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Association between diabetic retinopathy and incident cognitive impairment
  1. Preeti Gupta1,
  2. Alfred Tau Liang Gan1,
  3. Ryan Eyn Kidd Man1,2,
  4. Eva K Fenwick1,2,
  5. Charumathi Sabanayagam1,2,
  6. Paul Mitchell3,
  7. Carol Y Cheung4,
  8. Ning Cheung1,2,5,
  9. Tien Yin Wong1,2,5,
  10. Ching-Yu Cheng1,2,5,
  11. Ecosse Luc Lamoureux1,2
  1. 1 Singapore Eye Research Institute, Singapore, Singapore
  2. 2 Duke-NUS Medical School, Singapore, Singapore
  3. 3 Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
  4. 4 The University of Sydney, Sydney, New South Wales, Australia
  5. 5 Singapore National Eye Centre, Singapore, Singapore
  1. Correspondence to Dr Ecosse Luc Lamoureux, Singapore Eye Research Institute (SERI), Singapore 169856, Singapore; ecosse{at}


Background/Aim The relationship between diabetic retinopathy (DR) and cognitive impairment (CI) is unclear due to equivocal findings from cross-sectional studies and a lack of long-term data. In this population-based cohort study, we investigated the longitudinal association between the severity of DR and the incidence of CI.

Methods 682 participants with diabetes, gradable retinal photographs and no CI at baseline 2004–2011) and complete relevant data at follow-up 2010–2016 from the Singapore Epidemiology of Eye Disease Study were included. CI was assessed using the validated Abbreviated Mental Test (AMT), defined as scores of ≤6 and ≤8 for those with 0–6 and >6 years of formal education, respectively. Six-year incident CI was defined as having no CI at baseline but present at the follow-up visit.

Results Of the 682 included participants, 483 (70.8%) had no DR and 199 (29.2%) had any DR. Of those with DR, 142 (20.8%) had minimal/mild DR and 57 (8.4%) had moderate or worse DR at baseline. At the follow-up visit, 40 (5.9%) participants had incident CI based on AMT. In multivariate analysis compared with participants without DR, those with any DR had more than twofold increased odds of incident CI (OR (95% CI): 2.32 (1.07 to 5.03)). Participants with moderate or worse DR had threefold increased odds of developing CI (3.41 (1.06 to 11.00)), compared with those with no DR.

Conclusions DR, particularly at the more severe stages, is associated with increased risk of developing CI, independent of vision and other risk factors.

  • retina
  • epidemiology

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  • Contributors PG and ELL had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: PG, CS, C-YC, TYW, ELL. Acquisition, analysis or interpretation of data: PG, REKM, EKF, ATLG, ELL. Drafting of manuscript: PG, REKM, EKF, ATLG, ELL. Critical revision of the manuscript for important intellectual content: PG, REKM, EKF, ATLG, CS, Cheung, PM, TYW, C-YC, ELL. Obtained funding: TYW, CS, C-YC. Statistical analysis: PG, ATLG. Administrative, technical or material support: TYW, CS, C-YC. Study supervision: ATLG, TYW, CS, C-YC, ELL.

  • Funding Singapore Ministry of Health’s National Medical Research Council (NMRC) under its Talent Development Scheme NMRC/STaR/0003/2008 and Biomedical Research Council (BMRC), Singapore 08/1/35/19/550.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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