Severe diabetic retinal disease and dementia risk in type 2 diabetes

Lieza G. Exalto, Geert Jan Biessels, Andrew J. Karter, Elbert S. Huang, Charles P. Quesenberry, Rachel Whitmer

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Persons with type 2 diabetes are at an increased risk of dementia compared to those without, but the etiology of this increased risk is unclear. Cerebral microvascular disease may mediate the link between diabetes and dementia. Given the anatomical and physiological similarities between cerebral and retinal microvessels, we examined the longitudinal association between diabetic retinal disease and dementia in patients with type 2 diabetes. Longitudinal cohort study of 29,961 patients with type 2 diabetes aged ≥60 years. Electronic medical records were used to collect diagnoses and treatment of severe diabetic retinal disease (i.e., diabetic proliferative retinopathy and macular edema) between 1996-1998 and dementia diagnoses for the next ten years (1998-2008). The association between diabetic retinal disease and dementia was evaluated by Cox proportional hazard models adjusted for sociodemographics, as well as diabetes-specific (e.g., diabetes duration, pharmacotherapy, HbA1c, hypoglycemia, hyperglycemia) and vascular (e.g., vascular disease, smoking, body mass index) factors. Results: 2,008 (6.8%) patients had severe diabetic retinal disease at baseline and 5,173 (17.3%) participants were diagnosed with dementia during follow-up. Those with diabetic retinal disease had a 42% increased risk of incident dementia (demographics adjusted Hazards Ratio (HR) = 1.42, 95% Confidence Interval (CI) 1.27, 1.58); further adjustment for diabetes-specific (HR 1.29; 95% CI 1.14, 1.45) and vascular-related disease conditions (HR 1.35; 95% CI 1.21, 1.52) attenuated the relation slightly. Diabetic patients with severe diabetic retinal disease have an increased risk of dementia. This may reflect a causal link between microvascular disease and dementia.

Original languageEnglish (US)
Pages (from-to)S109-S117
JournalJournal of Alzheimer's Disease
Volume42
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Retinal Diseases
Type 2 Diabetes Mellitus
Dementia
Confidence Intervals
Vascular Diseases
Macular Edema
Electronic Health Records
Diabetic Retinopathy
Microvessels
Proportional Hazards Models
Hypoglycemia
Hyperglycemia
Blood Vessels
Longitudinal Studies
Body Mass Index
Cohort Studies
Smoking
Demography
Drug Therapy

Keywords

  • Dementia
  • diabetes
  • macular edema
  • microvascular disease
  • retinal disease
  • retinopathy

ASJC Scopus subject areas

  • Clinical Psychology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health

Cite this

Exalto, L. G., Biessels, G. J., Karter, A. J., Huang, E. S., Quesenberry, C. P., & Whitmer, R. (2014). Severe diabetic retinal disease and dementia risk in type 2 diabetes. Journal of Alzheimer's Disease, 42, S109-S117. https://doi.org/10.3233/JAD-132570

Severe diabetic retinal disease and dementia risk in type 2 diabetes. / Exalto, Lieza G.; Biessels, Geert Jan; Karter, Andrew J.; Huang, Elbert S.; Quesenberry, Charles P.; Whitmer, Rachel.

In: Journal of Alzheimer's Disease, Vol. 42, 01.01.2014, p. S109-S117.

Research output: Contribution to journalArticle

Exalto, LG, Biessels, GJ, Karter, AJ, Huang, ES, Quesenberry, CP & Whitmer, R 2014, 'Severe diabetic retinal disease and dementia risk in type 2 diabetes', Journal of Alzheimer's Disease, vol. 42, pp. S109-S117. https://doi.org/10.3233/JAD-132570
Exalto, Lieza G. ; Biessels, Geert Jan ; Karter, Andrew J. ; Huang, Elbert S. ; Quesenberry, Charles P. ; Whitmer, Rachel. / Severe diabetic retinal disease and dementia risk in type 2 diabetes. In: Journal of Alzheimer's Disease. 2014 ; Vol. 42. pp. S109-S117.
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