TOPLINE:

Individuals with type 2 diabetes — with or without retinopathy — had higher risks for incident Alzheimer’s disease and dementia than those without the blood sugar disorder. Among patients with diabetes, a greater severity of diabetic retinopathy was associated with a stepwise increase in the risks for vascular and all‑cause dementia but not Alzheimer’s disease. 

METHODOLOGY:

• Researchers conducted a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data of 769,930 individuals aged 65 years or older who underwent an eye exam or optical coherence tomography between January 2010 and January 2020 to examine the risk for dementia linked to diabetic retinopathy.
• Participants were categorized into four groups: 14,034 with proliferative retinopathy, 29,188 with nonproliferative retinopathy, 208,640 with only type 2 diabetes, and 447,054 control individuals without the condition; the groups were matched subsequently to account for differences at baseline.
• The study excluded individuals younger than 65 years, those with macular edema, and those with a diagnosis of dementia made before their diagnosis of diabetes.
• Outcome measures included incidence of dementia from any cause, Alzheimer’s disease, and vascular dementia; the mean duration of follow-up was approximately 6.73 years.
• Analysis compared each stage of diabetic retinopathy with the others and with the control group without diabetes to assess the effect of disease severity on the risk for dementia.

TAKEAWAY:

• Patients with diabetes only, patients with nonproliferative retinopathy, and patients with proliferative retinopathy had higher risks for all-cause dementia (hazard ratios [HRs], 1.262, 1.405, and 1.583, respectively), Alzheimer’s disease (HRs, 1.117, 1.233, and 1.175, respectively), and vascular dementia (HRs, 1.384, 1.917, and 2.077, respectively) than control individuals.
• Compared with participants with only type 2 diabetes, those with nonproliferative retinopathy and those with proliferative retinopathy had higher risks for all-cause dementia (HRs, 1.113 and 1.202, respectively) and vascular dementia (HRs, 1.322 and 1.504, respectively) but not for Alzheimer’s disease.
• When stratified by severity of diabetic retinopathy, proliferative retinopathy was associated with higher risks for all-cause dementia (HR, 1.121) and vascular dementia (HR, 1.177) than nonproliferative retinopathy, but no significant association was found between severity and the risk for Alzheimer’s disease.

IN PRACTICE:

“These findings underscore the role of systemic microvascular injury in cognitive decline,” the researchers reported.

“Ophthalmic examinations, already routine in diabetes management, provide a valuable opportunity for dementia risk assessment and education, enabling eye care clinicians to alert and/or refer patients with diabetic retinopathy to their primary care providers as an additional avenue for dementia screening,” they added.

SOURCE:

The study was led by Millen S. Khangura and Michelle A. Spratt, of the Renaissance School of Medicine at Stony Brook University in New York City. It was published online on February 13, 2026, in American Journal of Ophthalmology.

LIMITATIONS:

Education and socioeconomic status, which are known modifiers of dementia risk, were not well captured in the database. The follow-up time of approximately 6.7 years may have been insufficient for younger participants who may not have reached the typical age of dementia onset. The database did not provide age at death, preventing assessment of survival bias and duration of dementia. 

DISCLOSURES:

This study did not receive any financial support. One author reported serving on an advisory board and as a consultant, serving on a data‑safety monitoring board, acting as an ad hoc consultant, and receiving research funding from certain pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.