title: Retinal microvascular signs, cognitive function, and dementia in older persons: the Cardiovascular Health Study.
abstract: OBJECTIVE
  Cerebral microvascular disease may be a risk factor for the development of dementia in elderly persons. We describe the association of retinal microvascular signs with cognitive function and dementia among older individuals.
  
  
  METHODS
  In the population-based Cardiovascular Health Study, 2211 persons aged 69 to 97 years at recruitment had retinal photography. Photographs were evaluated for retinopathy (eg, microaneurysms, retinal hemorrhages), focal arteriolar narrowing, arteriovenous nicking, and retinal arteriolar and venular caliber. Cognitive status was determined from the Digit-Symbol Substitution Test and Modified Mini-Mental State Examination. Participants were also further evaluated for the presence of dementia with detailed neuropsychological testing. Persons with a prior stroke or taking antipsychotic or antidepressant medications were excluded.
  
  
  RESULTS
  After adjusting for age, gender, race, field center, education level, internal carotid intima-media thickness, body mass index, hypertension, diabetes, and cigarette smoking status, persons with retinopathy had lower mean Digit-Symbol Substitution Test scores but not Modified Mini-Mental State Examination than those without retinopathy (39 versus 41, P=0.002). In hypertensive persons, retinopathy (multivariable-adjusted OR, 2.10; 95% CI, 1.04 to 4.24) and focal arteriolar narrowing (OR, 3.02; 95% CI, 1.51 to 6.02) were associated with dementia. These associations were not present in individuals without hypertension.
  
  
  CONCLUSIONS
  In older persons, our study shows a modest cross-sectional association between retinopathy signs with poorer cognitive function and, in persons with hypertension, with dementia. These data support a possible role of cerebral microvascular disease in the pathogenesis of impaired cognitive function and dementia in older hypertensive persons.
authors.affiliation: Centre for Eye Research Australia, University of Melbourne, East Melbourne Victoria, Australia.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Baker
authors.forename: Emily K
authors.initials: EK
authors.lastname: Marino Larsen
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: Barbara E K
authors.initials: BE
authors.lastname: Klein
authors.forename: David S
authors.initials: DS
authors.lastname: Siscovick
authors.forename: Charles
authors.initials: C
authors.lastname: Bernick
authors.forename: Teri A
authors.initials: TA
authors.lastname: Manolio
authors.forename: Tien Yin
authors.initials: TY
authors.lastname: Wong
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000473:pathology / Q000503:physiopathology; D003071:Cognition / Q000502:physiology*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008833:Microcirculation / Q000002:abnormalities / Q000378:metabolism / Q000473:pathology; D009483:Neuropsychological Tests; D012171:Retinal Vessels / Q000002:abnormalities / Q000378:metabolism / Q000473:pathology; D012307:Risk Factors