Longitudinal patterns of visual impairment and trajectories of cognitive function and depressive symptoms in older adults: the moderating role of social vulnerability.

BACKGROUND

Most studies treat visual impairment (VI) as a static, binary exposure. Less is known about whether distinct longitudinal VI patterns are differentially associated with later cognitive and affective trajectories, and whether social vulnerability modifies these associations.

OBJECTIVE

To examine whether longitudinal VI patterns classified by directionality and chronicity are differentially associated with trajectories of cognitive function and depressive symptoms, and whether social vulnerability modifies these associations.

METHODS

We analyzed data from 15,393 older adults in the Health and Retirement Study. VI was classified into four patterns (Never, Worsening, Improving, Persistent) based on self-reported visual status in 2006 and 2008. Cognitive function and depressive symptoms were assessed biennially from 2008 to 2020 and 2022, respectively. Linear mixed-effects models estimated trajectories adjusting for demographic, socioeconomic, and health covariates. Three-way interactions tested effect modification by loneliness, living alone, and partner status. Benjamini-Hochberg false discovery rate correction was applied to the three-way interaction analyses.

RESULTS

All VI groups had lower baseline cognitive scores and higher depressive symptoms than Never VI. The Improving VI group showed the steepest cognitive decline (β = -0.051/wave, 95% CI: -0.100 to -0.002, p = 0.040). Persistent VI had the highest baseline depressive symptoms but showed a relative decline over follow-up (β = -0.035/wave, p = 0.002). After correction for multiple testing, partner status attenuated cognitive decline in the Improving VI group, and partner status, living arrangement, and loneliness modified selected depressive symptom trajectories.

CONCLUSION

Longitudinal VI patterns carry distinct prognostic significance for cognitive and affective trajectories. Improving VI was associated with modestly faster subsequent cognitive decline (cumulative difference approximately 0.31 points over 12 years, or 1.1% of the cognitive scale), warranting continued monitoring even after apparent visual improvement. Social vulnerability modified selected VI-related trajectories, supporting the need for future research on integrated sensory and social intervention strategies.