Diabetic Retinopathy and Cognitive Decline in Older People With Type 2 Diabetes

The Edinburgh Type 2 Diabetes Study

  1. on behalf of the Edinburgh Type 2 Diabetes Study (ET2DS) Investigators
  1. 1Centre for Population Health Sciences, University of Edinburgh, Edinburgh, U.K.;
  2. 2Metabolic Unit, Western General Hospital, Edinburgh, U.K.;
  3. 3Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, U.K.;
  4. 4Department of Diabetes, Royal Infirmary, Edinburgh, U.K.;
  5. 5Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, U.K.;
  6. 6Department of Psychology, University of Edinburgh, Edinburgh, U.K.;
  7. 7Section of Population Health, University of Aberdeen, Aberdeen, U.K.;
  8. 8Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, U.K.
  1. Corresponding author: Jie Ding, j.ding-2{at}, or Jackie Price, jackie.price{at}


OBJECTIVE Cerebral microvascular disease associated with type 2 diabetes may exacerbate the effects of aging on cognitive function. A considerable homology exists between the retinal and cerebral microcirculations; a hypothesized association between diabetic retinopathy (DR) and cognitive decline was examined in older people with type 2 diabetes.

RESEARCH DESIGN AND METHODS In the population-based Edinburgh Type 2 Diabetes Study, 1,046 men and women aged 60–75 years with type 2 diabetes underwent standard seven-field binocular digital retinal photography and a battery of seven cognitive function tests. A general cognitive ability score (g) was generated by principal components analysis. The Mill-Hill Vocabulary Scale was used to estimate premorbid cognitive ability. DR was graded using a modification of the Early Treatment of Diabetic Retinopathy Scale.

RESULTS After age and sex adjustment, a significant relationship was observed with increasing severity of DR (none, mild, and moderate to severe) for most cognitive measures. Participants with moderate-to-severe retinopathy had the worst g and the worst performances on the individual tests. There was a significant interaction between sex and retinopathy for g. In male subjects, the associations of retinopathy with g (and with tests of verbal fluency, mental flexibility, and processing speed but not memory and nonverbal reasoning) persisted (P < 0.05) when further adjusted for vocabulary (to estimate lifetime cognitive decline), depression, sociodemographic characteristics, cardiovascular risk factors, and macrovascular disease.

CONCLUSIONS DR was independently associated with estimated lifetime cognitive decline in older men with type 2 diabetes, supporting the hypothesis that cerebral microvascular disease may contribute to their observed accelerated age-related cognitive decline. A sex interaction with stronger findings in men requires further confirmation.


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  • Received May 26, 2010.
  • Accepted August 11, 2010.

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  1. Diabetes vol. 59 no. 11 2883-2889
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