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20-03-2012 | Psychology | Article

Retinopathy associated with cognitive impairment in older women


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MedWire News: Retinopathy may be a useful marker of cognitive decline in older women, suggest study findings.

The results, published in Neurology, show that retinopathy is significantly associated with increased deficits over time in cognitive function and with increased ischemic lesion volumes (ILV).

"The correspondence between retinopathy and cognitive impairment, along with larger ILV, strengthens existing evidence that retinopathy as a marker of small vessel disease is a risk factor for cerebrovascular disease," remark Mary Haan (University of California, San Francisco, USA) and co-investigators.

The researchers examined associations between cognitive performance, ischemic brain lesions, and regional brain volumes using data from three studies within the Women's Health Initiative Clinical Trial of Hormone Therapy (WHI HT CT).

They studied 511 women aged 65 years and over who had undergone cognitive assessments, structural brain scans, and standardized retinopathy evaluations as part of the WHI HT CT. Retinopathy and cognitive performance were assessed using fundus photography (2000-2002) and the modified Mini-Mental State Examination (3MSE; 1996-2007), respectively.

Haan et al report that 39 (7.6%) of the women were classified as having retinopathy. Of these, eight had mild retinopathy, 15 had microaneurysms, two had moderate and one had severe retinopathy, and 13 were classified as having another condition (fibrous proliferation).

Presence of retinopathy was associated with poorer 3MSE scores (mean difference 1.01), and therefore worse cognitive functioning, over the 10-year follow-up period.

Women with retinopathy also had significantly greater ILVs in the total brain (47% larger) and the parietal lobe (68% larger) than those without retinopathy.

Moreover, ILV was significantly larger among women with than without retinopathy, both within and outside the basal ganglia (42% larger within the basal ganglia and 46% larger outside the basal ganglia).

In an accompanying editorial, Rebecca Gottesman from Johns Hopkins University School of Medicine in Baltimore, Maryland, USA says that this study "further validates retinopathy as an early marker for brain small vessel disease in living persons."

Treatments for dementing illnesses are "most likely to be of benefit in individuals in the preclinical stage of the disease, and markers that identify those at risks for subsequent cognitive decline are most critical," she adds. "A retinal evaluation may be a way to screen for an underlying vascular etiology in individuals with evidence of cognitive impairment or dementia."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Nikki Withers

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