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

Published online by Cambridge University Press:  10 December 2021

Ashlyn Runk ,
Yichen Jia ,
Anran Liu ,
Chung-Chou H. Chang ,
Mary Ganguli  and
Beth E. Snitz Open the ORCID record for Beth E. Snitz [Opens in a new window]
Ashlyn Runk
Affiliation:
Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, USA
Yichen Jia
Affiliation:
Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, USA
Anran Liu
Affiliation:
Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, USA
Chung-Chou H. Chang
Affiliation:
Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, USA Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, USA
Mary Ganguli
Affiliation:
Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, USA Department of Neurology, University of Pittsburgh, School of Medicine, Pittsburgh, USA Department of Epidemiology, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, USA
Beth E. Snitz*
Affiliation:
Department of Neurology, University of Pittsburgh, School of Medicine, Pittsburgh, USA
*
*Correspondence and reprint requests to: Beth E. Snitz, Department of Neurology, University of Pittsburgh, 3501 Forbes Avenue, Suite 830, Pittsburgh, PA 15213, USA. E-mail: snitzbe@upmc.edu
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Abstract

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.

Keywords

Cognition disordersOcular visionCognitive agingEpidemiologyRisk factorsVision disorders
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 29 , Issue 1 , January 2023 , pp. 1 - 11
Copyright
Copyright © INS. Published by Cambridge University Press, 2021

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References

REFERENCES

Anstey, K.J., Luszcz, M.A., & Sanchez, L. (2001). Two-year decline in vision but not hearing is associated with memory decline in very old adults in a population-based sample. Gerontology, 47(5), 289–293. doi: 10.1159/000052814 CrossRefGoogle ScholarPubMed
Baker, M.L., Wang, J.J., Rogers, S., Klein, R., Kuller, L.H., Larsen, E.K., & Wong, T.Y. (2009). Early age-related macular degeneration, cognitive function, and dementia: The cardiovascular health study. Archives of Ophthalmology, 127(5), 667–673. doi: 10.1001/archophthalmol.2009.30 CrossRefGoogle ScholarPubMed
Benton, A.L. & Hamsher, K. (1976). Multilingual Aphasia Examination Manual. Iowa City: University of Iowa.Google Scholar
Biessels, G.J., Staekenborg, S., Brunner, E., Brayne, C., & Scheltens, P. (2006). Risk of dementia in diabetes mellitus: A systematic review. The Lancet Neurology, 5(1), 64–74. doi: 10.1016/s1474-4422(05)70284-2 CrossRefGoogle ScholarPubMed
Chen, S.P., Bhattacharya, J., & Pershing, S. (2017). Association of vision loss with cognition in older adults. JAMA Ophthalmology, 135(9), 963–970. doi: 10.1001/jamaophthalmol.2017.2838 CrossRefGoogle ScholarPubMed
Chen, Y.Y., Lai, Y.J., Yen, Y.F., Shen, Y.C., Wang, C.Y., Liang, C.Y., … Fan, L.W. (2018). Association between normal tension glaucoma and the risk of Alzheimer’s disease: A nationwide population-based cohort study in Taiwan. BMJ Open, 8(11), e022987. doi: 10.1136/bmjopen-2018-022987 CrossRefGoogle ScholarPubMed
Choi, J.S., Betz, J., Li, L., Blake, C.R., Sung, Y.K., Contrera, K.J., & Lin, F.R. (2016). Association of using hearing aids or cochlear implants with changes in depressive symptoms in older adults. JAMA Otolaryngology – Head & Neck Surgery, 142(7), 652–657. doi: 10.1001/jamaoto.2016.0700 CrossRefGoogle ScholarPubMed
Chou, R., Dana, T., Bougatsos, C., Grusing, S., & Blazina, I. (2016). Screening for impaired visual acuity in older adults: Updated evidence report and systematic review for the US preventive services task force. JAMA, 315(9), 915–933. doi: 10.1001/jama.2016.0783 CrossRefGoogle ScholarPubMed
Deal, J.A., Betz, J., Yaffe, K., Harris, T., Purchase-Helzner, E., Satterfield, S., … Lin, F.R. (2017). Hearing impairment and incident dementia and cognitive decline in older adults: The health ABC study. The Journals of Gerontology: Series A Biological Sciences & Medical Sciences, 72(5), 703–709. doi: 10.1093/gerona/glw069 Google ScholarPubMed
De la Fuente, J., Hjelmborg, J., Wod, M., de la Torre-Luque, A., Caballero, F.F., Christensen, K., & Ayuso-Mateos, J.L. (2019). Longitudinal associations of sensory and cognitive functioning: A structural equation modeling approach. The Journals of Gerontology: Series B Psychological Sciences and Social Sciences, 74(8), 1308–1316. doi: 10.1093/geronb/gby147 CrossRefGoogle ScholarPubMed
Dearborn, P.J., Elias, M.F., Sullivan, K.J., Sullivan, C.E., & Robbins, M.A. (2018). Poorer visual acuity is associated with declines in cognitive performance across multiple cognitive domains: The Maine-Syracuse longitudinal study. Journal of the International Neuropsychological Society, 24(7), 746–754. doi: 10.1017/s1355617718000358 CrossRefGoogle ScholarPubMed
Dong, Y. & Peng, C.Y. (2013). Principled missing data methods for researchers. SpringerPlus, 2(1), 222. doi: 10.1186/2193-1801-2-222 CrossRefGoogle ScholarPubMed
Fillenbaum, G.G. (1985). Screening the elderly: A brief instrumental activities of daily living measure. Journal of the American Geriatrics Society, 33(10), 698–706. doi: 10.1111/j.1532-5415.1985.tb01779.x CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. doi: 10.1016/0022-3956(75)90026-6 CrossRefGoogle ScholarPubMed
Fraser, M.L., Meuleners, L.B., Lee, A.H., Ng, J.Q., & Morlet, N. (2013). Vision, quality of life and depressive symptoms after first eye cataract surgery. Psychogeriatrics, 13(4), 237–243. doi: 10.1111/psyg.12028 CrossRefGoogle ScholarPubMed
Freedman, M., Leach, L., Kaplan, E., Winocur, G., Shulman, K., & Delis, D.C. (1994). Clock Drawing: A Neuropsychological Analysis. New York: Oxford University Press Inc. Google Scholar
Ganguli, M., Chang, C.C., Snitz, B.E., Saxton, J.A., Vanderbilt, J., & Lee, C.W. (2010). Prevalence of mild cognitive impairment by multiple classifications: The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) project. The American Journal of Geriatric Psychiatry, 18(8), 674–683. doi: 10.1097/JGP.0b013e3181cdee4f CrossRefGoogle ScholarPubMed
Ganguli, M., Dodge, H.H., Shen, C., & DeKosky, S.T. (2004). Mild cognitive impairment, amnestic type: An epidemiologic study. Neurology, 63(1), 115–121. doi: 10.1212/01.wnl.0000132523.27540.81 CrossRefGoogle ScholarPubMed
Ganguli, M., Snitz, B., Vander Bilt, J., & Chang, C.C. (2009). How much do depressive symptoms affect cognition at the population level? The Monongahela-Youghiogheny Healthy Aging Team (MYHAT) study. International Journal Geriatric Psychiatry, 24(11), 1277–1284. doi: 10.1002/gps.2257 CrossRefGoogle ScholarPubMed
Hall, C.B., Lipton, R.B., Katz, M.J., & Wang, C. (2015). Correcting bias caused by missing data in the estimate of the effect of apolipoprotein ϵ4 on cognitive decline. Journal of the International Neuropsychological Society, 21(1), 85–90. doi: 10.1017/s1355617714000952 CrossRefGoogle Scholar
Hong, T., Mitchell, P., Burlutsky, G., Liew, G., & Wang, J.J. (2016). Visual impairment, hearing loss and cognitive function in an older population: Longitudinal findings from the Blue Mountains Eye Study. PLOS ONE, 11(1), e0147646. doi: 10.1371/journal.pone.0147646 CrossRefGoogle Scholar
Ibrahim, J.G. & Molenberghs, G. (2009). Missing data methods in longitudinal studies: A review. Test (Madrid, Spain), 18(1), 1–43. doi: 10.1007/s11749-009-0138-x Google ScholarPubMed
Jin, J. (2016). JAMA patient page. Screening for impaired visual acuity in older adults. JAMA, 315(9), 954. doi: 10.1001/jama.2016.1670 CrossRefGoogle ScholarPubMed
Kaplan, E.F., Goodglass, H., & Weintraub, S. (1978). The Boston Naming Test. Philadelphia: Lea & Febiger.Google Scholar
Killen, A., Firbank, M.J., Collerton, D., Clarke, M., Jefferis, J.M., Taylor, J.P., … Mosimann, U.P. (2013). The assessment of cognition in visually impaired older adults. Age and Ageing, 42(1), 98–102.CrossRefGoogle ScholarPubMed
Kivipelto, M., Helkala, E.L., Laakso, M.P., Hänninen, T., Hallikainen, M., Alhainen, K., … Nissinen, A. (2001). Midlife vascular risk factors and Alzheimer’s disease in later life: Longitudinal, population based study. The BMJ, 322(7300), 1447–1451. doi: 10.1136/bmj.322.7300.1447 CrossRefGoogle ScholarPubMed
Klein, R. & Klein, B. E. (2013). The prevalence of age-related eye diseases and visual impairment in aging: Current estimates. Investigative Ophthalmology & Visual Science, 54(14), Orsf5–orsf13. doi: 10.1167/iovs.13-12789 CrossRefGoogle ScholarPubMed
Launer, L.J., Ross, G.W., Petrovitch, H., Masaki, K., Foley, D., White, L.R., & Havlik, R.J. (2000). Midlife blood pressure and dementia: the Honolulu-Asia aging study. Neurobiology of Aging, 21(1), 49–55. doi: 10.1016/s0197-4580(00)00096-8 CrossRefGoogle ScholarPubMed
Lin, M.Y., Gutierrez, P.R., Stone, K.L., Yaffe, K., Ensrud, K.E., Fink, H.A., … Mangione, C.M. (2004). Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women. Journal of the American Geriatrics Society, 52(12), 1996–2002. doi: 10.1111/j.1532-5415.2004.52554.x CrossRefGoogle ScholarPubMed
Litke, R., Garcharna, L. C., Jiwani, S., & Neugroschl, J. (2021). Modifiable risk factors in Alzheimer disease and related dementias: A review. Clinical Therapeutics, 43(6), S0149–2918.CrossRefGoogle ScholarPubMed
Livingston, G., Huntley, J., Sommerland, A., Ames, D., Ballard, C., Banerjee, S., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet 396, 413–446.CrossRefGoogle ScholarPubMed
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S.G., Huntley, J., Ames, D., … Cooper, C. (2017) Dementia prevention, intervention, and care. The Lancet 390, 2673–2734.CrossRefGoogle ScholarPubMed
Loewenstein, D.A., Acevedo, A., Schram, L., Ownby, R., White, G., Mogosky, B., … Duara, R. (2003). Semantic interference in mild Alzheimer disease: preliminary findings. The American Journal of Geriatric Psychiatry, 11(2), 252–255.CrossRefGoogle ScholarPubMed
Maharani, A., Dawes, P., Nazroo, J., Tampubolon, G., & Pendleton, N. (2018a). Cataract surgery and age-related cognitive decline: A 13-year follow-up of the English longitudinal study of ageing. PLOS ONE, 13(10), e0204833. doi: 10.1371/journal.pone.0204833 CrossRefGoogle ScholarPubMed
Maharani, A., Dawes, P., Nazroo, J., Tampubolon, G., & Pendleton, N. (2018b). Visual and hearing impairments are associated with cognitive decline in older people. Age and Ageing, 47(4), 575–581. doi: 10.1093/ageing/afy061 CrossRefGoogle ScholarPubMed
Maharani, A., Dawes, P., Nazroo, J., Tampubolon, G., & Pendleton, N. (2020). Associations Between self-reported sensory impairment and risk of cognitive decline and impairment in the health and retirement study cohort. The Journals of Gerontology: Series B Psychological Sciences and Social Sciences, 75(6), 1230–1242. doi: 10.1093/geronb/gbz043 CrossRefGoogle ScholarPubMed
Maharani, A., Pendleton, N., & Leroi, I. (2019). Hearing impairment, loneliness, social isolation, and cognitive function: Longitudinal analysis using English longitudinal study on ageing. The American Journal of Geriatric Psychiatry, 27(12), 1348–1356. doi: 10.1016/j.jagp.2019.07.010 CrossRefGoogle ScholarPubMed
McGrath, E.R., Beiser, A.S., DeCarli, C., Plourde, K.L., Vasan, R.S., Greenberg, S.M., & Seshadri, S. (2017). Blood pressure from mid- to late life and risk of incident dementia. Neurology, 89(24), 2447–2454. doi: 10.1212/wnl.0000000000004741 CrossRefGoogle ScholarPubMed
Monge, Z.A. & Madden, D.J. (2016). Linking cognitive and visual perceptual decline in healthy aging: The information degradation hypothesis. Neuroscience & Biobehavioral Reviews, 69, 166–173. doi: 10.1016/j.neubiorev.2016.07.031 CrossRefGoogle ScholarPubMed
Moyer, V.A. (2012). Prevention of falls in community-dwelling older adults: U.S. preventive services task force recommendation statement. Annals of Internal Medicine, 157(3), 197–204. doi: 10.7326/0003-4819-157-3-201208070-00462 CrossRefGoogle ScholarPubMed
Mungas, D., Marshall, S.C., Weldon, M., Haan, M., & Reed, B.R. (1996). Age and education correction of mini-mental state examination for English and Spanish-speaking elderly. Neurology, 46(3), 700–706. doi: 10.1212/wnl.46.3.700 CrossRefGoogle ScholarPubMed
Naël, V., Pérès, K., Dartigues, J.F., Letenneur, L., Amieva, H., Arleo, A., … Sense-Cog Consortium (2019). Vision loss and 12-year risk of dementia in older adults: The 3C cohort study. European Journal of Epidemiology, 34(2), 141–152. doi: 10.1007/s10654-018-00478-y CrossRefGoogle ScholarPubMed
Ong, S.Y., Cheung, C.Y., Li, X., Lamoureux, E.L., Ikram, M.K., Ding, J., … Wong, T.Y. (2012). Visual impairment, age-related eye diseases, and cognitive function: The Singapore Malay Eye study. Archives of Ophthalmology, 130(7), 895–900. doi: 10.1001/archophthalmol.2012.152 CrossRefGoogle ScholarPubMed
Pham, T.Q., Kifley, A., Mitchell, P., & Wang, J. J. (2006). Relation of age-related macular degeneration and cognitive impairment in an older population. Gerontology, 52(6), 353–358. doi: 10.1159/000094984 CrossRefGoogle Scholar
Radloff, L. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. 10.1177/014662167700100306 CrossRefGoogle Scholar
Reitan, R.M. (1955). The relation of the trail making test to organic brain damage. Journal of Consulting Psychology, 19(5), 393–394. doi: 10.1037/h0044509 CrossRefGoogle ScholarPubMed
Roberts, K.L. & Allen, H.A. (2016). Perception and cognition in the ageing brain: A brief review of the short- and long-term links between perceptual and cognitive decline. Frontiers in Aging Neuroscience, 8, 39. doi: 10.3389/fnagi.2016.00039 CrossRefGoogle Scholar
Semeraro, F., Cancarini, A., dell’Omo, R., Rezzola, S., Romano, M.R., & Costagliola, C. (2015). Diabetic retinopathy: Vascular and inflammatory disease. Journal of Diabetes Research, 2015, 582060. doi: 10.1155/2015/582060 CrossRefGoogle ScholarPubMed
Singh, B., Parsaik, A.K., Mielke, M.M., Erwin, P.J., Knopman, D.S., Petersen, R.C., & Roberts, R.O. (2014). Association of Mediterranean diet with mild cognitive impairment and Alzheimer’s disease: A systematic review and meta-analysis. Journals of Alzheimer‘s Disease, 39(2), 271–282. doi: 10.3233/jad-130830 CrossRefGoogle ScholarPubMed
Solfrizzi, V., Panza, F., & Capurso, A. (2003). The role of diet in cognitive decline. Journal of Neural Transmission (Vienna), 110(1), 95–110. doi: 10.1007/s00702-002-0766-8 CrossRefGoogle ScholarPubMed
Tay, T., Wang, J.J., Kifley, A., Lindley, R., Newall, P., & Mitchell, P. (2006). Sensory and cognitive association in older persons: Findings from an older Australian population. Gerontology, 52(6), 386–394. doi: 10.1159/000095129 CrossRefGoogle ScholarPubMed
Tucker-Drob, E.M. (2019). Cognitive aging and dementia: A life span perspective. Annual Review of Developmental Psychology, 1, 177–196. doi: 10.1146/annurev-devpsych-121318-085204 CrossRefGoogle ScholarPubMed
Unverzagt, F.W., Farlow, M.R., & Hendrie, H.C. (1999). Clinical utility of new visual learning memory and language subtests for use in the CERAD neuropsychological battery. Journal of the International Neuropsychological Society, 5, 129.CrossRefGoogle Scholar
Valentijn, S.A., van Boxtel, M.P., van Hooren, S.A., Bosma, H., Beckers, H.J., Ponds, R.W., & Jolles, J. (2005). Change in sensory functioning predicts change in cognitive functioning: Results from a 6-year follow-up in the Maastricht aging study. Journal of the American Geriatric Society, 53(3), 374–380. doi: 10.1111/j.1532-5415.2005.53152.x CrossRefGoogle ScholarPubMed
Varma, R., Vajaranant, T.S., Burkemper, B., Wu, S., Torres, M., Hsu, C., … McKean-Cowdin, R. (2016). Visual impairment and blindness in adults in the United States: Demographic and geographic variations from 2015 to 2050. JAMA Ophthalmology, 134(7), 802–809. doi: 10.1001/jamaophthalmol.2016.1284 CrossRefGoogle ScholarPubMed
Vespa, J., Armstrong, D.M., & Medina, L. (2018). Demographic Turning Points for the United States: Population Projections for 2020 to 2060. Washington, DC: US Department of Commerce, Economics and Statistics Administration, US Census Bureau.Google Scholar
Wechsler, D. (1987). Wechsler Memory Scale Revised. San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (1997). Wechsler Adult Intelligence Scale (3rd ed.). San Antonio, TX: The Psychological Corporation Google Scholar
Whitmer, R.A., Sidney, S., Selby, J., Johnston, S.C., & Yaffe, K. (2005). Midlife cardiovascular risk factors and risk of dementia in late life. Neurology, 64(2), 277–281. doi: 10.1212/01.wnl.0000149519.47454.f2 CrossRefGoogle ScholarPubMed
Whitson, H.E., Cronin-Golomb, A., Cruickshanks, K.J., Gilmore, G.C., Owsley, C., Peelle, J.E., … Lin, F.R. (2018). American geriatrics society and national institute on aging bench-to-bedside conference: Sensory impairment and cognitive decline in older adults. Journal of the American Geriatric Society, 66(11), 2052–2058. doi: 10.1111/jgs.15506 CrossRefGoogle ScholarPubMed
Woo, S.J., Park, K.H., Ahn, J., Choe, J.Y., Jeong, H., Han, J.W., … Kim, K. W. (2012). Cognitive impairment in age-related macular degeneration and geographic atrophy. Ophthalmology, 119(10), 2094–2101. doi: 10.1016/j.ophtha.2012.04.026 CrossRefGoogle ScholarPubMed
Yamada, Y., Denkinger, M.D., Onder, G., Henrard, J.C., van der Roest, H.G., Finne-Soveri, H., … Topinkova, E. (2016). Dual sensory impairment and cognitive decline: The results from the shelter study. The Journals of Gerontology: Series A Biological Sciences & Medical Sciences, 71(1), 117–123. doi: 10.1093/gerona/glv036 CrossRefGoogle ScholarPubMed
Zekveld, A.A., Kramer, S.E., & Festen, J.M. (2011). Cognitive load during speech perception in noise: The influence of age, hearing loss and cognition on the pupil response. Ear and Hearing, 32, 498–510. doi: 10.1097/AUD.0b013e31820512bb CrossRefGoogle ScholarPubMed
Zheng, D.D., Swenor, B.K., Christ, S.L., West, S.K., Lam, B.L., & Lee, D.J. (2018). Longitudinal associations between visual impairment and cognitive functioning: The Salisbury Eye Evaluation study. JAMA Ophthalmology, 136(9), 989–995. doi: 10.1001/jamaophthalmol.2018.2493 CrossRefGoogle ScholarPubMed
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