Retinopathy may be risk factor for cerebrovascular disease

In women aged 65 years and older, retinopathy is a marker for cerebrovascular disease that manifests as deficits in global cognition, a recent study found.

Key Point: Retinopathy as a marker of small vessel disease is a risk factor for cerebrovascular disease in women aged 65 years and older. Proactive diagnosis of retinopathy may be a useful clinical tool if it can be shown to be an early marker related to neurologic outcomes.

Little current data exist regarding the prevalence of cerebrovascular disease in India in women or in the overall population. Some reports have estimated the incidence to be 13 to 33 per 100,000 population annually (reported at the International Joint Conference on Stroke and Cerebral Circulation, Bombay, India, 1994). While the prevalence may be lower than in Western countries, the sheer numbers still are a public health concern given the population density in India.

In the recently reported U.S. Women’s Health Initiative Memory Study and the Women’s Health Initiative Sight Exam Study, 511 women aged 65 years and older (average age: 69 years) underwent[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] tests that measured thinking and memory skills annually for up to 10 years. The link between retinopathy and cognitive performance over time was examined using fundus photography an average of 4 years into the study, annual assessments on the modified Mini-Mental State Examination (3MSE), and white matter hyperintensities and lacunar infarcts in the basal ganglia as assessed by brain magnetic resonance imaging scans an average of 8 years into the study.

Thirty-nine (7.6%) of the women were classified as having retinopathy, more than 61% of whom were hypertensive. Retinopathy was associated with greater deficits over time in global cognitive function and with larger ischemic lesion volumes. Total lesion volumes were 47% greater in the women with retinopathy compared with those without retinopathy. In the parietal lobe of the brain, the women with retinopathy had 68% larger lesion volumes. The results were unchanged even after adjusting for blood pressure levels and the presence of diabetes.

Possible scores on the 3MSE range from 0 to 100. Covariate-adjusted mean 3MSE scores were significantly lower for women with retinopathy compared with others throughout follow-up, with a mean difference of 1.01. Prior to the time of the eye examination, the mean relative deficit averaged 0.72 (0.38) units. Following the eye examination, the mean relative deficit averaged 1.10.

On a test of visual acuity, the women with retinopathy had similar scores as the women without the disease.

Source: Haan M, Espeland MA, Klein BA, et al. Cognitive function and retinal and ischemic brain changes: The Women’s Health Initiative. Neurology. 2012;78(13):942-949.

Viriyavejakul A. The epidemiology of stroke in Asia. International joint conference on stroke and cerebral circulation; Bombay, 1994.

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This entry was posted in Neurology, Neurology Featured 2, Ophthalmology and tagged , , , , , , . Volume: .

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