Retinal microvascular signs and functional loss in older persons: The cardiovascular health study

Dae Hyun Kim, Anne B. Newman, Ihab Hajjar, Elsa S. Strotmeyer, Ronald Klein, Elizabeth Newton, Mark J. Sarnak, Gregory L. Burke, Lewis A. Lipsitz

Research output: Contribution to journalArticlepeer-review

35 Scopus citations

Abstract

Background And Purpose- We hypothesized that retinal microvascular signs are associated with executive dysfunction, slow gait, and depressive mood, which are characteristic features of microvascular disease affecting frontal subcortical regions of the brain. Methods- In the Cardiovascular Health Study, 1744 participants (mean age, 78) free of stroke had retinal photographs and carotid ultrasound during the 1997 to 1998 visit. We examined the cross-sectional association of retinal signs with the digit-symbol substitution test (DSST) score, gait speed, the Center for Epidemiologic Studies-Depression score, and depressive mood, defined as Center for Epidemiologic Studies-Depression score >9 or antidepressant use. Results- After adjusting for potential confounders, retinal signs were associated with lower DSST score (generalized arteriolar narrowing and arteriovenous nicking), slower gait (retinopathy), and depressive mood (generalized arteriolar narrowing). A higher number of retinal signs was associated with lower DSST score (-0.76 and -2.79 points for 1 sign and 2 signs versus none; P<0.001) and slower gait (-0.009 and -0.083 m/s; P=0.047), but not with the square root of Center for Epidemiologic Studies-Depression score (0.079 and -0.208; P=0.072). In addition, coexistence of retinal signs (generalized arteriolar narrowing and arteriovenous nicking) and carotid atherosclerosis was associated with lower DSST score compared with either process alone (P for interaction <0.01). Notably, further adjustment for ventricular size, white matter disease, and infarcts on MRI did not attenuate the association. Conclusions- Retinal signs are associated with executive dysfunction and slow gait, and possibly with depressive mood, suggesting a common process involving small vessels.

Original languageEnglish (US)
Pages (from-to)1589-1595
Number of pages7
JournalStroke
Volume42
Issue number6
DOIs
StatePublished - Jun 2011
Externally publishedYes

Keywords

  • depression
  • executive function
  • gait speed
  • retinal microvascular signs

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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