Association between diabetic retinopathy, brain structural abnormalities and cognitive impairment for accumulated evidence in observational studies

Yin-He Chai, Yong-Peng Zhang, Yu-Shun Qiao, Hong-Jian Gong, Hui Xu, Hai-Cheng She, Ikramulhaq Patel, Wei Liu, Coen D A Stehouwer, Jian-Bo Zhou*, Rafael Simó

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

2 Citations (Web of Science)


PURPOSE: To evaluate the association between diabetic retinopathy (DR) and cerebral disease or cognitive impairment.

DESIGN: systematic review and meta-analysis.

METHOD: The hypothesis was formulated prior to data collection. Cross-sectional studies and cohort studies that assessed the association between any measure of DR and cerebral small vessel disease or any type of cognitive impairment in diabetic participants were included. The data were independently extracted by two investigators. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines RESULTS: Twenty-seven studies were included. The combined odds ratio of five cross-sectional/cohort studies that reported that the associations between DR and cerebral structural changes was 1.75 (95% confidence interval [CI]: 1.36-2.25). The combined hazard ratio of four cohort studies that examined the association between DR and cognitive impairment events was 1.47 (95%CI: 1.22-1.78). The combined odds ratio of 14 cross-sectional/cohort studies that examined the association between DR and different cognitive impairment events was 1.43 (95%CI: 1.06-1.93). The overall coefficient (b) of four studies that examined the relationship between DR and specific cognitive performance was 0.09 (95%CI: 0.00-0.18). Considering the quality of the data, we have performed subgroup analysis in studies scored >7 and studies scored <=7 respectively according to Newcastle-Ottawa scale.

CONCLUSION: The present meta-analysis suggests that DR is associated with an increased risk of structural abnormalities in the brain and cognitive impairment. This association remained significant after adjusting for blood glucose levels, hemoglobin A1c, and the presence of hypertension, indicating that DR is an important danger signal for cerebral abnormalities.

Original languageEnglish
Pages (from-to)37-53
Number of pages17
JournalAmerican Journal of Ophthalmology
Early online date18 Jan 2022
Publication statusPublished - Jul 2022


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