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

Article type: Research Article

Authors: Mahanna-Gabrielli, Elizabeth^a | Kuwayama, Sayaka^b | Tarraf, Wassim^c | Kaur, Sonya^a | DeBuc, Delia Cabrera^d | Cai, Jianwen^e | Daviglus, Martha L.^f | Joslin, Charlotte E.^g | Lee, David J.^a | Mendoza-Santiesteban, Carlos^d | Stickel, Ariana M.^b | Zheng, Diane^a | González, Hector M.^b | Ramos, Alberto R.^{a; *}

Affiliations: [a] University of Miami Miller School of Medicine, Miami, FL, USA | [b] University of California, San Diego, La Jolla, CA, USA | [c] Wayne State University, Detroit, MI, USA | [d] Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA | [e] University of North Carolina, Chapel Hill, NC, USA | [f] University of Illinois at Chicago, Chicago, IL, USA | [g] University of Illinois, Chicago, IL, USA

Correspondence: [*] Correspondence to: Alberto R. Ramos, MD, MS, FAASM, FAAN, 1120 NW 14th Street, Suite 1350, Miami, FL 33136, USA. Tel.: +1 305 243 8393; E-mail: aramos@med.miami.edu.

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, health disparities, Hispanic/Latinos, sleep disorders, visual impairment

DOI: 10.3233/JAD-221073

Journal: Journal of Alzheimer's Disease, vol. 92, no. 4, pp. 1257-1267, 2023