The association between diabetic retinopathy and cognitive impairment in patients with diabetes mellitus: a systematic review and meta-analysis
12 affiliations
- 1College of Medicine, Alfaisal University
- 2Ophthalmology Department, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of The University
- 3College of Medicine, King Saud University
- 4Taif Armed Forces Hospital
- 5College of Medicine, University of Sharjah
- 6College of Medicine, Jouf University
- 7Al-Namas General Hospital
- 8Department of Neurology, Security Forces Hospital
- 9Kuwait Institute for Medical Specialization
- 10Faculty of Medicine, Hail University
- 11College of Medicine, Taif University
- 12Alhada Armed Forces Hospital
Abstract
Background: Diabetic retinopathy (DR) is a recognized microvascular complication of diabetes in which neurovascular and neurodegenerative mechanisms may also contribute. This systematic review evaluated the association between DR and cognitive impairment or dementia, including Alzheimer’s disease and vascular dementia, using evidence from cross-sectional and longitudinal observational studies.
Methods: We searched for relevant articles up to December 2025 from PubMed, Scopus, Web of Science, and Cochrane Library. Two independent reviewers extracted data from the selected studies, including baseline information and outcomes. All quantitative syntheses were conducted using R version 4.4.1.
Results: Fourteen studies with reported study populations totaling 2,871,847 participants were included. Seven studies contributed to the crude dichotomous synthesis, which did not demonstrate a statistically significant association between diabetic retinopathy and cognitive impairment or dementia (OR 1.07, 95% CI 0.94–1.23; p=0.310; I ² =52.3%). Seven studies contributed adjusted longitudinal estimates for incident dementia; diabetic retinopathy was associated with a higher incidence of dementia (HR 1.55, 95% CI 1.19–2.02; p=0.001; I ² =97.8%; 95% prediction interval 0.65–3.68). Evidence concerning Alzheimer’s disease and vascular dementia remained inconsistent.
Conclusion: Longitudinal evidence suggests that diabetic retinopathy is associated with a higher incidence of dementia, although substantial heterogeneity and the observational evidence base limit confidence in the pooled estimate. Evidence concerning Alzheimer’s disease and vascular dementia remains inconclusive.
Systematic review registration: https://doi.org/10.17605/OSF.IO/YS462 , identifier YS462.
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BibTeX
@article{subih2026association,
title = {{The association between diabetic retinopathy and cognitive impairment in patients with diabetes mellitus: a systematic review and meta-analysis}},
author = {Omar Subih and Wejdan Abdullah Al Mustafa and Tareq Ahmed AlOmem and Abdulaziz Mohammed Alrasheed and Maha Saeed Altunaiji and Aryam Abdullah Mubarak Alhasan and Abdulaziz Ibrahim Atef Alshehri and Bader Muzhier Alshahrani and Ruwaym Jaber Mohammed Alharbi and Ahmad Moahmmad Alshatti and Manar Eid Al Mutairi and Samar Mussari Alkhaldi and Inam N. Bifari},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1881602},
url = {https://www.frontiersin.org/articles/10.3389/fendo.2026.1881602/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The association between diabetic retinopathy and cognitive impairment in patients with diabetes mellitus: a systematic review and meta-analysis
AU - Omar Subih
AU - Wejdan Abdullah Al Mustafa
AU - Tareq Ahmed AlOmem
AU - Abdulaziz Mohammed Alrasheed
AU - Maha Saeed Altunaiji
AU - Aryam Abdullah Mubarak Alhasan
AU - Abdulaziz Ibrahim Atef Alshehri
AU - Bader Muzhier Alshahrani
AU - Ruwaym Jaber Mohammed Alharbi
AU - Ahmad Moahmmad Alshatti
AU - Manar Eid Al Mutairi
AU - Samar Mussari Alkhaldi
AU - Inam N. Bifari
PY - 2026
DA - 2026/10/15
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1881602
UR - https://www.frontiersin.org/articles/10.3389/fendo.2026.1881602/full
AB - Background: Diabetic retinopathy (DR) is a recognized microvascular complication of diabetes in which neurovascular and neurodegenerative mechanisms may also contribute. This systematic review evaluated the association between DR and cognitive impairment or dementia, including Alzheimer’s disease and vascular dementia, using evidence from cross-sectional and longitudinal observational studies. Methods: We searched for relevant articles up to December 2025 from PubMed, Scopus, Web of Science, and Cochrane Library. Two independent reviewers extracted data from the selected studies, including baseline information and outcomes. All quantitative syntheses were conducted using R version 4.4.1. Results: Fourteen studies with reported study populations totaling 2,871,847 participants were included. Seven studies contributed to the crude dichotomous synthesis, which did not demonstrate a statistically significant association between diabetic retinopathy and cognitive impairment or dementia (OR 1.07, 95% CI 0.94–1.23; p=0.310; I ² =52.3%). Seven studies contributed adjusted longitudinal estimates for incident dementia; diabetic retinopathy was associated with a higher incidence of dementia (HR 1.55, 95% CI 1.19–2.02; p=0.001; I ² =97.8%; 95% prediction interval 0.65–3.68). Evidence concerning Alzheimer’s disease and vascular dementia remained inconsistent. Conclusion: Longitudinal evidence suggests that diabetic retinopathy is associated with a higher incidence of dementia, although substantial heterogeneity and the observational evidence base limit confidence in the pooled estimate. Evidence concerning Alzheimer’s disease and vascular dementia remains inconclusive. Systematic review registration: https://doi.org/10.17605/OSF.IO/YS462 , identifier YS462.
SN - 1664-2392
ER -