Retinal biomarkers and dementia risk: A review of evidence across the 14 Lancet modifiable risk factors for dementia
Year: 2026
Type: preprint
Abstract: As the only central nervous system tissue that can be directly imaged non-invasively using widely available technology, the retina offers a uniquely accessible window into the brain. Quantitative retinal measures can be derived at scale and have been associated with mechanistic processes in the brain and throughout the body, positioning retinal biomarkers as promising tools for dementia prevention and intervention research. Evidence indicates that several retinal biomarkers can distinguish individuals with Alzheimer’s disease (AD) from cognitively healthy controls; however, it remains unclear whether these markers reflect preclinical AD-specific pathology or broader profiles of dementia risk, particularly in the earliest stages of disease. This review synthesises current evidence on retinal microvascular and neuronal morphological biomarkers and their associations with 14 modifiable dementia risk factors identified by the Lancet Commission on dementia. Robust evidence indicates that retinal biomarkers are influenced by vascular and metabolic risks, specifically hypertension and diabetes. However, associations with other modifiable risk factors, including social isolation, lower educational attainment, hearing loss, smoking, air pollution, and traumatic brain injury, are sparse or absent. Critical research gaps persist regarding how, when, and for whom the retina reflects vascular and metabolic risk factors, and whether non-biological risk factors, such as social isolation and educational attainment, are better understood as independent or confounding variables than as direct biological determinants of retinal biomarkers. Clarifying these associations is essential to establish retinal biomarkers as scalable, non-invasive indicators of dementia risk and to support their integration into targeted risk stratification, early detection, and preventive intervention studies.
Author: Ashleigh Barrett-Young
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7223220306