Diabetic Retinopathy Predicts Risk of Alzheimer's Disease: A Danish Registry-Based Nationwide Cohort Study

Frederik Nørregaard Pedersen*, Lonny Stokholm, Frans Pouwer, Katrine Hass Rubin, Tunde Peto, Ulrik Frydkjær-Olsen, Anne Suhr Thykjær, Nis Andersen, Jens Andresen, Toke Bek, Morten La Cour, Steffen Heegaard, Kurt Højlund, Ryo Kawasaki, Javad Nouri Hajari, Kirsten Ohm Kyvik, Caroline Schmidt Laugesen, Katja Christina Schielke, Rafael Simó, Jakob Grauslund

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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BACKGROUND: Retinal neurodegeneration is evident in early diabetic retinopathy (DR) which may be associated with other neurodegenerative diseases like Alzheimer's disease (AD).

OBJECTIVE: To investigate diabetes and DR as a risk marker of present and incident AD.

METHODS: A register-based cohort study was performed. We included 134,327 persons with diabetes above 60 years of age, who had attended DR screening, and 651,936 age- and gender-matched persons without diabetes.

RESULTS: At baseline, the prevalence of AD was 0.7% and 1.3% among patients with and without diabetes, respectively. In a multivariable regression model, patients with diabetes were less likely to have AD at baseline (adjusted OR 0.63, 95% CI 0.59-0.68). During follow-up, incident AD was registered for 1473 (0.35%) and 6,899 (0.34%) persons with and without diabetes, respectively. Compared to persons without diabetes, persons with diabetes and no DR had a lower risk to develop AD (adjusted HR 0.87, 95% CI 0.81-0.93), while persons with diabetes and DR had higher risk of AD (adjusted HR 1.24, 95% CI 1.08-1.43). When persons with diabetes and no DR were used as references, a higher risk of incident AD was observed in persons with DR (adjusted HR 1.34, 95% CI 1.18-1.53).

CONCLUSION: Individuals with diabetes without DR were less likely to develop AD compared to persons without diabetes. However, individuals with DR had a 34% higher risk of incident AD, which raise the question whether screening for cognitive impairment should be done among individuals with DR.

Original languageEnglish
JournalJournal of Alzheimer's Disease
Issue number1
Pages (from-to)451-460
Number of pages10
Publication statusPublished - 2022


  • Alzheimer's disease
  • cognitive impairment
  • diabetes mellitus
  • diabetic retinopathy
  • Diabetic Retinopathy/epidemiology
  • Denmark/epidemiology
  • Humans
  • Risk Factors
  • Alzheimer Disease/epidemiology
  • Registries
  • Diabetes Mellitus
  • Cohort Studies


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