Diabetic retinopathy and cognitive decline in older people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study.
OBJECTIVE
Cerebral microvascular disease associated with type 2 diabetes may exacerbate the effects of aging on cognitive function. A considerable homology exists between the retinal and cerebral microcirculations; a hypothesized association between diabetic retinopathy (DR) and cognitive decline was examined in older people with type 2 diabetes.


METHODS
In the population-based Edinburgh Type 2 Diabetes Study, 1,046 men and women aged 60-75 years with type 2 diabetes underwent standard seven-field binocular digital retinal photography and a battery of seven cognitive function tests. A general cognitive ability score (g) was generated by principal components analysis. The Mill-Hill Vocabulary Scale was used to estimate premorbid cognitive ability. DR was graded using a modification of the Early Treatment of Diabetic Retinopathy Scale.


RESULTS
After age and sex adjustment, a significant relationship was observed with increasing severity of DR (none, mild, and moderate to severe) for most cognitive measures. Participants with moderate-to-severe retinopathy had the worst g and the worst performances on the individual tests. There was a significant interaction between sex and retinopathy for g. In male subjects, the associations of retinopathy with g (and with tests of verbal fluency, mental flexibility, and processing speed but not memory and nonverbal reasoning) persisted (P < 0.05) when further adjusted for vocabulary (to estimate lifetime cognitive decline), depression, sociodemographic characteristics, cardiovascular risk factors, and macrovascular disease.


CONCLUSIONS
DR was independently associated with estimated lifetime cognitive decline in older men with type 2 diabetes, supporting the hypothesis that cerebral microvascular disease may contribute to their observed accelerated age-related cognitive decline. A sex interaction with stronger findings in men requires further confirmation.
Ding
Jie
J
Centre for Population Health Sciences, University of Edinburgh,Edinburgh, UK. j.ding-2@sms.ed.ac.uk
Strachan
Mark W J
MW
Reynolds
Rebecca M
RM
Frier
Brian M
BM
Deary
Ian J
IJ
Fowkes
F Gerald R
FG
Lee
Amanda J
AJ
McKnight
Janet
J
Halpin
Patricia
P
Swa
Ken
K
Price
Jackie F
JF
D000368:Aged; D002560:Cerebrovascular Circulation; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000209:etiology* / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000523:psychology*; D003925:Diabetic Angiopathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000209:etiology*; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008568:Memory; D008875:Middle Aged; D012606:Scotland; D012727:Sex Characteristics; D015348:Vision, Binocular; D014792:Visual Acuity
D007004:Hypoglycemic Agents; D007328:Insulin
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