Purpose Patients with Alzheimer’s Disease (AD) exhibit decreased retinal blood flow and vessel density (VD). However, it is not known whether these changes are also present in individuals with early AD (eAD) or amnestic type mild cognitive impairment (aMCI), an enriched pre-AD population with a higher risk for progressing to dementia. We performed a prospective case-control clinical study to investigate whether optical coherence tomography angiography (OCTA) parameters in the macula and disc are altered in those with aMCI and eAD. Methods This is a single center study of 32 participants. Individuals with aMCI/eAD (n = 16) were 1:1 matched to cognitively normal controls (n = 16). We evaluated OCTA images of the parafoveal superficial capillary plexus (SCP) and two vascular layers in the peripapillary region, the radial peripapillary capillary (RPC) and superficial vascular complex (SVC). Outcome vascular and structural parameters included VD, vessel length density (VLD), adjusted flow index (AFI) and structural retinal nerve fiber layer (RNFL) thickness. We compared these parameters between the two groups and examined the correlation between OCTA parameters and cognitive performance on the Montreal Cognitive Assessment (MoCA). Results Cognitively impaired participants demonstrated statistically significant decrease in parafoveal SCP VD and AFI as compared to controls, but no statistically significant difference in peripapillary parameters. Furthermore, we found a significant positive correlation between MoCA scores for the entire study cohort and both the parafoveal SCP VD and peripapillary RPC VLD. Conclusion OCTA shows significant decline in parafoveal flow and VD in individuals with early cognitive impairment related to AD, suggesting that these parameters could have potential utility as early disease biomarkers. In contrast, the presence of larger vascular channels in the peripapillary region may have obscured subtle capillary changes in that region. Overall, the correlation between vascular OCTA parameters and cognitive performance supports further OCTA studies in this population.

PURPOSE. To examine inner retinal hyperreflective features on adaptive optics scanning laser ophthalmoscopy (AOSLO) in individuals with early cognitive impairment. METHODS. In this prospective, cross-sectional study, we enrolled 12 participants with either amnestic mild cognitive impairment (aMCI, n ¼ 10) or early dementia due to Alzheimer's disease (eAD, n ¼ 2) and 12 age-, sex-, and race-matched cognitively normal controls. All participants completed AOSLO imaging of the inner retina. AOSLO montages of the peripapillary area were graded for hyperreflective features including granular membranes, mottled membranes, and nummular features. Regions of interest on AOSLO were compared qualitatively to corresponding optical coherence tomography (OCT) cross sections. OCT was also used to analyze peripapillary retinal nerve fiber layer (RNFL) thickness. RESULTS. Cognitively impaired individuals had a significantly higher number of granular membranes with a larger overall area compared to controls. The proportion of cognitively impaired individuals with two or more granular membranes was 41.7% compared to none in the control group. Granular membrane area was also inversely correlated with cognitive performance on the Montreal Cognitive Assessment. There was no difference between the two groups in terms of other membrane types or RNFL thickness. CONCLUSIONS. Individuals with early cognitive impairment related to Alzheimer's show hyperreflective granular membranes on high-resolution imaging, which we hypothesize to be manifestations of inner retinal gliosis. The presence of these subtle hyperreflective membranes may obscure underlying RNFL thinning in these eyes on OCT imaging. The distinctive phenotype of granular membranes surrounding the optic nerve on AOSLO may represent a new potential biomarker of early Alzheimer's.

Background In this study we hypothesize that depression is associated with perioperative neurocognitive dysfunction and altered quality of life one month after surgery. Methods Data were obtained as part of a study evaluating cerebral autoregulation monitoring for targeting arterial pressure during cardiopulmonary bypass. Neuropsychological testing was performed before surgery and one month postoperatively. Testing included the Beck Depression Inventory, a depression symptoms questionnaire (0–63 scale), as well as anxiety and quality of life assessments. Depression was defined as a Beck Depression Inventory score > 13. Results Beck Depression data were available from 320 patients of whom cognitive domain endpoints were available from 88–98% at baseline and 69–79% after surgery. This range in end-points data was due to variability in the availability of each neuropsychological test results between patients. Depression was present in 50 (15.6%) patients before surgery and in 43 (13.4%) after surgery. Baseline depression was not associated with postoperative domain-specific neurocognitive function compared with non-depressed patients. Those with depression one month after surgery, though, had poorer performance on tests of attention (p = 0.017), memory (p = 0.049), verbal fluency (p = 0.010), processing speed (p = 0.017), and fine motor speed (p = 0.014). Postoperative neurocognitive dysfunction as a composite outcome occurred in 33.3% versus 14.5% of patients with and without postoperative depression (p = 0.040). Baseline depression was associated with higher anxiety and lower self-ratings on several quality of life domains, these measures were generally more adversely affected by depression one month after surgery. Conclusions The results of this exploratory analysis suggests that preoperative depression is not associated with perioperative neurocognitive dysfunction, but depression after cardiac surgery may be associated with impairment in in several cognitive domains, a higher frequency of the composite neurocognitive outcome, and altered quality of life. Trial Registration www.clinicaltrials.gov, NCT00981474 (parent study).

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This paper seeks to address the effectiveness of total knee arthroplasty (TKA) when performed without patellar resurfacing. The objective of this article is to investigate the effect of total knee arthroplasty without patellofemoral resurfacing on postoperative outcome.All patients with degenerative knee osteoarthritis (OA) that underwent TKA without patellar resurfacing were included in the study. The clinical data of 163 patients, including 98 females and 65 males with a mean age of 63 years (range 54-78 years) were retrospectively analyzed from April 2008 to April 2011. Intraoperative cartilage degeneration according to Outerbridge classification criteria was as follows: 22 cases of grade I, 38 cases of grade II, 64 cases of grade III, 39 cases of grade IV. There were no significant differences in gender, age, and side differences between the patients at all levels (P > 0.05). The duration of tourniquet use and related complications were recorded. Knee function was assessed using the American Knee Society Scoring System (KSS) and the patellar score (PS). Patient satisfaction and knee pain were assessed by the pain visual analog scale (VAS). The evaluation was conducted using routine X-ray film to observe the position of the prosthesis and the patella. Statistical analysis used included a comparison between groups by analysis of variance (ANOVA) using the Student-Newman-Keuls (SNK) test and comparison of grade data using the rank-sum test.The average tourniquet time was 125 minutes, with a range of 90-150 minutes. All the incisions healed with primary intention without early complications. All patients were followed for two to five years with an average of 3.6 years. At six months and at the last follow-up, the KSS and PS scores were significantly higher than those before surgery (P < 0.05). There was no significant difference between the sixth month and the last follow-up (P > 0.05). There were significant differences in preoperative KSS and PS scores between patients with different grades of cartilage degeneration (P < 0.05), but there was no significant difference at the last follow-up (P > 0.05). At the last follow-up, seven patients had persistent anterior knee pain, five patients had mild pain, and two patients had moderate pain according to the VAS assessment criteria. Patient satisfaction evaluation was as follows: 90 patients were very satisfied, 66 patients were satisfied, five patients were uncertain, and two patients were unsatisfied. There were no significant differences in satisfaction and knee pain between patients with different grades of patellofemoral degeneration (P > 0.05).In conclusion, at six months and at the last follow-up, outcome measures for patients were significantly higher than before surgery for TKA without the use of patellar resurfacing and the majority of patients were satisfied with the outcome of the procedure. TKA continues to be a successful procedure without the use of patellar resurfacing.