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CME / ABIM MOC / CE

What Is the Effect of Sensory Deficits on Cognitive Impairment in Older Adults?

  • Authors: News Author: Batya Swift Yasgur, MA, LSW; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 6/30/2022
  • Valid for credit through: 6/30/2023
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  • Credits Available

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Target Audience and Goal Statement

This activity is intended for primary care physicians, geriatricians, neurologists, ophthalmologists, otolaryngologists, nurses, nurse practitioners, pharmacists, physician assistants, and other members of the healthcare team who treat and manage older adults.

The goal of this activity is for learners to better be able to evaluate the relationship between sensory impairment and cognitive symptoms among older adults.

Upon completion of this activity, participants will:

  • Distinguish rates of sensory impairment among older adults in the US
  • Evaluate the relationship between sensory impairment and cognitive symptoms among older adults
  • Outline implications for the healthcare team


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News Author

  • Batya Swift Yasgur, MA, LSW

    Freelance writer, Medscape

     

    Disclosures

    Batya Swift Yasgur, MA, LSW, has 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

    Disclosures

    Disclosure: Charles P. Vega, MD, has the following relevant financial relationships:
    Advisor or consultant for: GlaxoSmithKline; Johnson & Johnson

Editor/Nurse Planner

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

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

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

Compliance Reviewer

  • Lisa Simani, APRN, MS, ACNP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

    Disclosures

    Lisa Simani, APRN, MS, ACNP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


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CME / ABIM MOC / CE

What Is the Effect of Sensory Deficits on Cognitive Impairment in Older Adults?

Authors: News Author: Batya Swift Yasgur, MA, LSW; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 6/30/2022

Valid for credit through: 6/30/2023

processing....

Clinical Context

Visual and auditory deficits are associated with significant degrees of disability, and the authors of the current study perform a brief review of the importance of these senses among older adults in particular. Persons at age 65 or older made up 17% of the population in 2020, and this percentage should grow to 23% by 2060. One third of adults between ages 65 and 74 years of age have some degree of hearing loss, as do about one half of individuals aged 75 years and older. Meanwhile, 4% of adults between the ages of 65 and 74 years have visual impairment; this rate increases to 16% among adults at ages 80 to 84 years.

Sensory impairment contributes to cognitive impairment. One study found that peripheral hearing loss at midlife accounted for 9% of dementia cases, making it the largest preventable cause of dementia. Another study found that reductions in visual acuity, contrast sensitivity, and stereo acuity were associated with increases in the risk for cognitive impairment of 55%, 33%, and 28%, respectively. The current study elaborates on the risk for cognitive impairment related to sensory impairment, using a large national sample from the United States.

Study Synopsis and Perspective

Investigators analyzed data on more than 5 million US seniors. Adjusted results show that participants with hearing impairment alone had more than twice the odds of also having cognitive impairment, whereas those with vision impairment alone had more than triple the odds of cognitive impairment.

However, those with dual sensory impairment (DSI) had an 8-fold higher risk for cognitive impairment. In addition, half the participants with DSI also had cognitive impairment. Of those with cognitive impairment, 16% had DSI compared with only about 2% of their peers without cognitive impairment.

"The findings of the present study may inform interventions that can support older people with concurrent sensory impairment and cognitive impairment," lead author Esme Fuller-Thomson, PhD, professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Canada, told Medscape Medical News.

"Special attention, in particular, should be given to those aged 65 to 74 who have serious hearing and/or vision impairment [because] if the relationship with dementia is found to be causal, such interventions can potentially mitigate the development of cognitive impairment," said Dr Fuller-Thomson, who is also director of the Institute for Life Course and Aging and a professor in the Department of Family and Community Medicine and Faculty of Nursing, all at the University of Toronto.

The findings were published online May 2 in the Journal of Alzheimer's Disease Reports.[1]

Sensory Isolation

"The link between dual hearing loss and seeing loss and mental health problems such as depression and social isolation have been well researched, but we were very interested in the link between dual sensory loss and cognitive problems," Dr Fuller-Thomson said.

In addition, "there have been several studies in the past decade linking hearing loss to dementia and cognitive decline, but less attention has been paid to cognitive problems among those with DSI, despite this group being particularly isolated," she said.

Existing research into DSI suggests an association with cognitive decline; the current investigators sought to expand on this previous work.

To do so, they used merged data from 10 consecutive waves from 2008 to 2017 of the American Community Survey (ACS), which was conducted by the Census Bureau. The ACS is a nationally representative sample of 3.5 million randomly selected US addresses and includes community-dwelling adults and those residing in institutional settings.

Participants aged 65 or older (n = 5,405,135; 56.4% women) were asked yes/no questions regarding serious cognitive impairment, hearing impairment, and vision impairment. A proxy, such as a family member or nursing home staff member, provided answers for individuals not capable of self-report.

Potential confounding variables included age, race/ethnicity, sex, education, and household income.

Potential Mechanisms

Results showed that among those patients with cognitive impairment, there was a higher prevalence of hearing impairment, vision impairment, and DSI than among their peers without cognitive impairment; in addition, a lower percentage of these persons had no sensory impairment (P < .001).

Type of sensory impairment

Cognitive impairment

No cognitive impairment

Hearing only

22.2%

10.8%

Vision only

9.9%

3.1%

DSI

16.0%

1.9%

None

51.9%

84.3%

The prevalence of DSI climbed with age, from 1.5% for respondents aged 65 to 74 years to 2.6% for those aged 75 to 84 years and to 10.8% in those aged 85 years and older.

Individuals with higher levels of poverty also had higher levels of DSI. Among those who had not completed high school, the prevalence of DSI was higher compared with high school or university graduates (6.3% vs 3.1% and 1.8%, respectively).

After controlling for age, race, education, and income, the researchers found "substantially" higher odds of cognitive impairment in those with vs those without sensory impairments.

Type of sensory impairment

Odds ratio for cognitive impairment (95% confidence interval [CI])

Hearing only

2.66 (2.64-2.68)

Vision only

3.63 (3.59-3.67)

DSI

8.16 (8.07-8.25)

"The magnitude of the odds of cognitive impairment by sensory impairment was greatest for the youngest cohort (age 65-74) and lowest for the oldest cohort (age 85+)," the investigators write. Among participants in the youngest cohort, there was a "dose-response relationship" for those with hearing impairment only, visual impairment only, and DSI.

Type of sensory impairment

Odds ratio (95% CI)

Hearing only

3.45 (3.40-3.50)

Vision only

5.16 (5.06-5.25)

DSI

14.24 (13.94-14.53)

Because the study was observational, it "does not provide sufficient information to determine the reasons behind the observed link between sensory loss and cognitive problems," Dr Fuller-Thomson said. However, there are "several potential causal mechanisms [that] warrant future research."

Accurate Testing

"The big question is whether we can improve patients' cognitive performance by treating or accommodating their sensory impairments," she said. "If safe and feasible things like hearing aids or cataract surgery improve cognitive health, even a little bit, it would be a huge benefit to society, because sensory loss is very common, and there are many treatment options," Dr Whitson added.

Dr Fuller-Thomson emphasized that practitioners should "consider the full impact of sensory impairment on cognitive testing methods, as both auditory and visual testing methods may fail to take hearing and vision impairment into account."

Thus, "when performing cognitive tests on older adults with sensory impairments, practitioners should ensure they are communicating audibly and/or using visual speech cues for hearing impaired individuals, eliminating items from cognitive tests that rely on vision for those who are visually impaired, and using physical cues for individuals with hearing or dual sensory impairment, as this can help increase the accuracy of testing and prevent confounding," she said.

The study by Dr Fuller-Thomson and colleagues was funded by a donation from Janis Rotman. The investigators have reported no relevant financial relationships. The study by Dr Hwang and colleagues was funded by contracts from the National Heart, Lung, and Blood Institute; the National Institute of Neurological Disorders and Stroke; and the National Institute on Aging. Dr Hwang has disclosed no relevant financial relationships. The other investigators' disclosures are listed in the original article. Dr Reed received grants from the National Institute on Aging during the conduct of the study and has served on the advisory board of Neosensory outside the submitted work. Dr Oh and Dr Whitson have disclosed no relevant financial relationships.

J Alzheimers Dis Rep. Published online May 2, 2022.

JAMA Netw Open. Published online May 5, 2022.

Study Highlights

  • Data were drawn from the American Community Survey, a nationwide annual survey of 3.5 million Americans from the Census Bureau. The current study drew data from 10 surveys from 2008 to 2017, with a total of 5,405,135 respondents. The current study focused on adults at age 65 years and older.
  • The main study outcome was the relationship between a positive response to the question regarding cognitive symptoms and hearing impairment, vision impairment, or impairment of both senses. The study result was adjusted to account for demographic data, educational attainment level, and income levels among participants.
  • 56.4% of the study cohort was female, and 55.9% of respondents were between 65 and 74 years old.
  • There was a strong positive correlation between age and sensory impairment: 1.5% of participants from 65 to 74 years of age had DSI, but this rate increased to 10.8% among participants aged 85 years and older.
  • There was also a dose-response relationship between poverty and dual sensory loss.
  • Rates of hearing impairment among participants with and without cognitive symptoms were 22.2% and 10.8%, respectively. The respective rates of vision impairment were 9.9% and 3.1%, and the respective rates of dual sensory impairment were 16.0% and 1.9%.
  • The odds ratio for cognitive symptoms associated with hearing impairment was 2.66 (95% CI, 2.64-2.68), and the respective OR for vision impairment was 3.63 (95% CI, 3.59-3.67). Participants with DSI experienced an OR of 8.16 (95% CI, 8.07-8.25) for cognitive symptoms.
  • The relationship between sensory impairment and cognitive symptoms was similar among women and men. The magnitude of risk for cognitive symptoms associated with sensory impairment was most profound among adults aged 65 to 74 years.

Clinical Implications

  • One third of adults between ages 65 and 74 years have some degree of hearing loss, as do about one half of individuals aged 75 years and older. Meanwhile, 4% of adults between the ages of 65 and 74 years have visual impairment; this rate increases to 16% among adults at ages 80 to 84 years.
  • The current study suggests that both hearing and vision impairment can raise the risk for cognitive symptoms among older adults, with additive effects in cases of dual sensory impairment. These effects attenuated after age 75 years.
  • Implications for the healthcare team: The healthcare team should screen older adults for signs of sensory impairments and implement appropriate interventions when a deficit is discovered.

 

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