The association between vision impairment and incidence of dementia and cognitive impairment: a systematic review and meta-analysis

  • Xianwen Shang
    Affiliations
    Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshanerlu, Yuexiu District, Guangzhou, 510120, China
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  • Zhuoting Zhu
    Affiliations
    Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshanerlu, Yuexiu District, Guangzhou, 510120, China
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  • Wei Wang
    Affiliations
    State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
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  • Jason Ha
    Affiliations
    Centre for Eye Research Australia, 32 Gisborne Street, East Melbourne, VIC 3002, Australia
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  • Mingguang He
    Correspondence
    Correspondence Prof. Mingguang He, MD, PhD.
    Affiliations
    Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshanerlu, Yuexiu District, Guangzhou, 510120, China

    State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China

    Centre for Eye Research Australia, 32 Gisborne Street, East Melbourne, VIC 3002, Australia
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Published:January 07, 2021DOI:https://doi.org/10.1016/j.ophtha.2020.12.029

      Abstract

      Topic

      The magnitude and direction of the association between vision impairment and incident dementia/cognitive impairment in prospective cohort studies was estimated by systematic review and meta-analysis. The global burden of dementia associated with vision impairment was then estimated.

      Clinical Relevance

      As a predominant proportion of vision impairment is preventable or treatable, investigating its association with dementia/cognitive impairment may help identify an important modifiable factor for the prevention of dementia.

      Methods

      A literature search was conducted using PubMed, Embase, Web of Science, and Google Scholar on September 15, 2020. Relative risks (RRs) were pooled using random-effects models and stratified analyses for subgroups representing different study characteristics. Publication bias was evaluated with funnel plots and Egger’s test. The global burden of dementia associated with vision impairment was estimated based on the pooled RR for dementia associated with vision impairment as well as the Global Burden of Disease data on the prevalence of dementia and vision impairment.

      Results

      In the meta-analysis of 14 prospective cohort studies with 6,204,777 participants and 171,394 dementia cases (follow-up range, 4-14 years), the pooled RR (95% confidence interval [CI]) associated with vision impairment was 1.47 (1.36-1.60). In the meta-analysis of 12 prospective cohort studies with 45,065 participants and 13,299 cases of cognitive impairment (follow-up range, 3-18 years), the pooled RR (95% CI) was 1.35 (1.28-1.41). Stratified analyses showed the associations of vision impairment with incident dementia and cognitive impairment were similar across methods of vision assessment, length of follow-up, and study quality. The global number of people with dementia associated with moderate/severe vision impairment in 2016 was 2.1 (80% uncertainty interval: 1. 0-3.3) million, which accounted for 4.7% (2.3%-7.5%) of the global burden of dementia. Economic inequality was significant for the burden of dementia associated with vision impairment.

      Conclusions

      The overall quality of the body evidence was low due to the observational design of the studies included in the analysis. Vision impairment is associated with an increased risk of both dementia and cognitive impairment in older adults. Screening and treating vision impairment, especially in low- and middle-income countries may help to alleviate the global burden of dementia.

      Keywords

      Abbreviations:

      AMD ( (age-related macular degeneration)), CI ( (confidence interval)), HR ( (hazard ratio)), HRS ( (Health and Retirement Study)), OR ( (odds ratio)), PAR ( (population attributable risk)), RR ( (relative risk)), UI ( (uncertainty interval))
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