Diabetic Retinopathy and Dementia Association, Beyond Diabetes Severity

center dot PURPOSE: To investigate whether associations between diabetic retinopathy (DR) and dementia and Alzheimer's disease (AD) remain significant after controlling for sev-eral measures of diabetes severity.center dot DESIGN: Retrospective cohort study.center dot METHODS: Adult Changes in Thought (ACT) is a prospective cohort study of adults aged >65 years, ran-domly selected and recruited from the membership rolls of Kaiser Permanente Washington, who are dementia free at enrollment and followed biennially until incident demen-tia. The ACT participants were included in this study if they had type 2 diabetes mellitus at enrollment or devel-oped it during follow-up, and data were collected through September, 2018 (3516 person-years of follow-up). Di-abetes was defined by > 2 diabetes medication fills in 1 year. Diagnosis of DR was based on International Clas-sification of Diseases Ninth and Tenth Revision codes. Estimates of microalbuminuria, long-term glycemia, and renal function from longitudinal laboratory records were used as indicators of diabetes severity. Alzheimer's dis-ease and dementia were diagnosed using research criteria at expert consensus meetings.center dot RESULTS: A total of 536 participants (median baseline age 75 [interquartile range 71-80], 54% women) met in-clusion criteria. Significant associations between DR >5 years duration with dementia (hazard ratio 1.81 [95% CI 1.23, 2.65]) and AD (1.80 [1.15, 2.82]) were not altered by adjustment for estimates of microalbuminuria, long-term glycemia, and renal function (dementia: 1.69 [1.14, 2.50]; AD: 1.73 [1.10, 2.74]).center dot CONCLUSIONS: Among people with type 2 diabetes, DR itself appears to be an important biomarker of demen-tia risk in addition to glycemia and renal complications. (Am J Ophthalmol 2023;249: 90-98. (c) 2022 Elsevier Inc. All rights reserved.)