Evaluation of Ocular Perfusion in Alzheimer’s Disease Using Optical Coherence Tomography Angiography

Lahme, Larissa; Eßer, E; Mihailovic, Nataša; Schubert, Friederike; Lauermann, Jost Lennart; Johnen, Andreas; Eter, Nicole; Duning, Thomas; Alnawaiseh, Maged

doi:10.3233/jad-180738

Cited by 88 publications

(114 citation statements)

References 39 publications

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“…We showed that AD participants have a sparser VD of the SCP compared with control participants. Our ndings support most of the previous OCTA studies in AD participants (Table 4), [12][13][14]16] which is in keeping with studies on larger retinal vessels using fundus photographs. [3,33] It should be noted that two other studies did not observe any differences in the VD of the SCP in AD participants.…”

Section: Scp In Ad Individualssupporting

confidence: 91%

“…[10] While there are a few OCTA studies investigating AD, there have been mixed conclusions. [11][12][13][14][15] Some researchers reported nding signi cant reduction in the vessel density (VD) only in the super cial plexus, [14,16] which complements histology ndings [10] and OCT studies [9] since the super cial plexus mainly supplies the inner retinal layer. [17] However, others reported nding changes only in the deep plexus.…”

Section: Introductionmentioning

confidence: 64%

“…Four OCTA studies have investigated DCP VD in AD individuals, but there is generally a lack of agreement between studies (Table 4). Two studies [11,15] showed a signi cant reduction in VD in AD individuals whereas the others [14,16] did not observe any differences. Obtaining accurate OCTA metrics from the DCP layer is particularly challenging as it is affected by the physiologic variability of FAZ [18,19] and projection artefacts.…”

Section: Dcp In Ad Individualsmentioning

confidence: 92%

“…[39] Second, while Zabel et al removed the projection artefacts in the DCP, [11] the rest did not. [14][15][16] In the current study, we quanti ed the VD of the DCP without the in uence of FAZ and projection artefacts, which hopefully reduced measurement bias. We found a sparser VD of the DCP in AD participants but not in MCI individuals, which suggests the possibility of using the VD of the DCP to discriminate between (both SCP and DCP affected) and MCI (only SCP is affected) individuals.…”

Section: Dcp In Ad Individualsmentioning

confidence: 99%

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Retinal Microvascular Alterations in Alzheimer’s Disease and Mild Cognitive Impairment

Chua

et al. 2020

Preprint

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Background: The retina and brain share many neuronal and vasculature characteristics developmentally and potential biomarkers may be present in the retina. We investigated the retinal microvasculature in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) using optical coherence tomography angiography (OCTA).Methods: In this cross-sectional study, 24 AD participants, 37 MCI participants, and 29 controls were diagnosed according to internationally accepted criteria. OCTA images of the superficial and deep capillary plexus (SCP, DCP) of the retinal microvasculature were obtained using a commercial OCTA system (Zeiss Cirrus HD-5000 with AngioPlex, Carl Zeiss Meditec, Dublin, CA). The main outcome measures were vessel density (VD) and fractal dimension (FD) in the SCP and DCP within a 2.5-mm ring around the fovea were compared between groups. Perfusion density of large vessels and foveal avascular zone (FAZ) area were additional outcome parameters.Results: Age, gender and race did not differ among groups. However, there was a significant difference in diabetes status (P=0.039), and systolic blood pressure (P=0.008) among the groups. After adjusting for confounders, AD participants showed significantly decreased VD in SCP and DCP (P = 0.005 and P = 0.016, respectively) and decreased FD in SCP (P = 0.008), compared to controls. MCI participants showed significantly decreased VD and FD only in SCP (P = 0.005 and P < 0.001, respectively) and not the DCP (P > 0.05) compared with controls. There was no difference in the OCTA variables between AD and MCI (P > 0.05). Perfusion density of large vessels and FAZ area did not differ significantly between groups (P > 0.05).Conclusions and relevance: Eyes of patients with AD have significantly reduced macular VD in both plexuses whereas MCI participants only showed reduction in the superficial plexus. Changes in the retinal microvasculature and capillary network may mirror small vessel cerebrovascular changes in AD.

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Section: Scp In Ad Individualssupporting

confidence: 91%

Section: Introductionmentioning

confidence: 64%

Section: Dcp In Ad Individualsmentioning

confidence: 92%

Section: Dcp In Ad Individualsmentioning

confidence: 99%

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Retinal Microvascular Alterations in Alzheimer’s Disease and Mild Cognitive Impairment

Chua

et al. 2020

Preprint

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“…They found a reduction in the density of vessels in SVP in the eyes of AD compared to HC [18]. Subsequent research groups con rmed a decrease in retinal vascular density in SVP in patients diagnosed with AD [46][47][48]. Jiang et al found a slight decrease in GC-IPL thickness in AD compared with MCI and HC.…”

Section: Discussionmentioning

confidence: 97%

Quantitative Assessment of Retinal Thickness and Vessel Density Using Optical Coherence Tomography Angiography in Patients with Alzheimer’s Disease and Glaucoma

Zabel

Kałuz̊ny

Zabel

et al. 2020

Preprint

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Background Retinal imaging using optical coherence tomography (OCT) and OCT angiography (OCTA) may serve as an alternative approach to monitoring and diagnosing neurodegenerative diseases such as Alzheimer's disease (AD) and primary open-angle glaucoma (POAG). In this study, we performed direct comparisons of retinal vessel density with the thickness of inner retinal layer (IRL) and outer retinal layer (ORL) in patients with AD and POAG. Methods In this cross-sectional study, we analyzed data from 48 eyes of healthy control (HC) participants, 71 eyes of POAG patients, and 49 eyes of AD patients with confirmed presence of fibrillar brain amyloid on positron emission tomography (PET) imaging with florbetapir F 18. Ophthalmic examination included OCT imaging to measure IRL and ORL thickness in the macula and OCTA in the same region for the imaging of vessel density in the superficial vascular plexus (SVP) and deep vascular plexus (DVP) of the retina. A direct comparison of vessels density and retinal layers thickness, which different dynamic ranges, was obtained by normalizing values as percentage losses. Values were adjusted for inter-eye correlation, age, gender, and scan quality, where applicable. Results Patients with AD presented significantly greater losses of vascular density in the DVP and ORL thickness compared to POAG (p < 0.001), but percentage losses of vessel density in SVP and IRL thickness were considerable in POAG compared to AD eyes (p < 0.001). Positive associations among presence of AD were observed primarily in outer retina where a 1% decrease of ORL thickness was associated with about 24–29% increase in odds of the presence of AD. According to OCTA measurements, a 1% decrease of vessel density in DVP was positively associated with a 4–9% increase in odds of the presence of AD. In POAG positive associations among presence of disease were observed only in inner retina where 1% loss of IRL thickness and a 1% loss of vessel density in the SVP were positively associated with a 13–23% increase in risk of presence of the disease. Conclusions Analysis of ORL thickness and vessel density in DVP could potentially improve diagnostic capabilities and may provide a valuable approach for predicting of AD.

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Lower retinal capillary density in minimal cognitive impairment among older Latinx adults

Ashimatey

D’Orazio

Samantha

et al. 2020

Alzheimer's & Dementia: Diagnosis, Assessment &

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Introduction We investigated the hypothesis that retinal capillary perfusion is a biomarker of early cognitive decline and cerebrovascular perfusion associated with small vessel disease in a pilot data set of Latinx adults at high risk for vascular cognitive impairment and dementia. Methods High‐resolution optical coherence tomography angiography (OCTA) images were acquired from dilated eyes of Latinx subjects using a 3 × 3 mm 2 scan pattern from a commercially available device. A previously validated method was used to quantify the density of perfused retinal capillaries as the retinal vessel skeleton density (VSD). The association of VSD with Clinical Dementia Rating Sum of Boxes, total Montreal Cognitive Assessment (MoCA) score, and individual MoCA test elements were analyzed using multivariate statistics that adjusted for confounders. VSD was also compared with magnetic resonance imaging (MRI) measures of cerebrovascular reactivity (CVR) and perfusion in the middle cerebral artery perforator (MCA‐Perf) territory. Results The mean (± SD) age of the subjects was 68 (± 6) years. For every 0.01‐unit lower VSD, the risk of having a CDR‐SOB >0 was 20% higher (95%CI = 5%–90%; P = .031). Similarly, a lower VSD was associated with lower total MoCA score (r = 0.3; P = .038). The Visuospatial/Executive domain of the MoCA assessment showed the strongest association with VSD ( β = 0.02; P = .022). Lower retinal VSD was associated with worse MRI measure of CVR (r = 0.7, P = .04) and less perfusion in the MCA‐Perf territory (r = 0.45, P = .02). Discussion Impaired retinal capillary perfusion is associated with cognitive impairment and abnormalities in cerebrovascular perfusion and function. OCTA‐based retinal capillary assessment holds promise for identifying and quantifying retinal correlates of neurovascular abnormalities associated with vascular cognitive impairment.

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Evaluation of Ocular Perfusion in Alzheimer’s Disease Using Optical Coherence Tomography Angiography

Cited by 88 publications

References 39 publications

Retinal Microvascular Alterations in Alzheimer’s Disease and Mild Cognitive Impairment

Retinal Microvascular Alterations in Alzheimer’s Disease and Mild Cognitive Impairment

Quantitative Assessment of Retinal Thickness and Vessel Density Using Optical Coherence Tomography Angiography in Patients with Alzheimer’s Disease and Glaucoma

Lower retinal capillary density in minimal cognitive impairment among older Latinx adults

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