The Association between Retinal Vascular Occlusions and Dementia: A UK Biobank Retrospective Longitudinal Study.

PURPOSE

Vascular disease is associated with increased incidence of dementia and has the potential to be an indicator of underlying cognitive disease. The goal of this study is to investigate the association between retinal vascular occlusions and neurodegenerative disorders that lead to dementia, including all-cause dementia, Alzheimer disease (AD), and vascular dementia (VD).

DESIGN

Retrospective longitudinal cohort study.

PARTICIPANTS

This study consists of 502 133 participants from the UK Biobank, aged 40 to 69 years at recruitment. There are 1463 individuals with retinal vascular occlusion and 500 670 individuals without.

METHODS

Individuals were categorized as having retinal vein occlusion (RVO), retinal artery occlusion (RAO), and any retinal vascular occlusion (both RVO and RAO). Prevalence and incidence of all-cause dementia, AD, and VD were calculated. The patients with RVO were then matched on age, sex, education, and employment score on a 1:3 ratio to controls. Univariate and multivariate Cox proportional hazards models on the matched participants were used to determine associations over time to all-cause dementia, AD, and VD, with added adjustments for diabetes, hypertension, and smoking status.

MAIN OUTCOME MEASURES

Prevalence and hazard ratios (HRs) of all-cause dementia, AD, and VD.

RESULTS

The prevalence of all-cause dementia and AD is significantly increased among patients with RVO, RAO, and any retinal vascular occlusion, whereas the prevalence of VD is significantly increased in RVO and any retinal vascular occlusion. In the matched analysis, increased risk for all-cause dementia was seen in patients with any retinal vascular occlusion (HR, 1.52; confidence interval [CI], 1.11-2.07, P = 0.01) and RVO (HR, 1.38; CI, 1.01-1.90, P = 0.04). When adjusting for covariates, RVO did not show increased risk of all-cause dementia, AD, and VD.

CONCLUSIONS

Any retinal vascular occlusions and RVO are associated with increased risk of all-cause dementia, and individuals with RVO also have higher risk of VD. After adjusting for shared risk factors, there is no association between dementia and retinal vascular occlusions. Findings from this study are both consistent and in conflict with prior reports, and indicate that the connection between retinal vascular occlusions and neurodegenerative diseases causing dementia may be due to their shared pathogenesis and risk factors.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.