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

doi:10.1016/j.ajo.2022.01.011

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

Abstract

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 language	English
Pages (from-to)	37-53
Number of pages	17
Journal	American Journal of Ophthalmology
Volume	239
Early online date	18 Jan 2022
DOIs	https://doi.org/10.1016/j.ajo.2022.01.011
Publication status	Published - Jul 2022

Keywords

ALZHEIMERS-DISEASE
DECLINE
DEMENTIA
DYSFUNCTION
MELLITUS
MRI
PREDICTORS
PROLIFERATIVE RETINOPATHY
RETINAL MICROVASCULAR ABNORMALITIES
RISK

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10.1016/j.ajo.2022.01.011

Cite this

Chai, Y.-H., Zhang, Y.-P., Qiao, Y.-S., Gong, H.-J., Xu, H., She, H.-C., Patel, I., Liu, W., Stehouwer, C. D. A., Zhou, J.-B., & Simó, R. (2022). Association between diabetic retinopathy, brain structural abnormalities and cognitive impairment for accumulated evidence in observational studies. American Journal of Ophthalmology, 239, 37-53. https://doi.org/10.1016/j.ajo.2022.01.011

@article{5a392676665645058ffaa309c59184c1,

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

abstract = "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.",

keywords = "ALZHEIMERS-DISEASE, DECLINE, DEMENTIA, DYSFUNCTION, MELLITUS, MRI, PREDICTORS, PROLIFERATIVE RETINOPATHY, RETINAL MICROVASCULAR ABNORMALITIES, RISK",

author = "Yin-He Chai and Yong-Peng Zhang and Yu-Shun Qiao and Hong-Jian Gong and Hui Xu and Hai-Cheng She and Ikramulhaq Patel and Wei Liu and Stehouwer, {Coen D A} and Jian-Bo Zhou and Rafael Sim{\'o}",

note = "Copyright {\textcopyright} 2022. Published by Elsevier Inc.",

year = "2022",

month = jul,

doi = "10.1016/j.ajo.2022.01.011",

language = "English",

volume = "239",

pages = "37--53",

journal = "American Journal of Ophthalmology",

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Chai, Y-H, Zhang, Y-P, Qiao, Y-S, Gong, H-J, Xu, H, She, H-C, Patel, I, Liu, W, Stehouwer, CDA, Zhou, J-B & Simó, R 2022, 'Association between diabetic retinopathy, brain structural abnormalities and cognitive impairment for accumulated evidence in observational studies', American Journal of Ophthalmology, vol. 239, pp. 37-53. https://doi.org/10.1016/j.ajo.2022.01.011

TY - JOUR

T1 - Association between diabetic retinopathy, brain structural abnormalities and cognitive impairment for accumulated evidence in observational studies

AU - Chai, Yin-He

AU - Zhang, Yong-Peng

AU - Qiao, Yu-Shun

AU - Gong, Hong-Jian

AU - Xu, Hui

AU - She, Hai-Cheng

AU - Patel, Ikramulhaq

AU - Liu, Wei

AU - Stehouwer, Coen D A

AU - Zhou, Jian-Bo

AU - Simó, Rafael

PY - 2022/7

Y1 - 2022/7

N2 - 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.

AB - 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.

KW - ALZHEIMERS-DISEASE

KW - DECLINE

KW - DEMENTIA

KW - DYSFUNCTION

KW - MELLITUS

KW - MRI

KW - PREDICTORS

KW - PROLIFERATIVE RETINOPATHY

KW - RETINAL MICROVASCULAR ABNORMALITIES

KW - RISK

U2 - 10.1016/j.ajo.2022.01.011

DO - 10.1016/j.ajo.2022.01.011

M3 - (Systematic) Review article

C2 - 35063409

SN - 0002-9394

VL - 239

SP - 37

EP - 53

JO - American Journal of Ophthalmology

JF - American Journal of Ophthalmology

ER -