Brain signature and performance of cognition fingerprinting vascular health in diabetic individuals: Insights from multi-country cohorts

Abstract

Purpose : The role of cognitive function in diabetes management is inconclusive and insufficient. We aimed to evaluate the correlation between cognitive signatures and the risk of diabetic vascular complications and mortality, based on 27773 diabetics from the UK Biobank (UKB) and 1307 diabetics from the Guangzhou Diabetic Eye Study (GDES) cohort.

Methods : The exposures were brain volume and cognitive screening tests for the UKB participants, whereas the global cognitive score (GCS) measuring orientation to time and attention, episodic memory, and visuospatial abilities were designated for the GDES participants. The outcomes for the UKB were mortality, as well as macrovascular (myocardial infarction [MI] and stroke) and microvascular (end-stage renal disease [ESRD] and diabetic retinopathy [DR]) events. The outcomes for the GDES were retinal and renal microvascular damage.

Results : In UKB group, a 1-SD reduction in brain gray matter volume was associated with 34%–77% higher risks of incident MI, ESRD, and DR, respectively. The presence of impaired memory was associated with 18%-73% higher risk of mortality and ESRD; impaired reaction was associated with 1.2- to 1.7-fold higher risks of mortality, stroke, ESRD, and DR. In GDES group, the lower GCS tertile exhibited 1.4- to 2.2-fold higher risk of developing referable DR and a twofold faster decline in renal function and retinal capillary density compared with the higher GCS tertile. Restricting for individuals aged <65 years obtained consistent results.

Conclusions : Cognitive decline significantly elevates the risk of diabetic vascular complications and is correlated with retinal and renal microcirculation damage. Cognitive screening tests are highly recommended as routine tools for management of diabetes.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.

 

HRs (95% CIs) of mortality and vascular events with baseline cognitive impairment in the UKB.
Model 1: unadjusted; Model 2: adjusted for age, sex and ethnicity; Model 3: further adjusted for education, income, smoking, physical activity, BMI, systolic BP, hemoglobin A1c, cholesterol, serum creatinine, use of antihypertensive, lipid-lowering, and glucose-lowering medications; Model 4: further adjusted for ApoEε4 status and visual impairment. Cognitive test normal was considered as reference.

 

Baseline cognition status and longitudinal rate (% per year) of retinal capillary density in the GDES cohort.
VD, vessel density.