March 2012
Volume 53, Issue 14
ARVO Annual Meeting Abstract  |   March 2012
Cognitive impairment (CI) does not correlate with severity of diabetic retinopathy (DR) in people with Type 2 Diabetes (T2D)
Author Affiliations & Notes
  • Roxanne R. Crosby-Nwaobi
    King's College London, London, United Kingdom
  • Angus Forbes
    King's College London, London, United Kingdom
  • Sobha Sivaprasad
    Ophthalmology, King's College Hospital, London, London, United Kingdom
  • Footnotes
    Commercial Relationships  Roxanne R. Crosby-Nwaobi, None; Angus Forbes, None; Sobha Sivaprasad, None
  • Footnotes
    Support  King's College Hospital R & D Initiative Grant 2009
Investigative Ophthalmology & Visual Science March 2012, Vol.53, 5740. doi:
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      Roxanne R. Crosby-Nwaobi, Angus Forbes, Sobha Sivaprasad; Cognitive impairment (CI) does not correlate with severity of diabetic retinopathy (DR) in people with Type 2 Diabetes (T2D). Invest. Ophthalmol. Vis. Sci. 2012;53(14):5740.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: : To determine the relationship between severity of DR and CI in patients with T2D.

Methods: : 381 men and women with T2D were stratified by severity of DR into no retinopathy (R0) and proliferative diabetic retinopathy (PDR). Each subject underwent tests of cognitive function (ACE-R), depression (PHQ-9), diabetes related distress (PAID), vision-related quality of life (NEI-VFQ25), best corrected visual acuity (BCVA), optical coherence tomography, ophthalmic and physical examination. Bivariate analysis between categories of DR (ANOVA, Chi square) and ANCOVA for the cognitive scores by DR severity were conducted using SPSS v17.

Results: : The mean ranked ACE-R for the R0 group was significantly lower when compared to the PDR group, 177.86±111.45 vs 215.81±102.90, p=.001, where higher rank=better cognition. However, statistically significant differences were found between means of the R0 group versus the PDR groups for all other known risk factors: BCVA (0.09±.15 vs .18±.21, p< .001), HbA1c (8.13±1.85 vs 8.69±1.95, p< .012), albumin:creatinine ratio in urine (5.22±6.45 vs 16.44±32.10, p< .001), serum albumin (42.75±5.28 vs 40.70±3.67, p=.001), haemoglobin (12.68±1.59 vs 12.04±1.84, p=.002), PAID score (7.45±9.98 vs 10.33±14.39, p=.024) where higher score=increased diabetes related distress, NEI-VFQ25 score (90.31±11.90 vs 79.66±20.88, p< .001) where lower score=decreased vision-related quality of life. PDR was also significantly associated with insulin treatment (Χ2= 23.1, p< .001), presence of leg ulcers (Χ2= 15.5, p< .001), history of CABG/angiography (Χ2= 4.86, p=.028), neuropathy (Χ2= 13.2, p< .001), presence of nephropathy (Χ2= 3.73, p= .05), microvascular status (Χ2= 5.94, p= .02) and macrovascular status (Χ2= 15.63, p< .001). ANCOVA was conducted to explore the impact of severity of DR on cognition. After adjusting for age, gender and all significant covariates, the mean ranked ACE-R for the R0 group remained significantly lower than the PDR group (180.30 95%CI 154.96-205.65 vs 242.10 95%CI 215.22-268.97, p< .001).

Conclusions: : Severity of DR demonstrated an inverse relationship with CI in patients with T2D, despite accepted theoretical variance in the bivariate analyses. The concept that cognitive impairment in diabetes may be a microvascular disease has to be re-visited in light of these findings.

Keywords: diabetic retinopathy • memory • clinical (human) or epidemiologic studies: risk factor assessment 

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