Dual sensory impairment: The association between glaucomatous vision loss and hearing impairment and function

Altered static and dynamic functional network connectivity in primary angle-closure glaucoma patients

To explore altered patterns of static and dynamic functional brain network connectivity (sFNC and dFNC) in Primary angle-closure glaucoma (PACG) patients. Clinically confirmed 34 PACG patients and 33 age- and gender-matched healthy controls (HCs) underwent evaluation using T1 anatomical and functional MRI on a 3 T scanner. Independent component analysis, sliding window, and the K-means clustering method were employed to investigate the functional network connectivity (FNC) and temporal metrics based on eight resting-state networks. Differences in FNC and temporal metrics were identified and subsequently correlated with clinical variables. For sFNC, compared with HCs, PACG patients showed three decreased interactions, including SMN-AN, SMN-VN and VN-AN pairs. For dFNC, we derived four highly structured states of FC that occurred repeatedly between individual scans and subjects, and the results are highly congruent with sFNC. In addition, PACG patients had a decreased fraction of time in state 3 and negatively correlated with IOP (p < 0.05). PACG patients exhibit abnormalities in both sFNC and dFNC. The high degree of overlap between static and dynamic results suggests the stability of functional connectivity networks in PACG patients, which provide a new perspective to understand the neuropathological mechanisms of optic nerve damage in PACG patients.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Association between hearing loss and cognitive decline in the elderly: A systematic review with meta-analysis study

OBJECTIVE

Hearing loss has been pointed out as a potential predictor for cognitive decline. This study conducted a systematic review to evaluate the scientific evidence on the association between hearing loss in the elderly and cognitive decline, as well as whether race/color influences this relationship.

METHOD

The search for studies was performed in the following electronic databases: MedLine/PubMed Web of Science, Scopus and Virtual Health Library, and MedRkiv up to August 2022. Studies with epidemiological designs that assess the association between hearing loss and cognitive decline in the elderly were eligible for inclusion. Three independent reviewers performed the selection, data extraction and evaluation of the quality of the studies using the Newcastle-Ottawa Scale. A meta-analysis using a random effects model estimated the global association measurements (Beta coefficient: β) and their 95% confidence intervals (95%CI), and the Higgins and Thompson indicator (I2) was also estimated to assess statistical heterogeneity among the studies.

RESULTS

5,207 records were identified in the database surveys, of which only 18 were eligible studies, totaling 19,551 individuals. Hearing loss was associated with cognitive decline in the elderly, with statistical significance: β = -0.13; 95%CI = -0.23 to -0.04; I2 = 98.70%). For black individuals, the magnitude of the association increased: β = -0.64; 95%CI = -3.36 to 2.07; I2 = 95.65%, but it was not statistically significant.

CONCLUSION

The findings of this systematic review showed the existence of a significant relationship between hearing loss and cognitive decline in the elderly, as well as signaling that among black individuals the magnitude of the association can be increased.

Prevalence and impact of combined vision and hearing (dual sensory) impairment: A scoping review

Hearing and vision impairments are common globally. They are often considered separately in research, and in planning and delivering services. However, they can occur concurrently, termed dual sensory impairment (DSI). The prevalence and impact of hearing and vision impairment have been well-examined, but there has been much less consideration of DSI. The aim of this scoping review was to determine the nature and extent of the evidence on prevalence and impact of DSI. Three databases were searched: MEDLINE, Embase and Global Health (April 2022). We included primary studies and systematic reviews reporting the prevalence or impact of DSI. No limits were placed on age, publication dates, or country. Only studies where the full text was available in English were included. Two reviewers independently screened titles, abstract, full texts. Data were charted by two reviewers independently using a pre-piloted form. The review identified 183 reports of 153 unique primary studies and 14 review articles. Most evidence came from high-income countries (86% of reports). Prevalence varied across reports, as did age groups of participants and definitions used. The prevalence of DSI increased with age. Impact was examined across three broad groups of outcomes-psychosocial, participation, and physical health. There was a strong trend towards poorer outcomes for people with DSI across all categories compared to people with one or neither impairment, including activities of daily living (worse for people with DSI in 78% of reports) and depression (68%). This scoping review highlights that DSI is a relatively common condition with substantial impact, particularly among older adults. There is a gap in evidence from low and middle-income countries. There is a pressing need for a consensus position on the definition(s) of DSI and standardisation of reporting age groups to enable reliable estimates to be ascertained and compared and responsive services developed.

Multimorbidity patterns and the relation to self-rated health among older Japanese people: a nationwide cross-sectional study

OBJECTIVES

Classifying individuals into multimorbidity patterns can be useful to identify the target population with poorer clinical outcomes. Self-rated health (SRH) is one of the core outcomes in multimorbidity patients. Although studies have reported that multimorbidity is associated with poor SRH, whether certain patterns have stronger associations remains unknown. Therefore, this study aimed to identify the prevalence and patterns of multimorbidity and investigate the association between multimorbidity patterns and SRH in an older Japanese population.

DESIGN

Cross-sectional study.

SETTING

Data were obtained from the 2013 Comprehensive Survey of Living Conditions, a nationally representative survey of the general Japanese population.

PARTICIPANTS

This study mainly examined 23 730 participants aged ≥65 years who were not hospitalised or institutionalised.

PRIMARY OUTCOME MEASURE

Poor SRH was defined as choosing 'not very good' or 'bad' from five options: 'excellent', 'fairly good', 'average', 'not very good' and 'bad'.

RESULTS

The prevalence of multimorbidity was 40.9% and that of poor SRH was 23.8%. Three multimorbidity patterns were identified by exploratory factor analysis: (1) degenerative/mental health, (3) malignant/digestive/urological/haematological and (3) cardiovascular/metabolic. Multivariable modified Poisson regression analysis revealed that high malignant/digestive/urological/haematological, degenerative/mental health and cardiovascular/metabolic pattern scores, corresponding to the number of affected body systems in each pattern, were significantly associated with poor SRH (adjusted risk ratio (aRR)=1.68, 95% CI: 1.60 to 1.76; aRR=1.63, 95% CI: 1.58 to 1.69; and aRR=1.31, 95% CI: 1.26 to 1.36, respectively). When including the Kessler 6 score, a screening scale for psychological distress, in the analysis, the association between each multimorbidity pattern score and poor SRH decreased.

CONCLUSIONS

Malignant/digestive/urological/haematological and degenerative/mental health patterns may be associated with a high risk for poor SRH. Further research should focus on interventions to improve SRH in multimorbidity patients.

Associations of dual sensory impairment with incident mobility and ADL difficulty

BACKGROUND

There is a dearth of studies examining the associations of objectively measured dual sensory impairment (DSI) with incident mobility and activities of daily life (ADL) difficulty longitudinally.

METHODS

Cox proportional hazards models were used to examine the associations of DSI and single sensory impairment (hearing, vision) with incident mobility difficulty (many problems or inability to walk ¼ mile and/or climb 10 steps) and ADL difficulty up to six years of follow-up among 2020 participants of the Health, Aging, and Body Composition Study, a cohort of older adults aged 70-79 years from Pittsburgh, PA and Memphis, TN. Vision impairment (VI) was defined as impaired visual acuity (20/50 or worse on Bailey-Lovie distance test) and contrast sensitivity (<1.3 log units on Pelli-Robson test), and hearing impairment (HI) was defined as pure-tone average in better-hearing ear >25 decibels. Models were adjusted by age, race, sex, education, diabetes, depressive symptoms, hypertension, gait speed from 20-meter walk, global cognition score, prevalent cardiovascular disease, and body mass index.

RESULTS

There were 23% with DSI (n = 459). DSI was associated with increased risk of both incident report of mobility (hazard ratio [HR] = 2.25, 95% confidence interval [CI]: 1.47, 3.43), and ADL difficulty (HR = 2.26, 95% CI: 1.50, 3.40). Neither VI nor HI alone was associated with risk of either outcome.

CONCLUSIONS

DSI is associated with increased risk of incident mobility and ADL difficulty. Rehabilitation and adaptive environmental changes for individuals living with DSI may be important to maximize mobility and daily function.

The Impact of COVID-19 on Individuals Across the Spectrum of Visual Impairment

Purpose

TO assess perceptions and implications of COVID-19 infection across the spectrum of individuals with visually impairment (VI) and those with normal sight.

Design

Prospective cross-sectional comparative study.

Methods

Setting: institutional. Patients: 232 patients and their caregivers. Four groups were created based on better eye characteristics: blind (best-corrected distance visual acuity [BCDVA] <3/60 or visual field <10 central degrees); severe VI (BCDVA ≤3/60 to <6/60; vertical cup-to-disc ratio ≥0.85 or neuroretinal rim width ≤0.1); moderate VI (BCDVA ≤6/60 to <6/18); or no or mild VI (controls: BCDVA ≥6/18) based on International Classification of Diseases-10 criteria and Foster and Quigley's consensus definition of glaucoma. Procedure: telephone questionnaires. Main outcome measures: differences in perceptions and implications of COVID-19 infection across various levels of VI. Caregiver perceptions were a secondary outcome measure.

Results

Surveys were completed by 232 participants, with 58 participants in each VI group. Mean age was 58.9 ± 13.2 years old. Greater degrees of VI were associated with older age (P = .008) and lower education level (P = .046). Blind participants more commonly perceived vision as a risk factor for contracting COVID-19 (P = .045), were concerned about access to health care (P <.001), obtained news through word of mouth (P <.001), and less commonly wore masks (P = .003). Controls more commonly performed frequent handwashing (P = .001), were aware of telemedicine (P = .029), and had fewer concerns about social interactions (P = .020) than groups with substantial VI. All caregivers reported more frequent patient care since the COVID-19 pandemic began.

Conclusions

The pandemic might have had a disproportionate impact on the visually impaired, and evidence-based assessments of COVID-19 health outcomes in this population are warranted.

Age-Related Diseases and Driving Safety

Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson's disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.

Older adults with dual sensory loss in rehabilitation show high functioning and may fare better than those with single sensory loss

The population of older adults that have Dual Sensory Loss (DSL) is increasing, yet most research to date has focused on single sensory impairment and is inconclusive as to whether DSL is associated with worse impact on health and well-being over single sensory loss. The primary aim of this study was to characterize the health and functioning of community-dwelling older adults with DSL who were receiving sensory rehabilitation, using an understudied assessment: the interRAI Community Health Assessment (CHA). The secondary aim was to investigate whether older adults with DSL had worse health-related outcomes than their peers with only vision loss (VL) or only hearing loss (HL). We report and compare the interRAI CHA results in a sample of 200 older adults (61+ years of age) who had DSL, VL or HL. Overall, all sensory impairment groups showed high functioning in the areas of cognition, communication, activities of daily living, depression, and psycho-social well-being. DSL was not always associated with worse outcomes compared to a single sensory loss. Rather, the results varied depending on the tasks assessed, as well as which groups were compared. Our findings highlight that despite the negative impact of sensory losses, community-dwelling older adults receiving sensory rehabilitation services tend to have overall good health and a high level of independence. These results also show that DSL is not always associated with worse outcomes compared to a single sensory loss. Further research is needed to better characterize older adults with DSL who have more severe sensory and cognitive difficulties than those in our sample, and among those who are not receiving rehabilitation services.

Impact of sensory impairments on dementia incidence and symptoms among Japanese older adults

BACKGROUND

Dementia and behavioural and psychological symptoms of dementia affect older adults' care-need levels. With aging comes an increase in the incidence of sensory impairments, which promotes the development of dementia. We investigated the association between sensory impairments - visual impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI), the behavioural and psychological symptoms of dementia, and dementia incidence.

METHODS

This was a retrospective study that used Japanese long-term care insurance certification data from 2010 to 2017 of City A. The 2190 older adults who did not have dementia in 2010 were classified into four impairment categories: VI, HI, DSI, and no sensory impairment. The incidence of dementia was examined using Kaplan-Meier survival analysis and log-rank testing. Cox proportional hazards analysis was used to investigate the risk of developing dementia associated with sensory impairments, compared to the risk for no sensory impairment. Pearson's χ² tests were used to compare the prevalence of behavioural and psychological symptoms of dementia among the four groups.

RESULTS

HI and DSI were associated with a higher cumulative dementia incidence compared to no sensory impairment (log-rank χ² = 10.42; P  < 0.001, and log-rank χ² = 39.92; P  < 0.001, respectively), and DSI showed higher cumulative dementia incidence than HI (log-rank χ² = 11.37; P  = 0.001). Cox proportional hazards analysis showed that DSI is the greatest risk factor for developing dementia among sensory impairments (hazard ratio, 1.45; 95% CI, 1.22-1.71; P < 0.001). Older adults with VI had a significantly higher prevalence of day-night reversal than the other groups.

CONCLUSIONS

Our results indicate that older adults with sensory impairments have a high incidence of dementia, with DSI presenting the greatest risk. Older adults with VI were found to be more likely to have day-night reversal symptoms when dementia occurs.

Decline in Instrumental Activities of Daily Living over 4-Year: The Association with Hearing, Visual and Dual Sensory Impairments among Non-Institutionalized Women

OBJECTIVE

Most older adults express the wish to live at home as long as possible, thus autonomy promoting measures are essential. Hearing and visual impairments are common among older people, and they have been consistently associated with functional disability. However, longitudinal data are scarce, notably regarding dual sensory impairments (both in hearing and vision). We aimed at assessing the relationship between hearing, visual, and dual sensory impairments, and subsequent decline in instrumental activities of daily living (IADL).

DESIGN

Longitudinal.

SETTING

the French E3N-elderly sub-cohort.

PARTICIPANTS

4,010 community-dwelling older women born between 1925 and 1930, and free of IADL limitations in 2006.

MEASUREMENTS

Hearing and visual impairments were self-reported in 2006. IADLs were evaluated in 2006 and 2010.

RESULTS

After 4 years of follow-up, 588 women became limited in their IADLs. In logistic regression models adjusted for potential confounders, odds ratios [95% confidence interval] for developing IADL limitations were 1.18 [0.98; 1.41], 1.98 [1.26; 3.11], and 2.61 [1.50; 4.54] for hearing, visual, or both sensory impairments respectively, compared with no sensory impairment at baseline.

CONCLUSION

Results suggest that among autonomous older women, visual, and to a lesser extent, hearing impairment, have a short-term negative impact on their ability to perform daily activities, with some evidence of a multiplicative effect between sensory impairments. Appropriate evaluation and management of sensory impaired elderly, and more particularly those with dual impairments, may contribute to prevent disability in aging.