Association of Cognitive Function and Retinal Neural and Vascular Structure in Type 1 Diabetes


Fickweiler W, Wolfson EA, Paniagua SM, Yu MG, Adam A, Bahnam V, Sampani K, Wu I-H, Musen G, Aiello LP, Shah H, Sun JK, King GL. Association of Cognitive Function and Retinal Neural and Vascular Structure in Type 1 Diabetes. J Clin Endocrinol Metab 2020;

Date Published:

2020 Dec 30


CONTEXT: Cognitive dysfunction is a growing and understudied public health issue in the aging type 1 diabetic population and is difficult and time-consuming to diagnose. Studies in long duration type 1 diabetes have reported the presence of proliferative diabetic retinopathy (PDR) was associated with cognitive dysfunction. OBJECTIVE: This study assessed whether structural and vascular abnormalities of the retina, representing an extension of the central nervous system, are associated with cognitive impairment and other complications of type 1 diabetes. DESIGN: Observational cross-sectional study of individuals with ≥50 years of type 1 diabetes (Joslin Medalist Study). SETTING: University hospital in United States. PARTICIPANTS: 129 participants with complete cognitive testing. MAIN OUTCOME MEASURES: Validated cognitive testing measures which include psychomotor speed, and immediate, and delayed memory. Optical coherence tomography (OCT) and OCT angiography (OCTA) were performed to obtain neural retinal layer thicknesses and vascular density (VD) for superficial (SCP) and deep retinal capillary plexus (DCP). Multivariable modeling adjusted for potential confounders associated with outcomes in unadjusted analyses. RESULTS: Decreased vessel density of the SCP and DCP was associated with worse delayed memory (DCP: p=0.002) and dominant hand psychomotor speed (SCP: p=0.01). Thinning of retinal outer nuclear layer was associated with worse psychomotor speed in both non-dominant and dominant hands (p=0.01 and p=0.05, respectively). Outer plexiform layer thickness was associated with delayed memory (p=0.04). CONCLUSION: These findings suggest that noninvasive retinal imaging using OCT and OCTA may assist in estimating the risks for cognitive dysfunction in people with type 1 diabetes.

Last updated on 12/31/2020