Diabetic retinopathy and cognitive dysfunction: a systematic review and meta-analysis

BackgroundThis study aims to determine the relationship between diabetic retinopathy (DR) and cognitive dysfunction as well as explores the effects of DR on different cognitive domains.MethodsA systematic search of PubMed, Embase, Web of Science, Wanfang data, CBM, CNKI, and VIP databases from their inception to October 2021. The pooled odds ratio (ORs), hazard ratio (HRs), and 95% confidence interval (CIs) were calculated.ResultsTwenty-two studies met the inclusion criteria and meta-analysis included 15 studies. The presence of DR reflects a higher risk of cognitive dysfunction (OR = 2.45; 95% CI: 1.76–3.41; HR = 1.34 95% CI: 1.10–1.62). Cohort study combined risk was 2.62 (95% CI: 1.93–3.56), in cross-sectional study was 2.07 (95% CI: 1.11–3.88). The pooled OR was 2.38 (95% CI: 1.83–3.10) and 3.11 (95% CI: 1.15–8.40) in Asia and Oceania. No such association was found in North America (OR = 2.22; 95% CI: 0.77–6.38). The pooled risk was 2.47 (95% CI: 1.76–3.48) in patients with T2DM, while did not identify an association between these two conditions in T1DM. The combined unadjusted and adjusted ORs were 2.72 (95% CI: 1.99–3.73) and 2.06 (95% CI: 1.49–2.85). DR severity and the risk of cognitive impairment showed a positive correlation and mainly impaired the speeds of psychomotor and information processing.ConclusionsDR can help to identify people at high risk of cognitive dysfunction. Further studies are indispensable for exploring the relationship between DR and cognitive impairment in the patients for different age, gender and race, as well as to assess the risk of cognitive impairment in different populations.