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Association Between Visual Impairment and Decline in Cognitive Function in a Multiethnic Asian Population

IMPORTANCE: With the rapidly aging population, the burden of visual impairment (VI) and cognitive decline is expected to increase. Previous cross-sectional studies suggest an association between these 2 health outcomes. However, few longitudinal reports have examined this association, and to our kno...

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Autores principales: Lim, Zhi Wei, Chee, Miao-Li, Da Soh, Zhi, Cheung, Ning, Dai, Wei, Sahil, Thakur, Tao, Yijin, Majithia, Shivani, Sabanayagam, Charumathi, Chen, Christopher Li-Hsian, Wong, Tien Yin, Cheng, Ching-Yu, Tham, Yih-Chung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180417/
https://www.ncbi.nlm.nih.gov/pubmed/32324240
http://dx.doi.org/10.1001/jamanetworkopen.2020.3560
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author Lim, Zhi Wei
Chee, Miao-Li
Da Soh, Zhi
Cheung, Ning
Dai, Wei
Sahil, Thakur
Tao, Yijin
Majithia, Shivani
Sabanayagam, Charumathi
Chen, Christopher Li-Hsian
Wong, Tien Yin
Cheng, Ching-Yu
Tham, Yih-Chung
author_facet Lim, Zhi Wei
Chee, Miao-Li
Da Soh, Zhi
Cheung, Ning
Dai, Wei
Sahil, Thakur
Tao, Yijin
Majithia, Shivani
Sabanayagam, Charumathi
Chen, Christopher Li-Hsian
Wong, Tien Yin
Cheng, Ching-Yu
Tham, Yih-Chung
author_sort Lim, Zhi Wei
collection PubMed
description IMPORTANCE: With the rapidly aging population, the burden of visual impairment (VI) and cognitive decline is expected to increase. Previous cross-sectional studies suggest an association between these 2 health outcomes. However, few longitudinal reports have examined this association, and to our knowledge, no studies have been performed in Asian populations. Further investigation on this association may help to better identify individuals at risk of cognitive decline. OBJECTIVE: To examine the longitudinal association between VI and decline in cognitive function in a multiethnic Asian population. DESIGN, SETTING, AND PARTICIPANTS: In this longitudinal, population-based, prospective cohort study, Chinese, Indian, and Malay adults 60 years or older at baseline were recruited from the Singapore Epidemiology of Eye Diseases (SEED) study. At baseline, participants from the SEED study were recruited under 3 studies: the Singapore Malay Eye Study (SiMES; 2004-2006), the Singapore Indian Eye Study (SINDI; 2007-2009), and the Singapore Chinese Eye Study (SCES; 2009-2011). Eligible participants were reexamined after 6 years (2011-2013 for SiMES, 2013-2015 for SINDI, and 2015-2017 for SCES). Data analysis was performed from November 1 to 24, 2019. EXPOSURES: Visual impariment was defined as presenting visual acuity worse than 20/40 based on the better-seeing eye. MAIN OUTCOMES AND MEASURES: Cognitive function was assessed using a locally validated Abbreviated Mental Test (AMT). The association between baseline VI and change in AMT score was determined using the multivariable linear regression model adjusting for baseline age; sex; race/ethnicity; presence of diabetes, hyperlipidemia, hypertension, and chronic kidney disease; history of cardiovascular disease; smoking status; alcohol intake; body mass index; educational status; and AMT score. RESULTS: A total of 2478 individuals (1256 [50.7%] male; 1073 Chinese, 768 Indian, and 637 Malay adults) with mean (SD) age of 67.6 (5.6) years were evaluated, of whom 489 (19.7%) had reduction in AMT scores over 6 years. Baseline VI was associated with a decrease in AMT score over 6 years (β = −0.27; 95% CI, −0.37 to −0.17; P < .001). When change in vision over 6 years was evaluated, unchanged or deteriorated VI was associated with a decrease in AMT score over 6 years (β = −0.29; 95% CI, −0.40 to −0.18; P < .001). Among individuals with baseline VI and a substantial decrease in AMT score of 3 units or more over 6 years, the leading causes of VI were undercorrected refractive error (14 [45.2%]) and cataract (11 [35.5%]). CONCLUSIONS AND RELEVANCE: In this study, poor vision was independently associated with a decline in cognitive function. Causes of visual loss in these cases were mostly preventable, further suggesting that preserving good vision may be an important interventional strategy for mitigating cognitive decline.
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spelling pubmed-71804172020-04-29 Association Between Visual Impairment and Decline in Cognitive Function in a Multiethnic Asian Population Lim, Zhi Wei Chee, Miao-Li Da Soh, Zhi Cheung, Ning Dai, Wei Sahil, Thakur Tao, Yijin Majithia, Shivani Sabanayagam, Charumathi Chen, Christopher Li-Hsian Wong, Tien Yin Cheng, Ching-Yu Tham, Yih-Chung JAMA Netw Open Original Investigation IMPORTANCE: With the rapidly aging population, the burden of visual impairment (VI) and cognitive decline is expected to increase. Previous cross-sectional studies suggest an association between these 2 health outcomes. However, few longitudinal reports have examined this association, and to our knowledge, no studies have been performed in Asian populations. Further investigation on this association may help to better identify individuals at risk of cognitive decline. OBJECTIVE: To examine the longitudinal association between VI and decline in cognitive function in a multiethnic Asian population. DESIGN, SETTING, AND PARTICIPANTS: In this longitudinal, population-based, prospective cohort study, Chinese, Indian, and Malay adults 60 years or older at baseline were recruited from the Singapore Epidemiology of Eye Diseases (SEED) study. At baseline, participants from the SEED study were recruited under 3 studies: the Singapore Malay Eye Study (SiMES; 2004-2006), the Singapore Indian Eye Study (SINDI; 2007-2009), and the Singapore Chinese Eye Study (SCES; 2009-2011). Eligible participants were reexamined after 6 years (2011-2013 for SiMES, 2013-2015 for SINDI, and 2015-2017 for SCES). Data analysis was performed from November 1 to 24, 2019. EXPOSURES: Visual impariment was defined as presenting visual acuity worse than 20/40 based on the better-seeing eye. MAIN OUTCOMES AND MEASURES: Cognitive function was assessed using a locally validated Abbreviated Mental Test (AMT). The association between baseline VI and change in AMT score was determined using the multivariable linear regression model adjusting for baseline age; sex; race/ethnicity; presence of diabetes, hyperlipidemia, hypertension, and chronic kidney disease; history of cardiovascular disease; smoking status; alcohol intake; body mass index; educational status; and AMT score. RESULTS: A total of 2478 individuals (1256 [50.7%] male; 1073 Chinese, 768 Indian, and 637 Malay adults) with mean (SD) age of 67.6 (5.6) years were evaluated, of whom 489 (19.7%) had reduction in AMT scores over 6 years. Baseline VI was associated with a decrease in AMT score over 6 years (β = −0.27; 95% CI, −0.37 to −0.17; P < .001). When change in vision over 6 years was evaluated, unchanged or deteriorated VI was associated with a decrease in AMT score over 6 years (β = −0.29; 95% CI, −0.40 to −0.18; P < .001). Among individuals with baseline VI and a substantial decrease in AMT score of 3 units or more over 6 years, the leading causes of VI were undercorrected refractive error (14 [45.2%]) and cataract (11 [35.5%]). CONCLUSIONS AND RELEVANCE: In this study, poor vision was independently associated with a decline in cognitive function. Causes of visual loss in these cases were mostly preventable, further suggesting that preserving good vision may be an important interventional strategy for mitigating cognitive decline. American Medical Association 2020-04-23 /pmc/articles/PMC7180417/ /pubmed/32324240 http://dx.doi.org/10.1001/jamanetworkopen.2020.3560 Text en Copyright 2020 Lim ZW et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Lim, Zhi Wei
Chee, Miao-Li
Da Soh, Zhi
Cheung, Ning
Dai, Wei
Sahil, Thakur
Tao, Yijin
Majithia, Shivani
Sabanayagam, Charumathi
Chen, Christopher Li-Hsian
Wong, Tien Yin
Cheng, Ching-Yu
Tham, Yih-Chung
Association Between Visual Impairment and Decline in Cognitive Function in a Multiethnic Asian Population
title Association Between Visual Impairment and Decline in Cognitive Function in a Multiethnic Asian Population
title_full Association Between Visual Impairment and Decline in Cognitive Function in a Multiethnic Asian Population
title_fullStr Association Between Visual Impairment and Decline in Cognitive Function in a Multiethnic Asian Population
title_full_unstemmed Association Between Visual Impairment and Decline in Cognitive Function in a Multiethnic Asian Population
title_short Association Between Visual Impairment and Decline in Cognitive Function in a Multiethnic Asian Population
title_sort association between visual impairment and decline in cognitive function in a multiethnic asian population
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180417/
https://www.ncbi.nlm.nih.gov/pubmed/32324240
http://dx.doi.org/10.1001/jamanetworkopen.2020.3560
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