Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 1;141(8):786-790.
doi: 10.1001/jamaophthalmol.2023.2854.

Objectively Measured Visual Impairment and Dementia Prevalence in Older Adults in the US

Olivia J Killeen  1 , Yunshu Zhou  1 , Joshua R Ehrlich  1   2
Affiliations

Objectively Measured Visual Impairment and Dementia Prevalence in Older Adults in the US

Olivia J Killeen et al. JAMA Ophthalmol. .

Abstract

Importance: Estimates of the association between visual impairment (VI) and dementia in the US population are based on self-reported survey data or measures of visual function that are at least 15 years old. Older adults are at high risk of VI and dementia so there is a need for up-to-date national estimates based on objective assessments.

Objective: To estimate the association between VI and dementia in older US adults based on objective visual and cognitive function testing.

Design, setting, and participants: This secondary analysis of the 2021 National Health and Aging Trends Study (NHATS), a population-based, nationally representative panel study, included 3817 respondents 71 years and older. Data were analyzed from January to March 2023.

Intervention: In 2021, NHATS incorporated tablet-based tests of distance and near visual acuity and contrast sensitivity (CS) with habitual correction.

Main outcomes and measures: VI was defined as distance visual acuity more than 0.30 logMAR, near visual acuity more than 0.30 logMAR, and CS more than 1 SD below the sample mean. Dementia was defined as scoring 1.5 SDs or more below the mean in 1 or more cognitive domains, an AD8 Dementia Screening Interview Score indicating probable dementia, or diagnosed dementia. Poisson regression estimated dementia prevalence ratios adjusted for covariates.

Results: Of 2967 included participants, 1707 (weighted percentage, 55.3%) were female, and the median (IQR) age was 76.9 (77-86) years. The weighted prevalence of dementia was 12.3% (95% CI, 10.9-13.7) and increased with near VI (21.5%; 95% CI, 17.7-25.3), distance VI (mild: 19.1%; 95% CI, 13.0-25.2; moderate, severe, or blind: 32.9%; 95% CI, 24.1- 41.8), and CS impairment (25.9%; 95% CI, 20.5-31.3). Dementia prevalence was higher among participants with near VI and CS impairment than those without (near VI prevalence ratio: 1.40; 95% CI, 1.16-1.69; CS impairment prevalence ratio: 1.31; 95% CI, 1.04-1.66) and among participants with moderate to severe distance VI or blindness (prevalence ratio: 1.72; 95% CI, 1.26-2.35) after adjustment for covariates.

Conclusions and relevance: In this survey study, all types of objectively measured VI were associated with a higher dementia prevalence. As most VI is preventable, prioritizing vision health may be important for optimizing cognitive function.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Ehrlich has received grants from Research to Prevent Blindness during the conduct of the study; personal fees from MetLife outside the submitted work; and is a coinvestigator of the National Health and Aging Trends Study. No other disclosures were reported.

Comment in

References

    1. Burton MJ, Ramke J, Marques AP, et al. . The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. Lancet Glob Health. 2021;9(4):e489-e551. doi:10.1016/S2214-109X(20)30488-5 - DOI - PMC - PubMed
    1. Lee CS, Gibbons LE, Lee AY, et al. . Association between cataract extraction and development of dementia. JAMA Intern Med. 2022;182(2):134-141. doi:10.1001/jamainternmed.2021.6990 - DOI - PMC - PubMed
    1. Ehrlich JR, Goldstein J, Swenor BK, Whitson H, Langa KM, Veliz P. Addition of vision impairment to a life-course model of potentially modifiable dementia risk factors in the US. JAMA Neurol. 2022;79(6):623-626. doi:10.1001/jamaneurol.2022.0723 - DOI - PMC - PubMed
    1. Chen SP, Azad AD, Pershing S. Bidirectional association between visual impairment and dementia among older adults in the United States over time. Ophthalmology. 2021;128(9):1276-1283. doi:10.1016/j.ophtha.2021.02.021 - DOI - PMC - PubMed
    1. Chen SP, Bhattacharya J, Pershing S. Association of vision loss with cognition in older adults. JAMA Ophthalmol. 2017;135(9):963-970. doi:10.1001/jamaophthalmol.2017.2838 - DOI - PMC - PubMed

Publication types