{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:10:40Z","timestamp":1792080640622,"version":"4.4.0"},"reference-count":40,"publisher":"American Diabetes Association","issue":"12","content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,12,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>Longitudinal evidence linking diabetic retinopathy with changes in brain structure and cognition is sparse. We used data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial to determine whether diabetic retinopathy at baseline predicted changes in brain structure or cognition 40 months later.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>Participants from the ACCORD-MIND and ACCORD-Eye substudies were included in analyses of cognition (n = 1,862) and MRI-derived brain variables (n = 432). Retinopathy was categorized as none, mild nonproliferative, or moderate\/severe. Tests of cognition included the Mini-Mental State Examination (MMSE), Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test, and Stroop test. Primary brain outcomes were gray matter and abnormal white matter volumes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Baseline retinopathy was associated with lower gray matter volume (adjusted means of 470, 466, and 461 cm3 for none, mild, and moderate\/severe retinopathy, respectively; P = 0.03). Baseline retinopathy also predicted a greater change in MMSE and DSST scores at 40 months in each retinopathy category (MMSE: \u22120.20, \u22120.57, and \u22120.42, respectively [P = 0.04]; DSST: \u22121.30, \u22121.84, and \u22122.89, respectively[P = 0.01]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Diabetic retinopathy is associated with future cognitive decline in people with type 2 diabetes. Although diabetic retinopathy is not a perfect proxy for diabetes-related brain and cognitive decline, patients with type 2 diabetes and retinopathy represent a subgroup at higher risk for future cognitive decline.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc14-0502","type":"journal-article","created":{"date-parts":[[2014,9,6]],"date-time":"2014-09-06T07:24:46Z","timestamp":1409988286000},"page":"3244-3252","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":73,"title":["The Cross-sectional and Longitudinal Associations of Diabetic Retinopathy With Cognitive Function and Brain MRI Findings: The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Trial"],"prefix":"10.2337","volume":"37","clinical-trial-number":[{"clinical-trial-number":"nct00000620","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Christina E.","family":"Hugenschmidt","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Lovato","sequence":"additional","affiliation":[{"name":"Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter T.","family":"Ambrosius","sequence":"additional","affiliation":[{"name":"Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. Nick","family":"Bryan","sequence":"additional","affiliation":[{"name":"Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hertzel C.","family":"Gerstein","sequence":"additional","affiliation":[{"name":"Department of Medicine and Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen R.","family":"Horowitz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Case Western Reserve University, Cleveland, OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenore J.","family":"Launer","sequence":"additional","affiliation":[{"name":"National Institute on Aging, National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald M.","family":"Lazar","sequence":"additional","affiliation":[{"name":"Departments of Neurology and Neurosurgery, Columbia University College of Physicians and Surgeons, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne M.","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily Y.","family":"Chew","sequence":"additional","affiliation":[{"name":"National Eye Institute, National Institutes of Health, Bethesda, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald P.","family":"Danis","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff D.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingzhong","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2014,11,8]]},"reference":[{"key":"2022031219292338600_B1","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/j.1365-2990.2010.01139.x","article-title":"Review: cerebral microvascular pathology in ageing and neurodegeneration","volume":"37","author":"Brown","year":"2011","journal-title":"Neuropathol Appl Neurobiol"},{"issue":"Pt 7","key":"2022031219292338600_B2","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1093\/brain\/awq127","article-title":"Retinal microvascular abnormalities and subclinical magnetic resonance imaging brain infarct: a prospective study","volume":"133","author":"Cheung","year":"2010","journal-title":"Brain"},{"key":"2022031219292338600_B3","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1093\/aje\/kwj350","article-title":"Associations between findings on cranial magnetic resonance imaging and retinal photography in the elderly: the Cardiovascular Health Study","volume":"165","author":"Longstreth","year":"2007","journal-title":"Am J Epidemiol"},{"key":"2022031219292338600_B4","doi-asserted-by":"crossref","first-page":"2388","DOI":"10.1007\/s00125-007-0792-z","article-title":"Metabolic and vascular determinants of impaired cognitive performance and abnormalities on brain magnetic resonance imaging in patients with type 2 diabetes","volume":"50","author":"Manschot","year":"2007","journal-title":"Diabetologia"},{"key":"2022031219292338600_B5","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.2337\/diabetes.55.04.06.db05-1323","article-title":"Brain magnetic resonance imaging correlates of impaired cognition in patients with type 2 diabetes","volume":"55","author":"Manschot","year":"2006","journal-title":"Diabetes"},{"key":"2022031219292338600_B6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1001\/jama.288.1.67","article-title":"Cerebral white matter lesions, retinopathy, and incident clinical stroke","volume":"288","author":"Wong","year":"2002","journal-title":"JAMA"},{"key":"2022031219292338600_B7","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.2337\/dc08-2300","article-title":"Glycemic status and brain injury in older individuals: the Age Gene\/Environment Susceptibility-Reykjavik Study","volume":"32","author":"Saczynski","year":"2009","journal-title":"Diabetes Care"},{"key":"2022031219292338600_B8","doi-asserted-by":"crossref","first-page":"687","DOI":"10.2337\/diabetes.53.3.687","article-title":"Magnetic resonance imaging of the brain in diabetes: the Cardiovascular Determinants of Dementia (CASCADE) Study","volume":"53","author":"Schmidt","year":"2004","journal-title":"Diabetes"},{"key":"2022031219292338600_B9","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1148\/radiol.14131494","article-title":"Effect of diabetes on brain structure: the Action to Control Cardiovascular Risk in Diabetes MR imaging baseline data","volume":"272","author":"Bryan","year":"2014","journal-title":"Radiology"},{"key":"2022031219292338600_B10","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1111\/j.1469-7580.2005.00395.x","article-title":"Retinal vascular image analysis as a potential screening tool for cerebrovascular disease: a rationale based on homology between cerebral and retinal microvasculatures","volume":"206","author":"Patton","year":"2005","journal-title":"J Anat"},{"key":"2022031219292338600_B11","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.2337\/dc12-1311","article-title":"Diabetic retinopathy, its progression, and incident cardiovascular events in the ACCORD trial","volume":"36","author":"Gerstein","year":"2013","journal-title":"Diabetes Care"},{"key":"2022031219292338600_B12","first-page":"449","article-title":"Retinal microvascularisation abnormalities and cardiovascular risk","volume-title":"Arch Cardiovasc Dis","author":"Mimoun","year":"2009"},{"key":"2022031219292338600_B13","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1212\/01.WNL.0000033093.16450.5C","article-title":"Retinal arterial changes correlate with cerebral small-vessel disease","volume":"59","author":"Kwa","year":"2002","journal-title":"Neurology"},{"key":"2022031219292338600_B14","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1002\/ana.21614","article-title":"Microvascular lesions in the brain and retina: The Age, Gene\/Environment Susceptibility-Reykjavik Study","volume":"65","author":"Qiu","year":"2009","journal-title":"Ann Neurol"},{"key":"2022031219292338600_B15","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.2337\/dc06-2052","article-title":"Global and regional effects of type 2 diabetes on brain tissue volumes and cerebral vasoreactivity","volume":"30","author":"Last","year":"2007","journal-title":"Diabetes Care"},{"key":"2022031219292338600_B16","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1212\/01.WNL.0000086372.05488.8D","article-title":"Retinal microvascular changes and MRI signs of cerebral atrophy in healthy, middle-aged people","volume":"61","author":"Wong","year":"2003","journal-title":"Neurology"},{"key":"2022031219292338600_B17","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1161\/STROKEAHA.107.483586","article-title":"Retinal microvascular signs, cognitive function, and dementia in older persons: the Cardiovascular Health Study","volume":"38","author":"Baker","year":"2007","journal-title":"Stroke"},{"key":"2022031219292338600_B18","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1161\/01.STR.0000016789.56668.43","article-title":"Retinal microvascular abnormalities and cognitive impairment in middle-aged persons: the Atherosclerosis Risk in Communities Study","volume":"33","author":"Wong","year":"2002","journal-title":"Stroke"},{"key":"2022031219292338600_B19","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1002\/dmrr.632","article-title":"Cognitive dysfunction associates with white matter hyperintensities and subcortical atrophy on magnetic resonance imaging of the elderly diabetes mellitus Japanese Elderly Diabetes Intervention Trial (J-EDIT)","volume":"22","author":"Akisaki","year":"2006","journal-title":"Diabetes Metab Res Rev"},{"key":"2022031219292338600_B20","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1093\/ageing\/afl180","article-title":"Cognitive impairment and MRI correlates in the elderly patients with type 2 diabetes mellitus","volume":"36","author":"van Harten","year":"2007","journal-title":"Age Ageing"},{"key":"2022031219292338600_B21","doi-asserted-by":"crossref","first-page":"21i","DOI":"10.1016\/j.amjcard.2007.03.003","article-title":"Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial: design and methods","volume":"99","author":"ACCORD Study Group","year":"2007","journal-title":"Am J Cardiol"},{"key":"2022031219292338600_B22","doi-asserted-by":"crossref","first-page":"103i","DOI":"10.1016\/j.amjcard.2007.03.028","article-title":"Rationale, design, and methods of the Action to Control Cardiovascular Risk in Diabetes Eye Study (ACCORD-EYE)","volume":"99","author":"Chew","year":"2007","journal-title":"Am J Cardiol"},{"key":"2022031219292338600_B23","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1016\/S1474-4422(11)70188-0","article-title":"Effects of intensive glucose lowering on brain structure and function in people with type 2 diabetes (ACCORD MIND): a randomised open-label substudy","volume":"10","author":"Launer","year":"2011","journal-title":"Lancet Neurol"},{"key":"2022031219292338600_B24","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1093\/gerona\/62.8.844","article-title":"Cognitive function, gait speed decline, and comorbidities: the Health, Aging and Body Composition study","volume":"62","author":"Atkinson","year":"2007","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"2022031219292338600_B25","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1056\/NEJMc1011499","article-title":"Update of the ACCORD Eye Study","volume":"364","author":"Chew","year":"2011","journal-title":"N Engl J Med"},{"key":"2022031219292338600_B26","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J Psychiatr Res"},{"key":"2022031219292338600_B27","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1093\/geronj\/47.3.P110","article-title":"Within-context assessment of age differences in working memory","volume":"47","author":"Salthouse","year":"1992","journal-title":"J Gerontol"},{"key":"2022031219292338600_B28","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1080\/09658219408258945","article-title":"The Autobiographical Memory Interview (AMI) in organic and psychogenic amnesia","volume":"2","author":"Kopelman","year":"1994","journal-title":"Memory"},{"key":"2022031219292338600_B29","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1037\/0033-2909.109.2.163","article-title":"Half a century of research on the Stroop effect: an integrative review","volume":"109","author":"MacLeod","year":"1991","journal-title":"Psychol Bull"},{"key":"2022031219292338600_B30","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1097\/00004728-199809000-00030","article-title":"An image-processing system for qualitative and quantitative volumetric analysis of brain images","volume":"22","author":"Goldszal","year":"1998","journal-title":"J Comput Assist Tomogr"},{"key":"2022031219292338600_B31","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.acra.2007.10.012","article-title":"Computer-assisted segmentation of white matter lesions in 3D MR images using support vector machine","volume":"15","author":"Lao","year":"2008","journal-title":"Acad Radiol"},{"key":"2022031219292338600_B32","doi-asserted-by":"crossref","first-page":"2883","DOI":"10.2337\/db10-0752","article-title":"Diabetic retinopathy and cognitive decline in older people with type 2 diabetes: the Edinburgh Type 2 Diabetes Study","volume":"59","author":"Ding","year":"2010","journal-title":"Diabetes"},{"key":"2022031219292338600_B33","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1212\/WNL.0b013e3181b78436","article-title":"Retinal microvascular abnormalities and cognitive decline: the ARIC 14-year follow-up study","volume":"73","author":"Lesage","year":"2009","journal-title":"Neurology"},{"key":"2022031219292338600_B34","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s00125-010-1883-9","article-title":"Biomedical risk factors for decreased cognitive functioning in type 1 diabetes: an 18 year follow-up of the Diabetes Control and Complications Trial (DCCT) cohort","volume":"54","author":"Jacobson","year":"2011","journal-title":"Diabetologia"},{"key":"2022031219292338600_B35","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1212\/WNL.0b013e31824d9655","article-title":"Cognitive function and retinal and ischemic brain changes: the Women\u2019s Health Initiative","volume":"78","author":"Haan","year":"2012","journal-title":"Neurology"},{"key":"2022031219292338600_B36","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1002\/ana.24063","article-title":"Diabetes, markers of brain pathology and cognitive cognition: the Age, Gene\/Environment Susceptibility-Reykjavik Study","volume":"75","author":"Qiu","year":"2013","journal-title":"Ann Neurol"},{"key":"2022031219292338600_B37","doi-asserted-by":"crossref","first-page":"1826","DOI":"10.1161\/STROKEAHA.110.585042","article-title":"Retinal microvascular signs and 10-year risk of cerebral atrophy: the Atherosclerosis Risk in Communities (ARIC) study","volume":"41","author":"Kawasaki","year":"2010","journal-title":"Stroke"},{"key":"2022031219292338600_B38","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1212\/01.WNL.0000165985.97397.88","article-title":"Cerebral MRI findings and cognitive functioning: the Atherosclerosis Risk in Communities study","volume":"64","author":"Mosley","year":"2005","journal-title":"Neurology"},{"key":"2022031219292338600_B39","doi-asserted-by":"crossref","first-page":"3177","DOI":"10.2337\/dc12-2141","article-title":"The relationship between diabetic retinopathy and cognitive impairment","volume":"36","author":"Crosby-Nwaobi","year":"2013","journal-title":"Diabetes Care"},{"key":"2022031219292338600_B40","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/dmrr.1163","article-title":"Accelerated cognitive decline in patients with type 2 diabetes: MRI correlates and risk factors","volume":"27","author":"Reijmer","year":"2011","journal-title":"Diabetes Metab Res Rev"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/37\/12\/3244\/619485\/3244.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/37\/12\/3244\/619485\/3244.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,12]],"date-time":"2022-03-12T21:05:52Z","timestamp":1647119152000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/37\/12\/3244\/29238\/The-Cross-sectional-and-Longitudinal-Associations"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11,8]]},"references-count":40,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2014,11,8]]},"published-print":{"date-parts":[[2014,12,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc14-0502","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,11,8]]}}}