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(Stroke. 2007;38:2041.)
© 2007 American Heart Association, Inc.

Original Contributions

Retinal Microvascular Signs, Cognitive Function, and Dementia in Older Persons

The Cardiovascular Health Study

Michelle L. Baker, MD; Emily K. Marino Larsen, MS; Lewis H. Kuller, MD, DrPH; Ronald Klein, MD, MPH; Barbara E.K. Klein, MD, MPH; David S. Siscovick, MD, MPH; Charles Bernick, MD; Teri A. Manolio, MD, PhD Tien Yin Wong, MD, PhD

From the Centre for Eye Research Australia (M.L.B., T.Y.W.), University of Melbourne, Victoria, Australia; the Departments of Biostatistics (E.K.M.L.) and Epidemiology (D.S.S.), University of Washington, Wash; the Department of Epidemiology (L.H.K.), University of Pittsburgh, Pa; the Department of Ophthalmology (R.K., B.E.K.K.), University of Wisconsin—Madison, Madison, Wis; the Division of Neurology (C.B.), University of Nevada School of Medicine, Las Vegas, Nev; the National Heart, Lung, and Blood Institute (T.A.M.), Bethesda, Md; and Singapore Eye Research Institute (T.Y.W.), Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Correspondence to Tien Yin Wong, MD, PhD, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, East Melbourne Victoria 3002 Australia. E-mail twong{at}unimelb.edu.au

Background and Purpose— Cerebral microvascular disease may be a risk factor for the development of dementia in elderly persons. We describe the association of retinal microvascular signs with cognitive function and dementia among older individuals.

Methods— In the population-based Cardiovascular Health Study, 2211 persons aged 69 to 97 years at recruitment had retinal photography. Photographs were evaluated for retinopathy (eg, microaneurysms, retinal hemorrhages), focal arteriolar narrowing, arteriovenous nicking, and retinal arteriolar and venular caliber. Cognitive status was determined from the Digit–Symbol Substitution Test and Modified Mini-Mental State Examination. Participants were also further evaluated for the presence of dementia with detailed neuropsychological testing. Persons with a prior stroke or taking antipsychotic or antidepressant medications were excluded.

Results— After adjusting for age, gender, race, field center, education level, internal carotid intima-media thickness, body mass index, hypertension, diabetes, and cigarette smoking status, persons with retinopathy had lower mean Digit–Symbol Substitution Test scores but not Modified Mini-Mental State Examination than those without retinopathy (39 versus 41, P=0.002). In hypertensive persons, retinopathy (multivariable-adjusted OR, 2.10; 95% CI, 1.04 to 4.24) and focal arteriolar narrowing (OR, 3.02; 95% CI, 1.51 to 6.02) were associated with dementia. These associations were not present in individuals without hypertension.

Conclusions— In older persons, our study shows a modest cross-sectional association between retinopathy signs with poorer cognitive function and, in persons with hypertension, with dementia. These data support a possible role of cerebral microvascular disease in the pathogenesis of impaired cognitive function and dementia in older hypertensive persons.

Key Words: cognitive impairment • dementia • hypertension • retinal microvascular disease • retinopathy

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