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Can Interventions for Hearing and Vision Loss Prevent Dementia?

  • Authors: News Author: Adam Marcus; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 1/28/2022
  • Valid for credit through: 1/28/2023, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for all primary care physicians, neurologists, geriatricians, ophthalmologists, nurses, and other members of the healthcare team who care for older adults with cataracts.

The goal of this activity is to assess the potential effect of interventions for vision and hearing loss on the risk for incident dementia.

Upon completion of this activity, participants will:

  • Assess outcomes associated with the use of hearing aids among older adults
  • Evaluate the effect of cataract extraction on the risk for incident dementia among older adults
  • Outline implications for the healthcare team


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News Author

  • Adam Marcus

    Freelance writer, Medscape


    Disclosure: Adam Marcus has disclosed no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine
    Irvine, California


    Disclosure: Charles P. Vega, MD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: GlaxoSmithKline; Johnson & Johnson

Editor/CME Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance
    Medscape, LLC


    Disclosure: Amanda Jett, PharmD, BCACP, has disclosed no relevant financial relationships.

Nurse Planner

  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC


    Disclosure: Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has disclosed no relevant financial relationships.

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Can Interventions for Hearing and Vision Loss Prevent Dementia?

Authors: News Author: Adam Marcus; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 1/28/2022

Valid for credit through: 1/28/2023, 11:59 PM EST


Clinical Context

Loss of vision and hearing can have profound results in terms of other neurological function as well as social function. These effects may raise the risk for incident dementia, and a previous retrospective study of more than 114,000 older adults with hearing loss assessed how the use of hearing aids might affect the risks for dementia, depression or anxiety, and injurious falls. The results of this study by Mahmoudi and colleagues was published in the November 2019 issue of the Journal of the American Geriatrics Society.[1]

A total of 12.3% of all adults with hearing loss used hearing aids. Women and Black/Latinx adults were less likely to wear hearing aids. On adjusted analyses, the hazard ratios for dementia, depression or anxiety, and injurious falls associated with wearing hearing aids vs not wearing hearing aids were 0.82 (95% confidence interval [CI], 0.76-0.89), 0.89 (95% CI, 0.86-0.93), and 0.87 (95% CI, 0.80-0.95), respectively.

The current study analyzes the effect of cataract extraction on the subsequent risk for dementia while accounting for potential confounding variables.

Study Synopsis and Perspective

Older patients who undergo cataract surgery may reduce their risk of developing dementia by roughly 30%, new research shows.

Although previous studies have linked sensory impairment to dementia, whether correcting vision problems in particular can prevent cognitive decline has been unclear, according to Cecilia S. Lee, MD, the Klorfine Family Associate Professor in the Department of Ophthalmology at the University of Washington, Seattle, who led the study.

"Despite controlling for an extensive number of health-related factors and potential sources of bias that might have affected the relationship between cataract surgery and dementia, we still found strong associations between cataract surgery and reduced risk of dementia," said Dr Lee, whose group published their findings in JAMA Internal Medicine.[2] "Cataract surgery was associated with an approximately 30 percent lower risk of developing dementia, and we found similar associations with Alzheimer disease as well."

For the analysis, Dr Lee and colleagues used data from the ongoing Adult Changes in Thought (ACT) study, a longitudinal analysis of more than 5000 people aged 65 years and older in the Seattle area who did not have dementia on enrollment. They included 3038 participants in ACT who had been diagnosed with cataracts or glaucoma before the onset of dementia. Of those, 1800 (59%) were women, 1238 (41%) were men, and nearly all (91%) were White. The mean age at cataract diagnosis was 74.4 years.

Among the study participants, 853 were diagnosed with dementia and 709 with Alzheimer's dementia. Roughly half the group (n=1382) underwent cataract extraction.

After controlling for factors linked to the risk of developing dementia, including smoking history, years of education, apolipoprotein E (APOE) genotype (which has been linked to dementia), and other factors, patients in the study who underwent cataract extraction were 29% less likely to develop dementia than those who did not undergo the procedure (hazard ratio [HR], 0.71; P<.001), Dr Lee's group found. The researchers observed similar results for the development of dementia associated with Alzheimer's dementia. However, glaucoma surgery did not appear to be linked to a reduction in the risk for dementia, they report (HR, 1.08; P=.68).

The reduction in risk was particularly strong in the first 5 years after surgery (HR, 0.68; P<.001). "When considering the relative associations of cataract extraction, additional education, White race, smoking history, sex, and APOE genotype with dementia risks, the only covariate that was more protective than cataract surgery was not having an APOE e4 allele," the authors report.

A strength of the study, Dr Lee said, was its data set, which allowed the researchers to control for many confounding variables. "Healthier patients are usually more able to go through optional surgeries than people with many medical issues. So one could argue that the reduced dementia risk that we found was from people who had cataract surgery being healthier than people who did not have cataract surgery," she said. "For this study, we had access to a unique data set that allowed us to address many confounders, such as people's health status and health behavior."

Importance for Primary Care Providers

Dr Lee said the study, which was not designed to look for potential mechanisms for the association, has important implications for primary care providers.

"To date, there are only a few known dementia risk factors that are modifiable, such as certain diets and increased activity level," she said. "Our study results suggest that interventions to improve sensory impairment such as vision could play a role in preventing dementia or Alzheimer disease. Older adults who are experiencing symptoms of cataract, such as night driving difficulty or seeing halos around bright lights, should be evaluated by ophthalmologists."

Her group has also found that several neurodegenerative eye diseases, such as age-related macular degeneration and diabetic retinopathy, are linked to an increased risk for dementia, as well as Alzheimer's dementia. "Thus, primary care physicians who are taking care of older adults could play an important role in ensuring that older adults who are at risk of dementia are evaluated by ophthalmologists regularly," she said.

Michael F. Chiang, MD, director of the National Eye Institute of the National Institutes of Health, Bethesda, Maryland, which helped fund the research, said, "This study reinforces how closely the eye and the brain are linked, in this case through the association between cataract surgery and lower risk of dementia. I hope future studies will examine the underlying mechanistic relationships in more detail."

The study was funded by the National Institutes of Health, the Alzheimer's Drug Discovery Foundation, and Research to Prevent Blindness. Dr Lee has disclosed no relevant financial relationships. Several coauthors reported financial relationships with industry, a full listing of which is included in the original article.

JAMA Intern Med. Published online December 6, 2021.

Study Highlights

  • Study data were drawn from the Adult Changes in Thought study, which began recruiting older adults in 1994. The current study focused on participants who were at least 65 years of age at study entry and did not have dementia at enrollment.
  • All participants in the current study were diagnosed with cataracts and had at least 1 visit after the diagnosis of cataract.
  • Cataract extraction was assessed as a time-varying covariate. The main study outcome was incident dementia. Researchers also assessed rates of incident Alzheimer's dementia specifically. Study participants were screened biannually for cognitive dysfunction with the Cognitive Abilities Screening Instrument.
  • The study analysis accounted for multiple potential confounding factors, including health habits, comorbid illness, body mass index, healthcare contact, and the presence of the APOE allele.
  • 3038 older adults with cataract provided data for study analysis. The mean age at the time of cataract diagnosis was 74.4 years; 59% of participants were women and 91% of the cohort was White.
  • The mean follow-up period was 7.8 years; 46% of participants underwent cataract surgery during follow-up, and 28% of the cohort developed incident dementia.
  • The hazard ratio for dementia associated with cataract extraction was 0.71 (95% CI, 0.62-0.83). This lower risk was similar in examining the relationship between cataract extraction and Alzheimer's dementia specifically.
  • The association between cataract extraction and a lower risk for dementia was more powerful in the first 5 years of follow-up. A secondary analysis limited to participants who developed incident cataracts during follow-up failed to alter the main study conclusion.
  • Among different variables, the only more powerful effect on incident dementia other than cataract extraction was the presence of the APOE allele.
  • As a control, researchers also examined the possible effect of glaucoma surgery on the risk for incident dementia. Glaucoma surgery usually does not improve vision, and glaucoma surgery was not associated with a difference in the risk for dementia.

Clinical Implications

  • A previous study demonstrated that hearing aids were associated with lower risks for dementia, depression or anxiety, and injurious falls among older adults with hearing loss.
  • In the current study, cataract extraction was associated with an approximate 30% reduction in the risk for incident dementia. This lower risk was similar in examining the relationship between cataract extraction and Alzheimer's dementia specifically. Glaucoma surgery had no significant effect on the risk for dementia.
  • Implications for the healthcare team: The healthcare team may suggest that cataract extraction may improve the risk for future dementia among at-risk older adults.


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