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Using Retinal Imaging to Study Dementia
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The Association Between Diabetic Retinopathy Severity and Dementia Risk: A TriNetX Longitudinal Cohort Study.

Millen S Khangura1, Michelle A Spratt1, Audrey Gao2

  • 1From the Renaissance School of Medicine at Stony Brook University (M.S.K., M.A.S.), Stony Brook, New York, USA.

American Journal of Ophthalmology
|February 15, 2026
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Summary

Diabetic retinopathy (DR) severity correlates with increased dementia risk in type 2 diabetes (DM2) patients. Proliferative DR (PDR) and nonproliferative DR (NPDR) indicate higher risks for all-cause dementia and vascular dementia (VD) compared to DM2 without DR.

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Area of Science:

  • Ophthalmology
  • Neurology
  • Endocrinology

Background:

  • Diabetes mellitus (DM) and diabetic retinopathy (DR) are linked to higher dementia incidence.
  • DR may serve as a clinical indicator for underlying cognitive disease.

Purpose of the Study:

  • To investigate the association between diabetic retinopathy (DR) severity and the risk of dementia.
  • To compare dementia risk across different stages of DR and in patients with type 2 diabetes (DM2) without DR.

Main Methods:

  • Retrospective cohort study using the TriNetX database.
  • Participants categorized into proliferative DR (PDR), nonproliferative DR (NPDR), DM2 without DR, and no DM groups.
  • Propensity score matching and Cox proportional hazard ratios (HR) used to assess dementia incidence (all-cause, AD, VD).

Main Results:

  • All diabetic groups showed increased risk for all-cause dementia, Alzheimer's disease (AD), and vascular dementia (VD) compared to non-diabetics.
  • PDR and NPDR were associated with higher risks of all-cause dementia and VD compared to DM2 without DR.
  • PDR showed a higher risk for all-cause dementia and VD compared to NPDR.

Conclusions:

  • Greater DR severity is linked to increased risk of all-cause dementia and VD in DM2 patients.
  • Progressive DR may reflect systemic microvascular injury mirroring cerebral small vessel disease.
  • Ophthalmologic screening in DM patients could aid early identification of cognitive decline risk.