study, a nationally representative survey of Medicare beneficiaries, linked to their family/unpaid helpers from the National Study of Caregiving. Vision impairment was defined as self-reported blindness or difficulty with distance/near vision. Probable dementia was based on survey report, interviews, and cognitive tests. Our outcomes included hours of care provided, and number of valued activities (scored 0–4) affected by caregiving, per month. Results Among 1,776 caregivers, 898 (55.1%, weighted) assisted older adults without dementia or VI, 450 (21.9%) with dementia only, 224 (13.0%) with VI only, and 204 (10.0%) with dementia and VI. In fully adjusted negative binomial regression analyses, caregivers of individuals with dementia and VI spent 1.7 times as many hours (95% confidence interval [CI] = 1.4–2.2) providing care than caregivers of those without either impairment; however, caregivers of individuals with dementia only (95% CI = 1.1–1.6) and VI only (95% CI = 1.1–1.6) spent 1.3 times more hours. Additionally, caregivers of individuals with dementia and VI had 3.2 times as many valued activities affected (95% CI = 2.2–4.6), while caregivers of dementia only and VI only reported 1.9 times (95% CI = 1.4–2.6) and 1.3 times (95% CI = 0.9–1.8) more activities affected, respectively. Discussion and Implications Our results suggest that caring for older adults with VI involves similar time demands as caring for older adults with dementia, but that participation impacts are greater when caring for older adults with both dementia and VI.
Project description:Objective: To assess the joint impact of cognitive performance and visual acuity on mortality over 13-year follow-up in a representative US sample. Methods: Data from National Health and Nutrition Examination Survey (NHANES) participants (?18 years old) were linked with the death record data of the National Death Index (NDI) with mortality follow-up through December 31, 2011. Cognitive performance was evaluated by the Digit Symbol Substitution Test (DSST) and cognitive performance impairment was defined as the DSST score equal to or less than the median value in the study population. Visual impairment (VI) was defined as presenting visual acuity worse than 20/40 in the better-seeing eye. Risks of all-cause and specific-cause mortality were estimated with Cox proportional hazards models after adjusting for confounders. Results: A total of 2,550 participants 60 years and older from two waves of (NHANES, 1999-2000, 2001-2002) were included in the current analysis. Over a median follow-up period of 9.92 years, 952 (35.2%) died of all causes, of whom 239 (23.1%), 224 (24.0%), and 489 (52.9%) died from cardiovascular disease (CVD), cancer, and non-CVD/non-cancer mortality, respectively. Cognitive performance impairment and VI increased the odds for mortality. Co-presence of VI among cognitive impaired elderly persons predicted nearly a threefold increased risk of all-cause mortality [hazard ratios (HRs), 2.74; 95% confidence interval (CI), 2.02-3.70; P < 0.001) and almost a fourfold higher risk of non-CVD/non-cancer mortality (HR, 3.72; 95% CI, 2.30-6.00; P < 0.001) compared to having neither impairment. Conclusion: People aged 60 years and over with poorer cognitive performance were at higher risk of long-term mortality, and were especially vulnerable to further mortality when concomitant with VI. It is informative for clinical implication in terms of early preventive interventions.
Project description:Introduction:Visual impairment (VI) is associated with a variety of comorbidities including physical and mental health in industrial countries. Our aim is to examine associations between self-reported impairment and depressive symptoms in the German population. Methods:The point prevalence of self-reported VI in Germany was computed using data from the German Health Interview and Examination Survey for adults from 2008 to 2011 (N?=?7.783, 50.5% female, age range 18-79?years). VI was surveyed by two questions, one for seeing faces at a distance of 4?m and one for reading newspapers. Depressive symptoms were evaluated with the Patient Health Questionnaire-9 questionnaire and 2-week prevalence was computed with weighted data. Depressive symptoms were defined by a value of ?10. Logistic regression analysis was performed to analyze an association between self-reported VI and depressive symptoms. Multivariable analysis including adjustment for age, gender, socioeconomic status, and chronic diseases were carried out with weighted data. Results:The 2-week prevalence of depressive symptoms was 20.8% (95% CI: 16.6-25.7%) for some difficulties in distance vision and 14.4% (95% CI: 7.5-25.9%) for severe difficulties in distance vision, while 17.0% (95% CI: 13.3-21.4%), respectively, 16.7% (95% CI: 10.7-25.1%) for near vision. Analysis revealed that depressive symptoms were associated with self-reported VI for reading, respectively, with low VI for distance vision. Multivariable regression analysis including potential confounders confirmed these findings. Conclusion:Depressive symptoms are a frequent finding in subjects with difficulties in distance and near vision with a prevalence of up to 24%. Depressive comorbidity should therefore be evaluated in subjects reporting VI.
Project description:BACKGROUND:Recent estimates suggest that dementia incidence is decreasing in the US possibly due to better management of cardiovascular disease (CVD) risk factors, but these studies lack repeated cross-sectional assessment among a representative US sample. Our objective was to assess temporal trends in cognitive performance in relation to CVD risk factors among older National Health and Nutrition Examination Survey (NHANES) participants. METHODS:We used repeated cross-sectional assessment of 5711 participants ?60 years of age from four NHANES cycles: 1999-2000, 2001-2002, 2011-2012 and 2013-2014. Cognitive function was assessed during each cycle with the Digit Symbol Substitution Test (DSST). We estimated mean DSST score at each cycle and annual trend in DSST before and after adjustment for age, sex, race/ethnicity, education, smoking status, blood pressure, glucose status and body mass index. RESULTS:DSST scores was significantly higher for 2011-2012 (difference: 6.7, 95%?CI 4.4 to 9.0) and 2013-2014 (difference: 6.2, 95%?CI 4.0 to 8.5), but not 2001-2002 (difference: 2.3, 95%?CI -0.01 to 4.6) as compared with 1999-2000 before adjustment. We observed a linear trend for higher annual DSST score before adjustment (DSST/year: 0.44, 95%?CI 0.31 to 0.57) and after adjustment for age, sex, race/ethnicity, educational attainment and CVD risk factors (DSST/year: 0.17, 95%?CI 0.08 to 0.26). Educational attainment was most strongly associated with the attenuation in the trend in cognitive function (77% of trend attenuation and 20% of variance in DSST). CONCLUSION:Cognitive function is improving over time for US adults aged ?60 years. These improvements are strongly associated with greater educational attainment and irrespective of the changing US demographic and cardiovascular health profiles.
Project description:OBJECTIVES:To evaluate whether allostatic load (AL), a measure of cumulative biological risk, fully or partially mediates observed socioeconomic status (SES) differences in cognitive function in the elderly. DESIGN:Cross-sectional mediation analysis. SETTING:Community-dwelling US elderly who participated in the National Health and Nutrition Examination Survey (NHANES). PARTICIPANTS:The NHANES uses a complex, multistage, probability sampling design to select a nationally representative sample. Of the 4976 elderly (60 years or older) who were selected, 3234 agreed to participate in the household and medical exam interviews (65% response rate). PRIMARY AND SECONDARY OUTCOME MEASURES:Performance on the Digit Symbol Substitution Test (DSST)-a measure of cognitive function. RESULTS:Relative to participants with the lowest level of education or family income, participants who were college graduates (?=24.4, 95%?CI 22 to 26.8, p<0.0001) or in the highest income quartile (?=17.3, 95%?CI 15.2 to 19.4, p<0.0001) had the highest DSST scores and the least AL burden (?=-0.72, 95%?CI -0.98 to -0.47 and ?=-0.82, 95%?CI -1 to -0.57; p<0.0001, respectively). Although, AL was significantly negatively associated with cognitive performance (? = -1, 95%?CI -1.4 to -0.5, p<0.0001), it mediated at most 4.5% of the SES effect on DSST performance. CONCLUSIONS:The findings suggest that AL, as measured by a summary index of parameters for cardiovascular function, metabolism and chronic inflammation, is not a significant mediator of SES-related differences in cognitive function in the elderly. Further efforts are required to elucidate the exact physiological pathways and mechanisms through which SES impacts cognitive function in late life.
Project description:OBJECTIVES:To determine the prevalence of falls, fear of falling (FoF), and activity limitation due to FoF in a nationally representative study of older adults with self-reported vision impairment (VI). DESIGN:Cross-sectional analysis of panel survey data. SETTING:National Health and Aging Trends Study, a nationally representative survey administered annually from 2011 to 2016 to U.S. Medicare beneficiaries aged 65 and older. PARTICIPANTS:Respondents (N=11,558) who contributed 36,229 participant observations. MEASUREMENTS:We performed logistic regression to calculate the unadjusted and adjusted prevalence of self-reported history of more than 1 fall in the past year, any fall in the past month, FoF, and activity limitation due to FoF in participants with and without self-reported VI. RESULTS:The weighted proportion of participants reporting VI was 8.6% (95% confidence interval (CI)=8.0-9.2%). The unadjusted prevalence of more than 1 fall in the past year was 27.6% (95% CI=25.5-29.7%) in participants with self-reported VI and 13.2% (95% CI=12.7-13.7%) in those without self-reported VI. In respondents with self-reported VI, the prevalence of FoF was 48.3% (95% CI=46.1-50.6%) and of FoF limiting activity was 50.8% (95%CI 47.3-54.2%), and in those without self-reported VI, the prevalence of FoF was 26.7% (95% CI=25.9-27.5%) and of FoF limiting activity was 33.9% (95% CI=32.4-35.4%). The prevalence of all fall and fall-related outcomes remained significantly higher among those with self-reported VI after adjusting for sociodemographics and potential confounders. CONCLUSION:The prevalence of falls, FoF, and activity limitation due to FoF is high in older adults with self-reported VI. This is the first study to provide nationally representative data on the prevalence of fall-related outcomes in older Americans with self-reported VI. These findings demonstrate the need to treat avoidable VI and to develop interventions to prevent falls and fall-related outcomes in this population. J Am Geriatr Soc 67:239-245, 2019.
Project description:Importance:This study determines the prevalence of unilateral vision impairment (VI) and unilateral blindness to assist in policy formulation for eye health care services. Objective:To determine the prevalence and causes of unilateral VI and unilateral blindness in Australia. Design, Setting, and Participants:This cross-sectional population-based survey was conducted from March 2015 to April 2016 at 30 randomly selected sites across all strata of geographic remoteness in Australia. A total of 1738 indigenous Australians 40 years or older and 3098 nonindigenous Australians 50 years or older were included. Main Outcomes and Measures:The prevalence and causes of unilateral vision impairment and blindness, defined as presenting visual acuity worse than 6/12 and 6/60, respectively, in the worse eye, and 6/12 or better in the better eye. Results:Of the 1738 indigenous Australians, mean (SD) age was 55.0 (10.0) years, and 1024 participants (58.9%) were female. Among the 3098 nonindigenous Australians, mean (SD) age was 66.6 (9.7) years, and 1661 participants (53.6%) were female. The weighted prevalence of unilateral VI in indigenous Australians was 12.5% (95% CI, 11.0%-14.2%) and the prevalence of unilateral blindness was 2.4% (95% CI, 1.7%-3.3%), respectively. In nonindigenous Australians, the prevalence of unilateral VI was 14.6% (95% CI, 13.1%-16.3%) and unilateral blindness was found in 1.4% (95% CI, 1.0%-1.8%). The age-adjusted and sex-adjusted prevalence of unilateral vision loss was higher in indigenous Australians than nonindigenous Australians (VI: 18.7% vs 14.5%; P?=?.02; blindness: 2.9% vs 1.3%; P?=?.02). Risk factors for unilateral vision loss included older age (odds ratio [OR], 1.60 for each decade of age for indigenous Australians; 95% CI, 1.39-1.86; OR, 1.65 per decade for nonindigenous Australians; 95% CI, 1.38-1.96), very remote residence (OR, 1.65; 95% CI, 1.01-2.74) and self-reported diabetes (OR, 1.52; 95% CI, 1.12-2.07) for indigenous Australians, and having not undergone an eye examination in the past 2 years for nonindigenous Australians (OR, 1.54; 95% CI, 1.04-2.27). Uncorrected refractive error and cataract were leading causes of unilateral VI in both populations (70%-75%). Corneal pathology (16.7%) and cataract (13.9%) were leading causes of unilateral blindness in indigenous Australians, while amblyopia (18.8%), trauma (16.7%), and age-related macular degeneration (10.4%) were major causes of unilateral blindness in nonindigenous Australians. Conclusions and Relevance:Unilateral vision loss is prevalent in indigenous and nonindigenous Australians; however, most cases are avoidable. As those with unilateral vision loss caused by cataract and posterior segment diseases may be at great risk of progressing to bilateral blindness, national blindness prevention programs may benefit from prioritizing examination and treatment of those with unilateral vision loss.
Project description:BACKGROUND:Older adults with visual impairments are at increased risk of negative health outcomes. Here, we investigate the association between visual impairment and frailty. METHODS:Cross-sectional and longitudinal relationships between visual impairment (distance visual acuity) and frailty (frailty phenotype criteria) were examined using data from the National Health and Nutrition Examination Survey (NHANES, 1999-2002, ?60 years) and the Women's Health and Aging Studies (WHAS III). Imbalance of potential confounders, particularly age, was addressed using propensity score-based adjustment. Multinomial logistic regression determined the odds of prefrailty and frailty at baseline in NHANES and ordinal logistic regression examined the odds of baseline and incident frailty over 3 years in WHAS III after adjustment for confounders and probability weighting (survey weights × inverse propensity scores). RESULTS:In NHANES (n = 2,639, 9% vision impairment), participants with visual impairment were more likely to be prefrail (odds ratio [OR] = 3.2; 95% confidence interval [CI]: 1.9-5.3) and frail (OR = 3.7; 95% CI: 1.5-9.2) than those without visual impairment. In WHAS III (n = 796, 26% mild, 37% moderate/severe vision impairment), participants with mild and moderate/severe vision impairment were more likely to be frail (OR = 2.0; 95% CI: 1.5-2.5; OR = 5.5; 95% CI: 4.2-7.2, respectively). A one-line worse visual acuity (0.1 logMAR increase) was associated with greater odds of frailty (OR = 1.5; 95% CI: 1.4-1.7). Of those non-frail at baseline (n = 549), moderate/severe visual impairment and one-line worse visual acuity was associated with greater odds of incident frailty (OR = 3.5; 95% CI: 1.4-8.4; OR = 1.3; 95% CI: 1.1-1.5, respectively) over 3 years. CONCLUSIONS:Visual impairment may be an important, yet understudied risk factor for frailty.
Project description:OBJECTIVES:To compare the ability of frailty status to predict fall risk with that of community fall risk screening tools. DESIGN:Analysis of cross-sectional and longitudinal data from NHATS. SETTING:National Health and Aging Trend Study (NHATS) 2011-2015. PARTICIPANTS:Individuals aged 65 and older (N = 7,392). MEASUREMENTS:Fall risk was defined according to the Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative. Frailty was defined as exhaustion, weight loss, low activity, slow gait speed, and weak grip strength. Robust was defined as meeting 0 criteria, prefrailty as 1 or 2 criteria, and frailty as 3 or more criteria. Falls were self-reported and ascertained using NHATS subsequent rounds (2012-2015). We compared the ability of frailty to predict future falls with that of STEADI score, adjusting for age, race, sex, education, comorbidities, hearing and vision impairment, and disability. RESULTS:Of the 7,392 participants (58.5% female), there 3,545 (48.0%) were classified as being at low risk of falling, 2,966 (40.1%) as being at moderate risk, and 881 (11.9%) as being at high risk. The adjusted risk of falling over the 4 subsequent years was 2.5 times as great for the moderate-risk group (hazard ratio (HR) = 2.50, 95% confidence interval (CI) = 2.16-2.89) and almost 4 times as great (HR = 3.79, 95% CI = 2.76-5.21) for the high-risk group as for the low-risk group. Risk of falling was greater for those who were prefrail (HR = 1.34, 95% CI 1.16-1.55) and frail (HR = 1.20, 95% CI = 0.94-1.54) than for those who were robust. CONCLUSION:STEADI score is a strong predictor of future falls. Addition of frailty status does not improve the ability of the STEADI measure to predict future falls.
Project description:The aim of this study was to examine the association of coffee, caffeinated coffee, decaffeinated coffee and caffeine intake from coffee with cognitive performance in older adults. we used data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Coffee and caffeine intake were obtained through two 24-hour dietary recalls. Cognitive performance was evaluated by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) test, Animal Fluency test and Digit Symbol Substitution Test (DSST). Binary logistic regression and restricted cubic spline models were applied to evaluate the association of coffee and caffeine intake with cognitive performance. A total of 2513 participants aged 60 years or older were included. In the fully adjusted model, compared to those reporting no coffee consumption, those who reported 266.4-495 (g/day) had a multivariate adjusted odd ratio (OR) with 95% confidence interval (CI) of 0.56(0.35-0.89) for DSST test score, compared to those reporting no caffeinated coffee consumption, those who reported ?384.8 (g/day) had a multivariate-adjusted OR (95% CI) of 0.68(0.48-0.97) for DSST test score, compared to the lowest quartile of caffeine intake from coffee, the multivariate adjusted OR (95% CI) of the quartile (Q) three was 0.62(0.38-0.98) for the CERAD test score. L-shaped associations were apparent for coffee, caffeinated coffee and caffeine from coffee with the DSST test score and CERAD test score. No significant association was observed between decaffeinated coffee and different dimensions of cognitive performance. Our study suggests that coffee, caffeinated coffee and caffeine from coffee were associated with cognitive performance, while decaffeinated coffee was not associated with cognitive performance.