Cognitive Performance Concomitant With Vision Acuity Predicts 13-Year Risk for Mortality

Abstract

Objective: To assess the joint impact of cognitive performance and visual acuity on mortality over 13-year follow-up in a representative US sample. Methods: Data from National Health and Nutrition Examination Survey (NHANES) participants (≥18 years old) were linked with the death record data of the National Death Index (NDI) with mortality follow-up through December 31, 2011. Cognitive performance was evaluated by the Digit Symbol Substitution Test (DSST) and cognitive performance impairment was defined as the DSST score equal to or less than the median value in the study population. Visual impairment (VI) was defined as presenting visual acuity worse than 20/40 in the better-seeing eye. Risks of all-cause and specific-cause mortality were estimated with Cox proportional hazards models after adjusting for confounders. Results: A total of 2,550 participants 60 years and older from two waves of ( NHANES, 1999–2000, 2001–2002 ) were included in the current analysis. Over a median follow-up period of 9.92 years, 952 (35.2%) died of all causes, of whom 239 (23.1%), 224 (24.0%), and 489 (52.9%) died from cardiovascular disease (CVD), cancer, and non-CVD/non-cancer mortality, respectively. Cognitive performance impairment and VI increased the odds for mortality. Co-presence of VI among cognitive impaired elderly persons predicted nearly a threefold increased risk of all-cause mortality [hazard ratios (HRs), 2.74; 95% confidence interval (CI), 2.02–3.70; P < 0.001) and almost a fourfold higher risk of non-CVD/non-cancer mortality (HR, 3.72; 95% CI, 2.30–6.00; P < 0.001) compared to having neither impairment. Conclusion: People aged 60 years and over with poorer cognitive performance were at higher risk of long-term mortality, and were especially vulnerable to further mortality when concomitant with VI. It is informative for clinical implication in terms of early preventive interventions.

Association between vision impairment and mortality: a systematic review and meta-analysis

“…After removing duplicate references, we screened the titles and abstracts of 2670 articles. Of these, we identified 76 unique studies in 92 articles for full-text review, during which 48 studies were excluded, leaving 28 studies 5 , 6 , 7 , 8 , 9 , 10 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 that met the inclusion criteria. Two of the studies each included two distinct cohorts; therefore, these 28 studies comprised 30 distinct cohorts (446 088 participants) from 12 countries.…”

“…The findings from six cohorts had been published since 2015. 5 , 6 , 7 , 8 , 9 , 10 The duration of follow-up among included studies ranged from 17 months to 210 months, with a mean of 103·3 (SD 46·4) months. Sample sizes ranged from 193 participants in Finland 21 to 359 984 participants in Korea.…”

“…The current study has several key strengths. First, we included multiple additional studies published in 2016–19, 5 , 6 , 7 , 8 , 9 , 10 including those from regions of the world that were not well represented in the previous meta-analysis, 4 such as sub-Saharan Africa (Kenya) 5 and east Asia (South Korea). 6 Second, we only included studies that assessed visual acuity.…”

Relationship Between Cataract Surgery and Mortality in Elderly Patients with Cataract: Nationwide Population-based Cohort Study in South Korea

“…10,12−14 In one recent study that evaluated the effects of cognitive performance and visual acuity on mortality, impairment in cognitive performance and vision increased the odds for mortality. 15 Among cognitive impaired elderly population, impairment in vision predicted nearly a three-fold increased risk of all-cause mortality (HR, 2.74; 95% CI, 2.02-3.70) and nearly a four-fold higher risk of non-cardiovascular disease/non-cancer mortality (HR, 3.72; 95% CI, 2.30-6.00) compared to having neither impairment. 15 Our results, showing a protective association between cataract surgery and mortality from neurologic causes, were in line with those studies.…”

“…15 Among cognitive impaired elderly population, impairment in vision predicted nearly a three-fold increased risk of all-cause mortality (HR, 2.74; 95% CI, 2.02-3.70) and nearly a four-fold higher risk of non-cardiovascular disease/non-cancer mortality (HR, 3.72; 95% CI, 2.30-6.00) compared to having neither impairment. 15 Our results, showing a protective association between cataract surgery and mortality from neurologic causes, were in line with those studies. This protective relationship increased after fully adjusting for demographics, and systemic and ocular comorbidities, and patients with cataract surgery had almost 30% reduced adjusted hazard of mortality compared with those without cataract surgery.…”