{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T05:04:16Z","timestamp":1785301456652,"version":"3.55.0"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All VI groups had lower baseline cognitive scores and higher depressive symptoms than Never VI. The Improving VI group showed the steepest cognitive decline (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22120.051\/wave, 95% CI: \u22120.100 to \u22120.002,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.040). Persistent VI had the highest baseline depressive symptoms but showed a relative decline over follow-up (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22120.035\/wave,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.002). 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u202fyears, 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1899072","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T04:50:15Z","timestamp":1785300615000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Longitudinal patterns of visual impairment and trajectories of cognitive function and depressive symptoms in older adults: the moderating role of social vulnerability"],"prefix":"10.3389","volume":"14","author":[{"given":"Xia","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University-Ziyang Hospital, Ziyang Central Hospital","place":["Ziyang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Feng","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University-Ziyang Hospital, Ziyang Central Hospital","place":["Ziyang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Peng","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University-Ziyang Hospital, Ziyang Central Hospital","place":["Ziyang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital of Sichuan University-Ziyang Hospital, Ziyang Central Hospital","place":["Ziyang, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting-fan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Affiliated Hospital of Southwest Medical University","place":["Lu Zhou, Sichuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e1221","DOI":"10.1016\/S2214-109X(17)30393-5","article-title":"Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis","volume":"5","author":"Flaxman","year":"2017","journal-title":"Lancet Glob Health"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1001\/jamaophthalmol.2018.2493","article-title":"Longitudinal associations between visual impairment and cognitive functioning: the Salisbury eye evaluation Study","volume":"136","author":"Zheng","year":"2018","journal-title":"JAMA Ophthalmol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1093\/aje\/kwp453","article-title":"Untreated poor vision: a contributing factor to late-life dementia","volume":"171","author":"Rogers","year":"2010","journal-title":"Am J Epidemiol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.ophtha.2006.10.006","article-title":"Depression and anxiety in visually impaired older people","volume":"114","author":"Evans","year":"2007","journal-title":"Ophthalmology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1001\/jamaophthalmol.2013.2597","article-title":"Association between depression and functional vision loss in persons 20 years of age or older in the United States, NHANES 2005-2008","volume":"131","author":"Zhang","year":"2013","journal-title":"JAMA Ophthalmol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.1111\/jgs.15506","article-title":"American Geriatrics Society and National Institute on Aging bench-to-bedside conference: sensory impairment and cognitive decline in older adults","volume":"66","author":"Whitson","year":"2018","journal-title":"J Am Geriatr Soc"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/j.tics.2009.06.005","article-title":"Perceived social isolation and cognition","volume":"13","author":"Cacioppo","year":"2009","journal-title":"Trends Cogn Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1001\/jamainternmed.2021.6990","article-title":"Association between cataract extraction and development of dementia","volume":"182","author":"Lee","year":"2022","journal-title":"JAMA Intern Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1016\/j.socscimed.2011.11.028","article-title":"Loneliness, health, and mortality in old age: a national longitudinal study","volume":"74","author":"Luo","year":"2012","journal-title":"Soc Sci Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1097\/PSY.0b013e31827f09cd","article-title":"Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the English longitudinal Study of ageing","volume":"75","author":"Shankar","year":"2013","journal-title":"Psychosom Med"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"5797","DOI":"10.1073\/pnas.1219686110","article-title":"Social isolation, loneliness, and all-cause mortality in older men and women","volume":"110","author":"Steptoe","year":"2013","journal-title":"Proc Natl Acad Sci USA"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"e1000316","DOI":"10.1371\/journal.pmed.1000316","article-title":"Social relationships and mortality risk: a meta-analytic 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Meas"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"S93","DOI":"10.1093\/geronb\/60.2.S93","article-title":"The impact of childhood and adult SES on physical, mental, and cognitive well-being in later life","volume":"60","author":"Luo","year":"2005","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1001\/jamainternmed.2013.1868","article-title":"Hearing loss and cognitive decline in older adults","volume":"173","author":"Lin","year":"2013","journal-title":"JAMA Intern Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1001\/jamainternmed.2013.1880","article-title":"The prevalence of concurrent hearing and vision impairment in the United States","volume":"173","author":"Swenor","year":"2013","journal-title":"JAMA Intern Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v067.i01","article-title":"Fitting linear mixed-effects models using lme4","volume":"67","author":"Bates","year":"2015","journal-title":"J Stat Softw"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v082.i13","article-title":"lmerTest package: tests in linear mixed effects models","volume":"82","author":"Kuznetsova","year":"2017","journal-title":"J Stat Softw"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1093\/aje\/kwi187","article-title":"When is baseline adjustment useful in analyses of change? 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