The association between dual sensory impairment and dementia: A systematic review and meta-analysis

Abstract

Background

Sensory impairments have been linked to dementia. However, the impact of dual sensory impairment (DSI), combining both vision impairment and hearing impairment, on dementia has shown inconsistent results.

Objective

To systematically review the evidence on the association DSI and dementia.

Methods

A systematic literature search was conducted using MEDLINE, EMBASE, and the Cochrane Library databases. Included studies were prospective or retrospective cohort studies and a case-control study. The primary outcome was the onset of dementia or its various subtypes, including Alzheimer's disease (AD) and vascular dementia (VaD). Effect sizes, including hazard ratios (HRs), were pooled through a random-effects model.

Results

A total of 11 observational studies with 346,659 participants were included. DSI was significantly associated with the incidence of dementia compared to no sensory impairment (9 studies; HR: 1.46; 95% confidence interval [CI]: 1.29–1.65). Among subtypes of dementia, DSI was associated with AD onset (4 studies; HR: 2.07; 95% CI: 1.45–2.94); however, this association was not found in VaD (2 studies; HR: 1.65; 95% CI: 0.96–2.85).

Conclusions

These findings suggest that DSI is significantly associated with an increased risk of dementia. Further research is required to identify preventive strategies to decrease the incidence of dementia in individuals with sensory impairment.

Keywords

Alzheimer's disease dementia dual sensory impairment hearing impairment vision impairment

Introduction

Globally, over 55 million individuals are currently diagnosed with dementia, with nearly 10 million new cases emerging annually.¹ The condition exerts its impact beyond the affected individuals, placing physical, psychological, social, and economic strains on caregivers, families, and the broader community. Given the current insufficiency of therapeutic options for dementia, it is important to identify factors that could potentially delay or prevent the onset of dementia.

As the global population ages, there is a dramatic increase in the prevalence of sensory impairments, including vision impairment (VI) and hearing impairment (HI). Currently, it is estimated that at least 2.2 billion people worldwide suffer from VI, whereas more than 1.5 billion people are affected by HI.^2,3 These sensory impairments significantly impact daily activities and impose a considerable burden on society.^4–7 In the elderly population, VI and HI are associated with increased risk of falls,^8,9 reduced social participation,^10,11 and depression.^12,13 Previous studies have reported that VI and HI are each independently associated with an increased risk of dementia.^14–16

On the other hand, the impact of dual sensory impairment (DSI), combining both VI and HI, on dementia risk has not yet been clearly established. Some studies have shown that DSI is significantly associated with the risk of cognitive decline or cognitive impairment in elderly people,^17–22 whereas others have reported no association between DSI and dementia.^18,23 Since 2020, an increasing number of prospective cohort studies have explored the association between DSI and the incidence of dementia.^23–26 However, no systematic review and meta-analysis have assessed the association between DSI and dementia. Therefore, our study focuses on observational studies to find the potential pathway connecting DSI and the development of dementia. Considering the uncertainty in the field, this systematic review and meta-analysis aims to evaluate the impact of DSI on the development of dementia compared to no sensory impairment. Furthermore, this study also assesses the association between DSI and subtypes of dementia.

Methods

Search strategy

This systematic review and meta-analysis adhered to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines and was registered with PROSPERO (CRD42024526584). A literature search was conducted on MEDLINE, EMBASE, and the Cochrane Library databases, and through reference list cross-checking of previous articles from inception to 8 July 2024 (Supplemental Table 1).

Study selection

The selection of all relevant studies was conducted, with duplicates excluded and a screening process applied. Two authors (YY, YH) independently examined the titles and abstracts of all articles, followed by their full texts to determine the eligibility for inclusion. Our inclusion criteria were: (1) cohort studies (prospective or retrospective) or case-control studies; (2) studies involving populations comprised of adults aged at least 18 years; (3) populations defined as individuals without dementia at baseline. We included studies that identified sensory impairment through self-reported assessments, sensory function examinations, and the International Classification of Diseases (ICD). In this study, the primary outcome was the development of dementia or its various subtypes. The outcomes for studies were identified based on accepted clinical diagnostic criteria for dementia and its specific subtypes, and their cut-off scores from cognitive function tests. The exclusion criteria were: (1) case reports, case series, cross-sectional studies, qualitative studies, reviews, conference abstracts, meta-analyses or letters; (2) studies with no comparison group. In this study, there were no limits on language and date of publication. Finally, the quality of the remaining studies was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS).²⁷

Data extraction

A standardized data collection template was utilized for data extraction by two independent reviewers (YY, YH). The following data were extracted: first author name, publication year, country, study design, sample size, number of dementia cases, follow-up duration, age at baseline, gender, dementia type, methods used to assess VI and HI, and methods for identifying dementia.

Risk of bias assessment

The study quality was independently assessed by two reviewers (YY, YH) using the NOS, which is a risk of bias assessment tool for non-randomized controlled studies.²⁷ The NOS is an 8-item checklist categorized into 3 dimensions (selection, comparability, and outcome). In the total score range of 0 to 9, only studies achieving a score of 7 or above are regarded as high quality.

Grading of evidence

The overall quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Utilizing this framework, the quality of the evidence is categorized as high, moderate, low, or very low, with evidence from observational studies being initially classified as low.

Statistical analysis

The meta-analysis was performed using STATA/SE 15.0 (STATA Corporation, College Station, TX, USA), considering a p-value of less than 0.05 as indicative of statistical significance. Meta-regression analyses were also performed for sample size, follow-up period, methods of sensory assessment, study design, mean age, gender, and education as predictors. In this study, the primary outcome was the development of dementia during follow-up. Given the available data, maximally adjusted hazard ratios and risk ratios were pooled through a random-effects model to ascertain the overall risks of dementia in individuals with DSI compared to those without any sensory impairment. Meta-analyses were performed separately for specific types of dementia, including Alzheimer's disease (AD) and vascular dementia (VaD). In a similar manner, the overall hazards of all-cause dementia in individuals with single sensory impairment (SSI) were evaluated in comparison to those without any sensory impairments.

The I² test was performed to determine study heterogeneity. Heterogeneity is categorized as low, moderate, and substantial at I² of 25%, 50%, and 75%, respectively.²⁸ Publication bias was assessed by funnel plots for asymmetry and Egger's Test. Trim and Fill analysis was performed to evaluate the publication bias via funnel plot asymmetry and Egger's Test.

Results

Study characteristics

A total of 2569 studies were identified. After excluding duplicates, the titles and abstracts of 2255 studies were screened and 64 studies were identified for full-text review. Subsequently, 10 cohort studies^{18,23–26,29–33} and 1 case-control study²¹ were included in this systematic review and meta-analysis (Figure 1). As shown in Table 1, the number of participants varied significantly across the cohort studies, ranging from 2051 to 113,511. There is also one case-control study that included 122,730 participants. We conducted a cross-reference check of previous articles, but all identified articles were already retrieved via database searches. The quality of studies for this meta-analysis was assessed using the NOS. In the analysis of the included studies, the NOS scores were as follows: 9 points for 1 study,³³ 8 points for 2 studies,^29,32 7 points for 4 studies,^18,24,26,31 and 6 points for 4 studies.^21,23,25,30 The scoring criteria are detailed in Supplemental Table 2. In this study, additional data were directly obtained from the authors of the original articles.

Figure 1.

Flowchart of included studies.

Table 1.

Characteristics of included studies.

First Author, year	Country	Design	Gender, females, %	Age, years	Follow-up, years	Total population	Case	Dementia type	Identification methods			Adjustment for potential confounders
First Author, year	Country	Design	Gender, females, %	Age, years	Follow-up, years	Total population	Case	Dementia type	Dementia	Hearing impairment	Visual impairment	Adjustment for potential confounders
Hwang, 2020 ²⁴	USA	cohort	N/A	≥ 75	8	2051	321	D	DSM-4	self-reported	self-reported	age, gender, race, education, income, body mass index, alcohol intake, smoking status, physical activity, cardiovascular disease, cerebrovascular disease, diabetes, hypertension, clinic site, treatment status, and APOE
							220	A
							86	VaD
Maharani, 2020 ¹⁸	USA	cohort	55.4	57.8 ± 6.2	18	19618	951	D	TICS	self-reported	self-reported	age, gender, marital status, education, wealth, smoking and drinking behavior, physical exercise, depression scores and number of comorbidities
Maruta, 2020 ²⁵	Japan	cohort	79.4	78.9 ± 6.1	8	2190	1153	D	Dementia Scale	self-reported	self-reported	age, gender, care-need level, and degree of independent daily living for disabled older adults
Kuo, 2021 ²⁶	USA	cohort	58.3	≥ 65	7	4546	N/A	D	three information from NHATS	self-reported	self-reported	age, gender, levels of education, race/ethnicity, smoking history, hypertension, diabetes, stroke, heart attack, heart disease, lung disease, and cancer
Hu, 2022 ³²	UK	cohort	54.4	56.8 ± 8.09	11.1	113511	1135	D	ICD-9 and ICD-10	SRT of −5.5 dB or over	Presenting VA worse than 0.3 LogMAR units	age, gender, ethnicity, education, Townsend Index, smoking status, physical activity, history of hypertension, diabetes and depression, self-rated health status and APOE ε4 allele
Hwang, 2022 ³¹	USA	cohort	58.2	74.6 ± 4.8	8	2927	307	D	DSM-4	self-reported	self-reported	age, gender, race, education, body mass index, alcohol intake, smoking status, physical activity, cardiovascular disease, cerebrovascular disease, diabetes, hypertension, total cholesterol level, cohort, clinic site, and APOE genotype
							153	A
							144	VaD
Oh, 2023 ²⁹	Korea	cohort	N/A	≥ 65	7	55800	8289	D	ICD-10 & the prescription of anti-dementia medication	Inability to hear sounds above 40 dB in both ears	Presenting VA less than 0.3 in both eyes	age, gender, insurance percentile, comorbidity, smoking, alcohol, and activity
Kim, 2024 ³⁰	Japan	cohort	57.9	80.4 ± 7.5	1.8	14186	1194	AD	ICD-10	ICD-10	ICD-10	age, gender, long-term care needs levels, self-reliance levels, and comorbidities
Byeon, 2021 ²³	Korea	cohort	N/A	58–101	6	6520	245	D	DSM-IV	self-reported	self-reported	age, gender, education, income, modified Cumulative, Illness Rating Scale, body mass index, alcohol, smoking, caffeine, exercise, depression, and Medical Outcomes Study Social Support Survey
Byeon, 2021 ²³	Korea	cohort	N/A	58–101	6	6520	N/A	AD	DSM-IV	self-reported	self-reported	age, gender, education, income, modified Cumulative, Illness Rating Scale, body mass index, alcohol, smoking, caffeine, and exercise
Dintica, 2023 ³³	Sweden	cohort	N/A	≥ 60	10	2579	381	D	DSM-IV-TR	self-reported, ICD	reading acuity test	age, gender, education, smoking, alcohol consumption, ADL limitations, diabetes, depression, cardiovascular disease, and cerebrovascular disease.
Michalowsky, 2019 ²¹	Germany	case-control	61.0	81	5	122730	61364	D	ICD-10	ICD-10	ICD-10	age, gender, health insurance coverage, and the following comorbidities: diabetes mellitus, ischemic heart disease, stroke, intracranial injury, epilepsy, Parkinson's disease, and depression.

D: dementia; AD: Alzheimer's disease; VaD: vascular dementia; DSM: the Diagnostic and Statistical Manual of Mental Disorders; TICS: Telephone Interview for Cognitive Status; ICD: the International Classification of Diseases; NHATS: National Health and Aging Trends Study; VA: visual acuity; SRT: speech recognition threshold.

Table 1 details the summary of study characteristics. Four studies^18,24,26,31 were conducted in North America, 4 studies^23,25,29,30 in Asia, and 3 studies^21,32,33 in Europe. The follow-up time ranged from 1.8 to 18 years. Visual impairment was defined by visual acuity testing in 3 studies,^29,32,33 by self-report in 6 studies,^{18,23–26,31} and by ICD codes in 2 studies.^21,30 Hearing impairment was defined by hearing tests in 2 studies,^29,32 by self-report in 6 studies,^{18,23–26,31} by ICD codes in 2 study,^21,30 and by both self-report and ICD codes in 1 study.³³

Nine cohort studies^{18,23–26,29,31–33} and one case-control study²¹ investigated the association between DSI and all-cause dementia, 4 studies^23,24,30,31 investigated the association between DSI and incident AD, and only 2 studies^24,31 investigated the association between DSI and incident VaD. The diagnosis of outcomes for studies was identified based on the ICD codes in 4 studies,^21,29,30,32 and Diagnosis and Statistical Manual of Mental Disorders (DSM) criteria in 4 studies.^23,24,31,33 Maharani et al. used the Telephone Interview for Cognitive Status (TICS) and categorized 0 to 6 points out of 27 points as probable dementia.¹⁸ Maruta et al. utilized the Dementia Scale developed by the Japanese Ministry of Health, which is based on the degree of independence in daily living activities.²⁵ Kuo et al. used the classification by dementia status in National Health and Aging Trends Study (NHATS), which includes self-reported diagnosis information and cognitive test in 3 domains (memory, orientation, and executive function).²⁶

Dual sensory impairment and dementia

Among 10 cohort studies, two studies^24,31 had 3 separate arms stratified by subtypes of dementia, and one solely focused on AD.³⁰ DSI was significantly associated with the incidence of dementia compared to no sensory impairment (9 studies^{18,23–26,29,31–33}; hazard ratio (HR): 1.46; 95% confidence interval (CI): 1.29–1.65: I²= 40.7%) (Figure 2A). Subgroup analysis showed that the association between DSI and incident dementia was similar across methods of vision and hearing assessment (Supplemental Figure 1A). There were significant associations in all regions (North America; HR: 1.67; 95% CI: 1.25–2.22; I²= 65.6%, Asia; HR: 1.50; 95% CI: 1.32–1.69; I²= 0%, Europe; HR: 1.68; 95% CI: 1.27–2.22; I²= 0%) (Supplemental Figure 1B). Subgroup analysis by the quality of the study showed that there were significant associations for both high-quality (7 points and above) and low to moderate-quality (6 points or less) studies (Supplemental Figure 1C). Among subtypes of dementia, DSI was associated with the incidence of AD (4 studies^23,24,30,31; HR: 2.07; 95% CI: 1.45–2.94; I²= 50.6%), but this association was not observed in VaD (2 studies^24,31; HR: 1.65; 95% CI: 0.96–2.85; I²= 0%). (Figure 2B and C) Asymmetry in the original funnel plot suggested the possibility of publication bias. (Figure 3A) Egger's test suggested no significant publication bias (p = 0.057). Considering the Egger's test result and the asymmetry in the original funnel plot, we performed the trim and fill analysis to further investigate the potential publication bias. (Figures 2A and 3A) In the meta-regression analysis, none of the variables were associated with the above results (Supplemental Table 3A).

Figure 2.

(A) Dual sensory impairment and incidence of dementia. Forest plot shows the hazard ratios for development of dementia across study follow-up in participants with dual sensory impairment compared to no sensory impairment. In the analysis, four studies were imputed using the Trim and Fill method to account for potential publication bias. (B) Dual sensory impairment and incidence of Alzheimer's disease. Forest plot shows the hazard ratios for development of Alzheimer's disease across study follow-up in participants with dual sensory impairment compared to no sensory impairment. (C) Dual Sensory Impairment and Incidence of Vascular Dementia. Forest plot shows the hazard ratios for development of vascular dementia across study follow-up in participants with dual sensory impairment compared to no sensory impairment.

Figure 3.

(A) Funnel plot for dementia hazard ratio in participants with dual sensory impairment. Four studies were imputed using the Trim and Fill method to account for potential publication bias. (B) Funnel plot for dementia hazard ratio in participants with single sensory impairment.

Among 9 studies for which the risk ratio (RR) could be calculated, eight were cohort studies,^{18,23–26,29,32,33} and only one was a case-control study.²¹ Supplemental Figure 2 showed that DSI was significantly associated with increased risk of dementia compared to no sensory impairment (RR: 2.22; 95% CI: 1.49–3.29; I²= 99.0%). The meta-regression analysis with follow-up periods as the predictor resulted in a coefficient of 0.10 (SE = 0.30; p = 0.01). None of the other variables, including study design (coef = −0.83; SE = 0.48; p = 0.12), were significantly associated with the results.

Single sensory impairment and dementia

Out of 9 studies,^{18,23–26,29,31–33} the HR on either VI or HI were obtained from 4 studies,^18,23,24,31 whereas the results for only VI and only HI were obtained from 6 studies.^{24–26,29,32,33} Figure 4 shows that SSI was significantly associated with the incidence of dementia compared to no sensory impairment (either VI or HI; HR: 1.30; 95% CI: 1.05–1.59; I²= 59.0%, only VI; HR: 1.29; 95% CI: 1.16–1.43; I²= 37.8%, only HI; HR: 1.18; 95% CI: 1.09–1.26; I²= 31.6%). Visual inspection of the funnel plot (Figure 3B) and Egger's test suggested no publication bias (p = 0.920). In the meta-regression analysis, none of the variables were associated with the above results (Supplemental Table 3B).

Figure 4.

Single sensory impairment and incidence of dementia. Forest plot is stratified by three categories: either vision impairment (VI) or hearing impairment (HI), VI only, and HI only. Additionally, the forest plot shows the hazard ratios for development of dementia across study follow-up in participants with single sensory impairment compared to no sensory impairment.

Grading of recommendations assessment, development and evaluation (GRADE)

According to the GRADE approach, the overall quality of evidence was appraised as very low to low due to observational studies (Supplemental Table 4). However, most of the certainty retained its default level for observational studies without any identified downgrade factors.

Discussion

To the best of our knowledge, this is the first systematic review and meta-analysis to investigate the association between DSI and dementia. In this systematic review and meta-analysis of 10 cohort studies^{18,23–26,29–33} with 223,929 participants and 1 case-control study with 122,730 participants,²¹ DSI was associated with a 46% increased risk of dementia compared to no sensory impairment. Among subtypes of dementia, DSI was significantly associated with the incidence of AD, whereas VaD showed no association. Additionally, SSI was associated with an increased dementia risk. Individuals with only VI showed a 29% greater risk for dementia compared to those with no sensory impairment, while those with only HI demonstrated a 16% increased risk.

The relationship between visual and cognitive impairments, including dementia, has been widely reported in the literature. A previous meta-analysis reported that cataracts and diabetic retinopathy respectively increased the risk of dementia.³⁴ Our group demonstrated that cataract surgery improved cognitive function scores in patients with mild cognitive impairment.³⁵ Additionally, another meta-analysis by Shang et al. reported that VI increased the risk of dementia and cognitive impairment in elderly people.³⁶ Meanwhile, Ying et al. showed that HI is also a significant risk factor for dementia in older adults.³⁷ In addition, a previous meta-analysis reported that the use of hearing aids was associated with a lower risk of long-term cognitive decline.³⁸ However, only a limited number of reports currently indicated the association between DSI and dementia and cognitive impairment. In this meta-analysis, we investigated the impact of DSI and SSI on the development of dementia. All studies included in this meta-analysis have been published since 2019.

This meta-analysis found that DSI was significantly associated with an increased risk of dementia compared to no sensory impairment. Additionally, subgroup analyses, whether by region, sensory assessment method, or quality of studies, consistently showed significant associations. Regarding the method of visual assessment, Whillans and Nazroo showed that there was a significant correlation between self-reported and objective assessments.³⁹ In a previous cross-sectional study, a self-reported measure of hearing difficulty was in concordance with objective hearing data in older adults.⁴⁰ These findings indicate a high correlation between subjective and objective assessments. However, subjective and objective assessments are not always interchangeable and can be complementary. Future research should further examine these assessment methods to determine whether similar results can be obtained under different conditions and in diverse populations.

Considering that the development of dementia takes a considerable amount of time, it is important to include case-control studies alongside cohort studies. However, we found only one case-control study that investigated the association between DSI and all-cause dementia. Furthermore, the meta-analysis including the case-control study showed a high degree of heterogeneity (I²=99%). This heterogeneity was induced by the relationship between study follow-up period and study effect sizes. Therefore, in this study, the meta-analysis focusing on cohort studies with HRs may provide more reliable insights. Future research is needed to enhance the robustness and generalizability of the results.

Most included studies did not provide HRs stratified by subtypes of dementia; however, DSI might present a significant risk for AD (HR: 2.07; 95% CI: 1.45–2.94), but not for VaD (HR: 1.65; 95% CI: 0.96–2.85). To classify AD and VaD, three studies utilized standard clinical criteria,^23,24,31 and Kim et al. used ICD-10 codes.³⁰ The lack of consideration for neuropathological information might have led to misclassification. Additional studies are needed to explore the association between these subtypes and sensory impairment.

In this study, VI and HI were independently associated with incident dementia compared to no sensory impairment (only VI; HR: 1.29; 95% CI: 1.16–1.43, only HI; HR: 1.18; 95% CI: 1.09–1.26). The results are in line with the higher risk of VI and HI reported in previous studies.^36,41,42 A meta-analysis by Shang et al. reported the association between VI and incident dementia (pooled relative risk: 1.47; 95% CI: 1.36–1.60).³⁶ Golub et al. showed that HI was linked to a 1.7 times higher risk of the incidence of dementia.⁴¹ Moreover, previous studies have suggested that interventions, such as cataract surgery and hearing aids, might have the potential to prevent cognitive decline.^35,38,43,44 Given the lack of treatments for dementia, identifying risk factors and interventions for prevention is of great importance.

There are several potential mechanisms for the positive relationship between sensory impairment and dementia. First, a “common cause,” such as shared structural and pathological changes in the brain, may account for the strong associations observed between sensory impairment and dementia.⁴⁵ For instance, previous studies reported that the retina and cochlea in dementia exhibit the accumulation of amyloid-β plaques and hyperphosphorylated tau, reflecting similar pathological features observed in the brain.^46–48 Second, sensory impairments might have a direct impact on brain function. Previous studies showed that HI was significantly associated with volume decline in the primary auditory cortex and temporal lobe.^49,50 Garzone et al. investigated the association between VI and both total brain and hippocampal atrophy.⁵¹ Therefore, these findings may corroborate the association between sensory impairments and cognitive dysfunction. Third, sensory impairments might be indirectly linked to dementia and cognitive decline. For instance, older people with sensory impairment become less involved in physical and social activities,^10,11 potentially leading to a decline in cognitive functions.⁵² Similarly, depression and social isolation resulting from sensory impairment might, in turn, increase the risk of cognitive deterioration.^53,54 Fourth, multisensory impairment may increase the risk of dementia. In this study, DSI increased the risk of dementia by 46% compared to no sensory impairment, whereas SSI resulted in a 23% increase. Brenowitz et al. showed that multisensory impairment, which includes combinations of vision, hearing, smell, and touch, was strongly associated with a higher risk of dementia compared to a single or no sensory impairment.⁵⁵ However, in contrast, previous research showed no interaction effect on dementia between VI and HI.⁵⁶ Further research into the association between multisensory impairment and dementia is required. The 2024 report by the Lancet Commission has identified both VI and HI as risk factors for dementia,⁵⁷ highlighting the significance of DSI in its development. Moreover, based on these mechanisms, therapeutic interventions for sensory impairments might reduce the risk of cognitive impairment and dementia. Recent studies have reported that interventions such as cataract surgery and the use of hearing aids could help maintain cognitive function.^35,38 Additional research should involve long-term follow-up studies and investigations across diverse populations to deepen the understanding of the relationship between sensory impairments and dementia, and to evaluate the impact of interventions for sensory impairments on cognitive function.

This systematic review and meta-analysis have several limitations. Firstly, all included studies were non-randomized observational studies, and the meta-analysis was conducted on a relatively small number of observational studies. Specifically, the available studies on dementia subtypes, such as AD and VaD, were limited. Secondly, the methods for identifying dementia varied across studies, which may overestimate or underestimate cognitive function. The TICS method and the cognitive tests from NHATS might be difficult for individuals with sensory impairments. Thirdly, while most studies had a follow-up of over 5 years, one study³⁰ had a follow-up period of only 1.8 years. Fourthly, the adjusted confounding factors differed across the studies. Several studies lacked appropriate adjustments for confounders such as socio-economic status, depression, and comorbidities.

Conclusions

In this systematic review and meta-analysis of 11 observational studies, we investigated the relationship between sensory impairment and dementia. DSI and SSI were associated with an increased risk of dementia. Among subtypes of dementia, DSI was significantly associated with the incidence of AD, but not VaD. In conclusion, DSI might be useful in identifying the risk of dementia. Screening and treatment for DSI may potentially prevent the development of dementia.

Supplemental Material

sj-docx-1-alz-10.1177_13872877241304127 - Supplemental material for The association between dual sensory impairment and dementia: A systematic review and meta-analysis

Supplemental material, sj-docx-1-alz-10.1177_13872877241304127 for The association between dual sensory impairment and dementia: A systematic review and meta-analysis by Yuto Yoshida, Yoshimune Hiratsuka, Reiko Umeya, Koichi Ono and Shintaro Nakao in Journal of Alzheimer's Disease

Supplemental Material

sj-docx-2-alz-10.1177_13872877241304127 - Supplemental material for The association between dual sensory impairment and dementia: A systematic review and meta-analysis

Supplemental material, sj-docx-2-alz-10.1177_13872877241304127 for The association between dual sensory impairment and dementia: A systematic review and meta-analysis by Yuto Yoshida, Yoshimune Hiratsuka, Reiko Umeya, Koichi Ono and Shintaro Nakao in Journal of Alzheimer's Disease

Footnotes

Acknowledgments

The authors have no acknowledgments to report.

ORCID iDs

Yuto Yoshida

Koichi Ono

Author contributions

Yuto Yoshida (Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Validation; Visualization; Writing—original draft; Writing—review & editing); Yoshimune Hiratsuka (Conceptualization; Data curation; Formal analysis; Funding acquisition; Methodology; Resources; Supervision; Validation; Visualization; Writing—review & editing); Reiko Umeya (Funding acquisition; Supervision; Writing—review & editing); Koichi Ono (Supervision; Writing—review & editing); Shintaro Nakao (Supervision; Writing—review & editing).

Funding

This study was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI (21K09707; 24K13299).

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability

The data sharing is not applicable to this article as no datasets were generated or analyzed during this study.

Supplemental material

Supplemental material for this article is available online.

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