Associations between retinal artery/vein occlusions (RAVO) and risk of vascular dementia

Abstract

Purpose : To determine whether RAVO is associated with risk of developing vascular dementia, Alzheimer’s disease (AD), or all-cause dementia. Although retinal artery/vein occlusions are ophthalmic complications of systemic vascular pathology and vascular disease is a risk factor for AD and related dementia in older adults, associations between RAVO and dementia risk are unknown.

Methods : Data from Adult Changes in Thought (ACT) study participants were analyzed. This prospective, population-based cohort study recruited older adults (age ≥ 65) who were dementia-free at enrollment and followed them biennially for development of AD, vascular dementia, and all-cause dementia based on research criteria. The diagnosis of dementia and types were made based on consensus conference consideration of all relevant data. RAVO diagnoses were extracted from electronic medical records. Cox-regression survival analyses were stratified by APOE ε4 status (any ε4 versus none) and adjusted for sex, race, education, and smoking history. Secondary analyses controlled for potential confounders including diabetes, hypertension, congestive heart failure, coronary artery disease, transient ischemic attack, carotid endarterectomy, and ophthalmic comorbidities.

Results : On review of 41,216 person-years (4,743 participants), 266 had RAVO. Those with at least one APOE ε4 allele who developed RAVO had > four-fold higher risk for vascular dementia (HR 4.54, 95% CI 1.86, 11.10, p = 0.001) than those without RAVO.(Figure) When including other cerebrovascular disease in the model, the risk was three-fold higher (HR 3.06, 95% CI 1.23, 76.2). None of the other conditions evaluated in secondary analyses were found to confound this relationship. This association was not found in people who lacked APOE ε4 alleles (HR 1.03, 95% CI 0.37, 2.80). No significant associations were found between RAVO and AD or all-cause dementia in either APOE group.

Conclusions : Older dementia-free individuals who present with RAVO and carry at least one APOE ε4 allele are at higher risk for developing vascular dementia.

This is a 2021 ARVO Annual Meeting abstract.

 

Figure. Forest plots showing HR and 95% CI for six independent models of associations of RAVO and dementia (vascular dementia, Alzheimer’s disease [AD] dementia, and any dementia stratified by APOE ε4 status. All models were adjusted for sex, education, race, and smoking.