Retinal signs and risk of incident dementia in the Atherosclerosis Risk in Communities study
Deal, J. A., Sharrett, A. R., Albert, M., Bandeen-Roche, K., Burgard, S., Thomas, S. D., Gottesman, R. F., Knopman, D., Mosley, T., Klein, B., & Klein, R. (2019). Retinal signs and risk of incident dementia in the Atherosclerosis Risk in Communities study. Alzheimer's and Dementia, 15(3), 477-486. Advance online publication. https://doi.org/10.1016/j.jalz.2018.10.002
INTRODUCTION: The easily-imaged retinal microvasculature may reflect the brain microvasculature and therefore be related to dementia.
METHODS: In a population-based study of 12,482 adults aged 50-73 years (22% African American), we estimated the relationship of retinal characteristics from fundus photography (1993-1995) with incident all-cause dementia (1993-1995 to 2011-2013) and with etiologic subtype of dementia/mild cognitive impairment (2011-13).
RESULTS: A total of 1259 (10%) participants developed dementia over a mean 15.6 years. Moderate/severe (vs. no) retinopathy (hazard ratio [HR], 1.86; 95% confidence interval [CI]: 1.36-2.55) and central retinal arteriolar equivalent (narrowest quartile vs. widest three quartiles; HR, 1.26; 95% CI: 1.09-1.45) were associated with all-cause dementia. Results were qualitatively stronger (but not statistically significantly different) in participants with diabetes. Retinopathy was associated with a joint outcome of cerebrovascular-related, but not Alzheimer's disease-related, dementia/mild cognitive impairment (HR, 2.29; 95% CI: 1.24-4.23).
DISCUSSION: Exploration of measures in the eye may provide surrogate indices of microvascular lesions relevant to dementia.