03128nas a2200469 4500008004100000022001400041245008300055210006900138260001300207300001000220490000800230520178800238653003102026653000902057653002802066653002402094653004402118653002602162653002202188653001102210653001702221653001402238653002602252653002102278653003002299653001502329653001402344653002402358653002102382653001702403653001202420100001902432700002302451700002002474700001802494700002002512700002202532700002402554700002202578700002202600856003602622 2012 eng d a1538-360100aRetinal microvascular signs and disability in the Cardiovascular Health Study.0 aRetinal microvascular signs and disability in the Cardiovascular c2012 Mar a350-60 v1303 a
OBJECTIVE: To study the associations of retinal microvascular changes, which are associated with systemic conditions and cognitive decline, with disability in performing activities of daily living (ADL).
DESIGN: Prospective cohort study of 1487 community-dwelling participants in the Cardiovascular Health Study (mean age, 78 years) who were free of ADL disability and had available data on retinal signs and carotid intima-media thickness at the 1998-1999 visit. Main outcome measures were incident ADL disability, defined as self-reported difficulty in performing any ADL, by the presence of retinal signs and advanced carotid atherosclerosis, defined by carotid intima-media thickness in the 80th percentile or more or 25% or more stenosis, and potential mediation by cerebral microvascular disease on brain imaging or by executive dysfunction, slow gait, and depressive mood, which are symptoms of frontal subcortical dysfunction.
RESULTS: During the median follow-up of 3.1 years (maximum, 7.8 years), participants with 2 or more retinal signs had a higher rate of disability than those with fewer than 2 retinal signs (10.1% vs 7.1%; adjusted hazard ratio, 1.45; 95% confidence interval, 1.24-1.69; P < .001). There was no evidence of interaction by advanced carotid atherosclerosis (P > .10). The association seemed to be partially mediated by executive dysfunction, slow gait, and depressive symptoms but not by cerebral microvascular disease on brain imaging.
CONCLUSIONS: These results provide further support for the pathophysiologic and prognostic significance of microvascular disease in age-related disability. However, it remains to be determined how to best use retinal photography in clinical risk prediction.
10aActivities of Daily Living10aAged10aCarotid Artery Diseases10aCognition Disorders10aDiagnostic Techniques, Ophthalmological10aDisability Evaluation10aFollow-Up Studies10aHumans10aHypertension10aIncidence10aKaplan-Meier Estimate10aMicrocirculation10aPredictive Value of Tests10aPrevalence10aPrognosis10aProspective Studies10aRetinal Diseases10aRisk Factors10aSmoking1 aKim, Dae, Hyun1 aChaves, Paulo, H M1 aNewman, Anne, B1 aKlein, Ronald1 aSarnak, Mark, J1 aNewton, Elizabeth1 aStrotmeyer, Elsa, S1 aBurke, Gregory, L1 aLipsitz, Lewis, A uhttps://chs-nhlbi.org/node/1351