Relationship between Retinopathy and Cognitive Impairment among Hypertensive Subjects

Abstract

Background: The relationship between hypertension and cognitive impairment has been investigated in the literature; several clinical studies suggested a relationship between hypertension and retinopathy. Methods: We examined the relationship between the retinopathy status and cognitive functions by using the Mini-Mental State Examination (MMSE) among hypertensive subjects older than 40 years who were admitted to our Family Medicine, Internal Medicine and Ophthalmology clinics. The subjects were categorized into three groups: group 1 = control subjects (n = 39), group 2 = hypertensive patients without retinopathy (n = 32), and group 3 = hypertensive patients with retinopathy (n = 25). Results: The number of patients with total MMSE scores less than 24 was distributed as follows: group 1: 3 patients (7.7%), group 2: 4 patients (12.5%), and group 3: 14 patients (56%). Hypertension was found to be related with a significant decrease in total MMSE scores in comparison with group 1 subjects (p < 0.001). Furthermore, retinopathy significantly correlated with lower MMSE scores among hypertensive patients (p = 0.001). Compared with group 1, group 3 showed a significant decrease in orientation (p = 0.001), registration (p = 0.001), attention and calculation (p = 0.004), recall (p = 0.009), and total (p < 0.001) MMSE scores. We also found a significant decrease in recall (p = 0.032) and total (p = 0.034) scores in group 3 when compared with group 2. There was a significant decrease in registration (p = 0.002) and total (p = 0.029) MMSE scores in group 2 when compared with group 1. We also observed negative correlations between duration of the disease and orientation (R = –0.597, n = 32, p = 0.001), and between duration of the disease and total (R = –0.495, n = 32, p = 0.006) scores in group 2. Conclusions: Hypertension was found to be related with a decline in MMSE scores. This relation was even more significant in the group of hypertensive patients with retinopathy. Thus, we suggest that cognitive tests be routinely used in the follow-up of hypertensive patients.

Retinal Microvascular Signs and Cognitive Impairment

“…In this population of older persons, an association was found between retinal microvascular signs (retinopathy and venular dilation) and cognitive impairment, particularly in persons with hypertension. The findings are consistent with reports from three other studies, which indicated an association between retinopathy signs and various measures of cognitive impairment such as the MMSE, Digit Symbol Substitution Test, and Delayed Word Recall Test, as well as with clinical dementia, with associations strongest in persons with hypertension 6,7,24 . A case‐control study reported a similar relationship between retinopathy and cognitive impairment in persons with hypertension 6 .…”

“…Cerebral vascular disease is hypothesized to be involved in the pathogenesis of cognitive impairment, 1,2 with considerable data supporting the role of macrovascular disease 1,3,4 . In contrast, the role of subcortical microvascular disease in cognitive impairment is less clear, although studies indicate a substantial contribution, particularly in older persons 5 and those with cardiovascular risk factors such as hypertension 2,6,7 . Clinical data on the involvement of microvascular disease in cognitive impairment are sparse, principally because of the difficulty in noninvasively imaging the cerebral microcirculation 5 .…”

“…1,3,4 In contrast, the role of subcortical microvascular disease in cognitive impairment is less clear, although studies indicate a substantial contribution, particularly in older persons 5 and those with cardiovascular risk factors such as hypertension. 2,6,7 Clinical data on the involvement of microvascular disease in cognitive impairment are sparse, principally because of the difficulty in noninvasively imaging the cerebral microcirculation. 5 Furthermore, the majority of studies have been conducted in middle-aged individuals, in whom cognitive impairment and cerebral microvascular disease is less common.…”

Retinal microvascular abnormalities and cognitive dysfunction: a systematic review

“…Of the eight studies meeting our inclusion criteria,16 – 23 two were subsequently excluded, as they did not fulfil the quality criteria 16 17. The key details of the six included studies are summarised in tables 1, 2.…”

Retinopathy and Cognitive Impairment in Adults With CKD

“…6 This relationship between retinal microvascular abnormalities and cognitive impairment is especially significant for populations at high risk for cognitive impairment. 7-9 For example, among participants with type I or type II diabetes, retinopathy has been reported to be associated with cognitive impairment, 8, 10 and among participants with hypertension, it has been shown that those with retinopathy may be two times more likely to have dementia or cognitive impairment. 2, 4 …”