title: Cognitive function and retinal and ischemic brain changes: the Women's Health Initiative.
abstract: OBJECTIVE
  To examine the association between retinopathy and cognitive decline or brain lesions and volumes in older women.
  
  
  METHODS
  This study included 511 women aged 65 and older who were simultaneously enrolled in the Women's Health Initiative Memory Study and the Sight Examination Study. In this analysis, we examined the link between retinopathy, assessed using fundus photography (2000-2002), cognitive performance over time assessed by the modified Mini-Mental State Examination (3MSE) (1996-2007), and white matter hyperintensities and lacunar infarcts in the basal ganglia.
  
  
  RESULTS
  Presence of retinopathy was associated with poorer 3MSE scores (mean difference = 1.01, SE: 0.43) (p = 0.019) over a 10-year follow-up period and greater ischemic volumes in the total brain (47% larger, p = 0.04) and the parietal lobe (68% larger, p = 0.01) but not with measures of regional brain atrophy.
  
  
  CONCLUSIONS
  The correspondence we found between retinopathy and cognitive impairment, along with larger ischemic lesion volumes, strengthens existing evidence that retinopathy as a marker of small vessel disease is a risk factor for cerebrovascular disease that may influence cognitive performance and related brain changes. Retinopathy may be useful as a clinical tool if it can be shown to be an early marker related to neurologic outcomes.
authors.affiliation: Departments of Epidemiology and Biostatistics, University of California, San Francisco, USA. Mary.Haan@ucsf.edu
authors.forename: M
authors.initials: M
authors.lastname: Haan
authors.forename: M A
authors.initials: MA
authors.lastname: Espeland
authors.forename: B E
authors.initials: BE
authors.lastname: Klein
authors.forename: R
authors.initials: R
authors.lastname: Casanova
authors.forename: S A
authors.initials: SA
authors.lastname: Gaussoin
authors.forename: R D
authors.initials: RD
authors.lastname: Jackson
authors.forename: A E
authors.initials: AE
authors.lastname: Millen
authors.forename: S M
authors.initials: SM
authors.lastname: Resnick
authors.forename: J E
authors.initials: JE
authors.lastname: Rossouw
authors.forename: S A
authors.initials: SA
authors.lastname: Shumaker
authors.forename: R
authors.initials: R
authors.lastname: Wallace
authors.forename: K
authors.initials: K
authors.lastname: Yaffe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000473:pathology*; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D012164:Retinal Diseases / Q000453:epidemiology / Q000473:pathology*; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors; D016387:Women's Health / Q000639:trends