Objective:

To assess the risk of incident stroke and cognitive impairment in subjects with and without AMD. 

Background:

Retinal-vascular disorders have been associated with adverse cardiovascular outcomes but the association between age-related macular degeneration (AMD), a common degenerative disorder of the retina and choroid, and incident stroke and cognitive impairment has not been well established. 

Design/Methods:

We conducted a case-control, longitudinal study of subjects aged ≥40 years with retinal optical coherence tomography (OCT) imaging and brain MRI scanning from 2011–2015. Each subject with AMD was age-matched to a control subject without AMD in a 1:1 ratio and followed longitudinally for incident stroke and cognitive impairment until September 2021. AMD was diagnosed according to retinal abnormalities on OCT, ischemic stroke was diagnosed by a physician according to radiographic evidence of infarction, and cognitive impairment was diagnosed according to a Montreal Cognitive Assessment score of ≤19 or a Kokmen short test score of ≤29. Cox regression models evaluated the relationships between AMD and incident stroke and cognitive impairment. 

Results:

Of the 256 age-matched pairs included in our study (AMD: 126; no AMD: 130), the mean age was 75±9 years, 60.2% were women, and there were no differences in age or vascular risk factors between groups. During a median follow-up of 7.4 years, 26 subjects had incident strokes, and 34 developed cognitive impairment. After adjusting for vascular risk factors, AMD trended to associate with incident stroke (aHR 1.75, 95% CI 0.79-3.91, p=0.170) and cognitive impairment (aHR 1.93, 95% CI 0.93-4.01, p=0.077).

Conclusions:

In our study, while there was not statistically significant association of AMD with either incident stroke or cognitive impairment, the direction of effect was suggestive of increased risk for both. Future studies are needed to further explore possible relationships between AMD, stroke and neurodegeneration.