Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women
Vision impairment and combined vision and hearing impairment predict cognitive and functional decline in older women
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DOI：
10.1111/j.1532-5415.2004.52554.x
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发表时间：
2004-12-01
影响因子：
6.3
通讯作者：
Mangione, CM
中科院分区：
文献类型：
--
作者：
Lin, MY;Gutierrez, PR;Mangione, CM
目的：目的：探讨社区老年妇女视力和听力损伤与随后认知和功能下降之间的关系。设计：前瞻性队列研究。地点：美国的四个大城市。参与者：1992年至1994年间，共有6，112名年龄在69岁及以上的妇女参加骨质疏松性骨折研究（SOF）。测量：5345名参与者进行了听力测量，1,668名参与者进行了视力测量，1,636名参与者进行了听力和视力测量。视力损害定义为矫正视力低于20/40。听力障碍被定义为无法听到2,000赫兹的40 dB或更高的音调。参与者在基线和随访时完成了改良的简易精神状态检查和/或功能状态评估。认知和功能下降被定义为从基线到随访的下降量，超过观察到的平均变化分数至少1个标准差。结果：约六分之一（15.7%）的样本有认知下降，10.1%有功能下降。在针对社会人口统计学特征和慢性疾病调整的多变量模型中，基线视力损害与认知（比值比（OR）=1.78，95%置信区间（CI）=1.21-2.61）和功能（OR=1.79，95% CI=1.15-2.79）下降相关。听力障碍与认知或功能下降无关。联合损害与认知（OR=2.19，95%CI =1.26-3.81）和功能（OR=1.87，95%CI =1.01-3.47）下降的最大几率相关。结论：感觉损害与老年妇女的认知和功能下降有关。需要研究来确定视力和听力障碍的治疗是否可以降低认知和功能下降的风险。
OBJECTIVES: To determine the association between vision and hearing impairment and subsequent cognitive and functional decline in community-residing older women.DESIGN: Prospective cohort study.SETTING: Four metropolitan areas of the United States.PARTICIPANTS: A total of 6,112 women aged 69 and older participating in the Study of Osteoporotic Fractures (SOF) between 1992 and 1994.MEASUREMENTS: Five thousand three hundred forty-five participants had hearing measured, 1,668 had visual acuity measured, and 1,636 had both measured. Visual impairment was defined as corrected vision worse than 20/40. Hearing impairment was defined as the inability to hear a tone of 40 dB or greater at 2,000 hertz. Participants completed the modified Mini-Mental State Examination and/or a functional status assessment at baseline and follow-up. Cognitive and functional decline were defined as the amount of decline from baseline to follow-up that exceeded the observed average change in scores by at least 1 standard deviation.RESULTS: About one-sixth (15.7%) of the sample had cognitive decline; 10.1% had functional decline. In multivariate models adjusted for sociodemographic characteristics and chronic conditions, vision impairment at baseline was associated with cognitive (odds ratio (OR)=1.78, 95% confidence interval (CI)=1.21-2.61) and functional (OR=1.79, 95% CI=1.15-2.79) decline. Hearing impairment was not associated with cognitive or functional decline. Combined impairment was associated with the greatest odds for cognitive (OR=2.19, 95% CI=1.26-3.81) and functional (OR=1.87, 95% CI=1.01-3.47) decline.CONCLUSION: Sensory impairment is associated with cognitive and functional decline in older women. Studies are needed to determine whether treatment of vision and hearing impairment can decrease the risk for cognitive and functional decline.