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(Stroke. 2002;33:1487.)
© 2002 American Heart Association, Inc.

Original Contributions

Retinal Microvascular Abnormalities and Cognitive Impairment in Middle-Aged Persons

The Atherosclerosis Risk in Communities Study

Tien Yin Wong, MD, MPH; Ronald Klein, MD, MPH; A. Richey Sharrett, MD, DrPH; F. Javier Nieto, MD, PhD; Lori L. Boland, MPH; David J. Couper, PhD; Thomas H. Mosley, MD; Barbara E.K. Klein, MD, MPH; Larry D. Hubbard, MAT Moyses Szklo, MD, DrPH

From the Department of Ophthalmology, University of Wisconsin, Madison (T.Y.W., R.K., B.E.K.K., L.D.H.); Singapore National Eye Center and Department of Ophthalmology, National University of Singapore, Singapore (T.Y.W.); Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Md (F.J.N., M.S.); National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (A.R.S.); Division of Epidemiology, University of Minnesota, Minneapolis (L.L.B.); Department of Biostatistics, University of North Carolina, Chapel Hill (D.J.C.); and Department of Medicine, University of Mississippi Medical Center, Jackson (T.H.M.).

Correspondence to Tien Yin Wong, MD, MPH, Department of Ophthalmology, National University of Singapore, 10 Kent Ridge Crescent, Singapore 119260, Singapore. E-mail ophwty{at}nus.edu.sg

Background and Purpose— Cerebral microvascular disease has been hypothesized to contribute to cognitive impairment, but few clinical data are available. Here, we examine the relation of retinal microvascular abnormalities with cognitive function in middle-aged persons free of stroke.

Methods— The Atherosclerosis Risk in Communities Study is a population-based study with examinations every 3 years from 1987 through 1998. At visit 3, when participants were 51 to 70 years of age, retinal photographs were obtained and evaluated for retinal microvascular abnormalities according to standardized protocols. Cognitive function was assessed with standardized tests (Delayed Word Recall Test, Digit Symbol Subtest, and Word Fluency Test) at visits 2 and 4 and averaged for analysis. Persons with stroke or taking central nervous system–relevant medications were excluded, leaving 8734 with data for this study.

Results— After education, diabetes mellitus, blood pressure, carotid intima-media thickness, and other risk factors were controlled for, retinopathy was associated with lower cognitive test scores. The adjusted odds ratios for persons with Delayed Word Recall scores 2 SD or lower than the mean were 2.60 [95% confidence interval (CI), 1.30 to 2.91] for any retinopathy, 3.00 (95% CI, 1.81 to 4.98) for microaneurysms, 3.39 (95% CI, 1.99 to 5.78) for retinal hemorrhage, and 3.07 (95% CI, 1.53 to 6.17) for soft exudates. Results were similar for the other 2 cognitive tests and in people with and without diabetes and hypertension.

Conclusions— Retinopathy is independently associated with poorer cognitive function in middle-aged persons without stroke, suggesting that cerebral microvascular disease may contribute to the development of cognitive impairment.

Key Words: cognitive disorders • dementia, vascular • hypertension • retina • retinal diseases

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