{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:28:37Z","timestamp":1791959317501,"version":"4.3.4"},"reference-count":54,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Commission","doi-asserted-by":"publisher","award":["847749"],"award-info":[{"award-number":["847749"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Diabetologia"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims\/hypothesis<\/jats:title>\n                    <jats:p>There are no robust, reliable and easy to administer tests to screen for mild cognitive impairment (MCI) in people living with diabetes. Since the retina is ontogenically brain-derived, we hypothesised that retinal biomarkers could be used, alone or in combination with other simple tests, to screen for MCI in people with diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Baseline data from participants screened for RECOGNISED, a Horizon 2020-funded European project, were analysed. Main eligibility criteria for RECOGNISED included age \u226565 years, type 2 diabetes of over 5 years standing, no previous history of stroke or neurodegenerative disease, and no overt diabetic retinopathy or only mild-to-moderate non-proliferative diabetic retinopathy. Baseline characteristics of participants, including scores from the Montreal Cognitive Assessment test (MoCA) and Self-Administered Gerocognitive Examination, the Diabetes Specific Dementia Risk Score (DSDRS) and ophthalmological endpoints gathered from standardised seven field colour fundus photography, spectral domain optical coherence tomography, microperimetry and a hand-held portable electroretinography device (RETeval), were obtained and used in the work presented here as potential screening predictors for presence of MCI. MCI and normocognition (NC) were determined based on a full neuropsychological test battery and the Clinical Dementia Rating score. A stepwise selection of variables, based on Akaike\u2019s information criterion, and logistic regression models for predicting MCI were undertaken. Area under the receiver-operating characteristic curve analyses were used to predict the probability of the presence of MCI as well as sensitivity and specificity cut-off points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 313 people living with diabetes (128 with NC and 185 with MCI) were included. People with diabetes with MCI were older (\n                      <jats:italic>p<\/jats:italic>\n                      =0.006) and had fewer years of education (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001), lower retinal sensitivity (\n                      <jats:italic>p<\/jats:italic>\n                      =0.01) and less capacity of gaze fixation (\n                      <jats:italic>p<\/jats:italic>\n                      \u22640.001) than those with NC. Statistically significant differences in pupillary area ratio (\n                      <jats:italic>p<\/jats:italic>\n                      =0.002) and photopic b-wave amplitude (\n                      <jats:italic>p<\/jats:italic>\n                      =0.03) were detected between people with diabetes with NC and with MCI. Multivariable logistic regression showed that the best model to identify people with diabetes with MCI was that combining retinal sensitivity, gaze fixation, photopic b-wave amplitude and pupillary size change following stimulation, years of education, DSDRS and MoCA score, with an AUC of 0.84 (sensitivity 79.9, specificity 79.0). The visuo-construction domain was the most affected in people with diabetes with MCI and its impairment was independently related to retinal sensitivity and gaze fixation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>The assessment of retinal neurodysfunction in combination with simple clinical variables appears useful to identify people with diabetes with MCI. This strategy could optimise current screening of MCI in people living with diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-025-06664-4","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T21:42:42Z","timestamp":1769722962000},"page":"1337-1353","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Relationship between retinal neurodysfunction and cognitive impairment in type 2 diabetes: results of the RECOGNISED cross-sectional study"],"prefix":"10.1007","volume":"69","author":[{"given":"Rafael","family":"Sim\u00f3","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Hern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Frontoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Sbraccia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinier","family":"Schlingemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Valldeperas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stela","family":"Vujosevic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"In\u00eas","family":"Marques","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Cunha-Vaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jakob","family":"Grauslund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik N.","family":"Pedersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda-Jos\u00e9","family":"Barahona","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasa","family":"Popovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpaolo","family":"Zerbini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreea","family":"Ciudin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santiago","family":"Perez-Hoyos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lieza","family":"Exalto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert Jan","family":"Biessels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi","family":"Lois","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"issue":"1","key":"6664_CR1","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1016\/S1474-4422(05)70284-2","volume":"5","author":"GJ Biessels","year":"2006","unstructured":"Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P (2006) Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol 5(1):64\u201374. https:\/\/doi.org\/10.1016\/S1474-4422(05)70284-2","journal-title":"Lancet Neurol"},{"issue":"4","key":"6664_CR2","doi-asserted-by":"publisher","first-page":"677","DOI":"10.3233\/JAD-2009-1011","volume":"16","author":"D Kopf","year":"2009","unstructured":"Kopf D, Fr\u00f6lich L (2009) Risk of incident Alzheimer\u2019s disease in diabetic patients: a systematic review of prospective trials. J Alzheimers Dis 16(4):677\u2013685. https:\/\/doi.org\/10.3233\/JAD-2009-1011","journal-title":"J Alzheimers Dis"},{"issue":"6","key":"6664_CR3","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.2337\/dc12-0746","volume":"36","author":"PJJ Spauwen","year":"2013","unstructured":"Spauwen PJJ, K\u00f6hler S, Verhey FRJ, Stehouwer CDA, van Boxtel MPJ (2013) Effects of type 2 diabetes on 12-year cognitive change: results from the Maastricht Aging Study. Diabetes Care 36(6):1554\u20131561. https:\/\/doi.org\/10.2337\/dc12-0746","journal-title":"Diabetes Care"},{"issue":"1","key":"6664_CR4","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1186\/s13098-024-01346-4","volume":"16","author":"F Cao","year":"2024","unstructured":"Cao F, Yang F, Li J et al (2024) The relationship between diabetes and the dementia risk: a meta-analysis. Diabetol Metab Syndr 16(1):101. https:\/\/doi.org\/10.1186\/s13098-024-01346-4","journal-title":"Diabetol Metab Syndr"},{"issue":"4","key":"6664_CR5","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1159\/000337428","volume":"38","author":"KC Wang","year":"2012","unstructured":"Wang KC, Woung LC, Tsai MT, Liu CC, Su YH, Li CY (2012) Risk of Alzheimer\u2019s disease in relation to diabetes: a population-based cohort study. Neuroepidemiology 38(4):237\u2013244. https:\/\/doi.org\/10.1159\/000337428","journal-title":"Neuroepidemiology"},{"issue":"1","key":"6664_CR6","doi-asserted-by":"publisher","first-page":"e87095","DOI":"10.1371\/journal.pone.0087095","volume":"9","author":"CC Huang","year":"2014","unstructured":"Huang CC, Chung CM, Leu HB et al (2014) Diabetes mellitus and the risk of Alzheimer\u2019s disease: a nationwide population-based study. PLoS One 9(1):e87095. https:\/\/doi.org\/10.1371\/journal.pone.0087095","journal-title":"PLoS One"},{"issue":"7","key":"6664_CR7","doi-asserted-by":"publisher","first-page":"1774","DOI":"10.1111\/jgs.17345","volume":"69","author":"MP Aranda","year":"2021","unstructured":"Aranda MP, Kremer IN, Hinton L et al (2021) Impact of dementia: health disparities, population trends, care interventions, and economic costs. J Am Geriatr Soc 69(7):1774\u20131783. https:\/\/doi.org\/10.1111\/jgs.17345","journal-title":"J Am Geriatr Soc"},{"issue":"4","key":"6664_CR8","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1001\/archneur.64.4.570","volume":"64","author":"JA Luchsinger","year":"2007","unstructured":"Luchsinger JA, Reitz C, Patel B, Tang M, Manly JJ, Mayeux R (2007) Relation of diabetes to mild cognitive impairment. Arch Neurol 64(4):570\u2013575. https:\/\/doi.org\/10.1001\/archneur.64.4.570","journal-title":"Arch Neurol"},{"issue":"1","key":"6664_CR9","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.jalz.2013.01.001","volume":"10","author":"RO Roberts","year":"2014","unstructured":"Roberts RO, Knopman DS, Geda YE et al (2014) Association of diabetes with amnestic and nonamnestic mild cognitive impairment. Alzheimers Dement 10(1):18\u201326. https:\/\/doi.org\/10.1016\/j.jalz.2013.01.001","journal-title":"Alzheimers Dement"},{"issue":"6","key":"6664_CR10","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1007\/s00592-020-01648-9","volume":"58","author":"Y You","year":"2021","unstructured":"You Y, Liu Z, Chen Y et al (2021) The prevalence of mild cognitive impairment in type 2 diabetes mellitus patients: a systematic review and meta-analysis. Acta Diabetol 58(6):671\u2013685. https:\/\/doi.org\/10.1007\/s00592-020-01648-9","journal-title":"Acta Diabetol"},{"issue":"12","key":"6664_CR11","doi-asserted-by":"publisher","first-page":"1985","DOI":"10.1001\/archneur.58.12.1985","volume":"58","author":"RC Petersen","year":"2001","unstructured":"Petersen RC, Doody R, Kurz A et al (2001) Current concepts in mild cognitive impairment. Arch Neurol 58(12):1985\u20131992. https:\/\/doi.org\/10.1001\/archneur.58.12.1985","journal-title":"Arch Neurol"},{"issue":"3","key":"6664_CR12","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1212\/01.wnl.0000228244.10416.20","volume":"67","author":"PA Boyle","year":"2006","unstructured":"Boyle PA, Wilson RS, Aggarwal NT, Tang Y, Bennett DA (2006) Mild cognitive impairment: risk of Alzheimer disease and rate of cognitive decline. Neurology 67(3):441\u2013445. https:\/\/doi.org\/10.1212\/01.wnl.0000228244.10416.20","journal-title":"Neurology"},{"issue":"4","key":"6664_CR13","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.3233\/JAD-141566","volume":"43","author":"F Ma","year":"2015","unstructured":"Ma F, Wu T, Miao R, Xiao YY, Zhang W, Huang G (2015) Conversion of mild cognitive impairment to dementia among subjects with diabetes: a population-based study of incidence and risk factors with five years of follow-up. J Alzheimers Dis 43(4):1441\u20131449. https:\/\/doi.org\/10.3233\/JAD-141566","journal-title":"J Alzheimers Dis"},{"issue":"8","key":"6664_CR14","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.1016\/j.jdiacomp.2017.04.01","volume":"31","author":"A Ciudin","year":"2017","unstructured":"Ciudin A, Espinosa A, Sim\u00f3-Servat O et al (2017) Type 2 diabetes is an independent risk factor for dementia conversion in patients with mild cognitive impairment. J Diabetes Complications 31(8):1272\u20131274. https:\/\/doi.org\/10.1016\/j.jdiacomp.2017.04.01","journal-title":"J Diabetes Complications"},{"key":"6664_CR15","doi-asserted-by":"publisher","first-page":"7","DOI":"10.2147\/PRBM.S36238","volume":"9","author":"A Tomlin","year":"2016","unstructured":"Tomlin A, Sinclair A (2016) The influence of cognition on self-management of type 2 diabetes in older people. Psychol Res Behav Manag 9:7\u201320. https:\/\/doi.org\/10.2147\/PRBM.S36238","journal-title":"Psychol Res Behav Manag"},{"issue":"5","key":"6664_CR16","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s00592-017-0970-5","volume":"54","author":"R Sim\u00f3","year":"2017","unstructured":"Sim\u00f3 R, Ciudin A, Sim\u00f3-Servat O, Hern\u00e1ndez C (2017) Cognitive impairment and dementia: a new emerging complication of type 2 diabetes-the diabetologist\u2019s perspective. Acta Diabetol 54(5):417\u2013424. https:\/\/doi.org\/10.1007\/s00592-017-0970-5","journal-title":"Acta Diabetol"},{"key":"6664_CR17","doi-asserted-by":"publisher","unstructured":"(2017) Committee Report: Glycemic targets for elderly patients with diabetes: Japan Diabetes Society (JDS)\/Japan Geriatrics Society (JGS) Joint Committee on Improving Care for Elderly Patients with Diabetes. J Diabetes Investig 8(1):126\u2013128. https:\/\/doi.org\/10.1111\/jdi.12599","DOI":"10.1111\/jdi.12599"},{"issue":"Suppl 1","key":"6664_CR18","doi-asserted-by":"publisher","first-page":"S266","DOI":"10.2337\/dc25-S013","volume":"48","author":"American Diabetes Association Professional Practice Committee","year":"2025","unstructured":"American Diabetes Association Professional Practice Committee (2025) 13. Older adults: standards of care in diabetes-2025. Diabetes Care 48(Suppl 1):S266\u2013S282. https:\/\/doi.org\/10.2337\/dc25-S013","journal-title":"Diabetes Care"},{"issue":"3","key":"6664_CR19","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.jalz.2011.03.008","volume":"7","author":"MS Albert","year":"2011","unstructured":"Albert MS, DeKosky ST, Dickson D et al (2011) The diagnosis of mild cognitive impairment due to Alzheimer\u2019s disease: recommendations from the National Institute on Aging-Alzheimer\u2019s Association workgroups on diagnostic guidelines for Alzheimer\u2019s disease. Alzheimers Dement 7(3):270\u2013279. https:\/\/doi.org\/10.1016\/j.jalz.2011.03.008","journal-title":"Alzheimers Dement"},{"issue":"7","key":"6664_CR20","doi-asserted-by":"publisher","first-page":"CD010783","DOI":"10.1002\/14651858.CD010783.pub3","volume":"7","author":"I Arevalo-Rodriguez","year":"2021","unstructured":"Arevalo-Rodriguez I, Smailagic N, Roqu\u00e9-Figuls M et al (2021) Mini-Mental State Examination (MMSE) for the early detection of dementia in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 7(7):CD010783. https:\/\/doi.org\/10.1002\/14651858.CD010783.pub3","journal-title":"Cochrane Database Syst Rev"},{"issue":"11","key":"6664_CR21","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1017\/S1041610212001068","volume":"24","author":"Y Dong","year":"2012","unstructured":"Dong Y, Lee WY, Basri NA et al (2012) The Montreal Cognitive Assessment is superior to the Mini-Mental State Examination in detecting patients at higher risk of dementia. Int Psychogeriatr 24(11):1749\u20131755. https:\/\/doi.org\/10.1017\/S1041610212001068","journal-title":"Int Psychogeriatr"},{"issue":"10","key":"6664_CR22","doi-asserted-by":"publisher","first-page":"630","DOI":"10.1055\/s-0042-109606","volume":"124","author":"J Nicolau","year":"2016","unstructured":"Nicolau J, Sim\u00f3 R, Sanch\u00eds P et al (2016) Prevalence and clinical correlators of undiagnosed significant depressive symptoms among individuals with type 2 diabetes in a Mediterranean population. Exp Clin Endocrinol Diabetes 124(10):630\u2013636. https:\/\/doi.org\/10.1055\/s-0042-109606","journal-title":"Exp Clin Endocrinol Diabetes"},{"issue":"6","key":"6664_CR23","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1111\/dme.12874","volume":"33","author":"PS Koekkoek","year":"2016","unstructured":"Koekkoek PS, Janssen J, Kooistra M et al (2016) Case-finding for cognitive impairment among people with type 2 diabetes in primary care using the Test Your Memory and Self-Administered Gerocognitive Examination questionnaires: the Cog-ID study. Diabet Med 33(6):812\u2013819. https:\/\/doi.org\/10.1111\/dme.12874","journal-title":"Diabet Med"},{"issue":"1","key":"6664_CR24","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.tem.2013.09.005","volume":"25","author":"R Sim\u00f3","year":"2014","unstructured":"Sim\u00f3 R, Hern\u00e1ndez C, European Consortium for the Early Treatment of Diabetic Retinopathy (EUROCONDOR) (2014) Neurodegeneration in the diabetic eye: new insights and therapeutic perspectives. Trends Endocrinol Metab 25(1):23\u201333. https:\/\/doi.org\/10.1016\/j.tem.2013.09.005","journal-title":"Trends Endocrinol Metab"},{"issue":"19","key":"6664_CR25","doi-asserted-by":"publisher","first-page":"E2655","DOI":"10.1073\/pnas.1522014113","volume":"113","author":"EH Sohn","year":"2016","unstructured":"Sohn EH, van Dijk HW, Jiao C et al (2016) Retinal neurodegeneration may precede microvascular changes characteristic of diabetic retinopathy in diabetes mellitus. Proc Natl Acad Sci U S A 113(19):E2655\u2013E2664. https:\/\/doi.org\/10.1073\/pnas.1522014113","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"9","key":"6664_CR26","doi-asserted-by":"publisher","first-page":"2503","DOI":"10.2337\/db16-1453","volume":"66","author":"AR Santos","year":"2017","unstructured":"Santos AR, Ribeiro L, Bandello F, European Consortium for the Early Treatment of Diabetic Retinopathy (EUROCONDOR) et al (2017) Functional and structural findings of neurodegeneration in early stages of diabetic retinopathy: cross-sectional analyses of baseline data of the EUROCONDOR project. Diabetes 66(9):2503\u20132510. https:\/\/doi.org\/10.2337\/db16-1453","journal-title":"Diabetes"},{"key":"6664_CR27","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.ajo.2022.01.011","volume":"239","author":"YH Chai","year":"2022","unstructured":"Chai YH, Zhang YP, Qiao YS et al (2022) Association between diabetic retinopathy, brain structural abnormalities, and cognitive impairment for accumulated evidence in observational studies. Am J Ophthalmol 239:37\u201353. https:\/\/doi.org\/10.1016\/j.ajo.2022.01.011","journal-title":"Am J Ophthalmol"},{"issue":"1","key":"6664_CR28","doi-asserted-by":"publisher","first-page":"451","DOI":"10.3233\/JAD-215313","volume":"86","author":"FN Pedersen","year":"2022","unstructured":"Pedersen FN, Stokholm L, Pouwer F et al (2022) Diabetic retinopathy predicts risk of Alzheimer\u2019s disease: a Danish registry-based nationwide cohort study. J Alzheimers Dis 86(1):451\u2013460. https:\/\/doi.org\/10.3233\/JAD-215313","journal-title":"J Alzheimers Dis"},{"key":"6664_CR29","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.preteyeres.2017.01.001","volume":"57","author":"CY Cheung","year":"2017","unstructured":"Cheung CY, Ikram MK, Chen C, Wong TY (2017) Imaging retina to study dementia and stroke. Prog Retin Eye Res 57:89\u2013107. https:\/\/doi.org\/10.1016\/j.preteyeres.2017.01.001","journal-title":"Prog Retin Eye Res"},{"issue":"11","key":"6664_CR30","doi-asserted-by":"publisher","first-page":"e806","DOI":"10.1016\/S2589-7500(22)00169-8","volume":"4","author":"CY Cheung","year":"2022","unstructured":"Cheung CY, Ran AR, Wang S et al (2022) A deep learning model for detection of Alzheimer\u2019s disease based on retinal photographs: a retrospective, multicentre case-control study. Lancet Digit Health 4(11):e806\u2013e815. https:\/\/doi.org\/10.1016\/S2589-7500(22)00169-8","journal-title":"Lancet Digit Health"},{"issue":"12","key":"6664_CR31","doi-asserted-by":"publisher","first-page":"3098","DOI":"10.2337\/db17-0382","volume":"66","author":"A Ciudin","year":"2017","unstructured":"Ciudin A, Sim\u00f3-Servat O, Hern\u00e1ndez C et al (2017) Retinal microperimetry: a new tool for identifying patients with type 2 diabetes at risk for developing alzheimer disease. Diabetes 66(12):3098\u20133104. https:\/\/doi.org\/10.2337\/db17-0382","journal-title":"Diabetes"},{"issue":"1","key":"6664_CR32","doi-asserted-by":"publisher","first-page":"59","DOI":"10.3390\/jcm8010059","volume":"8","author":"O Sim\u00f3-Servat","year":"2019","unstructured":"Sim\u00f3-Servat O, Ciudin A, Ortiz-Z\u00fa\u00f1iga \u00c1M, Hern\u00e1ndez C, Sim\u00f3 R (2019) Usefulness of eye fixation assessment for identifying type 2 diabetic subjects at risk of dementia. J Clin Med 8(1):59. https:\/\/doi.org\/10.3390\/jcm8010059","journal-title":"J Clin Med"},{"issue":"8","key":"6664_CR33","doi-asserted-by":"publisher","first-page":"698","DOI":"10.3390\/jpm11080698","volume":"11","author":"\u00c1M Ortiz-Z\u00fa\u00f1iga","year":"2021","unstructured":"Ortiz-Z\u00fa\u00f1iga \u00c1M, Sim\u00f3-Servat O, Rojano-Toimil A et al (2021) The gaze fixation assessed by microperimetry: a useful tool for the monitoring of the cognitive function in patients with type 2 diabetes. J Pers Med 11(8):698. https:\/\/doi.org\/10.3390\/jpm11080698","journal-title":"J Pers Med"},{"key":"6664_CR34","doi-asserted-by":"publisher","first-page":"186106","DOI":"10.1155\/2013\/186106","volume":"2013","author":"K Alagiakrishnan","year":"2013","unstructured":"Alagiakrishnan K, Zhao N, Mereu L, Senior P, Senthilselvan A (2013) Montreal Cognitive Assessment is superior to Standardized Mini-Mental Status Exam in detecting mild cognitive impairment in the middle-aged and elderly patients with type 2 diabetes mellitus. Biomed Res Int 2013:186106. https:\/\/doi.org\/10.1155\/2013\/186106","journal-title":"Biomed Res Int"},{"issue":"1","key":"6664_CR35","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1097\/WAD.0b013e3181b03277","volume":"24","author":"DW Scharre","year":"2010","unstructured":"Scharre DW, Chang SI, Murden RA et al (2010) Self-administered Gerocognitive Examination (SAGE): a brief cognitive assessment Instrument for mild cognitive impairment (MCI) and early dementia. Alzheimer Dis Assoc Disord 24(1):64\u201371. https:\/\/doi.org\/10.1097\/WAD.0b013e3181b03277","journal-title":"Alzheimer Dis Assoc Disord"},{"issue":"8","key":"6664_CR36","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1002\/gps.4407","volume":"31","author":"C Pocklington","year":"2016","unstructured":"Pocklington C, Gilbody S, Manea L, McMillan D (2016) The diagnostic accuracy of brief versions of the Geriatric Depression Scale: a systematic review and meta-analysis. Int J Geriatr Psychiatry 31(8):837\u2013857. https:\/\/doi.org\/10.1002\/gps.4407","journal-title":"Int J Geriatr Psychiatry"},{"issue":"10","key":"6664_CR37","doi-asserted-by":"publisher","first-page":"1727","DOI":"10.1007\/s11136-011-9903-x","volume":"20","author":"M Herdman","year":"2011","unstructured":"Herdman M, Gudex C, Lloyd A et al (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20(10):1727\u20131736. https:\/\/doi.org\/10.1007\/s11136-011-9903-x","journal-title":"Qual Life Res"},{"key":"6664_CR38","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1001\/archopht.119.7.1050","volume":"119","author":"CM Mangione","year":"2001","unstructured":"Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD, National Eye Institute Visual Function Questionnaire Field Test Investigators (2001) Development of the 25-item national eye institute visual function questionnaire. Arch Ophthalmol 119:1050\u20131058. https:\/\/doi.org\/10.1001\/archopht.119.7.1050","journal-title":"Arch Ophthalmol"},{"issue":"3","key":"6664_CR39","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1001\/archneur.56.3.303","volume":"56","author":"RC Petersen","year":"1999","unstructured":"Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E (1999) Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 56(3):303\u2013308. https:\/\/doi.org\/10.1001\/archneur.56.3.303","journal-title":"Arch Neurol"},{"issue":"3","key":"6664_CR40","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1002\/gps.2334","volume":"25","author":"R Duara","year":"2010","unstructured":"Duara R, Loewenstein DA, Greig-Custo MT et al (2010) Diagnosis and staging of mild cognitive impairment, using a modification of the clinical dementia rating scale: the mCDR. Int J Geriatr Psychiatry 25(3):282\u2013289. https:\/\/doi.org\/10.1002\/gps.2334","journal-title":"Int J Geriatr Psychiatry"},{"issue":"3","key":"6664_CR41","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/S2213-8587(13)70048-2","volume":"1","author":"LG Exalto","year":"2013","unstructured":"Exalto LG, Biessels GJ, Karter AJ et al (2013) Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study. Lancet Diabetes Endocrinol 1(3):183\u2013190. https:\/\/doi.org\/10.1016\/S2213-8587(13)70048-2","journal-title":"Lancet Diabetes Endocrinol"},{"key":"6664_CR42","doi-asserted-by":"publisher","first-page":"E006","DOI":"10.1017\/S095252382000005X","volume":"37","author":"ED Eggers","year":"2020","unstructured":"Eggers ED, Carreon TA (2020) The effects of early diabetes on inner retinal neurons. Vis Neurosci 37:E006. https:\/\/doi.org\/10.1017\/S095252382000005X","journal-title":"Vis Neurosci"},{"issue":"1","key":"6664_CR43","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.tem.2021.10.008","volume":"33","author":"K Little","year":"2022","unstructured":"Little K, Llori\u00e1n-Salvador M, Scullion S, RECOGNISED consortium (GA 847749) et al (2022) Common pathways in dementia and diabetic retinopathy: understanding the mechanisms of diabetes-related cognitive decline. Trends Endocrinol Metab 33(1):50\u201371. https:\/\/doi.org\/10.1016\/j.tem.2021.10.008","journal-title":"Trends Endocrinol Metab"},{"issue":"1","key":"6664_CR44","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1186\/s12877-020-01776-5","volume":"20","author":"OY Bello-Chavolla","year":"2020","unstructured":"Bello-Chavolla OY, Aguilar-Salinas CA, Avila-Funes JA (2020) The type 2 diabetes-specific dementia risk score (DSDRS) is associated with frailty, cognitive and functional status amongst Mexican community-dwelling older adults. BMC Geriatr 20(1):363. https:\/\/doi.org\/10.1186\/s12877-020-01776-5","journal-title":"BMC Geriatr"},{"issue":"9","key":"6664_CR45","doi-asserted-by":"publisher","first-page":"2726","DOI":"10.3390\/jcm9092726","volume":"9","author":"AM Ortiz Zu\u00f1iga","year":"2020","unstructured":"Ortiz Zu\u00f1iga AM, Sim\u00f3 R, Rodriguez-G\u00f3mez O et al (2020) Clinical applicability of the specific risk score of dementia in type 2 diabetes in the identification of patients with early cognitive impairment: results of the MOPEAD study in Spain. J Clin Med 9(9):2726. https:\/\/doi.org\/10.3390\/jcm9092726","journal-title":"J Clin Med"},{"issue":"2","key":"6664_CR46","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1177\/13872877251318029","volume":"104","author":"N Popovic","year":"2025","unstructured":"Popovic N, Lois N, P\u00e9rez-Hoyos S, Sim\u00f3 R, Exalto LG, RECOGNISED Consortium (2025) Revisiting the Montreal Cognitive Assessment in a European cohort of elderly living with type 2 diabetes. J Alzheimers Dis 104(2):585\u2013594. https:\/\/doi.org\/10.1177\/13872877251318029","journal-title":"J Alzheimers Dis"},{"issue":"2","key":"6664_CR47","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1006\/brcg.1996.0038","volume":"31","author":"DX Rasmusson","year":"1996","unstructured":"Rasmusson DX, Carson KA, Brookmeyer R, Kawas C, Brandt J (1996) Predicting rate of cognitive decline in probable Alzheimer\u2019s disease. Brain Cogn 31(2):133\u2013147. https:\/\/doi.org\/10.1006\/brcg.1996.0038","journal-title":"Brain Cogn"},{"issue":"5","key":"6664_CR48","doi-asserted-by":"publisher","first-page":"742","DOI":"10.1176\/ajp.150.5.742","volume":"150","author":"JA Yesavage","year":"1993","unstructured":"Yesavage JA, Brooks JO 3rd, Taylor J, Tinklenberg J (1993) Development of aphasia, apraxia, and agnosia and decline in Alzheimer\u2019s disease. Am J Psychiatry 150(5):742\u2013747. https:\/\/doi.org\/10.1176\/ajp.150.5.742","journal-title":"Am J Psychiatry"},{"issue":"4","key":"6664_CR49","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1111\/j.1468-1331.2007.01693.x","volume":"14","author":"I Buccione","year":"2007","unstructured":"Buccione I, Perri R, Carlesimo GA et al (2007) Cognitive and behavioural predictors of progression rates in Alzheimer\u2019s disease. Eur J Neurol 14(4):440\u2013446. https:\/\/doi.org\/10.1111\/j.1468-1331.2007.01693.x","journal-title":"Eur J Neurol"},{"issue":"6","key":"6664_CR50","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1007\/s12529-024-10274-6","volume":"31","author":"T Sola","year":"2024","unstructured":"Sola T, Sola FM, Jehkonen M (2024) The effects of type 2 diabetes on cognitive performance: a review of reviews. Int J Behav Med 31(6):944\u2013958. https:\/\/doi.org\/10.1007\/s12529-024-10274-6","journal-title":"Int J Behav Med"},{"issue":"9","key":"6664_CR51","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1212\/wnl.42.9.1689","volume":"42","author":"JA Mortimer","year":"1992","unstructured":"Mortimer JA, Ebbitt B, Jun SP, Finch MD (1992) Predictors of cognitive and functional progression in patients with probable Alzheimer\u2019s disease. Neurology 42(9):1689\u20131696. https:\/\/doi.org\/10.1212\/wnl.42.9.1689","journal-title":"Neurology"},{"key":"6664_CR52","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1001\/archneur.1990.00530080033007","volume":"47","author":"DA Drachman","year":"1990","unstructured":"Drachman DA, O\u2019Donnel BF, Lew RA et al (1990) The prognosis of Alzheimer\u2019s disease. \u2018How far\u2019 rather than \u2018how fast\u2019 best predicts the course. Arch Neurol 47:851\u2013856. https:\/\/doi.org\/10.1001\/archneur.1990.00530080033007","journal-title":"Arch Neurol"},{"key":"6664_CR53","doi-asserted-by":"publisher","first-page":"102487","DOI":"10.1016\/j.arr.2024.102487","volume":"101","author":"S Arora","year":"2024","unstructured":"Arora S, Patten SB, Mallo SC et al (2024) The influence of education in predicting conversion from Subjective cognitive decline (SCD) to objective cognitive impairment: a systematic review and meta-analysis. Ageing Res Rev 101:102487. https:\/\/doi.org\/10.1016\/j.arr.2024.102487","journal-title":"Ageing Res Rev"},{"issue":"9","key":"6664_CR54","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1016\/j.jalz.2018.07.219","volume":"16","author":"Y Stern","year":"2020","unstructured":"Stern Y, Arenaza-Urquijo EM, Bartr\u00e9s-Faz D, the Reserve, Resilience and Protective Factors PIA Empirical Definitions and Conceptual Frameworks Workgroup et al (2020) Whitepaper: defining and investigating cognitive reserve, brain reserve, and brain maintenance. Alzheimers Dement 16(9):1305\u20131311. https:\/\/doi.org\/10.1016\/j.jalz.2018.07.219","journal-title":"Alzheimers Dement"}],"container-title":["Diabetologia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-025-06664-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00125-025-06664-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00125-025-06664-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T16:46:09Z","timestamp":1774111569000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00125-025-06664-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":54,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["6664"],"URL":"https:\/\/doi.org\/10.1007\/s00125-025-06664-4","relation":{},"ISSN":["0012-186X","1432-0428"],"issn-type":[{"value":"0012-186X","type":"print"},{"value":"1432-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"assertion":[{"value":"23 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 November 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The datasets generated during and\/or analysed in the current study are available from the corresponding authors upon reasonable request.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Data availability"}},{"value":"This work was funded by the European Commission's Horizon 2020 Work Programme 2018\u20132020 (Grant Agreement No. 847749). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Authors\u2019 relationships and activities"}},{"value":"All authors have participated in the conception and design, acquisition of data or analysis and interpretation of data. RS, CH and NL wrote the first draft of the manuscript. All authors participated in its critical review with important intellectual contributions, and approved the final version of the manuscript. RS is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Contribution statement"}}]}}