Association of Vision Impairment With Cognitive Decline Across Multiple Domains in Older Adults

Key Points

Question

Are there associations between visual and cognitive impairment across multiple cognitive domains and multiple measures of vision?

Findings

In this longitudinal cohort study of 1202 older adults, worse visual acuity and stereo acuity impairment were associated with greater declines in language and memory domain scores, whereas worse contrast sensitivity was associated with declines in language, memory, attention, and visuospatial ability domain scores.

Meaning

These findings suggest that the association between vision and cognition differs by measure of vision and that impaired contrast sensitivity is associated with declines across more cognitive domains than visual acuity.

Abstract

This cohort study examines the association between visual and cognitive impairments across multiple cognitive domains using multiple measures of vision.

Abstract

Importance

Associations between visual and global cognitive impairments have been previously documented, but there is limited research examining these associations between multiple measures of vision across cognitive domains.

Objective

To examine the association between vision and cognitive across multiple cognitive domains using multiple measures of vision.

Design, Setting, and Participants

This longitudinal cohort study used data from the Baltimore Longitudinal Study of Aging for 2003 to 2019. Participants in the current study were aged 60 to 94 years with vision and cognitive measures. Data analysis was performed from May 2020 to May 2021.

Main Outcomes and Measures

Cognitive function was measured across multiple domains, including language, memory, attention, executive function, and visuospatial ability. Cognitive domain scores were calculated as the mean of standardized cognitive test scores within each domain. Visual function was assessed using measures of visual acuity, contrast sensitivity, and stereo acuity at baseline.

Results

Analyses included 1202 participants (610 women [50.8%]; 853 White participants [71.0%]) with a mean (SD) age of 71.1 (8.6) years who were followed up for a mean (SD) of 6.9 (4.7) years. Worse visual acuity (per 0.1 logarithm of the minimal angle of resolution) at baseline was associated with greater declines in language (β, −0.0035; 95% CI, −0.007 to −0.001) and memory (β, −0.0052; 95% CI, −0.010 to −0.001) domain scores. Worse contrast sensitivity (per 0.1 log units) at baseline was associated with greater declines in language (β, −0.010; 95% CI, −0.014 to −0.006), memory (β, −0.009; 95% CI, −0.015 to −0.003), attention (β, −0.010; 95% CI, −0.017 to −0.003), and visuospatial ability (β, −0.010; 95% CI, −0.017 to −0.002) domain scores. Over the follow-up period, declines on tests of language (β, −0.019; 95% CI, −0.034 to −0.005) and memory (β, −0.032; 95% CI, −0.051 to −0.012) were significantly greater for participants with impaired stereo acuity compared with those without such impairment.

Conclusions and Relevance

These findings suggest that the association between vision and cognition differs between visual acuity, contrast sensitivity, and stereo acuity and that patterns of cognitive decline may differ by type of vision impairment, with impaired contrast sensitivity being associated with declines across more cognitive domains than other measures of visual functioning.