Cognitive function and retinal and ischemic brain changes: The Women's Health Initiative

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Abstract

Objective:

To examine the association between retinopathy and cognitive decline or brain lesions and volumes in older women.

Methods:

This study included 511 women aged 65 and older who were simultaneously enrolled in the Women's Health Initiative Memory Study and the Sight Examination Study. In this analysis, we examined the link between retinopathy, assessed using fundus photography (2000–2002), cognitive performance over time assessed by the modified Mini-Mental State Examination (3MSE) (1996–2007), and white matter hyperintensities and lacunar infarcts in the basal ganglia.

Results:

Presence of retinopathy was associated with poorer 3MSE scores (mean difference = 1.01, SE: 0.43) (p = 0.019) over a 10-year follow-up period and greater ischemic volumes in the total brain (47% larger, p = 0.04) and the parietal lobe (68% larger, p = 0.01) but not with measures of regional brain atrophy.

Conclusions:

The correspondence we found between retinopathy and cognitive impairment, along with larger ischemic lesion volumes, strengthens existing evidence that retinopathy as a marker of small vessel disease is a risk factor for cerebrovascular disease that may influence cognitive performance and related brain changes. Retinopathy may be useful as a clinical tool if it can be shown to be an early marker related to neurologic outcomes.

GLOSSARY

3MSE: modified Mini-Mental State Examination

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AMD: age-related macular degeneration

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CEE: conjugated equine estrogen

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ETDRS: Early Treatment Diabetic Retinopathy Study

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ICV: intracranial volume

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ILV: ischemic lesion volume

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MPA: medroxyprogesterone acetate

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WHI HT CT: Women's Health Initiative Clinical Trial of Hormone Therapy

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WHIMS: Women's Health Initiative Memory Study

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WHIMS-MRI: Women's Health Initiative Memory Study–Magnetic Resonance Imaging Study

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WHISE: Women's Health Initiative Sight Exam Study

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