title: Associations between Retinal Markers of Microvascular Disease and Cognitive Impairment in Newly Diagnosed Type 2 Diabetes Mellitus: A Case Control Study.
abstract: OBJECTIVE
  To investigate associations between retinal microvascular changes and cognitive impairment in newly diagnosed type 2 diabetes mellitus.
  
  
  METHODS
  Case control study.
  
  
  METHODS
  A primary care cohort with newly diagnosed type 2 diabetes mellitus.
  
  
  METHODS
  For this analysis, we compared 69 cases with lowest decile scores (for the cohort) on the Modified Telephone Interview for Cognitive Status and 68 controls randomly selected from the remainder of the cohort. Retinal images were rated and the following measures compared between cases and controls: retinal vessel calibre, arterio-venous ratio, retinal fractal dimension, and simple and curvature retinal vessel tortuosity.
  
  
  RESULTS
  Total and venular (but not arteriolar) simple retinal vessel tortuosity levels were significantly higher in cases than controls (t = 2.45, p = 0.015; t = 2.53, p = 0.013 respectively). The associations persisted after adjustment for demographic factors, retinopathy, neuropathy, obesity and blood pressure. There were no other significant differences between cases and controls in retinal measures.
  
  
  CONCLUSIONS
  A novel association was found between higher venular tortuosity and cognitive impairment in newly diagnosed type 2 diabetes mellitus. This might be accounted for by factors such as hypoxia, thrombus formation, increased vasoendothelial growth factor release and inflammation affecting both the visible retinal and the unobserved cerebral microvasculature.
authors.affiliation: King's College London, London, United Kingdom.
authors.forename: Vasanth Venkat
authors.initials: VV
authors.lastname: Naidu
authors.affiliation: King's College London, London, United Kingdom.
authors.forename: Khalida
authors.initials: K
authors.lastname: Ismail
authors.affiliation: King's College London, London, United Kingdom.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Amiel
authors.affiliation: Kent and Medway NHS and Social Care Partnership Trust, Maidstone, United Kingdom.
authors.forename: Reena
authors.initials: R
authors.lastname: Kohli
authors.affiliation: King's College London, London, United Kingdom.|NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Crosby-Nwaobi
authors.affiliation: King's College London, London, United Kingdom.|NIHR Moorfields Biomedical Research Centre, London, United Kingdom.
authors.forename: Sobha
authors.initials: S
authors.lastname: Sivaprasad
authors.affiliation: King's College London, London, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism*; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000378:metabolism* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000378:metabolism* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000378:metabolism* / Q000503:physiopathology; D008875:Middle Aged; D012160:Retina / Q000378:metabolism*; D055815:Young Adult
chemical_list: D015415:Biomarkers