背景：失智症是一種嚴重的神經退化性疾病，對患者及其家人造成極大負擔，並對社會健康系統帶來挑戰。過去的研究指出，視覺障礙與失智症風險增加有關，而白內障作為一種常見的眼部疾病，其手術治療對失智症的影響尚未被充分研究。因此，本研究旨在探討台灣65歲以上長者接受白內障手術與失智症風險之間的相關性。
目的：本研究的研究目的包括（一）探討白內障與失智症發生的相關性；（二）探討白內障患者是否接受手術與罹患阿茲海默症的風險之間的關係；進一步研究（三）白內障患者在接受手術後其失智症風險是否會與未患有白內障民眾罹患失智症的風險接近。
方法：本研究採用了回顧性世代追蹤研究方法，研究對象取自我國全民健康保險申報資料之2010年200萬人承保抽樣歸人檔，以2002至2017年滿65歲以上的長者為研究世代，並以接受手術之白內障患者作為暴露組。追蹤期間從2002至2018年，使用Cox比例風險模型計算白內障有手術組、白內障無手術組、無白內障組之65歲以上長者的全因失智症風險或阿茲海默症風險。競爭風險模型用於控制由於死亡導致無法觀測失智事件發生的誤差。最後，使用分層分析評估流感疫苗接踵對性別、年齡、投保金額、推估居住地、高血壓、糖尿病、高血脂與慢性腎臟病的影響。
結果：（一）研究世代為120,411名65歲以上長者，依白內障狀況分為白內障有手術組、白內障無手術組以及無白內障組。考慮潛在干擾因子後，與無白內障組相比，白內障無手術組罹患全因失智症風險上升相關（aHR 1.16，95% CI＝1.12-1.20）。（二）考慮潛在干擾因子後，與白內障無手術組相比，白內障有手術組罹患阿茲海默症風險降低相關（aHR 0.87，95% CI＝0.79-0.96）。（三）考慮潛在干擾因子後，與無白內障組相比，白內障有手術組罹患全因失智症風險無顯著差異（aHR 0.98，95% CI＝0.95-1.02）
結論：罹患白內障會增加全因失智症與阿茲海默症發生風險。其次白內障患者能夠透過手術降低阿茲海默症風險，但仍無法與正常人發生阿茲海默症風險達到無差異的程度。最後，接受手術治療後，白內障患者罹患全因失智症的風險與正常人並無明顯差異。我們的研究支持白內障手術可逆轉失智症風險的假設，為預防和治療失智症提供了新的見解。

Although several studies have examined the association between cataract surgery and dementia in the past, the current findings are difficult to generalize to the overall elderly population in Taiwan. This study, based on Taiwan's National Health Insurance database, conducted an extensive follow-up survey of 65-year-old individuals for 17 years to study the impact of cataract surgery on the risk of dementia. The results show that having cataracts increases the risk of all-cause dementia and Alzheimer's disease. Secondly, patients with cataracts can reduce their risk of Alzheimer's disease through surgery, but they still cannot have the same risk of developing Alzheimer's disease as those without cataracts. Finally, after surgical treatment, the risk of all-cause dementia in cataract patients was not significantly different from that in normal controls. Our study supports the hypothesis that cataract surgery reverses the risk of dementia, providing new insights into preventing and treating dementia.
INTRODUCTION
Dementia is a severe neurodegenerative disease that imposes a significant burden on patients and their families and presents challenges to societal health systems. Previous research has indicated that visual impairment is associated with an increased risk of dementia. However, the impact of cataract surgery—a common treatment for eye diseases—on dementia has not been thoroughly investigated. Therefore, this study aims to explore the relationship between cataract surgery and the risk of dementia in individuals aged 65 and older in Taiwan.
MATERIALS AND METHODS
This study employed a retrospective cohort study design, using data from Taiwan's Longitudinal Health Insurance Database (LHID 2010). The study cohort consisted of individuals aged 65 and older from 2002 to 2017, and was divided into three groups: those with cataracts who underwent surgery (exposed group), those with cataracts who did not undergo surgery, and those without cataracts. The follow-up period extended from 2002 to 2018. Cox proportional hazards models were used to calculate the all-cause dementia risk and Alzheimer’s disease risk for the cataract surgery group, cataract no-surgery group, and no cataract group. Competing risk models were utilized to account for biases due to deaths leading to unobserved dementia events. Additionally, stratified analyses assessed the impact of influenza vaccination on variables such as gender, age, insurance amount, estimated residence location, hypertension, diabetes, hyperlipidemia, and chronic kidney disease.
RESULTS AND DISCUSSION
The study cohort included 120,411 individuals aged 65 and older, categorized into the cataract surgery group, cataract no-surgery group, and no cataract group. After adjusting for potential confounders, the cataract no-surgery group had a higher risk of all-cause dementia compared to the no cataract group (aHR 1.16, 95% CI = 1.12-1.20). After adjusting for potential confounders, the cataract surgery group had a lower risk of Alzheimer's disease compared to the cataract no-surgery group (aHR 0.87, 95% CI = 0.79-0.96). After adjusting for potential confounders, there was no significant difference in the risk of all-cause dementia between the cataract surgery group and the no cataract group (aHR 0.98, 95% CI = 0.95-1.02).Additionally, in the stratified analysis, it was observed that cataract surgery had a more pronounced effect in reducing the risk of all-cause dementia among female cataract patients. Analyses across different age groups also found that older individuals benefited more from surgical treatment in alleviating the risk of all-cause dementia or non-Alzheimer's dementia. Notable differences were also observed among cataract patients residing in different geographical areas, with cataract removal surgery having a more significant impact on reducing all-cause or non-Alzheimer’s dementia in patients living in rural areas compared to those in urban areas. Alzheimer's disease is the most common form of dementia, accounting for 50%–70% of all cases globally. In Taiwan, previous studies have indicated that Alzheimer's disease represents approximately 43% of all dementia cases. However, the present study shows that Alzheimer's disease accounts for only about 11% of all dementia cases, which is significantly lower than expected. This discrepancy may be due to issues in the data collection process, possibly caused by data entry errors or overly stringent filtering criteria that might have missed some Alzheimer's cases. These issues may have led to an underestimation of the incidence of Alzheimer's disease. In the future, we recommend adding more validation steps in the data collection and analysis process to ensure the integrity and accuracy of the data.
CONCLUSION
Cataracts are associated with an increased risk of both all-cause dementia and Alzheimer’s disease. Cataract patients who undergo surgery can reduce their risk of Alzheimer’s disease, although this risk does not fully approach that of individuals without cataracts. Additionally, post-surgery, the risk of all-cause dementia in cataract patients does not significantly differ from that of individuals without cataracts. Our study supports the hypothesis that cataract surgery may reverse dementia risk, providing new insights for the prevention and treatment of dementia.

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