Nunley Karen A, Metti Andrea L, Klein Ronald, Klein Barbara E, Saxton Judith A, Orchard Trevor J, Costacou Tina, Aizenstein Howard J, Rosano Caterina
1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
2 Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA.
Diab Vasc Dis Res. 2018 May;15(3):223-232. doi: 10.1177/1479164118758581. Epub 2018 Feb 28.
To assess associations between cognitive impairment and longitudinal changes in retinal microvasculature, over 18 years, in adults with type 1 diabetes.
Participants of the Pittsburgh Epidemiology of Diabetes Complications Study received ≥3 fundus photographs between baseline (1986-1988) and time of cognitive assessment (2010-2015: N = 119; 52% male; mean age and type 1 diabetes duration 43 and 34 years, respectively). Central retinal arteriolar equivalent and central retinal venular equivalent were estimated via computer-based methods; overall magnitude and speed of narrowing were quantified as cumulative average and slope, respectively. Median regression models estimated associations of central retinal arteriolar equivalent and central retinal venular equivalent measures with cognitive impairment status, adjusted for type 1 diabetes duration. Interactions with HbA1c, proliferative retinopathy and white matter hyperintensities were assessed.
Compared with participants without cognitive impairment, those with clinically relevant cognitive impairment experienced 1.8% greater and 31.1% faster central retinal arteriolar equivalent narrowing during prior years (t = -2.93, p = 0.004 and t = -3.97, p < 0.0001, respectively). Interactions with HbA1c, proliferative retinopathy and white matter hyperintensities were not significant. No associations were found between central retinal arteriolar equivalent at baseline, at time of cognitive testing, or any central retinal venular equivalent measures, and cognitive impairment.
Long-term arterial retinal changes could indicate type 1 diabetes-related cognitive impairment. Studies examining longitudinal central retinal arteriolar equivalent changes as early biomarkers of cognitive impairment risk are warranted.
评估1型糖尿病成年患者认知障碍与视网膜微血管纵向变化之间的关联，随访时间超过18年。
匹兹堡糖尿病并发症流行病学研究的参与者在基线期（1986 - 1988年）至认知评估期（2010 - 2015年）期间接受了≥3次眼底照片检查（N = 119；男性占52%；1型糖尿病平均病程和年龄分别为34岁和43岁）。通过计算机方法估算视网膜中央动脉等效直径和视网膜中央静脉等效直径；将狭窄的总体程度和速度分别量化为累积平均值和斜率。中位数回归模型估计了视网膜中央动脉等效直径和视网膜中央静脉等效直径测量值与认知障碍状态之间的关联，并对1型糖尿病病程进行了校正。评估了与糖化血红蛋白、增殖性视网膜病变和脑白质高信号的相互作用。
与无认知障碍的参与者相比，有临床相关认知障碍的参与者在之前几年中视网膜中央动脉等效直径变窄程度高1.8%，速度快31.1%（t = -2.93，p = 0.004；t = -3.97，p < 0.0001）。与糖化血红蛋白、增殖性视网膜病变和脑白质高信号的相互作用不显著。在基线期、认知测试时的视网膜中央动脉等效直径或任何视网膜中央静脉等效直径测量值与认知障碍之间未发现关联。
视网膜动脉的长期变化可能表明1型糖尿病相关的认知障碍。有必要开展研究，将视网膜中央动脉等效直径的纵向变化作为认知障碍风险的早期生物标志物进行检测。
