Approaches in methodology for population-based longitudinal study on neuroprotective model for healthy longevity (TUA) among Malaysian Older Adults.

A number of longitudinal studies on aging have been designed to determine the predictors of healthy longevity, including the neuroprotective factors, however, relatively few studies included a wide range of factors and highlighted the challenges faced during data collection. Thus, the longitudinal study on neuroprotective model for healthy longevity (LRGS TUA) has been designed to prospectively investigate the magnitude of cognitive decline and its risk factors through a comprehensive multidimensional assessment comprising of biophysical health, auditory and visual function, nutrition and dietary pattern and psychosocial aspects. At baseline, subjects were interviewed for their status on sociodemographic, health, neuropsychological test, psychosocial and dietary intake. Subjects were also measured for anthropometric and physical function and fitness. Biospecimens including blood, buccal swap, hair and toenail were collected, processed and stored. A subsample was assessed for sensory function, i.e., vision and auditory. During follow-up, at 18 and 36 months, most of the measurements, along with morbidity and mortality outcomes will be collected. The description of mild cognitive impairment, successful aging and usual aging process is presented here. A total 2322 respondents were recruited in the data analysis at baseline. Most of the respondents were categorized as experiencing usual aging (73 %), followed by successful aging (11 %) and mild cognitive impairment (16 %). The LRGS TUA study is the most comprehensive longitudinal study on aging in Malaysia, and will contribute to the understanding of the aging process and factors associated with healthy aging and mental well-being of a multiethnic population in Malaysia.

Does the optimal level of illumination improve both visual functions and visual comfort in schoolchildren with low vision?

Lighting modification is commonly performed by optometrists and occupational therapists to enhance visibility and visual comfort among schoolchildren with low vision. The purpose of this study is to determine the optimal illumination level for visual function and visual comfort of schoolchildren with low vision and the relationship between them. A cross-sectional study was conducted to assess five levels of illumination ranging from 125 lux to 2000 lux to determine the optimal illumination for visual functions and visual comfort in schoolchildren with low vision from a special education school for blind in Malaysia. Purposive sampling was done to recruit forty-two schoolchildren with low vision for this study. Visual functions assessed were visual acuity, measured using the Early Treatment Diabetic Retinopathy Study LogMAR chart at distance and near, contrast sensitivity (CS) measured using the Pelli-Robson chart at distance and the Mars CS chart at near. Reading speed was determined using the Universiti Kebangsaan Malaysia Malay Language Related Word Reading Text test chart. Subjects were asked to rate their visual comfort using a validated questionnaire at the end of each measurement of visual functions and reading speed for the different illumination levels. Visual acuity and contrast sensitivity at distance and near, visual comfort and reading speed improved significantly with increase in illumination levels (p<0.05). However, the interaction between illumination level and level of low vision was not significant (p>0.05). Visual comfort was significantly associated with visual function (p<0.05), while direct association between visual comfort and illumination level was not significant (p>0.05). Optimal illumination for improvement of visual function, reading speed and visual comfort range from 276.67 lux to 701.59 lux. Majority of the schoolchildren with low vision had improved visual function, reading speed and visual comfort with increased illumination. Illumination of at least 600 lux is recommended for maximum visual functioning and visual comfort of schoolchildren with low vision.

Development and validation of parental knowledge, attitude and practice in eye problem among children questionnaire (PEPC-KAPQ).

BACKGROUND: Most eye problems among children can be detected and treated at an early age to reduce the prevalence of visual impairment. Understanding the knowledge, attitude, and practice (KAP) among parents about common children's eye problems is fundamental to encourage parents to seek early eye care services for their children. This study aims to develop a Parental Knowledge, Attitude, and Practice in Eye Problem among Children Questionnaire (PEPC-KAPQ) and evaluate its psychometric properties. METHODS: This study involved developing a questionnaire and was conducted in Kuala Lumpur, Malaysia from July 2021 until June 2022. The questionnaire was developed based on a literature review and expert consultation. The first phase includes a systematic literature review to generate the items for the questionnaire. A group of five panels was then invited to perform content validity for the questionnaire. Face validity was conducted among ten parents to get feedback for the questionnaire. Construct validity and reliability of the questionnaire were measured by which the questionnaire was administered to a total of 134 parents and 64 parents for reliability test. RESULT: The final PEPC-KAPQ consists of four main sections: demographic, knowledge, attitude, and practice with 52 items. The content validity index was 0.85 for all domains of KAP. Modified kappa showed excellent value for most items for all domains. The Kaiser-Meyer-Olkin sampling adequacy showed acceptable scores of 0.84, and Bartlett's Test of Sphericity was significant (x2 = 3172.09, p<0.0001). Kuder-Richardson-2 of the domain knowledge was 0.95. Cronbach's α coefficient of domain attitude and practice were 0.92 and 0.88, respectively and the intraclass correlation of domain attitude and practice were 0.93 and 0.94 respectively. Bland and Altman's plots show that majority of the data fell within the limits of agreement. CONCLUSION: The findings of this validation and reliability study show that the developed questionnaire has a satisfactory psychometric property for measuring the KAP of parents regarding eye problems among children.

Association between vision and cognitive function among community-dwelling older adults in Selangor, Malaysia.

AIM: To determine the association between distance and near visual acuity (VA) and cognitive function among older adults in Selangor, Malaysia. METHODS: A total of 230 older adults (age ≥60y) participated in this study. Habitual distance and near VA were measured using the Early Treatment Diabetic Retinopathy Study Chart and Lighthouse Near Visual Acuity Chart, respectively. Global cognitive function was assessed using the Mini-Mental State Examination (M-MSE) and the Malay language version of the Montreal Cognitive Assessment (M-MoCA). Digit Symbol (DS) subtest was used to measure information processing. RESULTS: No significant association was observed between vision and M-MSE and M-MoCA scores. However, poor distance and near VA were found to be significantly associated with low DS scores [distance VA: ß=-0.01, R 2=0.1, P=0.02; odds ratio (OR)=2.84, 95% confidence interval (CI), 1.10-7.33, P=0.03; near VA: ß=-0.05, R 2=0.08, P=0.00; OR=3.32, 95%CI, 1.28-8.59, P=0.01]. CONCLUSION: Poor vision is associated with a decline in information processing in older adults and substantiates the importance of preserving good vision in maintaining cognitive function.

The impact of near visual impairment on instrumental activities of daily living among community-dwelling older adults in Selangor.

OBJECTIVE: Near visual impairment (VI) is a common disability in an aging population. Near vision is crucial in activity of daily living including reading, smartphone and computer use and meal preparation. This study was conducted to determine the association between near visual acuity (VA) and contrast sensitivity (CS) with activity of daily living (ADL) among visually impaired older adults. RESULTS: A total of 208 participants aged ≥ 60 were recruited from the population-based longitudinal study on neuroprotective model for healthy longevity. Habitual near VA and CS were measured using Lighthouse near VA chart and Pelli-Robson CS chart, respectively. Lawton instrumental activities of daily living (IADL) was used to assess ADL. There are 41.8% participants with near visual impairment and 28.7% among them had IADL disability. Independent t test showed significant lower mean IADL score among visually impaired participants [t(206) = 2.03, p = 0.04]. IADL score significantly correlated with near VA (r = - 0.21, p = 0.05) but not with CS (r = - 0.14, p = 0.21). Near VA (B = - 0.44, p = 0.03) and age (B = - 0.07, p = 0.01) significantly predicted IADL. The findings show poorer VA renders higher IADL disability, which may necessitate interventions to improve ADL among visually impaired older adults.

Incidence and Predictors of Cognitive Frailty Among Older Adults: A Community-based Longitudinal Study.

(1) Background: Cognitive frailty (CF) is the simultaneous presence of physical frailty and cognitive impairment with an increased risk of dementia. Considering that the risk factors of CF are mostly elucidated from cross-sectional studies, we conducted a community-based longitudinal study to determine the incidence and the predictors of CF among Malaysian older adults.; (2) Methods: Out of 490 older adults participating in the Malaysian Towards Useful Aging (TUA) study, 282 were successfully followed-up at five-years for an analysis of the CF incidence. CF was defined as a comorbid physical frailty (>1 Fried criteria) and mild cognitive impairment (Petersen criteria). A comprehensive interview-based questionnaire was administered for sociodemographic information, cognitive function, physical function, dietary intake, psychosocial, and biochemical indices. Univariate analyses were performed for each variable, followed by a regression analysis to identify the predictors of CF that accounted for confounding effects between the studied factors; (3) Results: The incidence rate of CF was 7.1 per 100 person-years. Advancing age (OR=1.12, 95% CI:1.04-1.21, p < 0.05), depression (OR=1.20, 95% CI:1.05-1.37, p < 0.05), decreased processing speed, assessed by a lower digit symbol score (OR=0.67, 95%CI:0.0.56-0.80, p < 0.05), decreased functional mobility measured using Timed-Up-and-Go (TUG) (OR=1.23, 95% CI:1.04-1.46, p < 0.05), low vitamin D intake (OR:0.36, 95% CI:0.14-0.93, p < 0.05) and physical frailty (OR=2.16, 95% CI:1.02-4.58, p < 0.05) were predictors for CF incidence; and (4) Conclusions: Our study results could be used as an initial reference for future studies to formulate effective preventive management and intervention strategies to decelerate CF development among older adults.

Reading Performance and Compensatory Head Posture in Infantile Nystagmus after Null Zone Training.

This study aimed to assess the visual function, reading performance, and compensatory head posture (CHP) in schoolchildren with infantile nystagmus. A total of 18 participants aged between 13 to 18 years old were divided into spectacle (n = 9) and null zone group (n = 9) based on their visual acuity. Visual acuity (LogMAR), contrast sensitivity (Pelli-Robson), reading time and rate (Tobii TX300), and CHP were measured pre and post null zone reading training. Participants in the null zone group received 10 sessions of training (5 weeks). Visual acuity and contrast sensitivity of participants in the spectacle and null zone groups were not significantly different pre and post training. Reading performance, i.e., reading time (z = -1.36; p = 0.173) and reading rate (z = -0.06; p = 0.953), of participants in the spectacle group was not significantly different after 5 weeks. Reading time (z = -2.55; p = 0.011) and reading rate (z = -2.07; p = 0.038 of participants in the null zone group showed significant improvement post training. After 5 weeks, CHP improved in six out of the nine participants (66.7%) of the null zone group and was unchanged in all participants in the spectacle group. Null zone reading training could benefit children with infantile nystagmus in improving reading performance and compensatory head posture.

Methodology approaches and challenges in population-based longitudinal study of a neuroprotective model for healthy longevity.

AIM: The 36-month Long-Term Research Grant Scheme project: Towards Usual Aging - Neuroprotective Model for Healthy Longevity among Malaysian Elderly was designed to address multidimensional aspects including psychosocial, biophysical health, nutrition and dietary pattern, and auditory and visual function to highlight the magnitude of these associations in a single study. METHODS: A total of 2322 respondents aged ≥60 years were recruited at baseline using the multistage sampling method, followed up at 18 months and 36 months. RESULTS: Response rates at baseline, 18 months and 36 months were 87.8%, 77.3% and 67.1%, respectively. At baseline, the prevalence of successful aging, usual aging and mild cognitive impairment was 11%, 73% and 16%, respectively. The prevalence of single and multimorbidity at baseline were 25.9% and 50.3%, respectively. The incidence rates of mild cognitive impairment at 18 months and 36 months were 6.5 and 5.6 per 100 person-years. The incidence rates of multimorbidity at 18 months and 36 months were 23.7 and 21.5 per 100 person-years, respectively. CONCLUSIONS: The Long-Term Research Grant Scheme project: Towards Usual Aging study provides an opportunity to investigate the interactions between wide ranges of aspects of the older population in a nationally representative sample of the older population. Geriatr Gerontol Int 2019; 19: 233-239.

Mental health state and quality of life questionnaire in low vision assessment: a case report.

BACKGROUND: Vision impairment associated with diabetic retinopathy, is well known and low vision rehabilitation is always recommended. In this report, the importance of objective measure of mental health and quality of life screening in diabetic retinopathy low-vision assessment is discussed. CASE PRESENTATION: We describe the case of a 43-year-old Asian female who has mild vision impairment due to tractional retinal detachment secondary to diabetic retinopathy and how mental health screening and quality of life screening during low vision rehabilitation can improve in the management of this patient. CONCLUSION: Although vision impairment was mild, the psychological impact was enormous and affected her quality of life substantially. This case report illustrates that recognition of the mental health and quality of life impact on visual impairment is critical to the rehabilitation management of low vision patients with diabetic retinopathy.