[Recognition of early cognitive impairment in patients with cataract].

Abstract

Objective: To explore the influencing factors of early cognitive impairment in patients with age-related cataract, and to construct a risk prediction model, for the management of patients undergoing day surgery. Methods: This was a cross-sectional study. A total of 137 patients with age-related cataract admitted to the Department of Ophthalmology, Chinese PLA General Hospital from November 2023 to June 2024 were included. Among them, there were 48 males and 89 females, with an average age of 66.3 years, and one eye of each patient was included. According to the scores of the Montreal Cognitive Assessment Scale, the patients were divided into the cognitive impairment group (score<26, n=91) and the control group (score≥26, n=46). All patients received comprehensive ophthalmic examinations, including visual acuity, intraocular pressure, refractive status, biometry, fundus examination, optical coherence tomography, optical coherence tomography angiography and ultrasound examination of the vessels behind the eyeball. The main observation indicators included morphological parameters in different ocular regions (such as axial length, lens thickness, etc.), parameters related to the retina and optic disc [such as retinal thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness, peripapillary retinal nerve fiber layer (pRNFL), etc.], and ocular hemodynamic parameters (such as the flow velocity, pulsatility index and resistance index of the central retinal artery, posterior ciliary artery and ophthalmic artery, etc.). Variables with P<0.1 in the univariate analysis were included in the multivariate logistic regression analysis to construct a risk prediction model, the odds ratio (OR) and its 95% confidence interval (CI) were calculated to identify the independent risk factors for early cognitive impairment in patients with age-related cataract. And the receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of the model. Results: The univariate analysis showed that advanced age (P<0.001), decreased diastolic blood pressure (P=0.012), shallower anterior chamber (P=0.001) and thickened lens (P=0.003) were associated with early cognitive impairment. Increased flow velocities of the ophthalmic artery and central retinal artery (P=0.001, 0.006), and increased pulsatility index and resistance index of the short posterior ciliary artery (P=0.006, 0.005) were associated with cognitive impairment. In the cognitive impairment group, the inferior pRNFL was thinner (P=0.005), and the cup-to-disc ratio was larger (P=0.021). The multivariate logistic regression analysis identified advanced age (OR=1.127, 95%CI: 1.020-1.245, P=0.019), history of hypertension (OR=5.173, 95%CI: 1.588-16.849, P=0.006), decreased diastolic blood pressure (OR=0.942, 95%CI: 0.869-0.983, P=0.012), increased flow velocity of the central retinal artery (OR=1.268, 95%CI: 1.069-1.504, P=0.006) and thinner thickness of the inferior pRNFL region (OR=0.959, 95%CI: 0.932-0.987, P=0.005) as independent risk factors. The area under the ROC curve of the prediction model constructed based on the above indicators was 0.883 (95%CI: 0.824-0.943). with P=0.576 as the prediction probability cutoff, the sensitivity was 87.9%, the specificity was 76.1%, and the model had a good fit. Conclusions: Advanced age, history of hypertension, decreased diastolic blood pressure, increased flow velocity of the central retinal artery and thinner inferior pRNFL region are independent risk factors for early cognitive impairment in patients with age-related cataract. The prediction model constructed based on these ocular markers has good predictive efficacy, in the preoperative assessment on intraoperaive patient cooperation and helps provide an important basis for evaluating the cooperation of patients during surgery before optimize the management process of day surgery.