老年人的视觉障碍与认知功能：社会孤立和抑郁的中介作用的性别和年龄差异：视觉对认知的中介作用的年龄和性别差异

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-03-05 DOI:10.1016/j.ajo.2025.02.043

D. DIANE ZHENG , DAVID J. LEE , TATJANA RUNDEK , BYRON L. LAM , NINEL Z GREGORI , ROSIE E. CURIEL , DAVID A. LOEWENSTEIN

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引用次数: 0

摘要

目的：视力障碍（VI）在老年人中普遍存在，并与认知能力下降有关。然而，在衰老过程中，视觉障碍影响认知功能的机制尚不清楚。本研究旨在评估视力对认知功能的直接影响及其通过社会隔离和抑郁症状对性别和年龄的间接影响。设计：横断面研究参与者：117,231名年龄在40-70岁之间的个体参加了英国生物银行的基线和眼部评估。其中81%为白人，54%为女性，45.6%年龄在60-70岁之间。平均年龄56.8岁（SD 8.1）。方法：采用多方程通径分析方法，对视力（VA）的直接和间接影响进行分析。按性别和年龄进行分层分析。主要结局指标：LogMAR VA为暴露，社会隔离和抑郁症状为中介。认知功能，包括视觉记忆、语言-数字推理、处理速度和前瞻记忆是结果。结果：VA对认知功能有直接影响（β=-0.979, p）。结论及相关性：视力、社会孤立和抑郁症状是可改变的因素，可通过治疗保持认知功能。鼓励患有VI的男性和老年人参与社会活动，提高患有VI的女性和中年个体的心理健康意识，将减少VI对认知的负面影响，降低痴呆风险，并改善老年人的福祉。

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Visual Impairment and Cognitive Function in Aging Adults: Sex and Age Differences in Mediating Effect of Social Isolation and Depression

Purpose

Visual impairment (VI) is prevalent in older adults and associated with cognitive decline. However, the mechanisms through which visual impairment affects cognitive functioning during the aging process are poorly understood. Our study aims to estimate the direct effect of visual acuity on cognitive function and its indirect effect through social isolation and depressive symptoms by sex and age.

Design

Cross-sectional study.

Participants

117,231 individuals aged 40-70 participated in the UK Biobank baseline and ocular assessment. Of these, 81% were white, 54% were female, and 45.6% were aged 60-70. The mean age was 56.8 (SD 8.1) years.

Methods

Path analyses with multiple equations were conducted to examine the direct and indirect effects of visual acuity (VA). Stratified analyses by gender and age were performed.

Main Outcome Measures

LogMAR VA was the exposure, with social isolation and depressive symptoms as mediators. Cognitive functions, including visual memory, verbal-numerical reasoning, processing speed, and prospective memory, were the outcomes.

Results

VA had a direct effect on cognitive function (β = -0.979 for reasoning and OR = 0.67 for prospective memory). VA also influenced cognition indirectly through social isolation and depressive symptoms. The direct effect of VA on cognitive function was similar in men vs. women and middle-aged vs. older. However, there is a marked difference in the mediating effect via social isolation and depressive symptoms by age and sex. The mediating effect of VI on cognition via social isolation was stronger in older adults than middle-aged and in men than women; while the mediating effect via depressive symptoms was stronger in women and middle-aged individuals. VI had the largest mediating effect via social isolation in older males.

Conclusion and Relevance

Vision, social isolation, and depressive symptoms are modifiable factors and can be treated to preserve cognition. Encouraging social engagement among male and older adults with VI and promoting mental health awareness in women and middle-aged individuals with VI will reduce the negative impact of VI on cognition, lower dementia risk, and improve the well-being of aging adults.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.