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      Diabetic Retinopathy and Cognitive Decline in Older People With Type 2 Diabetes : The Edinburgh Type 2 Diabetes Study

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          Abstract

          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.

          RESEARCH DESIGN AND 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.

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          Grading diabetic retinopathy from stereoscopic color fundus photographs--an extension of the modified Airlie House classification. ETDRS report number 10. Early Treatment Diabetic Retinopathy Study Research Group.

          (1991)
          The modified Airlie House classification of diabetic retinopathy has been extended for use in the Early Treatment Diabetic Retinopathy Study (ETDRS). The revised classification provides additional steps in the grading scale for some characteristics, separates other characteristics previously combined, expands the section on macular edema, and adds several characteristics not previously graded. The classification is described and illustrated and its reproducibility between graders is assessed by calculating percentages of agreement and kappa statistics for duplicate gradings of baseline color nonsimultaneous stereoscopic fundus photographs. For retinal hemorrhages and/or microaneurysms, hard exudates, new vessels, fibrous proliferations, and macular edema, agreement was substantial (weighted kappa, 0.61 to 0.80). For soft exudates, intraretinal microvascular abnormalities, and venous beading, agreement was moderate (weighted kappa, 0.41 to 0.60). A double grading system, with adjudication of disagreements of two or more steps between duplicate gradings, led to some improvement in reproducibility for most characteristics.
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            Cerebral small-vessel disease and decline in information processing speed, executive function and memory.

            Niels D Prins, Ewoud van Dijk, Tom den Heijer … (2005)
            Cerebral small-vessel disease is common in older people and may contribute to the development of dementia. The objective of the present study was to evaluate the relationship between measures of cerebral small-vessel disease on MRI and the rate of decline in specific cognitive domains in participants from the prospective, population-based Rotterdam Scan Study. Participants were 60-90 years of age and free from dementia at baseline in 1995-1996. White matter lesions (WML), cerebral infarcts and generalized brain atrophy were assessed on the baseline MRI. We performed neuropsychological testing at baseline and repeatedly in 1999-2000 and in 2001-2003. We used random-effects models for repeated measures to examine the association between quantitative MRI measures and rate of decline in measures of global cognitive function, information processing speed, executive function and memory. There were a total of 2266 assessments for the 832 participants in the study, with an average time from the initial to last assessment of 5.2 years. Increasing severity of periventricular WML and generalized brain atrophy and the presence of brain infarcts on MRI were associated with a steeper decline in cognitive function. These structural brain changes were specifically associated with decline in information processing speed and executive function. The associations between MRI measures of cerebral small-vessel disease and cognitive decline did not change after additional adjustment for vascular risk factors or depressed mood. After exclusion of participants with an incident stroke, some of the associations of periventricular WML, brain infarcts and generalized brain atrophy with measures of information processing speed and executive function were no longer significant. This may indicate that stroke plays an intermediate role in the relationship between cerebral small-vessel disease and cognitive decline. Our results suggest that in older people cerebral small-vessel disease may contribute to cognitive decline by affecting information processing speed and executive function.
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              Fundus photographic risk factors for progression of diabetic retinopathy. ETDRS report number 12. Early Treatment Diabetic Retinopathy Study Research Group.

              (1991)
              In the Early Treatment Diabetic Retinopathy Study, a randomized clinical trial sponsored by the National Eye Institute, one eye of each patient was assigned to early photocoagulation and the other to deferral of photocoagulation (i.e., careful follow-up and initiation of photocoagulation only if high-risk proliferative retinopathy developed). This design allowed observation of the natural course of diabetic retinopathy in the initially untreated eye. Gradings of baseline stereoscopic fundus photographs of eyes with nonproliferative retinopathy assigned to deferral of photocoagulation were used to examine the power of various abnormalities and combinations of abnormalities to predict progression to proliferative retinopathy in photographs taken at the 1-, 3-, and 5-year follow-up visits. Severity of intraretinal microvascular abnormalities, hemorrhages and/or microaneurysms, and venous beading were found to be the most important factors in predicting progression. On the basis of these analyses and other considerations, a retinopathy severity scale was developed. This scale, which divides diabetic retinopathy into 13 levels ranging from absence of retinopathy to severe vitreous hemorrhage, can be used to describe overall retinopathy severity and change in severity over time.
              Article 0 comments Cited 130 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Diabetes
                Journal ID (hwp): diabetes
                Journal ID (pmc): diabetes
                Journal ID (publisher-id): Diabetes
                Title: Diabetes
                Publisher: American Diabetes Association
                ISSN (Print): 0012-1797
                ISSN (Electronic): 1939-327X
                Publication date (Print): November 2010
                Publication date (Electronic): 26 August 2010
                Volume: 59
                Issue: 11
                Pages: 2883-2889
                Affiliations
                [1] 1Centre for Population Health Sciences, University of Edinburgh, Edinburgh, U.K.;
                [2] 2Metabolic Unit, Western General Hospital, Edinburgh, U.K.;
                [3] 3Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, U.K.;
                [4] 4Department of Diabetes, Royal Infirmary, Edinburgh, U.K.;
                [5] 5Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, U.K.;
                [6] 6Department of Psychology, University of Edinburgh, Edinburgh, U.K.;
                [7] 7Section of Population Health, University of Aberdeen, Aberdeen, U.K.;
                [8] 8Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, U.K.
                Author notes
                Corresponding author: Jie Ding, j.ding-2@ 123456sms.ed.ac.uk , or Jackie Price, jackie.price@ 123456ed.ac.uk .
                Article
                Publisher ID: 0752
                DOI: 10.2337/db10-0752
                PMC ID: 2963547
                PubMed ID: 20798334
                SO-VID: 58126d74-c3b9-463a-91ae-f6f86f7932c8
                Copyright © © 2010 by the American Diabetes Association.
                License:

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

                History
                Date received : 26 May 2010
                Date accepted : 11 August 2010
                Categories
                Subject: Pathophysiology

                ScienceOpen disciplines: Endocrinology & Diabetes
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes

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