Multiple Sensory Impairment Is Associated With Increased Risk of Dementia Among Black and White Older Adults

Depression, loneliness, and lower social activity as partial mediators of the association between visual impairment and cognitive decline

OBJECTIVES

Sensory impairment is a hypothesized risk factor for cognitive decline; however, the psychosocial pathways are not well understood. We evaluated whether the association between visual impairment (VI) and cognitive decline was partially mediated via depressive symptoms, loneliness, or social activity.

METHODS

We used data from 2601 older adults enrolled in the Memory and Aging Project in 1997 and the Minority Aging Research Study in 2004 with neuropsychological tests across five domains measured annually for up to 16 years. VI was assessed with the Rosenbaum Pocket Vision Screener. Depressive symptoms, loneliness, and social activity were self-reported using validated scales. We used structural equation models to estimate the associations of VI with baseline and change in cognitive function, directly and indirectly through each mediator (depressive symptoms, loneliness, and social activity). We evaluated mediation via "psychological distress" using a latent variable combining depressive symptoms and loneliness.

RESULTS

The association between VI and global cognitive decline was mediated via lower social activity (indirect effect) [95% confidence interval (CI)] of linear slope: -0.025 (-0.048, -0.011), via loneliness (-0.011 [95% CI: -0.028, -0.002]), and via psychological distress (-0.017 [95% CI: -0.042, -0.003]). We did not find sufficient evidence for mediation via depressive symptoms alone.

CONCLUSIONS

The harmful effect of VI on cognitive decline may be partially mediated through loneliness and lower social activity.

Adult-onset hearing loss and incident cognitive impairment and dementia - A systematic review and meta-analysis of cohort studies

BACKGROUND

We comprehensively summarized the cohort evidence to date on adult-onset hearing loss as risk factor for incident cognitive impairment and dementia, and examined the evidence for dose-response, risk for various dementia subtypes, and other moderators. Previous meta-analyses were less comprehensive.

METHODS

We included cohort studies with participants without dementia and with hearing assessments at baseline, minimum 2 years follow-up and incident cognitive outcomes. We used random-effect models and subgroup and meta-regression on moderator analyses.

RESULTS

We identified fifty studies (N=1,548,754). Hearing loss (yes/no) was associated with incident dementia risk (HR=1.35 [95% CI = 1.26 - 1.45), mild cognitive impairment (MCI HR=1.29 [95% CI = 1.11 - 1.50]), cognitive decline not specified as MCI or dementia (HR=1.29 [95% CI = 1.17 - 1.42]), and Alzheimer's disease dementia (ADD, HR=1.56 [95% CI = 1.30 - 1.87]), but not with vascular dementia (HR, 1.30 [95% CI = 0.83 - 2.05]). Each 10-decibel worsening of hearing was associated with a 16% increase in dementia risk (95% CI = 1.07 - 1.27). The effect of hearing loss did not vary across potential moderators.

CONCLUSIONS

Cohort studies consistently support that adult-onset hearing loss increases the risk of incident cognitive decline, dementia, MCI, and ADD.

Association Between Multisensory Impairment and Depression Among Older Adults: A Population-Based Analysis

OBJECTIVE

In this study, we examine how impairments in vision, hearing, touch, and olfaction relate to depression in older adults, considering both individual and multisensory impairments (MSIs).

STUDY DESIGN

Analysis of cross-sectional data from a longitudinal investigation involving black and white older adults aged 70 to 79 at enrollment.

SETTING

We studied 1640 black and white participants in the Health ABC study using complete sensory evaluation data from years 3 to 5.

METHODS

Our MSI assessment utilized data obtained for visual acuity, hearing perception, olfactory performance, and tactile function. We performed multivariable logistic regression analyses to examine the associations between the presence of individual and MSIs and depression which was defined as the presence of antidepressants prescribed for depression, or a Center for Epidemiological Studies Depression Scale score of greater than 10.

RESULTS

We observed a possible dose-response relationship between the number of sensory impairments and depression. In adjusted models, when compared to no impairments, vision (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.09-1.93) and hearing impairments (OR = 1.49, 95% CI: 1.11-1.99) were significantly associated with depression, whereas olfaction (OR = 1.11, 95% CI: 0.83-1.47) and tactile impairments (OR = 1.28, 95% CI: 0.96-1.70) were not. Participants with 3 sensory impairments had a higher rate of depression (OR = 2.05, 95% CI: 1.22-3.54) compared to those without impairments, and this risk increased further for those with 4 sensory impairments (OR = 2.95, 95% CI: 1.48-5.88).

CONCLUSION

The findings suggest that individuals with MSI represent a high-risk population for depression, warranting close monitoring to screen for depression. The study emphasizes the importance of considering multiple sensory impairments in the context of mental health and supports the early identification and monitoring of depression in this population.

The effects of sensorial and mobility frailty on the overall and domain-specific cognition performance of Chinese community-dwelling older adults

This study aimed to investigate the different impacts of sensorial and mobility frailty on overall and domain-specific cognitive function. Further, the independent associations between other intricate capacity (IC) dimensions, including vitality and psychological dimensions, and overall and domain-specific cognitive function were investigated. A total of 429 participants (mean age, 72.91 ± 7.014 years; 57.30% female) underwent IC capacity assessment. Other covariates, such as demographics, health-related variables were also assessed. Overall or domain-specific cognitive impairment was used as a dependent variable in logistic regression analyses adjusted for demographic, health-related, and psychosocial confounders. After adjustment for demographic, health-related, and psychosocial confounders, individuals with sensorial frailty (odds ratio [OR] = 0.435; 95% confidence interval [CI] = 0.236-0.801; P = .008) had a significantly lower risk of mild cognitive impairment (MCI), marginally low delayed memory impairment (OR = 0.601, 95% CI = 0.347-1.040; P = .069), and language impairment (OR = 0.534, 95% CI = 0.305-0.936; OR = 0.318, P = .029; OR = 0.318,95% CI = 0.173-0.586; P < .001) by Boston naming and animal fluency tests than did those with both sensorial and mobility frailty or mobility frailty only. Depressive symptoms had a significant negative influence on executive function. Cardiovascular disease and non-skin malignancy were independent determinants of MCI, and diabetes mellitus was independently associated with processing speed, attention, and executive function. Sensorial and mobility frailty were independent risk factors for cognitive impairment. Mobility frailty had a greater negative influence on the overall cognitive function and memory and language function than did sensorial frailty. The reserve decline in the psychological dimension of IC and chronic diseases also had a significant adverse influence on overall and domain-specific cognition function.

Cross-sectional associations between multisensory impairment and brain volumes in older adults: Baltimore Longitudinal Study of Aging

Sensory impairment and brain atrophy is common among older adults, increasing the risk of dementia. Yet, the degree to which multiple co-occurring sensory impairments (MSI across vision, proprioception, vestibular function, olfactory, and hearing) are associated with brain morphometry remain unexplored. Data were from 208 cognitively unimpaired participants (mean age 72 ± 10 years; 59% women) enrolled in the Baltimore Longitudinal Study of Aging. Multiple linear regression models were used to estimate cross-sectional associations between MSI and regional brain imaging volumes. For each additional sensory impairment, there were associated lower orbitofrontal gyrus and entorhinal cortex volumes but higher caudate and putamen volumes. Participants with MSI had lower mean volumes in the superior frontal gyrus, orbitofrontal gyrus, superior parietal lobe, and precuneus compared to participants with < 2 impairments. While MSI was largely associated with lower brain volumes, our results suggest the possibility that MSI was associated with higher basal ganglia volumes. Longitudinal analyses are needed to evaluate the temporality and directionality of these associations.

Prevalence, associated risk factors; and patient and economic impact of multiple sensory impairment in a multi-ethnic elderly population in Singapore: the PIONEER study

BACKGROUND

To determine the prevalence, risk factors; and impact on patient health and economic outcomes across the laterality spectrum of multiple sensory impairment (MSI) in a multi-ethnic older Asian population.

METHODS

In this population-based study of Singaporeans aged ≥ 60 years, MSI was defined as concomitant vision (visual acuity > 0.3 logMAR), hearing (pure-tone air conduction average > 25 dB), and olfactory (score < 12 on the Sniffin' Sticks test) impairments across the spectrum of laterality (any, unilateral, combination [of unilateral and bilateral], and bilateral).

RESULTS

Among 2,057 participants (mean ± SD 72.2 ± 0.2 years; 53.1% female), the national census-adjusted prevalence rates of any, unilateral, combination, and bilateral MSI were 20.6%, 1.2%, 12.2%, and 7.2%, respectively. Older age, male gender, low socioeconomic status (SES), and smoking (all p < 0.05) were independently associated with higher likelihood of any MSI. Compared to those with no sensory loss, those with MSI had significantly decreased mobility (range 5.4%-9.2%), had poor functioning (OR range 3.25-3.45) and increased healthcare costs (range 4-6 folds) across the laterality spectrum. Additionally, bilateral MSI had a significant decrease in HRQoL (5.5%, p = 0.012).

CONCLUSIONS

MSI is a highly prevalent medical condition, with 1 in 5; and almost 1 in 10 community-dwelling older Asians having any and bilateral MSI, respectively, with a higher likelihood in men, smokers, and those with low SES. Critically, MSI has a substantial negative impact on patient health and economic outcomes across the laterality spectrum. Sensory testing is critical to detect and refer individuals with MSI for management to improve their functional independence and QoL.

The Association of Vision and Hearing Impairment on Cognitive Function and Loneliness: Evidence From the Mexican Health and Aging Study

Objectives: We investigated whether self-reported vision and hearing were associated with cognitive function and loneliness among Mexican adults aged 50 and older. Methods: Mexican Health and Aging Study data. Vision/hearing status was self-reported (excellent-very good, good, fair-poor). Cognition was measured using nine tasks. Loneliness was measured using the UCLA Loneliness Scale. Analyses controlled for demographic and health characteristics. Results: Among 12,353 participants (mean age = 67, 58% female), poor vision, but not hearing, was associated with lower global cognition (β = -0.03, p < .05). Poor vision (OR = 1.57, 95% CI = 1.30-1.91) and hearing (OR = 1.35, 95% CI = 1.14-1.61) were associated with higher odds of being lonely after adjusting for demographics and comorbidities, but not when adjusting for limitations in daily activities and depressive symptoms. Discussion: Poor vision is a potentially modifiable risk factor for lower cognition and loneliness among Mexican adults. These associations are partly due to functional characteristics of older adults with poor vision.

Sensory and motor deficits as contributors to early cognitive impairment

INTRODUCTION

Age-related sensory and motor impairment are associated with risk of dementia. No study has examined the joint associations of multiple sensory and motor measures on prevalence of early cognitive impairment (ECI).

METHODS

Six hundred fifty participants in the Baltimore Longitudinal Study of Aging completed sensory and motor function tests. The association between sensory and motor function and ECI was examined using structural equation modeling with three latent factors corresponding to multisensory, fine motor, and gross motor function.

RESULTS

The multisensory, fine, and gross motor factors were all correlated (r = 0.74 to 0.81). The odds of ECI were lower for each additional unit improvement in the multisensory (32%), fine motor (30%), and gross motor factors (12%).

DISCUSSION

The relationship between sensory and motor impairment and emerging cognitive impairment may guide future intervention studies aimed at preventing and/or treating ECI.

HIGHLIGHTS

Sensorimotor function and early cognitive impairment (ECI) prevalence were assessed via structural equation modeling. The degree of fine and gross motor function is associated with indicators of ECI. The degree of multisensory impairment is also associated with indicators of ECI.

Hearing loss and dementia in older adults: A narrative review

The prevalence of hearing loss is high among older adults; globally, 65% of adults over 60 years have hearing loss. Over the past decade, evidence from epidemiologic studies has linked hearing loss to nearly two times greater risk of dementia. The hypothesized mechanistic pathways through which hearing loss could contribute to increased dementia risk include the effects of hearing on greater cognitive load, changes in brain structure and function, and decreased social engagement. These mechanistic pathways may be modified by management of hearing loss using existing intervention (eg, hearing aids). Hearing treatment may be an effective intervention for slowing cognitive decline in some older adults. In this review, we update existing reviews of the current epidemiologic research on the association between hearing loss and dementia risk and discuss hypothesized mechanisms of this association. We also discuss management of hearing loss as a potential intervention for slowing cognitive decline and reducing dementia risk.

Physical Function Trajectories and Mortality in Older Adults With Multisensory Impairment

Importance

Single sensory impairment is associated with reduced functional resilience and increased mortality, though the effects of multiple sensory deficits are not known.

Objective

To investigate longitudinal associations of the type, severity, and number of sensory impairments with physical function trajectories and mortality in older adults.

Design, Setting, and Participants

This retrospective analysis of a longitudinal cohort study, the Health, Aging, and Body Composition (Health ABC) study, incorporated data from April 1997 to July 2013, featuring a 16-year follow-up with annual examinations and questionnaires. The cohort comprised 3075 men and women, aged 70 to 79 years at baseline, residing in Memphis, Tennessee, and Pittsburgh, Pennsylvania. All participants with complete sensory testing and covariate data at analytical baseline (year 5, 2002) were included. The data were analyzed September 1, 2022.

Exposures

Visual, olfactory, auditory, and touch sensory functions were assessed between 2000 and 2002.

Main Outcomes

The main outcomes included physical functioning trajectories and mortality risk. Physical function was assessed longitudinally using the Health ABC physical performance battery (HABCPPB).

Results

A total of 1825 individuals (mean [SD] age, 77.4 [3.2] years; 957 [52%] female) were included in this study. Multivariable analysis of HABCPPB decline indicated that having 1 sensory impairment (β estimate, -0.01 [95% CI, -0.02 to -0.001]); 2 sensory impairments (β estimate, -0.01 [95% CI, -0.02 to -0.01]); 3 sensory impairments (β estimate, -0.03 [95% CI, -0.04 to -0.02]); or 4 sensory impairments (β estimate, -0.04 [95% CI, -0.05,-0.03]) was significantly associated with a steeper HABCPPB score decline in a dose-dependent manner. Adjusted Cox proportional hazards models indicated that having 1 sensory impairment (hazard ratio [HR], 1.35 [95% CI, 1.01-1.81]), 2 sensory impairments (HR, 1.58 [95% CI, 1.19-2.11]), 3 sensory impairments (HR, 1.79 [95% CI, 1.33-2.42]), or 4 sensory impairments (HR, 1.97 [95% CI, 1.39-2.79]) was significantly associated with increased mortality risk in a similarly dose-dependent manner.

Conclusion

In this retrospective cohort study, the degree and number of multiple sensory impairments were associated with worse physical functioning and increased mortality risk. These findings represent an opportunity for further investigation into the value of screening, prevention, and treatment of sensory impairments to reduce morbidity and mortality in older adults.

Hearing Loss, Hearing Aid Use, and Risk of Dementia in Older Adults

Importance

Hearing loss has been suggested as a risk factor for dementia, but there is still a need for high-quality research to better understand the association between these 2 conditions and the underlying causal mechanisms and treatment benefits using larger cohorts and detailed data.

Objective

To investigate the association between hearing loss and incident dementia, as well as how hearing aid use contributes to this association.

Design, Setting, and Participants

This population-based cohort study was conducted in Southern Denmark between January 2003 and December 2017 and included all residents 50 years and older. We excluded all persons with dementia before baseline as well as those who did not live in the region 5 years before baseline, with incomplete address history, or who had missing covariate information.

Exposures

Individual hearing status based on the Hearing Examinations in Southern Denmark database, which contains data on all pure-tone audiometry examinations performed at public hearing rehabilitation clinics in Southern Denmark.

Main Outcomes and Measures

Incident cases of dementia and Alzheimer disease as identified from national registries.

Results

The study population comprised 573 088 persons (298 006 women [52%]; mean [SD] age, 60.8 [11.3] years) with 23 023 cases of dementia and mean (SD) follow-up of 8.6 (4.3) years. Having a hearing loss was associated with an increased risk of dementia, with an adjusted hazard ratio (HR) of 1.07 (95% CI, 1.04-1.11) compared with having no hearing loss. Severe hearing loss in the better and worse ear was associated with a higher dementia risk, with an HR of 1.20 (95% CI, 1.09-1.32) and 1.13 (95% CI, 1.06-1.20), respectively, compared with having no hearing loss in the corresponding ear. Compared with people without hearing loss, the risk of dementia was higher among people with hearing loss who were not using hearing aids than those who had hearing loss and were using hearing aids, with HRs of 1.20 (95% CI, 1.13-1.27) and 1.06 (95% CI, 1.01-1.10), respectively.

Conclusions and Relevance

The results of this cohort study suggest that hearing loss was associated with increased dementia risk, especially among people not using hearing aids, suggesting that hearing aids might prevent or delay the onset and progression of dementia. The risk estimates were lower than in previous studies, highlighting the need for more high-quality longitudinal studies.

Lifestyle and factors of vascular and metabolic health and inflammation are associated with sensorineural-neurocognitive aging in older adults

This study's aim was to identify risk factors associated with sensorineural and neurocognitive function (brain aging) in older adults. In N = 1,478 Epidemiology of Hearing Loss Study participants (aged 64-100 years, 59% women), we conducted sensorineural and cognitive tests, which were combined into a summary measure using Principal Component Analysis (PCA). Participants with a PCA score <-1 standard deviation (SD) were considered to have brain aging. Incident brain aging was defined as PCA score <-1 SD at 5-year follow-up among participants who had a PCA score ≥-1 SD at baseline. Logistic regression and Poisson models were used to estimate associations between baseline risk factors of lifestyle, vascular and metabolic health, and inflammation and prevalent or incident brain aging, respectively. In an age-sex adjusted multivariable model, not consuming alcohol (odds ratio(OR) = 1.77, 95% confidence Interval (CI) = 1.18,2.66), higher interleukin-6 levels (OR = 1.30, 95% CI = 1.03,1.64), and depressive symptoms (OR = 2.44, 95% CI = 1.63,3.67) were associated with a higher odds of having brain aging, while higher education had protective effects (OR = 0.55, 95% CI = 0.33,0.94). A history of stroke, arterial stiffness, and obesity were associated with an increased risk of developing brain aging during the five years of follow-up. Lifestyle, vascular, metabolic and inflammatory factors were associated with brain aging in older adults, which adds to the evidence of shared pathways for sensorineural and neurocognitive declines in aging. Targeting these shared central processing etiological factors with interventions may lead to retention of better neurological function, benefiting multiple systems, i.e., hearing, smell, and cognition, ultimately helping older adults retain independence and higher quality of life longer.

Reduced tactile sensitivity is associated with mild cognitive impairment

BACKGROUND

Sensory impairment has been related to age-associated cognitive decline. While these associations were investigated primarily in the auditory and visual domain, other senses such as touch have rarely been studied. Thus, it remains open whether these results are specific for particular sensory domains, or rather point to a fundamental role of sensory deficits in cognitive decline.

METHODS

Data from 31 participants with mild cognitive impairment (MCI), 46 participants with frailty, and 23 non-clinical control participants (NCCs) were included. We assessed sensory function using visual acuity and contrast sensitivity, hearing threshold, and mechanical detection threshold. Cognitive function in participants with MCI was assessed using associative memory performance. Group differences on sensory thresholds were tested using analyses of covariance with age, sex, and years of education as covariates. Associations between measures within participants with MCI were evaluated using Spearman correlations.

FINDINGS

We found a significant difference in mechanical detection threshold between the groups (p < 0.001, η2 = 0.18). Participants with MCI showed significantly reduced tactile sensitivity compared to participants with frailty and NCCs. In participants with MCI, lower associative memory performance was significantly related to reduced tactile sensitivity (rs = 0.39, p = 0.031) and auditory acuity (rs = 0.41, p = 0.022).

INTERPRETATION

Our results indicate that reduced tactile sensitivity is related to cognitive decline. Prospective studies should investigate the age-related alterations of multimodal sensory processes and their contribution to dementia-related processes.

FUNDING

Deutsche Forschungsgemeinschaft (FL 156/41-1) and a grant of the Hector-Stiftung II, Weinheim, Germany.

Midlife sensory and motor functions improve prediction of blood-based measures of neurodegeneration and Alzheimer's disease in late middle-age

INTRODUCTION

We assessed whether midlife sensory and motor functions added to prediction models using the Cardiovascular Risk Factors, Aging, and Incidence of Dementia Score (CAIDE) and Framingham Risk Score (FRS) improve risk predictions of 10-year changes in biomarkers of neurodegeneration and Alzheimer's disease.

METHODS

Longitudinal data of N = 1529 (mean age 49years) Beaver Dam Offspring Study participants from baseline, 5-year, and 10-year follow-up were included. We tested whether including baseline sensory (hearing, vision, olfactory) impairment and motor function measures improves CAIDE or FRS risk predictions of 10-year incidence of biomarker positivity of serum-based neurofilament light chain (NfL) and amyloid beta (Aβ)42/Aβ40 using logistic regression.

RESULTS

Adding sensory and motor measures to CAIDE-only and FRS-only models significantly improved NfL and Aβ42/Aβ40 positivity predictions in adults above the age of 55.

DISCUSSION

Including midlife sensory and motor function improved long-term biomarker positivity predictions. Non-invasive sensory and motor assessments could contribute to cost-effective screening tools that identify individuals at risk for neurodegeneration early to target interventions and preventions.

Highlights

Sensory and motor measures improve risk prediction models of neurodegenerative biomarkersSensory and motor measures improve risk prediction models of AD biomarkersPrediction improvements were strongest in late midlife (adults >55 years of age)Sensory and motor assessments may help identify high-risk individuals early.

Midlife sensory and motor functions improve long-term predictions of cognitive decline and incidence of cognitive impairment

INTRODUCTION

We aimed to assess whether midlife sensory and motor functions improve risk prediction of 10-year cognitive decline and impairment when added to risk prediction models using the Cardiovascular Risk Factors, Aging, and Incidence of Dementia Score (CAIDE) and Framingham Risk Score (FRS).

METHODS

Longitudinal data of N = 1529 (mean age 49 years; 54% women) Beaver Dam Offspring Study (BOSS) participants from baseline, 5 and 10-year follow-up were included. We tested whether including baseline sensory (hearing, vision, olfactory) impairment and motor function improves CAIDE or FRS risk predictions of 10-year cognitive decline or cognitive impairment incidence using logistic regressions.

RESULTS

Adding sensory and motor measures to CAIDE-only and FRS-only models significantly improved areas under the curve for cognitive decline and impairment models.

DISCUSSION

Including midlife sensory and motor function improved risk predictions of long-term cognitive decline and impairment in middle-aged to older adults. Sensory and motor assessments could contribute to cost-effective and non-invasive screening tools that identify high-risk individuals earlier to target intervention and prevention strategies.

Highlights

Sensory and motor measures improve risk prediction models of cognitive decline.Sensory and motor measures improve risk prediction models of cognitive impairment.Prediction improvements were strongest in midlife (adults < 55 years of age).Sensory and motor changes may help identify high-risk individuals early.

Alterations of Audiovisual Integration in Alzheimer's Disease

Audiovisual integration is a vital information process involved in cognition and is closely correlated with aging and Alzheimer's disease (AD). In this review, we evaluated the altered audiovisual integrative behavioral symptoms in AD. We further analyzed the relationships between AD pathologies and audiovisual integration alterations bidirectionally and suggested the possible mechanisms of audiovisual integration alterations underlying AD, including the imbalance between energy demand and supply, activity-dependent degeneration, disrupted brain networks, and cognitive resource overloading. Then, based on the clinical characteristics including electrophysiological and imaging data related to audiovisual integration, we emphasized the value of audiovisual integration alterations as potential biomarkers for the early diagnosis and progression of AD. We also highlighted that treatments targeted audiovisual integration contributed to widespread pathological improvements in AD animal models and cognitive improvements in AD patients. Moreover, investigation into audiovisual integration alterations in AD also provided new insights and comprehension about sensory information processes.

The Association of Multiple Sensory Impairment and Telomere Length: The Health ABC Study

OBJECTIVES

The objective of this study was to characterize the associations of sensory impairments, including olfaction (OI), vision (VI), hearing (HI), and touch (TI), with telomere length (TL) in a group of community-dwelling older adults who participated in the Health ABC study.

METHODS

Across 1603 participants, OI was classified with the Brief Smell Identification Test (<11), HI with pure-tone averages (<25 dB), VI with visual acuity (20/50 or worse), and TI with monofilament testing (inability to detect three of four touches). Shorter TL was defined as the lowest quartile of sample TLs. Adjusted multivariable regressions were used to examine the cross-sectional association between the modality, severity, and number of sensory impairments with TL.

RESULTS

Participants had an average age of 77.4 ± 2.84 years, and 89.7% (n = 1438) had at least one or more sensory impairments. Severe OI (odds ratio [OR] = 1.73, 95% confidence interval [CI] = [1.19, 2.6]) was independently associated with increased odds of shorter TL. Additionally, having one (OR = 2.79, 95% CI = [1.69, 4.70]), two (OR = 2.5, 95% CI = [1.51, 4.26]), three (OR = 3.04, 95% CI = [1.79, 5.36]), or four impairments (OR = 3.72, 95% CI = [1.52, 7.33]) was associated with increased odds of shorter TL in a dose-dependent manner.

CONCLUSION

Severe OI and TI appear to be particularly robust markers of shortened TL. Additionally, multiple sensory impairment is strongly associated with shortened TL, suggesting that sensory dysfunction may represent a unique biomarker of unhealthy aging.

LEVEL OF EVIDENCE

Level II Laryngoscope, 133:3132-3138, 2023.

Association of Performance on Olfactory and Cognitive Screening Tests With Conversion to Dementia in a Biracial Cohort of Older Adults

BACKGROUND AND OBJECTIVES

Odor identification deficits are associated with transition to dementia, whereas intact odor identification and global cognition test performance may identify lack of transition. The purpose of this study was to examine intact odor identification and global cognition as prognostic indicators of lack of transition to dementia in a biracial (Black and White) cohort.

METHODS

In a community-dwelling sample of older adults from the Health, Aging, and Body Composition study, odor identification was measured using the Brief Smell Identification Test (BSIT), and global cognition was measured using the Teng Modified Mini-Mental State Examination (3MS). Survival analyses for dementia transition over 4 and 8 years of follow-up used Cox proportional hazards models.

RESULTS

A total of 2,240 participants had an average age of 75.5 years (SD 2.8). Approximately 52.7% were female individuals. Approximately 36.7% were Black and 63.3% were White individuals. Impaired odor identification (hazard ratio [HR] 2.29, 95% CI 1.79-2.94, p < 0.001) and global cognition (HR 3.31, 95% CI 2.26-4.84, p < 0.001) were each independently associated with transition to dementia (n = 281). Odor identification remained robustly associated with transition to dementia for Black (HR 2.02, 95% CI 1.36-3.00, p < 0.001, n = 821) and White participants (HR 2.45, 95% CI 1.77-3.38, p < 0.001, n = 1,419), whereas global cognition was associated with transition among Black participants only (HR 5.06, 95% CI 3.18-8.07, p < 0.001). ApoE genotype was consistently associated with transition among White participants only (HR 1.75, 95% CI 1.20-2.54, p < 0.01). Among participants with intact performance on both odor identification (BSIT ≥9/12 correct) and global cognition (3MS ≥ 78/100 correct), 8.8% transitioned to dementia over 8 years. Intact performance on both measures had high positive predictive value for identifying individuals who did not transition to dementia over 4 years (0.98 for ages 70-75 years with only 2.3% transitioning, 0.94 for ages 76-82 years with only 5.8% transitioning).

DISCUSSION

Odor identification testing paired with a global cognitive screening test identified individuals at low risk of transition to dementia in a biracial community cohort with a pronounced effect in the eighth decade of life. Identification of such individuals can reduce the need for extensive investigation to establish a diagnosis. Odor identification deficits showed utility in both Black and White participants, unlike the race-dependent utility of a global cognitive test and ApoE genotype.

Understanding the Association Between Sensory Impairment and Dementia: Toward Informing Future Research and Health Policy

Recent epidemiological research has linked decline in multiple sensory functions with an increased risk of dementia. However, the pathways linking such factors with neurodegenerative disorders remain unclear. Studies that assess this are crucial for guiding the distribution of public health resources and the development of clinical trials aiming to delay or prevent dementia. This commentary examines the contribution of a study by Dintica and colleagues to the field of sensory-cognitive research.

Alzheimer's disease: a continuum with visual involvements

Introduction

Alzheimer's disease (AD) is the most common form of dementia affecting the central nervous system, and alteration of several visual structures has been reported. Structural retinal changes are usually accompanied by changes in visual function in this disease. The aim of this study was to analyse the differences in visual function at different stages of the pathology (family history group (FH+), mild cognitive impairment (MCI), mild AD and moderate AD) in comparison with a control group of subjects with no cognitive decline and no family history of AD.

Methods

We included 53 controls, 13 subjects with FH+, 23 patients with MCI, 25 patients with mild AD and, 21 patients with moderate AD. All were ophthalmologically healthy. Visual acuity (VA), contrast sensitivity (CS), colour perception, visual integration, and fundus examination were performed.

Results

The analysis showed a statistically significant decrease in VA, CS and visual integration score between the MCI, mild AD and moderate AD groups compared to the control group. In the CS higher frequencies and in the colour perception test (total errors number), statistically significant differences were also observed in the MCI, mild AD and moderate AD groups with respect to the FH+ group and also between the control and AD groups. The FH+ group showed no statistically significant difference in visual functions compared to the control group. All the test correlated with the Mini Mental State Examination score and showed good predictive value when memory decline was present, with better values when AD was at a more advanced stage.

Conclusion

Alterations in visual function appear in subjects with MCI and evolve when AD is established, being stable in the initial stages of the disease (mild AD and moderate AD). Therefore, visual psychophysical tests are a useful, simple and complementary tool to neuropsychological tests to facilitate diagnosis in the preclinical and early stages of AD.

Association Between Sensory Impairment and Dementia: The Roles of Social Network and Leisure Activity

BACKGROUND

Evidence suggests that sensory impairment is linked to dementia; however, the role of social network and leisure activity in this relationship is unclear.

OBJECTIVE

Examine the association of hearing and visual impairment with dementia, and whether a rich social network and leisure activity moderates this association.

METHODS

Dementia-free older adults from the Swedish National Study on Aging and Care in Kungsholmen (n = 2,579) were followed up for up for a median of 10 years (interquartile range = 6). Visual impairment was assessed with a reading acuity test, and hearing impairment was ascertained via self-report and medical records. Dementia was diagnosed following international criteria. Data on social network and leisure activity was collected via self-report. Hazard ratios (HRs) of dementia risk were derived from Cox regression models.

RESULTS

Dual impairment, but not single impairment in hearing and vision was associated with a higher risk of dementia (HR: 1.62, 95% CI: 1.16 to 2.27). Compared to participants with no sensory impairment and a moderate-to-rich social network, those with dual impairment and low social network or leisure activity had higher dementia risk (HR: 2.08, 95% CI: 1.43 to 3.22; HR: 2.08, 95% CI: 1.43 to 3.22, respectively), whereas participants with dual impairment with a moderate-to-rich social network or leisure activity did not have significantly higher dementia risk (HR; 1.42, 95% CI: 0.87 to 2.33; HR; 1.42, 95% CI: 0.87 to 2.33, respectively).

CONCLUSION

A richer social network and participation in stimulating activities may mitigate the higher dementia risk in older adults with dual impairment in vision and hearing.

Association of cataract extraction and the risk of dementia-A systematic review and meta-analysis

Objectives

This research aims to investigate if cataract extraction lowers the risk of all-cause dementia.

Methods

Original literature on cataract surgery associated with all-cause dementia as of November 27, 2022, was searched in several commonly used databases. Manual review was used to include eligible studies. Stata software (version 16) was used to perform statistical analysis on pertinent data. Publication bias can be precisely evaluated using funnel plots and Egger's test.

Results

In the meta-analysis of 4 cohort studies with 245,299 participants. Pooled analysis indicated that cataract surgery was linked to a lower incidence of all-cause dementia (OR = 0.77, 95%CI: 0.66-0.89; I²= 54.7%; P < 0.001). Cataract surgery was linked to a lower risk of AD (OR = 0.60, 95%CI: 0.35-1.02; I²= 60.2%; P < 0.001).

Conclusions

Cataract surgery is linked to a lower incidence of all-cause dementia and Alzheimer's disease. A cataract is a reversible visual impairment. Cataract surgery may be a protective factor against the onset of all-cause dementia and can reduce the economic and family burden caused by all-cause dementia worldwide. Given the restricted pool of included studies, our findings necessitate meticulous interpretation.

Systematic review registration

http://www.crd.york.ac.uk/prospero retrieve registration details by searching CRD4202379371.

Vision impairment, hearing impairment and functional Limitations of subjective cognitive decline: a population-based study

BACKGROUND

The association between sensory impairment including vision impairment (VI), hearing impairment (HI), dual impairment (DI) and the functional limitations of SCD (SCD-related FL) are still unclear in middle-aged and older people.

METHODS

162,083 participants from BRFSS in 2019 to 2020 was used in this cross-sectional study. After adjusting the weights, multiple logistic regression was used to study the relationship between sensory impairment and SCD or SCD-related FL. In addition, we performed subgroup analysis on the basis of interaction between sensory impairment and covariates.

RESULTS

Participants who reported sensory impairment were more likely to report SCD or SCD-related FL compared to those without sensory impairment (p < 0.001). The association between dual impairment and SCD-related FL was the strongest, the adjusted odds ratios (aORs) and 95% confidence interval (95% CI) were [HI, 2.88 (2.41, 3.43); VI, 3.15(2.61, 3.81); DI, 6.78(5.43, 8.47)] respectively. In addition, subgroup analysis showed that men with sensory impairment were more likely to report SCD-related FL than women, the aORs and 95% CI were [HI, 3.15(2.48, 3.99) vs2.69(2.09, 3.46); VI,3.67(2.79, 4.83) vs. 2.86(2.22, 3.70); DI, 9.07(6.67, 12.35) vs. 5.03(3.72, 6.81)] respectively. The subject of married with dual impairment had a stronger association with SCD-related FL than unmarried subjects the aOR and 95% CI was [9.58(6.69, 13.71) vs. 5.33(4.14, 6.87)].

CONCLUSIONS

Sensory impairment was strongly associated with SCD and SCD-related FL. Individuals with dual impairment had the greatest possibility to reported SCD-related FL, and the association was stronger for men or married subjects than other subjects.

Sensory impairment and beta-amyloid deposition in the Baltimore longitudinal study of aging

Introduction

Beta-amyloid (Aβ) plaque deposition is a biomarker of preclinical Alzheimer's disease (AD). Impairments in sensory function are associated with cognitive decline. We sought to investigate the relationship between PET-indicated Aβ deposition and sensory impairment.

Methods

Using data from 174 participants ≥55 years in the Baltimore Longitudinal Study of Aging, we analyzed associations between sensory impairments and Aβ deposition measured by PET and Pittsburgh Compound B (PiB) mean cortical distribution volume ratio (cDVR).

Results

The combinations of hearing and proprioceptive impairment and hearing, vision, and proprioceptive impairment, were positively correlated with cDVR (β = 0.087 and p = 0.036, β = 0.110 and p = 0.018, respectively). In stratified analyses of PiB+ participants, combinations of two, three, and four sensory impairments (all involving proprioception) were associated with higher cDVR.

Discussion

Our findings suggest a relationship between multi-sensory impairment (notably proprioceptive impairment) and Aβ deposition, which could reflect sensory impairment as an indicator or potentially a risk factor for Aβ deposition.

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.

The association between vision impairment and cognitive outcomes in older adults: a systematic review and meta-analysis

OBJECTIVES

To provide a quantitative synthesis of studies on the relationship between vision impairment (VI) and cognitive outcomes in older adults.

METHOD

A systematic search was undertaken of relevant databases for original articles published before April 2020. Random effect models were used to obtain pooled estimates of the associations between VI and cognitive outcomes (cognitive impairment and dementia) with subgroup analyses of VI measures, cross-sectional associations of VI with cognitive impairment, and longitudinal associations of baseline VI with incident cognitive impairment and dementia. Potential sources of heterogeneity were explored by meta-regression. Publication bias was evaluated with Egger's test.

RESULTS

Sixteen studies including 76,373 participants were included in this meta-analysis, with five cross-sectional studies and eleven longitudinal studies. There was a significantly increased risk of cognitive outcomes with VI identified by subjective measures (odds ratio (OR)=1.63; 95% confidence interval (CI): 1.26-1.99) and objective measures (OR = 1.59; 95% CI: 1.40-1.78). The odds of baseline cognitive impairment were 137% higher in older adults with VI compared with those without VI (OR = 2.37, 95% CI: 1.84-3.03) at baseline. Compared with older adults without VI at baseline, those with baseline VI had a higher relative risk (RR) of incident cognitive impairment (RR = 1.41; 95% CI: 1.31-1.51) and dementia (RR = 1.44, 95% CI: 1.19-1.75).

CONCLUSIONS

VI was associated with increased risks of cognitive impairment and dementia across cross-sectional and longitudinal studies. Additional research and randomized clinical trials are warranted to examine the implications of treatment for VI, such as wearing glasses and cataract surgery, to avoid cognitive impairment and dementia.

Sensory impairment and cognitive function among older adults in China: The mediating roles of anxiety and depressive symptoms

OBJECTIVES

Through a cross-sectional study, we explored the association between sensory impairment and cognitive function in Chinese older adults, and tested the mediating roles of anxiety and depressive symptoms between this relationship.

METHODS

Based on the 2018 Chinese Longitudinal Healthy Longevity Survey, a total of 10,895 older adults aged 65 and above were selected as samples for research. Anxiety, depressive symptoms and cognitive function were evaluated by the Generalized Anxiety Disorder, the Center for Epidemiologic Studies Depression (CES-D10) and the Chinese version of modified Mini-Mental State Examination scales, respectively. Sensory impairment was assessed from self-reported vision and hearing functions. Multiple linear regression and SPSS Macro PROCESS were used for statistical analysis.

RESULTS

Compared with no sensory impairment, vision impairment (B = -1.012, 95%CI: -1.206, -0.818), hearing impairment (B = -2.683, 95%CI: -2.980, -2.386) and dual sensory impairment (B = -6.302, 95%CI: -6.585, -6.020) have a significant association with cognitive function in older adults, respectively. Anxiety and depressive symptoms not only acted as independent mediators, but also played sequential mediating effects on the relationship between sensory impairment and cognitive function.

CONCLUSIONS

Greater attention should be paid to anxiety and depressive symptoms of older adults with sensory impairment, which might be beneficial to maintain cognitive function.

Associations of sensory and motor function with blood-based biomarkers of neurodegeneration and Alzheimer's disease in midlife

Pathological biomarkers of dementia and Alzheimer's disease (AD) change decades before clinical symptoms. Common sensory and motor changes in aging adults may be early markers of neurodegeneration. We investigated if midlife sensory and motor functions in Beaver Dam Offspring Study (BOSS) participants (N = 1529) were associated with longitudinal changes in blood-based biomarkers of neurodegeneration (neurofilament light chain (NfL); total tau (TTau)) and AD (amyloid beta (Aβ)). Mixed-effects models with baseline sensory and motor function as determinants and 10-year biomarker change as outcome were used. Participants with hearing impairment and worse motor function (among women) showed faster increases in NfL level over time (0.8% per year; 0.3% per year, respectively). There were no significant associations with TTau or Aβ. We found consistent relationships between worse baseline hearing and motor function with a faster increase in neurodegeneration, specifically serum NfL level. Future studies with longer follow-up should determine if sensory and motor changes are more reflective of general neurodegeneration than AD-specific pathology and whether sensory and motor tests may be useful screening tools for neurodegeneration risk.

Associations among Visual, Auditory, and Olfactory Functions in Community-Based Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

PURPOSE

Objective examination of relationships among visual, hearing, and olfactory function may yield mechanistic insights and inform our understanding of the burden of multiple-sensory impairments.

METHODS

This cross-sectional study capitalized on continuous measures of visual acuity (VA), contrast sensitivity, pure tone audiometry, Quick Speech-in-Noise (QuickSIN), and Sniffin' Sticks from a subset of ARIC participants at two community sites (EyeDOC Study, 2017-2019). Scales of all measures were aligned such that higher values indicated greater impairment. Intersensory bivariate associations were assessed graphically, and correlations assessed using Kendall's tau. Intersensory associations, independent of age, education, smoking, diabetes, and hypertension, were examined using linear regression. Analyses were stratified by community/race (Washington County/White vs Jackson/Black) and sex (men vs women) to explore community-sex heterogeneity.

RESULTS

We included 834 participants (mean age, 79 years); 39% were from Jackson and 63% females. We found weak intersensory correlations (tau generally ≤0.15). In the demographics-adjusted regression models, results were heterogeneous across communities and sex. Worse near VA, contrast sensitivity, and olfaction were associated with worse QuickSIN and worse near VA was associated with worse olfaction in some but not all community/race-sex groups (e.g., Jackson/Black women, 0.1 logMAR worse near VA was associated with 0.27 units increase in QuickSIN [95% confidence interval, 0.10-0.45]). Associations were modestly attenuated by adjustment for the shared risk factors of smoking, diabetes, and hypertension.

CONCLUSIONS

Visual dysfunction showed little or no association with hearing or olfaction impairments, suggesting a modest role for shared risk factors.

TRANSLATIONAL RELEVANCE

Visually impaired individuals have only a modestly higher risk of other sensory impairment.

The effect of Alzheimer's blanket activity program on behavioral symptoms, activities of daily living, and quality of life

PURPOSE

The study was conducted to evaluate the effects of the Alzheimer's blanket activity program (ABAP) on the behavioral symptoms, activities of daily living, and quality of life of people with Alzheimer's disease.

DESIGN AND METHOD

The study was conducted between November 2019 and February 2020 in the homes of the participants with Alzheimer's disease with a single group pre- post-test design. As part of the ABAP, the researchers made two home visits, conducted telephone interviews, and provided counseling services during the 3-month follow-up process.

FINDINGS

It was found that after the program, the people with Alzheimer's disease had improved daily life activity, quality of life, and neuropsychiatric symptom scores; however, the change was not statistically significant.

PRACTICE IMPLICATIONS

Future studies involving longer intervention and follow-up using the ABAP may help assess the long-term effects of the program.

The Longitudinal Association of Late-Life Visual and Hearing Difficulty and Cognitive Function: The Role of Social Isolation

OBJECTIVES

Sensory impairments are prevalent among older adults and have been associated with cognitive challenges in later life, yet mechanisms are less well understood. We examined the mediating role of social isolation in the longitudinal relationship between self-reported sensory difficulty and impaired cognitive functioning among older adults.

METHODS

Data were taken from the NHATS Study, an annual survey of Medicare beneficiaries' age ≥ 65. Participants (N = 6,338) provided data at Rounds 5, 6, and 7 (2015, 2016, 2017). Structural equation models were estimated to test longitudinal direct and indirect associations.

RESULTS

All sensory difficulties were negatively associated with all cognitive functioning measures cross-sectionally through social isolation. Longitudinally, vision difficulty and dual sensory difficulty were indirectly associated with cognitive functioning across time. Hearing difficulty had no longitudinal indirect associations with cognitive functioning through social isolation.

DISCUSSION

Social isolation is an important pathway through which late-life vision difficulty is associated with decreased cognitive function.

Olfactory, Auditory, and Vestibular Performance: Multisensory Impairment Is Significantly Associated With Incident Cognitive Impairment

Background

Dysfunction in the olfactory, auditory, and vestibular systems are commonly seen in aging and are associated with dementia. The impact of sensory loss(es) on cognition is not well understood. Our aim was to assess the relationships between performance on objective multisensory testing and quantify the impact of dysfunction on cognition.

Methods

Patients presenting with subjective hearing loss presenting to a tertiary care otologic/audiologic clinic were identified and underwent multisensory testing using the Affordable, Rapid Olfactory Measurement Array (AROMA), pure tone audiometric evaluations, and the Timed “Up and Go” test. Cognitive impairment (CI) was assessed via the Montreal Cognitive Assessment (MoCA) was also administered.

Key Results

180 patients were enrolled. Thirty one percentage (n = 57) screened positive for cognitive impairment. When evaluating single sensory impairments, we found that olfactory dysfunction, gait impairment, and sensorineural hearing loss were all statistically significantly (p &lt; 0.05) associated with a higher risk of cognitive impairment (ORs 3.89, 3.49, and 2.78, respectively) for CI. Multisensory impairment was significantly associated with cognitive impairment. Subjects with dysfunction in all domains were at the highest risk for cognitive impairment (OR 15.7, p &lt; 0.001) vs. those with impairment in 2 domains (OR 5.32, p &lt; 0.001).

Conclusion

Dysfunction of the olfactory, auditory, and vestibular systems is associated with a significantly increased risk of CI. The dramatically increased risk of CI with multisensory dysfunction in all three systems indicated that MSD may synergistically contribute to CI.

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.

Associations of Lower Extremity Peripheral Nerve Impairment and Risk of Dementia in Black and White Older Adults

BACKGROUND AND OBJECTIVES

Peripheral nerve impairments and dementia are common among older adults and share risk factors. However, few studies have examined whether peripheral nerve function and dementia are associated. We evaluated whether lower extremity peripheral nerve impairments were associated with higher incidence of dementia and whether associations differed by comorbidity subgroups (diabetes, low vitamin B12, and APOE ε4 allele carriers).

METHODS

We studied Black and White Health, Aging, and Body Composition Study participants 70 to 79 years of age and without dementia at enrollment. Lower extremity sensory and motor peripheral nerve function was measured at year 4 (the analytic baseline of this study). Sensory nerve impairments were measured with monofilament (1.4 g, 10 g) and vibration threshold of the toe. Monofilament insensitivity was defined as unable to detect monofilament (3 of 4 touches), and vibration detection impairment was defined as >130 μm. Fibular motor impairments were defined as <1 mV compound motor action potential (CMAP) amplitude and slow nerve conduction velocity <40 m/s. Incident dementia over the following 11 years was determined from medical records, cognitive scores, and medications. Cox proportional hazard models adjusted for demographics and health conditions assessed associations of nerve impairments with incident dementia.

RESULTS

Among 2,174 participants (52% women, 35% Black), 45% could not detect monofilament 1.4 g, 9% could not detect monofilament 10 g, 6% could not feel vibration, 10% had low CMAP amplitude, and 24% had slow conduction velocity. Monofilament 10 g (hazard ratio [HR] 1.35, 95% CI 0.99-1.84) and vibration detection insensitivity (HR 1.73, 95% CI 1.24-2.40) were associated/borderline associated with a higher risk of dementia after covariate adjustment. Estimates were elevated but not significant for monofilament 1.4 g, CMAP amplitude, and conduction velocity (p > 0.05). Increasing number of peripheral nerve impairments was associated with higher risk of dementia in a graded fashion; for ≥3 impairments, the HR was 2.37 (95% CI 1.29-4.38). In subgroup analyses, effect estimates were generally higher among those with diabetes, low vitamin B12, and APOE ε4 allele except for vibration detection.

DISCUSSION

Peripheral nerve impairments, especially sensory, were associated with a higher risk of dementia even after adjustment for age and other health factors. These associations may represent a shared susceptibility to nervous system degeneration.

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 visual trajectories and cognitive impairment: insights from the Taiwan Longitudinal Study on Aging

BACKGROUND

Visual impairment (VI) was associated with cognitive impairment. However, different visual trajectories might contribute to different risks of cognitive decline in the elderly.

AIMS

This study aimed to evaluate the association between visual trajectories and cognitive impairment.

METHODS

Four thousand two hundred eight community-dwelling elder adults were identified from Waves IV-VII (1999-2011) survey of the Taiwan Longitudinal Study on Aging (TLSA). Cognitive function was determined using the Short Portable Mental Status Questionnaire (SPMSQ) scores. Visual impairment was self-reported and visual trajectories were assessed in at least two waves of the survey. Ordinal logistic regression was performed to estimate adjusted odds ratios (adjORs) and 95% confidence intervals (CIs).

RESULTS

Participants with visual trajectory from no VI to VI had significantly higher risk of cognitive impairment with an adjOR of 1.69 (95% CI 1.12-2.57) than participants without VI. Compared to participants without VI, participants with persistent VI (adjOR 1.32; 95% CI 0.89-1.96) and with visual trajectory from VI to no VI (adjOR 1.25; 95% CI 0.83-1.88) were not associated with cognitive impairment. A protective association between eyeglasses use and cognitive impairment (adjOR 0.69; 95% CI 0.55-0.87) was found in this study. Importantly, cataract was associated with higher risk of cognitive impairment (adjOR 1.34; 95% CI 1.10-1.62). However, nonsurgical cataract treatment did not show protective effect on cognitive impairment in patients with cataract.

CONCLUSIONS AND DISCUSSION

Visual trajectory from no VI to VI is a significant risk factor for cognitive impairment that physicians should pay special attention during community screening.

Combined effects of handgrip strength and sensory impairment on the prevalence of cognitive impairment among older adults in Korea

Older adults commonly experience concurrent lower handgrip strength and sensory impairment. However, previous studies have analyzed the individual effects of either handgrip strength or sensory impairment on cognitive impairment. To address this gap, this study investigated the combined effects of handgrip strength and sensory impairment on cognitive impairment among older adults. In total, 2930 participants aged 65 and older were analyzed using 2014–2018 data from the Korean Longitudinal Study of Aging. Participants underwent assessments of handgrip strength (grip dynamometer), sensory impairment (self-reported responses), and cognitive impairment (Korean version of the Mini-Mental State Examination). Low handgrip strength, compared to normal handgrip strength, was associated with cognitive impairment. In participants with low handgrip strength, vision and hearing impairment were associated with cognitive impairment (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.06–1.75; OR 2.58, 95% CI 1.77–3.78, respectively) compared to those with normal handgrip strength. Participants with low handgrip strength and dual sensory impairment had the highest OR for cognitive impairment (OR 3.73, 95% CI 2.65–5.25). Due to the strong association of low handgrip strength and dual sensory impairment with cognitive impairment, people living with low handgrip strength and dual sensory impairment should be classified as a high-risk group for cognitive impairment and should be prioritized for interventions.

Sensorimotor Synchronization in Healthy Aging and Neurocognitive Disorders

Sensorimotor synchronization (SMS), the coordination of physical actions in time with a rhythmic sequence, is a skill that is necessary not only for keeping the beat when making music, but in a wide variety of interpersonal contexts. Being able to attend to temporal regularities in the environment is a prerequisite for event prediction, which lies at the heart of many cognitive and social operations. It is therefore of value to assess and potentially stimulate SMS abilities, particularly in aging and neurocognitive disorders (NCDs), to understand intra-individual communication in the later stages of life, and to devise effective music-based interventions. While a bulk of research exists about SMS and movement-based interventions in Parkinson's disease, a lot less is known about other types of neurodegenerative disorders, such as Alzheimer's disease, vascular dementia, or frontotemporal dementia. In this review, we outline the brain and cognitive mechanisms involved in SMS with auditory stimuli, and how they might be subject to change in healthy and pathological aging. Globally, SMS with isochronous sounds is a relatively well-preserved skill in old adulthood and in patients with NCDs. At the same time, natural tapping speed decreases with age. Furthermore, especially when synchronizing to sequences at slow tempi, regularity and precision might be lower in older adults, and even more so in people with NCDs, presumably due to the fact that this process relies on attention and working memory resources that depend on the prefrontal cortex and parietal areas. Finally, we point out that the effect of the severity and etiology of NCDs on sensorimotor abilities is still unclear: More research is needed with moderate and severe NCD, comparing different etiologies, and using complex auditory signals, such as music.

Visual Impairment and Risk of Dementia in 2 Population-Based Prospective Cohorts: UK Biobank and EPIC-Norfolk

Visual impairment has emerged as a potential modifiable risk factor for dementia. However, there is a lack of large studies with objective measures of vision and with more than 10 years of follow-up. We investigated whether visual impairment is associated with an increased risk of incident dementia in UK Biobank and European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk). In both cohorts, visual acuity was measured using a "logarithm of the minimum angle of resolution" (LogMAR) chart and categorized as no (≤0.30 LogMAR), mild (>0.3 to ≤0.50 LogMAR), and moderate to severe (>0.50 LogMAR) impairment. Dementia was ascertained through linkage to electronic medical records. After restricting to those aged ≥60 years, without prevalent dementia and with eye measures available, the analytic samples consisted of 62 206 UK Biobank and 7 337 EPIC-Norfolk participants, respectively. In UK Biobank and EPIC-Norfolk, respectively, 1 113 and 517 participants developed dementia over 11 and 15 years of follow-up. Using multivariable Cox proportional-hazards models, the hazard ratios for mild and moderate to severe visual impairment were 1.26 (95% confidence interval [CI]: 0.92-1.72) and 2.16 (95% CI: 1.37-3.40), in UK Biobank, and 1.05 (95% CI: 0.72-1.53) and 1.93 (95% CI: 1.05-3.56) in EPIC-Norfolk, compared to no visual impairment. When excluding participants censored within 5 years of follow-up or with prevalent poor or fair self-reported health, the direction of the associations remained similar for moderate impairment but was not statistically significant. Our findings suggest visual impairment might be a promising target for dementia prevention; however, the possibility of reverse causation cannot be excluded.

Hearing Loss and Cognition: What We Know and Where We Need to Go

Although a causal association remains to be determined, epidemiologic evidence suggests an association between hearing loss and increased risk of dementia. If we determine the association is causal, opportunity for targeted intervention for hearing loss may play a fundamental role in dementia prevention. In this discussion, we summarize current research on the association between hearing loss and dementia and review potential casual mechanisms behind the association (e.g., sensory-deprivation hypothesis, information-degradation hypothesis, common cause). We emphasize key areas of research which might best inform our investigation of this potential casual association. These selected research priorities include examination of the causal mechanism, measurement of co-existing hearing loss and cognitive impairment and determination of any bias in testing, potential for managing hearing loss for prevention of dementia and cognitive decline, or the potential to reduce dementia-related symptoms through the management of hearing loss. Addressing these research gaps and how results are then translated for clinical use may prove paramount for dementia prevention, management, and overall health of older adults.

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.

Association Between Cataract Extraction and Development of Dementia

IMPORTANCE

Visual function is important for older adults. Interventions to preserve vision, such as cataract extraction, may modify dementia risk.

OBJECTIVE

To determine whether cataract extraction is associated with reduced risk of dementia among older adults.

DESIGN, SETTING, AND PARTICIPANTS

This prospective, longitudinal cohort study analyzed data from the Adult Changes in Thought study, an ongoing, population-based cohort of randomly selected, cognitively normal members of Kaiser Permanente Washington. Study participants were 65 years of age or older and dementia free at enrollment and were followed up biennially until incident dementia (all-cause, Alzheimer disease, or Alzheimer disease and related dementia). Only participants who had a diagnosis of cataract or glaucoma before enrollment or during follow-up were included in the analyses (ie, a total of 3038 participants). Data used in the analyses were collected from 1994 through September 30, 2018, and all data were analyzed from April 6, 2019, to September 15, 2021.

EXPOSURES

The primary exposure of interest was cataract extraction. Data on diagnosis of cataract or glaucoma and exposure to surgery were extracted from electronic medical records. Extensive lists of dementia-related risk factors and health-related variables were obtained from study visit data and electronic medical records.

MAIN OUTCOMES AND MEASURES

The primary outcome was dementia as defined by Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Multivariate Cox proportional hazards regression analyses were conducted with the primary outcome. To address potential healthy patient bias, weighted marginal structural models incorporating the probability of surgery were used and the association of dementia with glaucoma surgery, which does not restore vision, was evaluated.

RESULTS

In total, 3038 participants were included (mean [SD] age at first cataract diagnosis, 74.4 (6.2) years; 1800 women (59%) and 1238 men (41%); and 2752 (91%) self-reported White race). Based on 23 554 person-years of follow-up, cataract extraction was associated with significantly reduced risk (hazard ratio, 0.71; 95% CI, 0.62-0.83; P < .001) of dementia compared with participants without surgery after controlling for years of education, self-reported White race, and smoking history and stratifying by apolipoprotein E genotype, sex, and age group at cataract diagnosis. Similar results were obtained in marginal structural models after adjusting for an extensive list of potential confounders. Glaucoma surgery did not have a significant association with dementia risk (hazard ratio, 1.08; 95% CI, 0.75-1.56; P = .68). Similar results were found with the development of Alzheimer disease dementia.

CONCLUSIONS AND RELEVANCE

This cohort study found that cataract extraction was significantly associated with lower risk of dementia development. If validated in future studies, cataract surgery may have clinical relevance in older adults at risk of developing dementia.

Vision impairment and cognitive decline among older adults: a systematic review

OBJECTIVES

There has been increasing epidemiological research examining the association between vision impairment (VI) and cognitive impairment and how poor vision may be a modifiable risk factor for cognitive decline. The objective of this systematic review is to synthesise the published literature on the association of VI with cognitive decline, cognitive impairment or dementia, to aid the development of interventions and guide public policies pertaining to the relationship between vision and cognition.

METHODS

A literature search was performed with Embase, Medline and Cochrane library databases from inception to March 2020, and included abstracts and articles published in peer-reviewed journals in English. Our inclusion criteria included publications that contained subjective/objective measures of vision and cognition, or a diagnosis of VI, cognitive impairment or dementia. Longitudinal or cross-sectional studies with ≥100 participants aged >50 years were included. The search identified 11 805 articles whose abstracts underwent screening by three teams of study authors. Data abstraction and quality assessment using the Effective Public Health Practice Project Quality Assessment Tool were performed by one author (NN). 10% of the articles underwent abstraction and appraisal by a second author (LA/VV), results were compared between both and were in agreement.

RESULTS

110 full-text articles were selected for data extraction, of which 53 were cross-sectional, 43 longitudinal and 14 were case-control studies. The mean age of participants was 73.0 years (range 50-93.1). Ninety-one (83%) of these studies reported that VI was associated with cognitive impairment.

CONCLUSION

Our systematic review indicates that a majority of studies examining the vision-cognition relationship report that VI is associated with more cognitive decline, cognitive impairment or dementia among older adults. This synthesis supports the need for additional research to understand the mechanisms underlying the association between VI and cognitive impairment and to test interventions that mitigate the cognitive consequences of VI.

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.

Examining older adults with neuroatypical conditions for MCI/dementia: Barriers and recommendations of the Neuroatypical Conditions Expert Consultative Panel

The Neuroatypical Conditions Expert Consultative Panel composed of numerous clinical and academic experts was convened to examine barriers to the examination of cognitive impairment in adults with a variety of neuroatypical conditions. Neuroatypical conditions affect normative intellectual development and function (such as intellectual disability and intellectual disability with conjoint psychiatric conditions), thought, moods, and cognition (such as severe mental illness), communication functions (such as the autism spectrum and hearing/vision impairments), and brain and motor function (such as cerebral palsy and acquired or traumatic brain injury). The panel concluded that current federal guidance for the assessment of cognitive impairment for mild cognitive impairment (MCI) or dementia does not sufficiently include information as to how to assess such adults. In addition, it concluded that adults with these conditions (1) challenge clinicians when attempting to discern current behavior and function from that which was pre‐existing; (2) often have inherent comprehension and oral communication difficulties, motor task performance impediments, and difficulty with visuals; and (3) pose difficulties when assessed with standardized dementia measures and can benefit from the use of specialized instruments. The panel recommended that federal guidance be broadened to include adaptations of assessment practices to accommodate neuroatypical conditions; that educational packs be developed for clinicians about such conditions and on detecting and diagnosing MCI or dementia; and that research be expanded to produce more evidence‐based information on both assessing adults with neuroatypical conditions for later‐life adult cognitive diseases/disorders and planning post‐diagnostic care.

Associations of sensory impairment and cognitive function in middle-aged and older Chinese population: The China Health and Retirement Longitudinal Study

Background

Little is known about the associations between vision impairment, hearing impairment, and cognitive function. The aim of this study was to examine whether vision and hearing impairment were associated with a high risk for cognitive impairment in middle-aged and older Chinese adults.

Methods

A total of 13 914 Chinese adults from the China Health and Retirement Longitudinal Study (CHARLS) baseline were selected for analysis. Sensory impairment was assessed from a single self-report question, and we categorized sensory impairment into four groups: no sensory impairment, vision impairment, hearing impairment, and dual sensory impairment. Cognitive assessment covered memory, mental state, and cognition, and the data was obtained through a questionnaire.

Results

Memory was negatively associated with hearing impairment (β = -0.043, 95% confidence interval (CI) = -0.076, -0.043) and dual sensory impairment (β = -0.033, 95% CI = -0.049, -0.017); mental status was negatively associated with vision impairment (β = -0.034, 95% CI = -0.049, -0.018), hearing impairment (β = -0.070, 95% CI = -0.086, -0.055), and dual sensory impairment (β = -0.054, 95% CI = -0.070, -0.039); and cognition was negatively associated with vision impairment (β = -0.028, 95% CI = -0.044, -0.013), hearing impairment (β = -0.074, 95% CI = -0.090, -0.059), and dual sensory impairment (β = -0.052, 95% CI = -0.067, -0.036), even after adjusting for demographics, social economic factors, and lifestyle behavior.

Conclusions

Vision and hearing impairment are negatively associated with memory, mental status, and cognition for middle-aged and elderly Chinese adults. There were stronger negative associations between sensory impairment and cognitive-related indicators in the elderly compared to the middle-aged.

Electroencephalogram Image under Complex Domain Analysis Algorithm to Analyze Neurological Status Epilepticus and Poor Prognostic Factors of Children

This study was to adopt the electroencephalogram (EEG) image to analyze the neurological status epilepticus (SE) and adverse prognostic factors of children using the complex domain analysis algorithm, aiming at providing a theoretical basis for the clinical treatment of children with SE. 24-hour EEG was adopted to diagnose 197 children with SE. The patients were divided into an experimental group (100 cases) and a control group (97 cases) using a random number table method. The EEGs of children in the experimental group were analyzed using the compound domain analysis algorithm, and those in the control group were diagnosed by a professional doctor. The indicators of children in two groups were compared to analyze the effect of the compound domain analysis algorithm in diagnosing diseases through EEG. The prognostic scores of 197 children were scored one month after they were diagnosed, treated, and discharged, and the adverse prognostic factors were analyzed. As a result, EEG can accurately and effectively analyze the brain diseases in children. The sensitivity and specificity of the complex domain analysis algorithm for the detection of epilepsy EEG were much higher than those of the EEG automatic detection algorithm based on time-domain waveform similarity and the EEG automatic detection algorithm based on convolutional neural network (CNN), and the average running time was opposite, showing obvious difference (P < 0.05).The average accuracy, sensitivity, and specificity of children in the experimental group were 96.11%, 97.10%, and 95.19%, respectively; and those in the control group were 88.83%, 90.14%, and 87.82%, respectively, so there was an obvious difference in accuracy between two groups (P < 0.05). There were 57 cases with good prognosis and 140 cases with poor prognosis; there were 70 males with good prognosis and 19 poor prognoses and 69 women with good prognosis and 19 poor prognoses. Among 121 patients with infections, 84 cases had good prognosis and 37 cases had poor prognosis; 39 cases of irregular medication had good prognosis in 31 cases and a poor prognosis in 8 cases; and 37 cases had no obvious cause, including 25 cases with good prognosis and 12 cases with poor prognosis. In short, the EEG diagnosis and treatment effect of the compound domain analysis algorithm were better than those of professional doctors; the gender of the patient had no effect on the poor prognosis, and the pathogenic factors had an impact on the poor prognosis of the patient.

Association between visual impairment and cognitive disorders in low-and-middle income countries: a systematic review

OBJECTIVES

Visual impairment and cognitive disorders are common among older people in Low-and Middle-Income Countries (LMIC). Several recent studies performed in High-Income Countries suggested that visual impairment is associated with cognitive disorders. However, no synthesis of current knowledge exists for LMIC.

METHODS

We have conducted an extensive literature search combining six databases and two grey literature databases. We searched for studies assessing the link between visual and cognitive impairments carried out in LMIC. The systematic search was performed up to 14th February 2019.

RESULTS

Overall, eight studies were included in this review. Among them, five studies were performed in Asia and seven studies had a cross-sectional design. Mean age of the participants varied from 64.2 to 76.2 years. Participants were most often females. Only three studies were specifically focused on the association between visual impairment and cognitive disorders. Out of the eight studies included, four reported a significant association; two showed a possible association and two did not retrieve any statistically significant effect. Heterogeneity in assessments of visual and cognitive impairments was high.

CONCLUSION

In LMIC, very few studies explored the association between visual and cognitive impairments among older people. The current review seems to suggest that visual impairment is associated with cognitive disorders in LMIC. However, further studies are required to improve the knowledge on this relationship. Improving vision, in particular through optical correction and cataract surgery, could potentially be easy pathways to reduce cognitive disorders incidence and to improve quality of life of people affected by this disorder.