Association of Visual Impairment With Neuropsychiatric Symptoms of Dementia

Background: Visual impairment is a risk factor for cognitive impairment and hallucinations in older adults, but associations with other neuropsychiatric symptoms (NPS) of dementia have not been examined. Methods: We analyzed cross-sectional data from the Aging, Demographics, and Memory Study (ADAMS), a nationally representative sample of the US population aged 70+ years. Vision was measured by self-report and using a near card. Dementia was ascertained through cognitive testing with expert consensus, and NPS were screened using the Neuropsychiatric Inventory. We used logistic regression to measure the association between visual impairment and prevalent NPS adjusting for sociodemographic factors and comorbidities. Analyses incorporated sample weights to account for the complex survey design of ADAMS. Results: Of 624 participants with dementia, 332 (53%) had self-reported visual impairment and 193 (31%) had best-corrected acuity of 20/40 or worse. In unadjusted models, self-reported visual impairment was significantly associated with hallucinations (OR 2.88; 95% CI 1.12–7.44), depression (OR 2.79; 95% CI 1.7–4.57), and agitation (OR 1.61; 95% CI 1.05–2.48). Reduced visual acuity was associated with hallucinations (OR 10.13; 95% CI 2.93–34.98), psychosis (OR 6.69, 95% CI 2.53–17.7), and mania (OR 5.92, 95% CI 1.77–19.82). However, these associations did not remain significant after covariate adjustment. Conclusions: Visual impairment was associated with hallucinations, depression, agitation, psychosis, and mania in patients with dementia, but at least some of this relationship is explained by age, comorbidities, and other factors.