Association of Sensory Impairments With Cognitive Decline and Depression Among Older Adults in China

Importance Sensory impairments may heighten the risk of premature brain aging. Little is known regarding the association of sensory impairments with cognitive function and depression in China. Objective To examine the association of visual and/or hearing impairments with cognitive decline and depression. Design, Setting, and Participants This cross-sectional study used the data from 18038 respondents to the 2015 survey of the China Health and Retirement Longitudinal Study, a nationally representative survey of adults aged 45 years or older and their spouses. Exposures The presence of sensory impairments was identified by self-reported assessment of visual and/or hearing functions. Main Outcomes and Measures Overall, 3 composite measures were used to assess the respondents' cognitive performance, including episodic memory, mental intactness, and global cognitive function. Depression was examined using the 10-item Center for Epidemiological Studies-Depression scale score. Multiple generalized linear regression models, adjusting for self-reported sociodemographic characteristics, health behaviors, chronic conditions, and participants' overall health, were used. Results Of 18038 respondents, 9244 (51.2%) were women. The mean (SD) age was 59.9 (9.7) years. Respondents with visual impairment had poorer episodic memory (beta = -0.12; 95% CI, -0.19 to -0.05) and global cognition (beta = -0.16; 95% CI, -0.31 to -0.02) and a greater risk of depression (odds ratio, 1.78; 95% CI, 1.59 to 1.99) than those without visual impairment. Respondents with hearing impairment had poorer episodic memory (beta = -0.24; 95% CI, -0.30 to -0.18), mental intactness (beta = -0.19; 95% CI, -0.28 to -0.10), and global cognition (beta = -0.43; 95% CI, -0.55 to -0.31) as well as a greater risk of depression (odds ratio, 1.57; 95% CI, 1.44 to 1.70) than those without hearing impairment. People who reported dual sensory impairment performed worse on all of the aforementioned outcome measures (episodic memory: beta = -0.23; 95% CI, -0.31 to -0.14; mental intactness: beta = -0.13; 95% CI, -0.27 to -0.0003; global cognition: beta = -0.37; 95% CI, -0.55 to -0.19; depression: odds ratio, 2.19; 95% CI, 1.90 to 2.52). Conclusions and Relevance In this study, visual and hearing impairments were independently and together associated with poorer cognitive and depression outcomes. A more comprehensive and integrated system of care, covering vision, hearing, and cognition, is needed in China's health care system to address age-related sensory impairments. This cross-sectional study examines the association of visual and/or hearing impairments with cognitive decline and depression among older adults in China. Question Are visual and/or hearing impairments associated with cognitive decline and depression? Findings In this cross-sectional study of 18038 participants aged 45 years or older in China, visual impairment was associated with worse performance in episodic memory and global cognition as well as with worse depression symptoms. Hearing impairment was also associated with poorer performance in episodic memory, mental intactness, and global cognition. Meaning In this study, visual and/or hearing impairments were associated with higher risks of cognitive decline and depression among middle-aged and older adults in China.