Abstract
AIM: To investigate associations between cognitive status and retinal parameters in older adults. METHODS: The population-based Beichen Eye Study (BCES) recruited 5840 older adults from Tianjin, China. Retinal thickness and vessel density (VD) were measured using optical coherence tomography angiography (OCT/OCTA). Cognitive function was assessed via the Mini-Mental State Examination (MMSE). Participants with gradable images and valid MMSE scores (n = 3606) were analyzed. RESULTS: Cognitive impairment (CI) was identified in 32.7% of participants. Compared to non-CI individuals, those with CI exhibited reduced average retinal thickness (p = 0.007) and choroid thickness (p < 0.001). Superficial VD (VD(SVP)) was significantly higher in moderate to severe CI compared to mild CI (p = 0.030). Linear mixed-effects regression demonstrated positive correlations between MMSE scores and retinal parameters (r = 0.518 to 0.530). CONCLUSION: Retinal thinning may occur in mild CI, with VD changes as CI progresses. Choroidal thinning is a potential cognitive indicator. OCT/OCTA, as a non-invasive tool, offers potential for early cognitive disorder screening in aging populations. HIGHLIGHTS: Retinal thinning (average retinal thickness: p = 0.007) and choroidal thinning (p < 0.001) are significantly associated with CI in older adults.A paradoxical increase in VD(SVP) was observed in moderate to severe CI (p = 0.030), suggesting compensatory vascular remodeling.Choroidal thickness emerges as a robust biomarker for cognitive decline (correlation coefficient range: 0.518 to 0.530).The large-scale population-based study (n = 5840) was conducted integrating OCT/OCTA imaging with MMSE cognitive assessments.The study supports OCT/OCTA as a noninvasive, cost-effective screening tool for early detection of cognitive disorders in resource-limited settings.The study highlights vascular risk management (e.g., glycemic control, smoking cessation) as a dual target for retinal and cognitive health.