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Title: The relationship between diabetic retinopathy and cognitive impairment
Author: Crosby-Nwaobi, Roxanne
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2012
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One of the most significant complications of diabetes is retinopathy. Diabetic retinopathy (DR), a chronic progressive sight-threatening disease of the retinal microvasculature, is the leading cause of treatable blindness in the working age group. Another emerging complication of diabetes is cognitive impairment (Cl). The exact link between diabetes and Cl remains elusive. One theory is that microvascular changes in the brain may be responsible for change in cognition in diabetes. In this study, it was hypothesised that increased severity of DR was associated with impaired cognition (cerebro-microvascular disease) in individuals with Type 2 Diabetes (T2DM). 381 men and women with T2DM recruited to the South East London Diabetic Retinopathy Study were stratified by severity of DR (no/mild retinopathy and proliferative diabetic retinopathy (PDR)) and severity of diabetic maculopathy (non-clinically significant macular oedema (non-CSMO) and CSMO). Each subject underwent tests of cognitive function, psychosocial assessment, ophthalmic and physical examination. Bivariate analysis between categories of DR and maculopathy (ANOVA, Chi square) and ANCOVA for the cognitive scores by DR severity were conducted using SPSS v17. Severity of DR demonstrated an inverse relationship with Cl in patients with T2DM (fully adjusted model). No association was found between severity of maculopathy and Cl. Retinal arteriolar and venular dilation was associated with lower cognition scores in patients with no/mild retinopathy. Decreased levels of serum factor Apo A was associated with decreased cognition. Participants with Cl had consistently elevated risk of stroke compared to participants with no Cl, irrespective of their DR status. Cognition scores also varied by ethnic grouping; participants of ethnic minorities had significantly lower cognition scores than Caucasian participants.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available