Middle-age and older adults with retinopathy have a higher risk for accelerated 20-year cognitive decline compared with individuals without retinopathy, according to an analysis of the Atherosclerosis Risk in Communities (ARIC) Study published in Neurology.

Investigators evaluated 12,317 men and women (age 50 to 73) from the ARIC Study with no (n=11,692), mild (n=365), or moderate/severe (n=256) retinopathy.

Patients with moderate/severe retinopathy were often less educated, more likely to be black, have a higher body mass index, have a history of stroke, and have diabetes.

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 Neuropsychological tests on memory (Delayed Word Recall Test), language (Word Fluency Task), and executive function/attention (Digit Symbol Substitution Test) were used to create a composite cognitive score at visit 2 (1990 to 1992), visit 4 (1996 to 1998), and visit 5 (2011 to 2013), and fundus photography was used to measure retinal signs between 1993 and 1995.

The average 20-year change in cognitive function was greater in patients with moderate/severe retinopathy (−1.22 standard deviation [SD]; 95% CI, −1.43 to −1.00) vs patients without retinopathy (−0.91 SD; 95% CI, −0.96 to −0.87). Retinopathy as well as an overall loss of vascular integrity was significantly associated with a greater 20-year cognitive decline after controlling for attrition (difference in 20-year cognitive change for moderate/severe vs no retinopathy −0.53 SD; 95% CI, −0.74 to −0.33).

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In this study, participants had retinal photographs taken in only 1 randomly selected eye, which presents a potential limitation associated with the findings. Also, the investigators did not control for multiple comparisons in their analyses.

Since retinal photography has the ability to capture only small vascular signs, the investigators encourage the utilization of optical coherence tomography angiography as this imaging technique “may have the sensitivity to provide surrogate indexes of even microvascular lesions that may be most relevant to cognitive decline in older adults.”


Deal JA, Sharrett AR, Rawlings AM, et al. Retinal signs and 20-year cognitive decline in the Atherosclerosis Risk in Communities Study [published online February 28, 2018]. Neurology. doi:10.1212/WNL.0000000000005205