title: Retinal microvascular signs and functional loss in older persons: the cardiovascular health study.
abstract: OBJECTIVE
  We hypothesized that retinal microvascular signs are associated with executive dysfunction, slow gait, and depressive mood, which are characteristic features of microvascular disease affecting frontal subcortical regions of the brain.
  
  
  METHODS
  In the Cardiovascular Health Study, 1744 participants (mean age, 78) free of stroke had retinal photographs and carotid ultrasound during the 1997 to 1998 visit. We examined the cross-sectional association of retinal signs with the digit-symbol substitution test (DSST) score, gait speed, the Center for Epidemiologic Studies-Depression score, and depressive mood, defined as Center for Epidemiologic Studies-Depression score >9 or antidepressant use.
  
  
  RESULTS
  After adjusting for potential confounders, retinal signs were associated with lower DSST score (generalized arteriolar narrowing and arteriovenous nicking), slower gait (retinopathy), and depressive mood (generalized arteriolar narrowing). A higher number of retinal signs was associated with lower DSST score (-0.76 and -2.79 points for 1 sign and ≥2 signs versus none; P<0.001) and slower gait (-0.009 and -0.083 m/s; P=0.047), but not with the square root of Center for Epidemiologic Studies-Depression score (0.079 and -0.208; P=0.072). In addition, coexistence of retinal signs (generalized arteriolar narrowing and arteriovenous nicking) and carotid atherosclerosis was associated with lower DSST score compared with either process alone (P for interaction <0.01). Notably, further adjustment for ventricular size, white matter disease, and infarcts on MRI did not attenuate the association.
  
  
  CONCLUSIONS
  Retinal signs are associated with executive dysfunction and slow gait, and possibly with depressive mood, suggesting a common process involving small vessels.
authors.affiliation: Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA. dkim2@bidmc.harvard.edu
authors.forename: Dae Hyun
authors.initials: DH
authors.lastname: Kim
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Ihab
authors.initials: I
authors.lastname: Hajjar
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Ronald
authors.initials: R
authors.lastname: Klein
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Newton
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Sarnak
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.forename: Lewis A
authors.initials: LA
authors.lastname: Lipsitz
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000473:pathology / Q000503:physiopathology*; D003866:Depressive Disorder / Q000503:physiopathology; D005625:Frontal Lobe / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008833:Microcirculation; D009483:Neuropsychological Tests; D012164:Retinal Diseases / Q000503:physiopathology*; D012171:Retinal Vessels / Q000503:physiopathology*; D012307:Risk Factors