Jennifer A Deal1, A Richey Sharrett2, Andreea M Rawlings2, Rebecca F Gottesman2, Karen Bandeen-Roche2, Marilyn Albert2, David Knopman2, Elizabeth Selvin2, Bruce A Wasserman2, Barbara Klein2, Ronald Klein2. 1. From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison. jdeal1@jhu.edu. 2. From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison.
Abstract
OBJECTIVE: To test the hypothesis that retinal vascular signs are associated with greater cognitive decline over 20 years in 12,317 men and women 50 to 73 years of age at baseline. METHODS: A composite cognitive score was created with 3 neuropsychological tests measured at 3 time points (1990-1992 to 2011-2013). Retinal signs were measured with fundus photography (1993-1995). Differences in cognitive change by retinal signs status were estimated with linear mixed models. Cognitive scores were imputed for living participants with incomplete cognitive testing. RESULTS: In multivariable-adjusted analyses that controlled for attrition, loss of vascular integrity (retinopathy and its components) was associated with greater 20-year decline (difference in 20-year cognitive change for moderate/severe vs no retinopathy -0.53 SD, 95% confidence interval -0.74 to -0.33). Estimated differences were similar in participants with and without diabetes mellitus and in white and black participants. CONCLUSIONS: Retinopathy was associated with accelerated rates of 20-year cognitive decline. These findings support the exploration of more sensitive measures in the eye such as optical coherence tomography angiography, which may provide surrogate indexes of microvascular lesions relevant to cognitive decline in older adults.
OBJECTIVE: To test the hypothesis that retinal vascular signs are associated with greater cognitive decline over 20 years in 12,317 men and women 50 to 73 years of age at baseline. METHODS: A composite cognitive score was created with 3 neuropsychological tests measured at 3 time points (1990-1992 to 2011-2013). Retinal signs were measured with fundus photography (1993-1995). Differences in cognitive change by retinal signs status were estimated with linear mixed models. Cognitive scores were imputed for living participants with incomplete cognitive testing. RESULTS: In multivariable-adjusted analyses that controlled for attrition, loss of vascular integrity (retinopathy and its components) was associated with greater 20-year decline (difference in 20-year cognitive change for moderate/severe vs no retinopathy -0.53 SD, 95% confidence interval -0.74 to -0.33). Estimated differences were similar in participants with and without diabetes mellitus and in white and black participants. CONCLUSIONS: Retinopathy was associated with accelerated rates of 20-year cognitive decline. These findings support the exploration of more sensitive measures in the eye such as optical coherence tomography angiography, which may provide surrogate indexes of microvascular lesions relevant to cognitive decline in older adults.
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