Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
J Am Geriatr Soc. 2019 Jun;67(6):1197-1203. doi: 10.1111/jgs.15795. Epub 2019 Feb 1.
To determine the prevalence of retinal microvascular signs and associations between retinal signs and cognitive status.
Cross-sectional analysis of visit 5 (2011-2013) of the Atherosclerosis Risk in Communities (ARIC) cohort. Data analysis took place November 30, 2017, to May 1, 2018.
Biracial population-based cohort from four US communities.
A total of 2624 participants with a mean age of 76 years (SD = 5 years) (19% African American) with data on cognitive status and complete retinal examination.
Retinal signs measured with fundus photography. Cognitive status: normal cognition, mild cognitive impairment (MCI)/dementia with a primary diagnosis of Alzheimer disease (AD) without cerebrovascular disease (CVD), and MCI/dementia with a primary or secondary diagnosis of CVD (irrespective of AD).
Overall, 6% of the cohort had mild retinopathy and 2% had moderate/severe retinopathy. Of the cohort, 7% had microaneurysms, 6% had retinal hemorrhages, and 8% had arteriovenous (AV) nicking. There was a low prevalence of soft exudates (1%) and focal narrowing (1%). In weighted fully adjusted models, individuals with retinal hemorrhages had a two-fold higher odds of all-cause MCI/dementia (95% confidence interval [CI] = 1.3-3.0; P = .001) and a 2.5-fold higher odds (95% CI = 1.6-3.9; P < .001) of MCI/dementia with CVD compared to individuals with no retinal hemorrhages. Individuals with AV nicking had a 1.6-fold higher odds of MCI/dementia with CVD (95% CI = 1.0-2.4) compared to individuals with no AV nicking (P < .05). There were no associations between retinal signs and MCI/dementia without CVD.
Our findings are confirmatory of recent research, and suggest that retinal microvascular signs may reflect microvascular pathology in the brain, potentially contributing to dementia and earlier MCI. The low prevalence of retinal signs and modest associations with cognitive status, however, limit the current clinical utility of these findings. Further work is needed to determine whether more sophisticated imaging may detect more subtle retinal signs with higher sensitivity to identify individuals at risk of dementia.
确定视网膜微血管病变的发生率，以及视网膜病变与认知状态之间的关系。
横断面分析，来自美国四个社区的动脉粥样硬化风险社区（ARIC）队列的第 5 次随访（2011-2013 年）。数据分析于 2017 年 11 月 30 日至 2018 年 5 月 1 日进行。
基于人群的两种族队列。
共 2624 名参与者，平均年龄 76 岁（SD=5 岁）（19%为非裔美国人），有认知状态和完整视网膜检查数据。
眼底摄影测量视网膜病变。认知状态：正常认知、轻度认知障碍（MCI）/痴呆症（伴有阿尔茨海默病（AD）的主要诊断且无脑血管疾病（CVD））、伴有 MCI/痴呆症的主要或次要诊断为 CVD（不论 AD 诊断）。
总体而言，队列中有 6%的人患有轻度视网膜病变，2%的人患有中度/重度视网膜病变。队列中有 7%的人有微动脉瘤，6%的人有视网膜出血，8%的人有动静脉（AV）吻合。软渗出物（1%）和局灶性狭窄（1%）的发生率较低。在加权完全调整模型中，有视网膜出血的个体发生全因 MCI/痴呆症的可能性增加两倍（95%置信区间[CI]为 1.3-3.0；P=.001），且发生伴有 CVD 的 MCI/痴呆症的可能性增加两倍半（95%CI 为 1.6-3.9；P<.001）。与无视网膜出血的个体相比，有 AV 吻合的个体发生伴有 CVD 的 MCI/痴呆症的可能性增加 1.6 倍（95%CI=1.0-2.4；P<.05）。视网膜病变与不伴有 CVD 的 MCI/痴呆症之间无关联。
我们的发现与最近的研究结果一致，表明视网膜微血管病变可能反映大脑的微血管病理学，可能导致痴呆和更早的 MCI。然而，视网膜病变与认知状态的关联程度较低，限制了这些发现的当前临床应用。需要进一步研究以确定更复杂的成像是否可以更敏感地检测到更细微的视网膜病变，从而识别出痴呆症的高危人群。
