TY - JOUR
T1 - Addition of Vision Impairment to a Life-Course Model of Potentially Modifiable Dementia Risk Factors in the US
AU - Ehrlich, Joshua R.
AU - Goldstein, Jenna
AU - Swenor, Bonnie K.
AU - Whitson, Heather
AU - Langa, Kenneth M.
AU - Veliz, Phillip
N1 - Funding Information:
reported receiving grants from the National Institutes of Health (NIH) during the conduct of the
Funding Information:
study. Dr Swenor reported receiving grants from the NIH during the conduct of the study. Dr Langa reported grants from the National Institute on Aging (NIA) of the NIH during the conduct of the study; grants from NIA/NIH and grants from Alzheimer’s Association outside the submitted work. No other disclosures were reported.
Funding Information:
Funding/Support: This research was supported by grants P30AG066582, P30AG024824, P30AG072958, P30AG028716, R01AG053972, R01AG062623, and K01AG052640 from the NIA. Dr Ehrlich is supported by grant K23EY027848 from the National Eye Institute of the NIH. The Health and Retirement Study is funded by NIA grant U01AG009741 and performed at the Institute for Social Research, University of Michigan. This research was also supported by an unrestricted grant to the University of Michigan Department of Ophthalmology and Visual Sciences from Research to Prevent Blindness.
Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/6
Y1 - 2022/6
N2 - Importance: Dementia prevention is a high priority, given the large impact of dementia on the well-being of individuals and society. The number of older adults with dementia in the US and globally is projected to increase as a result of population aging and growth. Thus, it is vital to identify potentially modifiable dementia risk factors. Vision impairment has been identified as a risk factor for accelerated cognitive decline and incident dementia. An estimated 90% of vision impairment is preventable or has yet to be treated. Nevertheless, vision impairment has not been included in the dominant life-course models of dementia risk factors used to shape public health policy and research priorities. Objective: To strengthen an existing model of potentially modifiable dementia risk factors through the inclusion of vision impairment and to estimate the contributions of those risk factors in the US population. Design, Setting, and Participants: Population-based, cross-sectional study using data from the 2018 round of the Health and Retirement Study. Analyses were conducted from March 11 through September 24, 2021. The study population was a probability sample of US adults aged 50 years and older. Exposures: Potentially modifiable dementia risk factors, including vision impairment. Main Outcomes and Measures: The estimated population attributable fractions (PAFs) of dementia associated with vision impairment and other dementia risk factors were calculated. The PAF represents the number of cases of dementia that would potentially be prevented if a risk factor were eliminated. Results: The probability sample from the Health and Retirement Study included 16690 participants (weighted demographic characteristics: 54.0% female, 52.0% age ≥65, 10.6% Black, 80% White, and 9.2% identified as other [including American Indian or Alaska Native, Asian, and Hawiian Native or Pacific Islander, although specific data were not available]). The 12 dementia risk factors in the PAF model were associated with an estimated 62.4% of dementia cases in the US. The risk factor with the highest weighted PAF for dementia was hypertension (12.4%). The PAF of vision impairment was 1.8%, suggesting that more than 100000 prevalent dementia cases in the US could potentially have been prevented through healthy vision. Conclusions and Relevance: Existing life-course models of potentially modifiable dementia risk factors may consider including vision impairment. Since a large majority of vision impairment can be treated with cost-effective but underused interventions, this may represent a viable target for future interventional research that aims to slow cognitive decline and prevent incident dementia.
AB - Importance: Dementia prevention is a high priority, given the large impact of dementia on the well-being of individuals and society. The number of older adults with dementia in the US and globally is projected to increase as a result of population aging and growth. Thus, it is vital to identify potentially modifiable dementia risk factors. Vision impairment has been identified as a risk factor for accelerated cognitive decline and incident dementia. An estimated 90% of vision impairment is preventable or has yet to be treated. Nevertheless, vision impairment has not been included in the dominant life-course models of dementia risk factors used to shape public health policy and research priorities. Objective: To strengthen an existing model of potentially modifiable dementia risk factors through the inclusion of vision impairment and to estimate the contributions of those risk factors in the US population. Design, Setting, and Participants: Population-based, cross-sectional study using data from the 2018 round of the Health and Retirement Study. Analyses were conducted from March 11 through September 24, 2021. The study population was a probability sample of US adults aged 50 years and older. Exposures: Potentially modifiable dementia risk factors, including vision impairment. Main Outcomes and Measures: The estimated population attributable fractions (PAFs) of dementia associated with vision impairment and other dementia risk factors were calculated. The PAF represents the number of cases of dementia that would potentially be prevented if a risk factor were eliminated. Results: The probability sample from the Health and Retirement Study included 16690 participants (weighted demographic characteristics: 54.0% female, 52.0% age ≥65, 10.6% Black, 80% White, and 9.2% identified as other [including American Indian or Alaska Native, Asian, and Hawiian Native or Pacific Islander, although specific data were not available]). The 12 dementia risk factors in the PAF model were associated with an estimated 62.4% of dementia cases in the US. The risk factor with the highest weighted PAF for dementia was hypertension (12.4%). The PAF of vision impairment was 1.8%, suggesting that more than 100000 prevalent dementia cases in the US could potentially have been prevented through healthy vision. Conclusions and Relevance: Existing life-course models of potentially modifiable dementia risk factors may consider including vision impairment. Since a large majority of vision impairment can be treated with cost-effective but underused interventions, this may represent a viable target for future interventional research that aims to slow cognitive decline and prevent incident dementia.
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U2 - 10.1001/jamaneurol.2022.0723
DO - 10.1001/jamaneurol.2022.0723
M3 - Article
C2 - 35467745
AN - SCOPUS:85129754823
SN - 2168-6149
VL - 79
SP - 623
EP - 626
JO - JAMA Neurology
JF - JAMA Neurology
IS - 6
ER -