Association of Retinal Neurodegeneration on Optical Coherence Tomography With Dementia

Abstract

IMPORTANCE Retinal structures may serve as a biomarker for dementia, but longitudinal studies examining this link are lacking. OBJECTIVE To investigate the association of inner retinal layer thickness with prevalent and incident dementia in a general population of Dutch adults. DESIGN, SETTING, AND PARTICIPANTS From September 2007 to June 2012, participants from the prospective population-based Rotterdam Study who were 45 years and older and had gradable retinal optical coherence tomography images and at baseline were free from stroke, Parkinson disease, multiple sclerosis, glaucoma, macular degeneration, retinopathy, myopia, hyperopia, and optic disc pathology were included. They were followed up until January 1, 2015, for the onset of dementia. EXPOSURES Inner retinal layer thicknesses (ie, retinal nerve fiber layer [RNFL]) and ganglion cell-inner plexiform layer (GC-IPL) thicknesses measured on optical coherence tomography images. MAIN OUTCOMES AND MEASURES Odds ratios and hazard ratios for incident dementia per SD decrease in retinal layer thickness adjusted for age, sex, education, and cardiovascular risk factors. RESULTS Of 5065 individuals eligible for optical coherence tomography scanning, 3289 (64.9%) (mean [SD] age 68.9 [9.9] years, 1879 [57%] women) were included in the analysis. Of these 3289 individuals, 41 (1.2%) already had dementia. Thinner GC-IPL was associated with prevalent dementia (odds ratio per SD decrease in GC-IPL, 1.37 [95% CI, 0.99-1.90]). No association was found of RNFL with prevalent dementia. During 14 674 person-years of follow-up (mean [SD], 4.5 [1.6] years), 86 individuals (2.6%) developed dementia of whom 68 (2.1%) had Alzheimer disease. Thinner RNFL at baseline was associated with an increased risk of developing dementia (hazard ratio per SD decrease in RNFL, 1.44 [95% CI, 1.19-1.75]), which was similar for Alzheimer disease (hazard ratio, 1.43 [95% CI, 1.15-1.78]). No association was found between GC-IPL thickness and incident dementia (hazard ratio, 1.13 [95% CI, 0.90-1.43]). CONCLUSIONS AND RELEVANCE Thinner RNFL is associated with an increased risk of dementia, including Alzheimer disease, suggesting that retinal neurodegeneration may serve as a preclinical biomarker for dementia.

Retinal nerve fibre changes in sports‐related repetitive traumatic brain injury

“…Two recent studies have demonstrated a correlation between RNFL thinning and brain atrophy as assessed on MRI . These findings are supported by studies in Alzheimer disease and multiple sclerosis, where RNFL thinning has been shown to correlate with wider white matter changes and neurodegeneration. Evaluating the RNFL may therefore serve as a proxy for wider cortical neurodegeneration in contact sport athletes.…”

“…28 RNFL thinning has also been shown to predict a greater likelihood of future cognitive decline 28 and dementia. 29 Two recent studies have demonstrated a correlation between RNFL thinning and brain atrophy as assessed on MRI. 30,31 These findings are supported by studies in Alzheimer disease 29,[32][33][34][35] and multiple sclerosis, 36 where RNFL thinning has been shown to correlate with wider white matter changes and neurodegeneration.…”

“…Furthermore, studies have reported that RNFL thinning in individuals without a neurodegenerative disease is associated with reduced visual acuity and worse cognitive function . RNFL thinning has also been shown to predict a greater likelihood of future cognitive decline and dementia …”

Association of Retinal Nerve Fiber Layer Thickness With Brain Alterations in the Visual and Limbic Networks in Elderly Adults Without Dementia

“…Moreover, within a large population, the Rotterdam Study 5 recently found that a thinner RNFL was associated with a higher risk of developing dementia and AD in subsequent years, suggesting that a thinner RNFL may be a biomarker for dementia and AD. Nevertheless, beyond the clinical diagnosis of AD and MCI, the relationship between the RNFL and brain structures remains underexplored in the elderly population.…”

Grey Matter Age Prediction as a Biomarker for Risk of Dementia: A Population-based Study

“…All participants were monitored for dementia at baseline and following visits to the study center using the Mini-Mental State Examination (MMSE) and the Geriatric Mental State (GMS) organic level. Further investigation was initiated for participants who scored lower than 26 for their MMSE or above 0 for their GMS 15 . Additionally, the entire cohort was continuously checked for dementia through electronic linkage between the study center and medical records from general practitioners and the regional institute for outpatient mental health care.…”