Is brain health in the eye of the beholder?

Arteriolar disease of the brain manifests itself structurally as lacunar infarcts and leukoaraiosis, and may also lead to cognitive dysfunction. Although the pathogenesis of leukoaraiosis is somewhat controversial, its strong association with vascular risk factors, in particular hypertension, implies a microvascular etiology. These subclinical brain changes and their associated effects on cognition are likely to be associated with microvascular disease in other organs. In the article by Haan et al.¹ in this issue of Neurology^®, the association between retinal microvascular changes and cerebral outcomes (i.e., cognitive performance and subclinical brain lesions and volume) is evaluated in the Women's Health Initiative (WHI).

In this WHI study, although retinopathy is found infrequently (in 7.6% of 511 participants), it is associated with worsening over 10 years on cognitive assessment with the modified Mini-Mental State Examination (3MSE) and with larger ischemic volumes on brain MRI (using a composite measure of lacunar infarcts and white matter hyperintensities [WMH]). This parallels other epidemiologic studies that have demonstrated associations between retinal microvascular disease and MRI evidence of small vessel disease (lacunar infarcts or WMH)² and between …