Supplementary Material for: The Association of Cognitive and Visual Function in a Nationally Representative Study of Older Adults in India

<b><i>Introduction:</i></b> Due to population aging, India is poised to experience a large increase in the burden of both dementia and vision impairment (VI). Prior studies from other settings suggest that VI may be a modifiable risk factor for cognitive decline and dementia. However, to date, no studies have examined the association of impaired visual acuity and cognition in India. <b><i>Methods:</i></b> A total of 3,784 participants in wave 1 of the population-based Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India underwent visual acuity testing and a cognitive test battery. Multivariable linear regression was used to model the cross-sectional associations of mild (&lt;6/12–6/16), moderate (&lt;6/18–6/60), and severe visual acuity impairment/blindness (&lt;6/60) with cognitive performance scores corresponding to total cognition, orientation, memory, language/fluency, executive function, and informant-reported cognitive status. Models were adjusted for demographic, socioeconomic, and health characteristics. <b><i>Results:</i></b> The weighted percentage of participants with any VI was 52.6%. VI was independently associated with lower cognitive scores across all domains, even after adjustment for known dementia risk factors. In fully adjusted models of total cognition (mean score: 130.7), mild, moderate, and severe VI/blindness were associated with a significant change of −3.5 (95% CI: −6.3, −0.6), −8.2 (95% CI −10.5, −5.6), and −16.8 (95% CI −22.3, −11.3) units, respectively. A dose-response association between level of VI and cognitive function was observed for all cognitive outcomes except for language/fluency domain scores. Associations were robust when cognitive tests dependent on visual function were excluded. Across each fully adjusted model of total, domain-specific, and informant-reported cognitive performance, moderate VI was equivalent to 5–9 years of cognitive aging. <b><i>Discussion/Conclusion:</i></b> This study illustrates that VI is cross-sectionally associated with lower cognitive performance, largely in a dose-response pattern, across various cognitive domains in the Indian population. These findings are important for informing future longitudinal and interventional studies.