ImportanceVision impairment is a potentially modifiable risk factor for dementia. Although few prior studies have estimated the contribution of vision impairments to dementia, none have reported on multiple objectively measured vision impairments (eg, distance and near visual acuity and contrast sensitivity) in a nationally representative sample of older adults.ObjectiveTo quantify population attributable fractions of dementia from objective vision impairments in older adults, stratified by age, self-reported sex, self-reported race and ethnicity, and educational attainment.Design, Setting, and ParticipantsThis was a population-based cross-sectional analysis in the National Health and Aging Trends Study, which gathers nationally representative information on Medicare beneficiaries aged 65 years and older in the US. A total of 2767 community-dwelling adults eligible for vision and cognitive testing in 2021 were included. Data were analyzed from April to August 2023.ExposuresNear and distance visual acuity impairments were each defined as >0.30 logMAR. Contrast sensitivity impairment was defined as <1.55 logCS. At least 1 vision impairment was defined as impairment to either near acuity, distance acuity, or contrast sensitivity.Main Outcomes and MeasuresAdjusted population attributable fractions of prevalent dementia, defined using a standardized algorithmic diagnosis (≥1.5 SDs below mean on 1 or more cognitive domains, self- or proxy-reported dementia diagnosis, or the Ascertain Dementia-8 Dementia Screening Interview Score of probable dementia).ResultsThe survey-weighted prevalence of vision impairment among participants aged 71 and older (1575 [54.7%] female and 1192 [45.3%] male; 570 [8.0%] non-Hispanic Black, 132 [81.7%] Hispanic, 2004 [81.7%] non-Hispanic White, and 61 [3.3%] non-Hispanic other) was 32.2% (95% CI, 29.7-34.6). The population attributable fraction of prevalent dementia from at least 1 vision impairment was 19.0% (95% CI, 8.2-29.7). Contrast sensitivity impairment yielded the strongest attributable fraction among all impairments (15.0%; 95% CI, 6.6-23.6), followed by near acuity (9.7%; 95% CI, 2.6-17.0) and distance acuity (4.9%; 95% CI, 0.1-9.9). Population attributable fractions from at least 1 impairment were highest among participants aged 71 to 79 years (24.3%; 95% CI, 6.6-41.8), female (26.8%; 95% CI, 12.2-39.9), and non-Hispanic White (22.3%; 95% CI, 9.6-34.5) subpopulations, with estimates consistent across educational strata.Conclusions and RelevanceThe population attributable fraction of dementia from vision impairments ranged from 4.9%-19.0%. While not proving a cause-and-effect relationship, these findings support inclusion of multiple objective measures of vision impairments, including contrast sensitivity and visual acuity, to capture the total potential impact of addressing vision impairment on dementia.

中文翻译：

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老年人视力障碍和痴呆症的人群归因部分


重要性视力障碍是痴呆的潜在可改变风险因素。尽管先前很少有研究估计视力障碍对痴呆的影响，但没有一项研究报告在具有全国代表性的老年人样本中客观测量的多种视力障碍（例如，远近视力和对比敏感度）。目的量化老年人客观视力障碍导致痴呆的人群归因部分，按年龄、自我报告的性别、自我报告的种族和民族以及教育程度分层。设计、设置和参与者这是国家健康和老龄化趋势研究中的一项基于人群的横断面分析，该研究收集了美国 65 岁及以上 Medicare 受益人的全国代表性信息。共有 2767 名符合视力和认知测试条件的社区居民成年人在 2021 年被纳入。数据于 2023 年 4 月至 8 月进行分析。0.30 logMAR.对比敏感度障碍定义为 <1.55 logCS。至少 1 例视力障碍被定义为近视力、远视力或对比敏感度受损。主要结局和措施使用标准化算法诊断定义普遍痴呆的调整人群归因分数（≥1.5 SD s低于平均值 1 个或多个认知领域、自我或代理报告的痴呆诊断，或确定可能痴呆的痴呆症 8 痴呆症筛查访谈评分）。结果2004 年 71 岁及以上参与者（1575 名 [54.7%] 女性和 1192 名 [45.3%] 男性;570 名 [8.0%] 非西班牙裔黑人，132 名 [81.7%] 西班牙裔）的视力障碍调查加权患病率 [81.7%] 非西班牙裔白人和 61 [3.3%] 非西班牙裔其他）为 32.2%（95% CI，29.7-34.6）。至少 1 例视力障碍的普遍痴呆的人群归因比例为 19.0% （95% CI，8.2-29.7）。在所有损伤中，对比敏感度损伤的归因分数最强 （15.0%;95% CI，6.6-23.6），其次是近视力 （9.7%;95% CI，2.6-17.0） 和远视力 （4.9%;95% CI，0.1-9.9）。在 71 至 79 岁 （24.3%;95% CI，6.6-41.8）、女性 （26.8%;95% CI，12.2-39.9） 和非西班牙裔白人 （22.3%;95% CI，9.6-34.5） 亚群中，至少 1 种损伤的群体归因分数最高，各教育阶层的估计值一致。结论和相关性 视力障碍导致痴呆的人群归因比例为 4.9%-19.0%。虽然没有证明因果关系，但这些发现支持纳入视力障碍的多种客观测量方法，包括对比敏感度和视力，以捕捉解决视力障碍对痴呆症的总体潜在影响。