IMPORTANCE Sensory impairments may heighten the risk of premature brain aging. Little is known regarding the association of sensory impairments with cognitive function and depression in China. OBJECTIVE To examine the association of visual and/or hearing impairments with cognitive decline and depression. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the data from 18 038 respondents to the 2015 survey of the China Health and Retirement Longitudinal Study, a nationally representative survey of adults aged 45 years or older and their spouses. EXPOSURES The presence of sensory impairments was identified by self-reported assessment of visual and/or hearing functions. MAIN OUTCOMES AND MEASURES Overall, 3 composite measures were used to assess the respondents' cognitive performance, including episodic memory, mental intactness, and global cognitive function. Depression was examined using the 10-item Center for Epidemiological Studies-Depression scale score. Multiple generalized linear regression models, adjusting for self-reported sociodemographic characteristics, health behaviors, chronic conditions, and participants' overall health, were used. RESULTS Of 18 038 respondents, 9244 (51.2%) were women. The mean (SD) age was 59.9 (9.7) years. Respondents with visual impairment had poorer episodic memory (β =-0.12; 95% CI,-0.19 to-0.05) and global cognition (β =-0.16; 95% CI,-0.31 to-0.02) and a greater risk of depression (odds ratio, 1.78; 95% CI, 1.59 to 1.99) than those without visual impairment. Respondents with hearing impairment had poorer episodic memory (β =-0.24; 95% CI,-0.30 to-0.18), mental intactness (β =-0.19; 95% CI,-0.28 to-0.10), and global cognition (β =-0.43; 95% CI,-0.55 to-0.31) as well as a greater risk of depression (odds ratio, 1.57; 95% CI, 1.44 to 1.70) than those without hearing impairment. People who reported dual sensory impairment performed worse on all of the aforementioned outcome measures (episodic memory: β =-0.23; 95% CI,-0.31 to-0.14; mental intactness: β =-0.13; 95% CI,-0.27 to-0.0003; global cognition: β =-0.37; 95% CI,-0.55 to-0.19; depression: odds ratio, 2.19; 95% CI, 1.90 to 2.52). CONCLUSIONS AND RELEVANCE In this study, visual and hearing impairments were independently and together associated with poorer cognitive and depression outcomes. A more comprehensive and integrated system of care, covering vision, hearing, and cognition, is needed in China's health care system to address age-related sensory impairments.

A hierarchical block-matching motion tracking algorithm for strain imaging is presented. Displacements are estimated with improved robustness and precision by utilizing a Bayesian regularization algorithm and an unbiased subsample interpolation technique. A modified least-squares strain estimator is proposed to estimate strain images from a noisy displacement input while addressing the motion discontinuity at the wall-lumen boundary. Methods to track deformation over the cardiac cycle incorporate a dynamic frame skip criterion to process data frames with sufficient deformation to produce high signal-to-noise displacement and strain images. Algorithms to accumulate displacement and/or strain on particles in a region of interest over the cardiac cycle are described. New methods to visualize and characterize the deformation measured with the full 2D strain tensor are presented. Initial results from patients imaged prior to carotid endarterectomy suggest that strain imaging detects conditions that are traditionally considered high risk including soft plaque composition, unstable morphology, abnormal hemodynamics and shear of plaque against tethering tissue can be exacerbated by neoangiogenesis. For example, a maximum absolute principal strain exceeding 0.2 is observed near calcified regions adjacent to turbulent flow, protrusion of the plaque into the arterial lumen and regions of low echogenicity associated with soft plaques. Non-invasive carotid strain imaging is therefore a potentially useful tool for detecting unstable carotid plaque.

Inflammation and angiogenesis play major roles in carotid plaque vulnerability. The purpose of this study was to determine if grayscale features of carotid plaques are associated with histological markers for inflammation. Thirty-eight individuals completed a dedicated research carotid ultrasound exam prior to carotid endarterectomy. Grayscale analysis was performed on plaque images to measure plaque echogenicity (grayscale median [GSM] pixel brightness), plaque area, presence of discrete white areas [DWAs], and the percent of black area near the lumen on any one component of the plaque. Plaques with higher ultrasound GSM had greater percent calcification (p=0.013) on histopathology. Presence of an ultrasound DWA was associated with more plaque hemosiderin (p=0.0005) and inflammation (p=0.019) on histopathology examination. The percent of plaque black area in any one component was associated with a higher score for macroscopic ulceration (p=0.028). Ultrasound plaque characteristics (GSM, DWAs and Black areas) represent histopathological markers associated with plaque vulnerability.

Instability in carotid vulnerable plaque can generate cerebral microemboli, that may be related to both stroke and eventual cognitive abnormality. Strain imaging to detect plaque vulnerability based on regions with large strain fluctuations, with arterial pulsation, may be able to determine risk of cognitive impairment. Plaque instability may be characterized by increased strain variations over a cardiac cycle. Radiofrequency signals for ultrasound strain imaging were acquired from the carotid arteries of 24 human subjects using a Siemens Antares with a VFX 13-5 linear array transducer. These patients underwent standardized cognitive assessment (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)). Plaque regions were segmented by a radiologist at end-diastole using the Medical Imaging Interaction Toolkit. A hierarchical block-matching motion tracking algorithm was utilized to estimate the cumulated axial, lateral, and shear strains within the imaging plane. The maximum, minimum and peak-to-peak strain indices in the plaque computed from the mean cumulated strain over a small region of interest in the plaque with large deformations, were obtained. The maximum and peak-to-peak mean cumulated strain indices over the entire plaque region were also computed. All the strain indices were then correlated with RBANS Total performance. Overall cognitive performance (RBANS Total) was negatively associated with values of the maximum strain and the peak-to-peak for axial and lateral strains respectively. There was no significant correlation between the RBANS Total score and shear strain, and strain indices averaged over the entire identified plaque for this group of patients. However, correlation of the maximum lateral strain was higher for symptomatic patients (r=−0.650, p=0.006) than that for asymptomatic patients (r=−0.115, p=0.803). On the other hand correlation for maximum axial strain averaged over the entire plaque region was significantly higher for asymptomatic patients (r=−0.817, p=0.016) than that for symptomatic patients (r=−0.224, p=0.402). The results reveal a direct relationship between the maximum axial and lateral strain indices in carotid plaque with cognitive impairment.