The association between diabetic retinopathy and cognitive impairment in patients with diabetes mellitus: a systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background Diabetic retinopathy (DR) is a recognized microvascular complication of diabetes in which neurovascular and neurodegenerative mechanisms may also contribute. This systematic review evaluated the association between DR and cognitive impairment or dementia, including Alzheimer’s disease and vascular dementia, using evidence from cross-sectional and longitudinal observational studies. Methods We searched for relevant articles up to December 2025 from PubMed, Scopus, Web of Science, and Cochrane Library. Two independent reviewers extracted data from the selected studies, including baseline information and outcomes. All quantitative syntheses were conducted using R version 4.4.1. Results Fourteen studies with reported study populations totaling 2,871,847 participants were included. Seven studies contributed to the crude dichotomous synthesis, which did not demonstrate a statistically significant association between diabetic retinopathy and cognitive impairment or dementia (OR 1.07, 95% CI 0.94–1.23; p=0.310; I 2 =52.3%). Seven studies contributed adjusted longitudinal estimates for incident dementia; diabetic retinopathy was associated with a higher incidence of dementia (HR 1.55, 95% CI 1.19–2.02; p=0.001; I 2 =97.8%; 95% prediction interval 0.65–3.68). Evidence concerning Alzheimer’s disease and vascular dementia remained inconsistent. Conclusion Longitudinal evidence suggests that diabetic retinopathy is associated with a higher incidence of dementia, although substantial heterogeneity and the observational evidence base limit confidence in the pooled estimate. Evidence concerning Alzheimer’s disease and vascular dementia remains inconclusive. Systematic review registration https://doi.org/10.17605/OSF.IO/YS462 , identifier YS462.
Source: Frontiers in Endocrinology
Authors: Omar Subih, Wejdan Abdullah Al Mustafa, Tareq Ahmed AlOmem, Abdulaziz Mohammed Alrasheed, Maha Saeed Altunaiji, Aryam Abdullah Mubarak Alhasan, Abdulaziz Ibrahim Atef Alshehri, Bader Muzhier Alshahrani, Ruwaym Jaber Mohammed Alharbi, Ahmad Moahmmad Alshatti, Manar Eid Al Mutairi, Samar Mussari Alkhaldi, Inam N. Bifari
Institutions: Alfaisal University, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, King Saud University, Armed Forces Hospital, University of Sharjah, Jouf University, Security Forces Hospital, Kuwait Institute for Medical Specialization, University of Ha'il, Taif University
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7153779910