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Cataract, Cataract Surgery, and Risk of Incident Dementia: A Prospective Cohort Study of 300,823 Participants

  • Author Footnotes
    1 L-ZM and Y-RZ contributed equally to this work as joint first authors.
    Ling-Zhi Ma
    Footnotes
    1 L-ZM and Y-RZ contributed equally to this work as joint first authors.
    Affiliations
    Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China

    Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
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  • Author Footnotes
    1 L-ZM and Y-RZ contributed equally to this work as joint first authors.
    Ya-Ru Zhang
    Footnotes
    1 L-ZM and Y-RZ contributed equally to this work as joint first authors.
    Affiliations
    Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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  • Yu-Zhu Li
    Affiliations
    Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
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  • Ya-Nan Ou
    Affiliations
    Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
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  • Liu Yang
    Affiliations
    Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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  • Shi-Dong Chen
    Affiliations
    Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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  • Qiang Dong
    Affiliations
    Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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  • Jian-Feng Feng
    Affiliations
    Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China

    Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education, Fudan University, Shanghai, China

    Fudan ISTBI—ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China

    Department of Computer Science, University of Warwick, Coventry, United Kingdom
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  • Wei Cheng
    Affiliations
    Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China

    Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China

    Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education, Fudan University, Shanghai, China

    Fudan ISTBI—ZJNU Algorithm Centre for Brain-Inspired Intelligence, Zhejiang Normal University, Jinhua, China
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  • Lan Tan
    Correspondence
    Lan Tan, M.D., Ph.D.
    Affiliations
    Department of Neurology, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
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  • Jin-Tai Yu
    Correspondence
    Address correspondence to Jin-Tai Yu, M.D., Ph.D.
    Affiliations
    Department of Neurology and National Center for Neurological Disorders, Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Shanghai Medical College, Fudan University, Shanghai, China
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  • Author Footnotes
    1 L-ZM and Y-RZ contributed equally to this work as joint first authors.

      Abstract

      Background

      Visual impairment and interventions to preserve vision may impact dementia risk. Thus, we aimed to explore the associations of cataract and cataract surgery with the risk of dementia.

      Methods

      Prospective data from 300,823 individuals in the UK Biobank were used. We used multivariate Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals for associations, with healthy control subjects as a reference. The same method was used to explore the effects of surgery on dementia outcomes of patients with cataract. One-way analysis of variance was performed to examine the associations between cataract and brain morphometric measures.

      Results

      After a mean follow-up of 8.4 years, 3226 individuals were diagnosed with dementia. The nonsurgical cataract group had increased risk of all-cause dementia (HR, 1.214; 95% CI, 1.012–1.456; p = .037) and Alzheimer’s disease (HR, 1.479; 95% CI, 1.105–1.981; p = .009). However, there was no difference in dementia risk between the cataract surgery group and the healthy control group. Cataract surgery was associated with decreased risk of all-cause dementia (HR, 0.632; 95% CI, 0.421–0.947; p = .026) and Alzheimer’s disease (HR, 0.399; 95% CI, 0.196–0.812; p = .011) compared with the nonsurgical group. Additionally, cataract was negatively associated with cortical volumes, aging-related subcortical volumes, and fractional anisotropy of white matter fibers.

      Conclusions

      Cataract patients who did not receive surgical treatment had an increased risk of dementia. However, cataract surgery could reverse the risk of dementia. Our findings on brain structures and pathways in patients with cataract also provided evidence for the mechanism. Reversible visual impairment, such as cataract, is a promising modifiable risk factor for dementia.

      Keywords

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