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 Featured Article: Christina E. Hugenschmidt, James F. Lovato, Walter T. Ambrosius, R. Nick Bryan, Hertzel C. Gerstein, Karen R. Horowitz, Lenore J. Launer, Ronald M. Lazar, Anne M. Murray, Emily Y. Chew, Ronald P. Danis, Jeff D. Williamson, Michael E. Miller, and Jingzhong Ding Diabetes Care Volume 37: December, 2014

STUDY OBJECTIVE Data from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial was used to determine whether diabetic retinopathy at baseline predicted changes in brain structure or cognition 40 months later Hugenschmidt C. E. et al. Diabetes Care 2014;37:

STUDY DESIGN AND METHODS Participants from the ACCORD-MIND and ACCORD-Eye substudies were included in analyses of cognition and MRI- derived brain variables Retinopathy was categorized as none, mild nonproliferative, or moderate/severe Tests of cognition included: Mini-Mental State Examination (MMSE) Digit Symbol Substitution Test (DSST) Rey Auditory Verbal Learning Test Stroop test Primary brain outcomes were gray matter and abnormal white matter volumes Hugenschmidt C. E. et al. Diabetes Care 2014;37:

RESULTS Baseline retinopathy was associated with lower gray matter volume Baseline retinopathy predicted a greater change in MMSE and DSST scores at 40 months in each retinopathy category Hugenschmidt C. E. et al. Diabetes Care 2014;37:

CONCLUSIONS Diabetic retinopathy is associated with future cognitive decline in people with type 2 diabetes Patients with type 2 diabetes and retinopathy represent a subgroup at higher risk for future cognitive decline Hugenschmidt C. E. et al. Diabetes Care 2014;37: