The Bidirectional Relationship between Vision and Cognition
Ophthalmology, vol. 128, pp. 981–992
Abstract
TOPIC: Visual impairment (VI) and cognitive impairment (CIM) are prevalent age-related conditions that impose substantial burden on the society. Findings on the hypothesized bidirectional association of VI and CIM remains equivocal. Hence, we conducted a systematic review and meta-analysis to examine this bidirectional relationship. CLINICAL RELEVANCE: Sixty percent risk of CIM has not been well elucidated in the literature. A bidirectional relationship between VI and CIM may support the development of strategies for early detection and management of risk factors for both conditions in older people. METHODS: PubMed, Embase, and Cochrane Central registers were searched systematically for observational studies, published from inception until April 6, 2020, in adults 40 years of age or older reporting objectively measured VI and CIM assessment using clinically validated cognitive screening tests or diagnostic evaluation. Meta-analyses on cross-sectional and longitudinal associations between VI and CIM outcomes (any CIM assessed using screening tests and clinically diagnosed dementia) were examined. Random effect models were used to generate pooled odds ratios (ORs) and 95% confidence intervals (CIs). We also examined study quality, publication bias, and heterogeneity. RESULTS: Forty studies were included (n = 47 913 570). Meta-analyses confirmed that persons with VI were more likely to have CIM, with significantly higher odds of: (1) any CIM (cross-sectional: OR, 2.38 [95% CI, 1.84-3.07]; longitudinal: OR, 1.66 [95% CI, 1.46-1.89]) and (2) clinically diagnosed dementia (cross-sectional: OR, 2.43 [95% CI, 1.48-4.01]; longitudinal: OR, 2.09 [95% CI, 1.37-3.21]) compared with persons without VI. Significant heterogeneity was explained partially by differences in age, sex, and follow-up duration. Also, some evidence suggested that individuals with CIM, relative to cognitively intact persons, were more likely to have VI, with most articles (8/9 [89%]) reporting significantly positive associations; however, meta-analyses on this association could not be conducted because of insufficient data. DISCUSSION: Overall, our work suggests that VI is a risk factor of CIM, although further work is needed to confirm the association of CIM as a risk factor for VI. Strategies for early detection and management of both conditions in older people may minimize individual clinical and public health consequences.
Authors 25
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Affiliation as printed
Duke-NUS Medical School, Singapore, Republic of Singapore
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National University of Singapore · Singapore National Eye Center · Singapore Eye Research Institute · Duke-NUS Medical School
Affiliation as printed
Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
Duke-NUS Medical School, Singapore, Republic of Singapore
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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Singapore National Eye Center · Singapore Eye Research Institute
Affiliation as printed
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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National University of Singapore · Singapore National Eye Center · Singapore Eye Research Institute · Duke-NUS Medical School
Affiliation as printed
Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
Duke-NUS Medical School, Singapore, Republic of Singapore
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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National University of Singapore
Affiliation as printed
Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
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Singapore National Eye Center · Singapore Eye Research Institute
Affiliation as printed
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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Singapore National Eye Center · UNSW Sydney · The George Institute for Global Health · Singapore Eye Research Institute
Affiliation as printed
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; School of Optometry and Visual Science, University of New South Wales, Sydney, Australia; Injury Division, The George Institute for Global Health, Sydney, Australia
Injury Division, The George Institute for Global Health, Sydney, Australia
School of Optometry and Visual Science, University of New South Wales, Sydney, Australia
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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Florida Agricultural and Mechanical University
Affiliation as printed
Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Agricultural and Mechanical University, Florida
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Stella Trompet Aachen
Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center, Leiden, The Netherlands
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Jacobijn Gussekloo Aachen
Leiden University Medical Center
Affiliation as printed
Leiden University Medical Center, Leiden, The Netherlands
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Affiliation as printed
Scheie Eye Institute, University of Pennsylvania, Philadelphia, Pennsylvania
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University of Applied Sciences Utrecht · University Medical Center Utrecht
Affiliation as printed
University Medical Center Utrecht, Utrecht, The Netherlands; University of Applied Sciences Utrecht, Utrecht, The Netherlands
University Medical Center Utrecht, Utrecht, The Netherlands
University of Applied Sciences Utrecht, Utrecht, The Netherlands
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National University of Singapore · Singapore National Eye Center · Singapore Eye Research Institute · Duke-NUS Medical School
Affiliation as printed
Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
Duke-NUS Medical School, Singapore, Republic of Singapore
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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Singapore National Eye Center · Singapore Eye Research Institute
Affiliation as printed
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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National University of Singapore · Singapore National Eye Center · Singapore Eye Research Institute · Duke-NUS Medical School
Affiliation as printed
Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
Duke-NUS Medical School, Singapore, Republic of Singapore
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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Chinese University of Hong Kong
Affiliation as printed
Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Affiliation as printed
Department of Primary Care and Population Health, University College London, London, United Kingdom
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Johns Hopkins University · Johns Hopkins Medicine
Affiliation as printed
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Johns Hopkins University · Johns Hopkins Medicine
Affiliation as printed
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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University of California, San Francisco
Affiliation as printed
Department of Psychiatry, University of California, San Francisco, California
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Affiliation as printed
Department of Ophthalmology, Duke University Eye Center, Durham, North Carolina
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Université de Bordeaux · Inserm · Bordeaux Population Health
Affiliation as printed
Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
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National University of Singapore · Singapore General Hospital · Duke-NUS Medical School · National Neuroscience Institute
Affiliation as printed
Duke-NUS Medical School, Singapore, Republic of Singapore; National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Republic of Singapore
Duke-NUS Medical School, Singapore, Republic of Singapore
National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Republic of Singapore
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National University of Singapore
Affiliation as printed
Memory Aging and Cognition Center, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
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Ecosse Luc Lamoureux corresponding
The University of Melbourne · National University of Singapore · Singapore National Eye Center · Singapore Eye Research Institute · Duke-NUS Medical School
Affiliation as printed
Duke-NUS Medical School, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore; Department of Ophthalmology, The University of Melbourne, Melbourne, Australia. Electronic address: ecosse.lamoureux@seri.com.sg
Department of Ophthalmology, The University of Melbourne, Melbourne, Australia
Duke-NUS Medical School, Singapore, Republic of Singapore
Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Republic of Singapore
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