title: Retinal Vascular Changes and Prospective Risk of Disabling Dementia: the Circulatory Risk in Communities Study (CIRCS).
abstract: OBJECTIVE
  To investigate the association of retinal vascular changes with a risk of dementia in longitudinal population-based study.
  
  
  METHODS
  We performed a nested case-control study of 3,718 persons, aged 40-89 years, enrolled between 1983 and 2004. Retinal vascular changes were observed in 351 cases with disabling dementia (average period before the onset, 11.2 years) and in 702 controls matched for sex, age, and baseline year. Incidence of disabling dementia was defined as individuals who received cares for disabilities including dementia-related symptoms and/or behavioral disturbance. Conditional logistic regression analysis was used to calculate odds ratio (OR) and multivariable adjusted OR (Models 1 and 2) for incidence of disabling dementia according to each retinal vascular change. Regarding confounding variables, Model 1 included overweight status, hypertension, hyperglycemia, dyslipidemia, and smoking status, whereas Model 2 also included incidence of stroke prior to disabling dementia for further analysis.
  
  
  RESULTS
  The proportion of cases (controls) with retinal vascular changes was 23.1 (15.7)% for generalized arteriolar narrowing, 7.7 (7.5)% for focal arteriolar narrowing, 15.7 (11.8)% for arteriovenous nicking, 10.5 (9.3)% for increased arteriolar wall reflex, and 11.4 (9.8)% for any other retinopathy. Generalized arteriolar narrowing was associated with an increased risk of disabling dementia: crude OR, 1.66 (95% confidence interval, 1.19-2.31); Model 1: OR, 1.58 (1.12-2.23); Model 2: OR, 1.48 (1.04-2.10). The number of retinal abnormalities was associated in a dose-response manner with the risk.
  
  
  CONCLUSIONS
  Generalized arteriolar narrowing and total number of retinal abnormalities may be useful markers for identifying persons at higher risks of disabling dementia.
authors.affiliation: Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Jinnouchi
authors.affiliation: Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.|Osaka Center for Cancer and Cardiovascular Disease Prevention.|Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kitamura
authors.affiliation: Osaka Center for Cancer and Cardiovascular Disease Prevention.|Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yamagishi
authors.affiliation: Osaka Center for Cancer and Cardiovascular Disease Prevention.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kiyama
authors.affiliation: Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.
authors.forename: Hironori
authors.initials: H
authors.lastname: Imano
authors.affiliation: Osaka Center for Cancer and Cardiovascular Disease Prevention.
authors.forename: Takeo
authors.initials: T
authors.lastname: Okada
authors.affiliation: Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.
authors.forename: Renzhe
authors.initials: R
authors.lastname: Cui
authors.affiliation: Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba.|Department of Public Health, Dokkyo Medical University School of Medicine.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Umesawa
authors.affiliation: Osaka Center for Cancer and Cardiovascular Disease Prevention.
authors.forename: Isao
authors.initials: I
authors.lastname: Muraki
authors.affiliation: Osaka Center for Cancer and Cardiovascular Disease Prevention.
authors.forename: Mina
authors.initials: M
authors.lastname: Hayama-Terada
authors.affiliation: Department of Public Health, Yamagata University Graduate School of Medical Science.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kawasaki
authors.affiliation: Department of Community Health, Faculty of Medicine, University of Tsukuba.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Sankai
authors.affiliation: Department of Epidemiology, Fukushima Medical University School of Medicine.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Ohira
authors.affiliation: Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003704:Dementia / Q000209:etiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012164:Retinal Diseases / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000473:pathology
keywords: Cohort studies; Dementia; Nested case-control studies; Retinal vascular changes; Retinopathy