Background: The global aging population has led to a concurrent rise in age-related diseases, including type 2 diabetes mellitus (T2DM), diabetic retinopathy (DR), and cognitive decline. Emerging evidence suggests a potential microvascular link between DR and cognitive impairment, as both conditions share underlying pathophysiological mechanisms such as endothelial dysfunction and chronic inflammation.

Objective: This study aimed to investigate the cross-sectional association between the severity of diabetic retinopathy and cognitive function in elderly patients with T2DM.

Method: A simulated cross-sectional study was conducted using synthesized academic training data of 350 elderly patients (aged ≥65 years) with T2DM. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). DR severity was graded via fundus photography according to the Early Treatment Diabetic Retinopathy Study (ETDRS) criteria. Multivariate logistic regression was used to adjust for potential confounders.

Results: The prevalence of cognitive impairment (MMSE < 24) was 24.3%. A significant inverse correlation was observed between DR severity and MMSE scores (r = -0.41, p < 0.001). Compared to patients without DR, those with moderate-to-severe non-proliferative DR or proliferative DR had a significantly higher odds of cognitive impairment (Adjusted Odds Ratio [aOR] = 3.45, 95% Confidence Interval [CI] = 1.82–6.54, p < 0.001).