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Vision loss and 12-year risk of dementia in older adults: the 3C cohort study


To analyze the longitudinal relationships between vision loss and the risk of dementia in the first 2 years, from 2 to 4 years and beyond 4 years after inclusion and to determine the roles of depressive symptomatology and engagement in cognitively stimulating activities in these associations. This study is based on the Three-City (3C) study, a population-based cohort of 7736 initially dementia-free participants aged 65 years and over with 12 years of follow-up. Near visual impairment (VI) was measured and distance visual function (VF) loss was self-reported. Dementia was diagnosed and screened over the 12-year period. At baseline, 8.7% had mild near VI, 4.2% had moderate to severe near VI, and 5.3% had distance VF loss. Among the 882 dementia cases diagnosed over the 12-year follow-up period, 140 cases occurred in the first 2 years, 149 from 2 to 4 years and 593 beyond 4 years after inclusion. In Cox multivariate analysis, moderate to severe near VI was associated with an increased risk of dementia in the first 2 years (HR 2.0, 95% CI 1.2–3.3) and from 2 to 4 years (HR 1.8, 95% CI 1.1–3.1) but the association was not significant beyond 4 years after inclusion even if pointing in similar direction (HR 1.3, 95% CI 0.95–1.9). Mild near VI was associated with an increased risk of dementia only in the first 2 years (HR 1.6, 95% CI 1.1–2.5). Moreover, self-reported distance VF loss was associated with an increased risk beyond 4 years after inclusion (HR 1.5, 95% CI 1.1–2.0) but the association was no longer significant after taking into account baseline cognitive performances. Further adjustment for engagement in cognitively stimulating activities only slightly decreased these associations. However, there was an interaction between vision loss and depressive symptomatology, with vision loss associated with dementia only among participants with depressive symptomatology. These results suggest that poor vision, in particular near vision loss, may represent an indicator of dementia risk at short and middle-term, mostly in depressed elderly people.

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Study funding: The Three-City study is conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the University Bordeaux 2 Victor Segalen and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The Three-City study is also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Conseils Régionaux d’Aquitaine et Bourgogne, Fondation de France, Ministry of Research-INSERM Programme “Cohortes et collections de données biologiques”, Agence Nationale de la Recherche ANR PNRA 2006 and LongVie 2007, the “Fondation Plan Alzheimer” (FCS 2009-2012) and the Caisse Nationale de Solidarité pour l’Autonomie (CNSA). None of the sponsors participated in the collection, management, statistical analysis and interpretation of the data, nor in the preparation, review or approval of the present manuscript. SENSE-Cog has received funding from the European Union’s Horizon 2020 research and innovation program under Grant agreement No. 668648.

List of Sense-Cog Consortium: Geir Bertelsen1,2, Suzanne Cosh3, Audrey Cougnard-Grégoire3, Piers Dawes4, Cécile Delcourt3, Fofi Constantinidou5, Catherine Helmer3, M. Arfan Ikram 6,7, Caroline CW Klaver 6,8, Iracema Leroi 9, Asri Maharani 9,10, Magda Meester-Smor 6,8, Unal Mutlu 6,8, Virginie Nael3,11,12, Neil Pendleton 9,10, Henrik Schirmer 13, Gindo Tampubolon 14, Henning Tiemeier 6,15, Therese von Hanno 16,17.

1: UiT The Arctic University of Norway, Department of Community Medicine, Faculty of Health Sciences, N-9037 Tromsø, Norway

2: University Hospital of North Norway, Department of Ophthalmology, N-9038 Tromsø, Norway

3: Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, team LEHA, UMR 1219, F-33000 Bordeaux, France

4: University of Manchester, Manchester Centre for Audiology and Deafness, School of Health Sciences, Manchester, UK

5: University of Cyprus, Department of Psychology & Center for Applied Neuroscience, Nicosia, Cyprus

6: Erasmus Medical Centre, Department of Epidemiology, Rotterdam, The Netherlands

7: Erasmus Medical Centre, Departments of Neurology and Radiology, Rotterdam, The Netherlands

8: Erasmus Medical Centre, Department of Ophthalmology, Rotterdam, The Netherlands

9: University of Manchester, Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK

10: University of Manchester, Academic Health Science Centre, Manchester, UK

11: Sorbonne University, UMPC University of Paris 06, INSERM, CNRS, Vision Institute, F-75012 Paris, France

12: R&D Life and Vision Science, Essilor International, F-75012 Paris, France

13: UiT-The Arctic University of Norway, Department of Clinical Medicine, Cardiovascular research Group-UNN, N-9037 Tromsø, Norway

14: University of Manchester, Global Development Institute, Manchester, UK

15: Erasmus Medical Centre, Department of Psychiatry, Rotterdam, The Netherlands

16: UiT-The Arctic University of Norway, Department of Clinical Medicine, Faculty of Health Sciences, N-9037 Tromsø, Norway

17: Nordland Hospital, Department of Ophthalmology, N-8092 Bodø, Norway

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Correspondence to Virginie Naël.

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Authors V. Naël and AC Scherlen are Essilor International employees. Author C. Delcourt is a consultant for Bausch & Lomb, Novartis, and Laboratoires Théa and has received research grants from Laboratoires Théa. The authors K. Pérès, JF. Dartigues, L. Letenneur, H. Amieva, A. Arleo, I. Carrière, C. Tzourio, C. Berr and C. Helmer declare that they have no conflict of interest.

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Naël, V., Pérès, K., Dartigues, JF. et al. Vision loss and 12-year risk of dementia in older adults: the 3C cohort study. Eur J Epidemiol 34, 141–152 (2019).

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  • Vision loss
  • Dementia
  • Cohort study
  • Epidemiology