Retinal microvascular abnormalities and cognitive dysfunction: a systematic review

Ding, Jie; Patton, Niall; Deary, Ian J.; Strachan, Mark W. J.; Fowkes, F. G. R.; Mitchell, Robert J.; Price, Jackie F.

doi:10.1136/bjo.2008.141994

Cited by 63 publications

(51 citation statements)

References 46 publications

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“…This was supported in a subsequent study by Patton et al 21 In the population-based Cardiovascular Health Study, there was a modest association between retinopathy and poor cognition and, in persons with hypertension, between retinopathy and dementia. 22 Ding et al 23 have recently confirmed this association. Thus, numerous studies, but particularly those of Wong and his colleagues, have linked the occurrence of SVD in the retina with their occurrence in the brain and cognitive decline.…”

Section: Association Of Small Vessel Disease In the Brain With Retinasupporting

confidence: 67%

Living Beyond Our Physiological Means

Thompson

Hakim

2009

Stroke

177

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Background and Purpose-It is our premise that the pathophysiology of small vessel disease in the brain is similar to small vessel disease in other heavily perfused tissues and that the presence of small vessel disease elsewhere in the body foretells its presence in the brain as well as its consequences on cognitive function. The hypothesis presented in this article is that small vessel disease is a systemic condition of aging that is exacerbated by vascular risk factors, which results from dysfunction of arteriolar perfusion. This condition, which we term systemic arteriolar dysfunction, affects the brain as well as a number of extracranial systems. Summary of Review-Recent literature is synthesized to suggest a possible etiology of this condition, highlighting the multiple pathways that may conspire to produce the endothelial and other vascular changes seen in systemic arteriolar dysfunction. Conclusions-Regardless of the etiology, we emphasize that small vessel disease is a systemic condition with major healthcare consequences, requiring a new paradigm in the way we practice medicine. Because this condition can be decelerated by control of vascular risk factors, doing so may significantly reduce morbidity, mortality, and healthcare costs. (Stroke. 2009;40:e322-e330.)

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Section: Association Of Small Vessel Disease In the Brain With Retinasupporting

confidence: 67%

Living Beyond Our Physiological Means

Thompson

Hakim

2009

Stroke

177

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“…Finally, with respect to cognitive decline and dementia, several large population-based studies have shown that retinal vascular changes are associated with cognitive impairment [87,88,89,90,91,92]. Furthermore, in the ARIC Study, in patients without stroke, retinal vascular changes were associated with poorer cognitive function [93].…”

Section: Retinal Vascular Caliber and Brain Diseasesmentioning

confidence: 99%

Retinal Vascular Caliber Measurements: Clinical Significance, Current Knowledge and Future Perspectives

Ikram¹,

Ong

Cheung³

et al. 2012

Ophthalmologica

191

187

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The retinal vasculature provides a unique window to assess vascular health noninvasively and directly in vivo. Advances in fundus photography and retinal image analysis techniques have enabled the objective and accurate assessment of quantitative retinal vascular caliber measurement. Over the last decade, large population-based studies have shown that retinal vascular calibers are associated with a wide range of subclinical (e.g. atherosclerosis, inflammation and endothelial dysfunction) and clinical cardiovascular diseases (hypertension, diabetes mellitus, stroke, kidney and heart diseases). However, while retinal image analysis provided exciting possibilities to study the pathogenesis of these diseases, its direct applicability in a clinical setting as a ‘test' to predict cardiovascular diseases is yet to be established, particularly within the context of being used as a population screening tool. Nevertheless, with continual development of retinal imaging techniques and newer understanding of the clinical significance of these retinal changes, there remains scope for the development of retinal vascular caliber measurements as a biomarker for vascular disease risk assessment in targeted areas and patient subgroups (e.g. patients with diabetes, suspected hypertension and stroke).

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“…The retinal vascular bed can be directly visualised non-invasively with retinal photography. Some previous studies [8], including the cohort studied here [9], have shown a significant association between diabetic retinopathy signs (e.g. microaneurysms, retinal haemorrhages) and reduced cognitive performance in people with diabetes and in the general population.…”

Section: Introductionmentioning

confidence: 62%

Association of retinal arteriolar dilatation with lower verbal memory: the Edinburgh Type 2 Diabetes Study

et al. 2011

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Aims/hypothesis Retinal vascular calibre changes may reflect early subclinical microvascular disease in diabetes. Because of the considerable homology between retinal and cerebral microcirculation, we examined whether retinal vascular calibre, as a proxy of cerebral microvascular disease, was associated with cognitive function in older people with type 2 diabetes. Methods A cross-sectional analysis of 954 people aged 60-75 years with type 2 diabetes from the population-based Edinburgh Type 2 Diabetes Study was performed. Participants underwent standard seven-field binocular digital retinal photography and a battery of seven cognitive function tests. The Mill Hill Vocabulary Scale was used to estimate pre-morbid cognitive ability. Retinal vascular calibre was measured from an image field with the optic disc in the centre using a validated computer-based program.Results After age and sex adjustment, larger retinal arteriolar and venular calibres were significantly associated with lower scores for the Wechsler Logical Memory test, with standardised regression coefficients −0.119 and −0.084, respectively (p<0.01), but not with other cognitive tests. There was a significant interaction between sex and retinal vascular calibre for logical memory. In male participants, the association of increased retinal arteriolar calibre with logical memory persisted (p<0.05) when further adjusted for vocabulary, venular calibre, depression, cardiovascular risk factors and macrovascular disease. In female participants, this association was weaker and not significant. Conclusions/interpretation Retinal arteriolar dilatation was associated with poorer memory, independent of estimated prior cognitive ability in older men with type 2 diabetes. The sex interaction with stronger findings in men requires confirmation. Nevertheless, these data suggest that impaired cerebral arteriolar autoregulation in smooth muscle cells,

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Retinal microvascular abnormalities and cognitive dysfunction: a systematic review

Cited by 63 publications

References 46 publications

Living Beyond Our Physiological Means

Living Beyond Our Physiological Means

Retinal Vascular Caliber Measurements: Clinical Significance, Current Knowledge and Future Perspectives

Association of retinal arteriolar dilatation with lower verbal memory: the Edinburgh Type 2 Diabetes Study

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