The Effect of Self-Reported Visual Impairment and Sleep on Cognitive Decline: Results of the Hispanic Community Health Study/Study of Latinos

J Alzheimers Dis. 2023;92(4):1257-1267. doi: 10.3233/JAD-221073.

Abstract

Background: Visual impairment could worsen sleep/wake disorders and cognitive decline.

Objective: To examine interrelations among self-reported visual impairment, sleep, and cognitive decline in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Miami-site.

Method: HCHS/SOL Miami-site participants ages 45-74 years (n = 665) at Visit-1, who returned for cognitive test 7-years later (SOL-INCA). Participants completed the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ), validated sleep questionnaires and test for obstructive sleep apnea (OSA) at Visit-1. We obtained verbal episodic learning and memory, verbal fluency, processing speed, and executive functioning at Visit-1 and at SOL-INCA. Processing speed/executive functioning were added to SOL-INCA. We examined global cognition and change using a regression-based reliable change index, adjusting for the time lapse between Visit-1 and SOL-INCA. We used regression models to test whether 1) persons with OSA, self-reported sleep duration, insomnia, and sleepiness have an increased risk for visual impairment, 2a) visual impairment is associated with worse cognitive function and/or decline, and 2b) sleep disorders attenuate these associations.

Result: Sleepiness (β= 0.04; p < 0.01) and insomnia (β= 0.04; p < 0.001) were cross-sectionally associated with visual impairment, adjusting for sociodemographic characteristics, behavioral factors, acculturation, and health conditions. Visual impairment was associated with lower global cognitive function at Visit-1 (β= -0.16; p < 0.001) and on average 7-years later (β= -0.18; p < 0.001). Visual impairment was also associated with a change in verbal fluency (β= -0.17; p < 0.01). OSA, self-reported sleep duration, insomnia, and sleepiness did not attenuate any of the associations.

Conclusion: Self-reported visual impairment was independently associated with worse cognitive function and decline.

Keywords: Cognitive decline; Hispanic/Latinos; health disparities; sleep disorders; visual impairment.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Cognitive Dysfunction* / diagnosis
  • Cognitive Dysfunction* / ethnology
  • Cognitive Dysfunction* / etiology
  • Cognitive Dysfunction* / psychology
  • Hispanic or Latino* / psychology
  • Humans
  • Middle Aged
  • Self Report
  • Sleep
  • Sleep Apnea, Obstructive* / complications
  • Sleep Apnea, Obstructive* / diagnosis
  • Sleep Apnea, Obstructive* / ethnology
  • Sleep Apnea, Obstructive* / psychology
  • Sleep Duration
  • Sleep Initiation and Maintenance Disorders* / complications
  • Sleep Initiation and Maintenance Disorders* / diagnosis
  • Sleep Initiation and Maintenance Disorders* / ethnology
  • Sleep Initiation and Maintenance Disorders* / psychology
  • Sleepiness
  • Speech Disorders / diagnosis
  • Speech Disorders / ethnology
  • Speech Disorders / etiology
  • Speech Disorders / psychology
  • Vision Disorders* / complications
  • Vision Disorders* / diagnosis
  • Vision Disorders* / ethnology
  • Vision Disorders* / psychology