The Association Between Hearing Impairment, Vision Impairment, Dual Sensory Impairment, and Serious Cognitive Impairment: Findings from a Population-Based Study of 5.4 million Older Adults

Management of MCI in the Outpatient Setting

PURPOSE OF REVIEW

We review current literature related to the clinical assessment of Mild Cognitive Impairment (MCI). We compile recommendations related to the evaluation of MCI and examine literature regarding the use of clinical biomarkers in this assessment, the role of non-pharmacologic therapy in the prevention of cognitive decline, and recent approval of anti-amyloid therapy in the treatment of MCI.

RECENT FINDINGS

The role of imaging and plasma biomarkers in the clinical assessment of MCI has expanded. There is data that non-pharmacologic therapy may have a role in the prevention of neurocognitive decline. Anti-amyloid therapies have recently been approved for clinical use. Clinical assessment of MCI remains multifactorial and includes screening and treating for underlying psychiatric and medical co-morbidities. The use of biomarkers in clinical settings is expanding with the rise of anti-amyloid therapies. These new diagnostics and therapeutics require nuanced discussion of risks and benefits. Psychiatrist's skillset is uniquely suited for these complex evaluations.

A Prospective Association Between Sensory Impairment and Cognitive Performance Among Older Community-Dwelling Adults: The Role of Depressive Symptoms

We examined whether vision impairment (VI) and hearing impairment (HI) and dual sensory impairment (DSI) affect cognitive performance and whether depression mediates that effect. We examined 55,340 participants from the Survey of Health, Aging and Retirement in Europe, which assessed 32,325 participants in 2011 (baseline, Time 1), 2015 (follow-up, Time 2), sociodemographic data and health factors, self-reported VI, HI, and DSI at baseline, depression, and cognitive performance after four years. A multiple mediator model was tested using bootstrapping and resampling. At baseline, 22.9% had VI, 10.2% HI, and 10.4% had DSI. We found a significant negative association between VI (b = -0.023, p = .001) and DSI (b = -0.083, p = .001) and cognitive performance; both were also associated with depression, which was linked with poor cognition. VI or DSI among older adults are associated with poor cognitive function directly and indirectly by increasing depression symptoms.

The Role of Sensory Impairment in Cognitive Health Appraisal: A Study of Older Korean Americans Living in Subsidized Senior Housing

OBJECTIVES

We examined how the association between cognitive performance and cognitive health appraisal would be moderated by vision and/or hearing impairment.

METHODS

Data were collected from 315 older Korean-American residents in subsidized senior housing in Los Angeles (M age = 79.4 years). Linear regression models examined the direct and interactive effects of cognitive performance, vision impairment, and hearing impairment on cognitive health appraisal.

RESULTS

Negative appraisal of cognitive health was associated with lower cognitive performance and poorer ratings for vision and hearing. Moreover, we found a significant interaction between cognitive performance and hearing impairment (β = .13, p < .05), as well as a three-way interaction among cognitive performance, vision impairment, and hearing impairment (β = .12, p < .05).

DISCUSSION

The association between objective and subjective measures of cognition was weakened when hearing was impaired. Such a pattern was further evident when both vision and hearing were impaired.

Bidirectional associations between hearing difficulty and cognitive function in Chinese adults: a longitudinal study

Background

Middle-aged and older adults frequently experience hearing loss and a decline in cognitive function. Although an association between hearing difficulty and cognitive function has been demonstrated, its temporal sequence remains unclear. Therefore, we investigated whether there are bidirectional relationships between hearing difficulty and cognitive function and explored the mediating role of depressive symptoms in this relationship.

Method

We used the cross-lagged panel model and the random-intercept cross-lagged panel model to look for any possible two-way link between self-reported hearing difficulty and cognitive function. To investigate depressive symptoms' role in this association, a mediation analysis was conducted. The sample was made up of 4,363 adults aged 45 and above from the China Health and Retirement Longitudinal Study (CHARLS; 2011-2018; 44.83% were women; mean age was 56.16 years). One question was used to determine whether someone had a hearing impairment. The tests of cognitive function included episodic memory and intelligence. The Center for Epidemiologic Studies Depression Scale, which consists of 10 items, was used to measure depressive symptoms.

Results

A bidirectional association between hearing and cognition was observed, with cognition predominating (Wald χ2 (1) = 7.241, p < 0.01). At the between-person level, after controlling for potential confounders, worse hearing in 2011 predicted worse cognitive function in 2013 (β = -0.039, p < 0.01) and vice versa (β = -0.041, p < 0.01) at the between-person level. Additionally, there was no corresponding cross-lagged effect of cognitive function on hearing difficulty; rather, the more hearing difficulty, the greater the cognitive decline at the within-person level. According to the cross-lagged mediation model, depressive symptoms partially mediates the impact of cognitive function on subsequent hearing difficulty (indirect effect: -0.003, bootstrap 95% confidence interval: -0.005, -0.001, p < 0.05), but not the other way around.

Conclusion

These results showed that within-person relationships between hearing impairment and cognitive function were unidirectional, while between-person relationships were reciprocal. Setting mental health first may be able to break the vicious cycle that relates hearing loss to cognitive decline. Comprehensive long-term care requires services that address depressive symptoms and cognitive decline to be integrated with the hearing management.

Subjective vision assessment in companion dogs using dogVLQ demonstrates age-associated visual dysfunction

Introduction

Dim light vision as assessed by proxy and clinical tools is commonly impaired in older humans and impacts quality of life. Although proxy visual assessment tools have been developed for dogs, it is unclear if they are sensitive enough to detect subtle visual dysfunction in older dogs. We sought to determine if a newly designed proxy visual function questionnaire could detect age-associated differences in visual behaviors in varying lighting conditions in dogs.

Methods

A 27-item questionnaire (the dog variable lighting questionnaire, dogVLQ) was designed to assess visual behavior in dogs in different lighting settings. We conducted the dogVLQ, a previously validated visual function questionnaire the dog vision impairment score and performed light- and dark-adapted electroretinography (ERG) on a subset of dogs. Questionnaire scores were analyzed for dog age associations using correlation analysis.

Results

Questionnaire responses from 235 dog owners were obtained (122 female, 112 male dogs), 79 of which underwent ERG (43 female, 36 male dogs). Bright light visual behavior was significantly associated with light-adapted bright flash ERG amplitudes, visual behavior in near darkness was associated with dark-adapted ERG amplitudes. The dogVLQ identified worse vision in older dogs in bright light, dim light, and darkness; predicted onset was younger for vision in near darkness. Older dogs had more difficulty navigating transitions between lighting conditions.

Discussion

Subjective dog owner assessment of visual function associates with objective measurement of retinal function in dogs and supports reduced vision-mediated behaviors in older dogs.

The interaction between instrumental activities of daily living and dual sensory function on cognition among the elderly in China: A cross-sectional survey

To explore the interaction of instrumental activities of daily living (IADLs) and dual sensory function on cognition in the elderly. A cross-sectional survey was conducted in six general hospitals in China, from October 2022 to December 2022. Data collection included general information, IADLs scale, self-reported sensory function questionnaire, and mini-mental state examination (MMSE). Binary logistic regression was used to examine the association between factors and cognition. The interactive effect was evaluated by synergy index (S), relative excess risk due to interaction (RERI), and attributable proportion due to interaction (AP). The odds ratio (OR) of IADLs decline in cognition is 4.412 (95% confidence interval [CI]: 3.633-5.358, p < 0.001); the OR of dual sensory difficulty on cognition is 2.502 (95% CI: 1.272-4.921, p = 0.008). The OR of interaction between IADLs decline and dual sensory difficulty on cognition is 13.737 (95% CI: 9.726-19.400, p < 0.001). RERI (95% CI) = 7.823 (3.230-12.417), AP (95% CI) = 0.570 (0.392-0.747), S (95% CI) = 2.593 (1.616-4.160). IADLs decline and dual sensory difficulty are associated with cognitive decline. IADLs decline and dual sensory difficulty have interaction with cognitive decline; the interaction is greater than the sum effect of those two on cognitive decline independently. Sensory and IADLs assessment can be used as early screening items for cognition among the elderly. In addition, protecting sensory function and maintaining IADLs in the elderly can help protect their cognition.

Vitamin K and the Visual System-A Narrative Review

Vitamin K occupies a unique and often obscured place among its fellow fat-soluble vitamins. Evidence is mounting, however, that vitamin K (VK) may play an important role in the visual system apart from the hepatic carboxylation of hemostatic-related proteins. However, to our knowledge, no review covering the topic has appeared in the medical literature. Recent studies have confirmed that matrix Gla protein (MGP), a vitamin K-dependent protein (VKDP), is essential for the regulation of intraocular pressure in mice. The PREDIMED (Prevención con Dieta Mediterránea) study, a randomized trial involving 5860 adults at risk for cardiovascular disease, demonstrated a 29% reduction in the risk of cataract surgery in participants with the highest tertile of dietary vitamin K1 (PK) intake compared with those with the lowest tertile. However, the specific requirements of the eye and visual system (EVS) for VK, and what might constitute an optimized VK status, is currently unknown and largely unexplored. It is, therefore, the intention of this narrative review to provide an introduction concerning VK and the visual system, review ocular VK biology, and provide some historical context for recent discoveries. Potential opportunities and gaps in current research efforts will be touched upon in the hope of raising awareness and encouraging continued VK-related investigations in this important and highly specialized sensory system.

Analysing Realistic effects of modifiable risk factors for dementia in a large National Dataset

BACKGROUND

Modifiable risk factors affect 40% of dementia risk thus creating an opportunity for prevention or delay. The risk factor life-course model of dementia prevention by the Lancet Commission has yet to be tested in the general populations. We aimed to assess the model's assumptions in a large national dataset of older adults assessed for support services.

METHODS

The interRAI assessment is a comprehensive evidence-based tool encompassing 236 items that is mandatory in New Zealand (NZ) for older adults providing a standardized national dataset. We tested the Lancet model of dementia prevention in a sample of 66,638 participants who underwent an interRAI assessment during the period 2013-2018. There were 59% female interviewees; mean age was 82 years (range: 65-107). Our cross-sectional dataset analysis was performed in using a logistic regression model with diagnosis of dementia as the primary outcome.

RESULTS

The Lancet prevention model was supported in part. Hypertension, Hearing Impairment and past or present Depression increase risk of dementia. Age - increased risk demonstrated until 85 years; Gender - females at increased risk; BMI - initial effect of high BMI increases risk of dementia. However, exercise, diabetes, vision impairment and smoking as modifiable factors were not associated with dementia risk as predicted by the Lancet model.

CONCLUSIONS

Limitations of the dataset analysed may have affected our findings. Nevertheless, important modifiable factors are herein confirmed as increasing dementia risk. BMI, hypertension, hearing impairment and depression are risks confirmed in the older NZ population lending credibility to prevention efforts targeted at these variables.

Do Sensory Impairments Portend Cognitive Decline in Older Chinese Adults? Longitudinal Evidence from a Nationally Representative Survey, 2011-2018

Previous studies on longitudinal sensory-cognition association are limited and have yielded inconsistent conclusions in western and developed countries. The present study obtained data from the China Health and Retirement Longitudinal Survey (CHARLS, 2011−2018) and aimed to investigate the longitudinal effects of sensory impairments including single vision impairment (SVI), single hearing impairment (SHI), and dual sensory impairment (DSI) on cognitive decline in middle-aged and older Chinese population. In total, 11,122 participants accomplished all 4 interviews over 8 years and were included. Cognitive performances were assessed using Mini-Mental Status Examination (MMSE) and self-reported sensory status were accepted as well. Confounding variables included age, sex, educational level, marital status, medical, and lifestyle related information. The impact of sensory impairment on cognitive decline over time was assessed using linear mixed-effects models (LMM). After being adjusted for multiple confounders, SVI/SHI/DSI were all shown to be significantly associated with executive functions, episodic memory impairment, and global cognitive decline over 8 years (all p < 0.05). Such associations become less significant among female and relatively younger populations (45−59 years old). Single vision and hearing impairments, along with dual sensory impairment, are all independently associated with subsequent cognitive decline among middle-aged and older Chinese populations over 8 years of longitudinal observation.

Do Not Go Gentle into That Deaf Night: A Holistic Perspective on Cochlear Implant Use as Part of Healthy Aging

Research suggests that cochlear implant (CI) use in elderly people improves speech perception and health-related quality of life (HRQOL). CI provision could also prevent dementia and other comorbidities and support healthy aging. The aim of this study was (1) to prospectively investigate potential changes in HRQOL and speech perception and (2) to identify clinical action points to improve CI treatment. Participants (n = 45) were CI recipients aged 60-90 with postlingual deafness. They were divided into groups, according to age: Group 1 (n = 20) received a CI between the age of 60-70 years; group 2 (n = 25) between the age of 71-90 years. HRQOL and speech perception were assessed preoperatively, and three and twelve months postoperatively. HRQOL and speech perception increased significantly within one year postoperatively in both groups. No difference between groups was found. We conclude that CI treatment improves speech perception and HRQOL in elderly users. Improvement of the referral process for CI treatment and a holistic approach when discussing CI treatment in the elderly population could prevent auditory deprivation and the deterioration of cognitive abilities.