People living with type 2 diabetes (T2D) are at increased risk of developing mild cognitive impairment (MCI) and dementia yet identifying cognitive decline in routine clinical practice remains challenging. Traditional neuropsychological assessments are often time-consuming and require specialist expertise, making widespread screening difficult.
RECOGNISED (Retinal and Cognitive Dysfunction in T2D: Unravelling the Common Pathways and Identification of People at Risk of Dementia) was a Horizon 2020-funded European research project involving clinical centres across Denmark, Italy, Montenegro, the Netherlands, Portugal, Spain and the United Kingdom. The project investigated the relationship between retinal changes and cognitive decline in people living with T2D, exploring whether retinal biomarkers could support earlier identification of people at risk of dementia. As a partner in the RECOGNISED project, IDF Europe led communication and dissemination activities to ensure the project’s findings reached people living with diabetes (PwD), healthcare professionals, researchers and other relevant stakeholders, while raising awareness of the links between retinal health and cognitive function.
Newly published findings from the RECOGNISED project, published in Diabetologia,  suggest that the retina, often described as “a window to the brain”, may offer valuable insights into cognitive health in PwD. The study found that simple retinal assessments, combined with clinical information, could help identify people living with T2D who are experiencing mild cognitive impairment at an earlier stage.
Why cognitive impairment matters in diabetesÂ
Cognitive impairment can affect memory, attention, decision-making and the ability to carry out everyday tasks. For PwD, these changes can make diabetes self-management more difficult, including monitoring blood glucose, taking medication correctly, following healthy eating plans and recognising symptoms of hyper- and hypoglycaemia. As a result, cognitive decline is associated with poorer diabetes management, increased hospital admissions and higher morbidity and mortality.
Although clinical guidelines recommend assessing cognition in older adults with diabetes, there are currently no simple, reliable screening tools that can easily be integrated into routine diabetes care.
What did the study find?
The cross-sectional study included 313 people aged 65 years or older with T2DResearchers compared participants with normal cognition to those with mild cognitive impairment using comprehensive neuropsychological assessments alongside several retinal examinations.Â
Researchers found that participants with mild cognitive impairment had significantly:
- Lower retinal sensitivity
- Poorer gaze fixation
- Altered pupillary responses
- Differences in retinal electrical activity compared with participants with normal cognitionÂ
Importantly, when retinal measurements were combined with simple clinical variables and standard cognitive screening tools, researchers achieved improved accuracy in identifying people with mild cognitive impairment compared with using clinical information alone.
The study also found that changes in retinal function were associated with difficulties in processing visual information and interacting with the surrounding environment, which can affect many everyday activities. Participants with greater difficulties in these areas also reported a lower quality of life.
The potential impact of retinal assessments in diabetes care
The results suggest that relatively quick, non-invasive retinal assessments could become valuable tools for the early detection of mild cognitive impairment in people living with T2D. Rather than replacing comprehensive neuropsychological testing, these assessments could helping healthcare professionals identify those who may benefit from further evaluation and tailor diabetes management to individual needs. The authors conclude that combining retinal assessments with simple clinical variables represents a promising strategy to improve screening for mild cognitive impairment and support more personalised care for PwD.
