Detection of retinal changes with optical coherence tomography angiography in mild cognitive impairment and Alzheimer’s disease patients: A meta-analysis

Objective To assess retinal microvascular network impairments in the eyes of mild cognitive impairment (MCI) and Alzheimer’s disease (AD) patients with optical coherence tomography angiography (OCTA). Design Systematic review and meta-analysis. Methods A literature search was conducted in the PubMed and EMBASE databases to identify relevant studies detecting retinal microvascular attenuation among AD, MCI patients and cognitively healthy controls (HCs) by OCTA. Data were extracted by Review Manager V.5.4 and Stata V.14.0. Results Eight investigations were included in this meta-analysis, with 150 AD patients, 195 MCI patients and 226 HCs were eligible for meta-analysis. Evidence based on these studies demonstrated that there was a significantly decreased vessel density (VD) of the Optovue group in superficial capillary plexus (SCP): WMD = -2.26, 95% CI: -3.98 to -0.55, p = 0.01; in deep capillary plexus (DCP): WMD = -3.40, 95% CI: -5.99 to -0.81, p = 0.01, VD of the Zeiss group in SCP:WMD = -0.91, 95% CI: -1.79 to -0.02, p = 0.05 and an enlarged fovea avascular zone (FAZ):WMD = 0.06, 95% CI: 0.01 to 0.11, P = 0.02 in OCTA measurements of MCI patients. Additionally, in OCTA measurements of AD patients, there was a significantly decreased VD in the SCP: WMD = -1.88, 95% CI: -2.7 to -1.07, p<0.00001. In contrast, there was no significant decrease in DCP nor enlargement of FAZ in AD patients. Conclusion Retinal microvascular alternations could be optimally screened in MCI patients detected by OCTA, which could be a warning sign of relative changes in the MCI before progressing to AD. Retinal microvasculature changes worth further investigation in larger scale clinical trials.

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Decreased Retinal Vascular Density in Alzheimer’s Disease (AD) and Mild Cognitive Impairment (MCI): An Optical Coherence Tomography Angiography (OCTA) Study

Frontiers in Aging Neuroscience ◽

10.3389/fnagi.2020.572484 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xi Wang ◽

Qianhua Zhao ◽

Rui Tao ◽

Huimeng Lu ◽

Zhenxu Xiao ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Optical Coherence Tomography ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Patient Group ◽

Optical Coherence Tomography Angiography ◽

Vascular Density ◽

Optical Coherence ◽

Patient Groups

BackgroundTo explore the retinal vascular density changes in Alzheimer’s disease (AD) and mild cognitive impairment (MCI) patients using optical coherence tomography angiography (OCTA).MethodsWe recruit 62 AD patients, 47 MCI patients, and 49 cognitively healthy controls (HC) in this study. All participants in the study received a comprehensive ophthalmological and neurological evaluation, including global cognitive screening, as well as the Mini-Mental State Examination (MMSE), and completed the following eye examinations: visual acuity (VA), intraocular pressure (IOP), examination with slit-lamp, fundus photography (Version 1.5.0.0, NIDEK CO, LTD) and Optical coherence tomography imaging (software ReVue version 2017.1.0.155, Optovue Inc., Fremont, CA, United States). The visual rating scales for atrophy and white matter lesion in MRI was evaluated for all the patients with AD and MCI.ResultsIn the AD patient group, the superficial vascular density in the superior, inferior and whole retina was 44.64 ± 3.34, 44.65 ± 3.55, and 44.66 ± 3.36, respectively. These values were 44.24 ± 3.15, 43.72 ± 3.16, and 44 ± 3.07, respectively, in the MCI patient group. After multivariate analysis of the generalized linear model, adjustments for the confounding factors of sex, age, hypertension, diabetes and the quality index of OCTA image, the superficial vascular density in the AD and MCI patient groups was significantly lower than that in the HC group (P < 0.05): 46.94 ± 2.04, 46.67 ± 2.26, and 46.82 ± 2.08, respectively. No difference in the area of the FAZ among the three groups was observed (AD group: 0.34 ± 0.11 mm2; MCI group: 0.36 ± 0.12 mm2; control group: 0.33 ± 0.12 mm2, p > 0.05). The ganglion cell complex (GCC) thickness, inner parafovea thickness, and peripapillary retinal nerve fiber layer (p-RNFL) thickness were associated with the superficial vascular density. We found no significant correlation between the global cognition (MMSE scores) or between the Fazekas score and retinal OCT angiogram flow density.ConclusionThe superficial vascular density in the AD and MCI patient groups was significantly lower than that in the HC group. Our findings suggest the retinal microvascular dysfunction occurred in MCI and AD.

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Retinal alterations in mild cognitive impairment and Alzheimer’s disease: an optical coherence tomography study

Journal of Neurology ◽

10.1007/s00415-014-7374-z ◽

2014 ◽

Vol 261 (8) ◽

pp. 1522-1530 ◽

Cited By ~ 97

Author(s):

Francisco J. Ascaso ◽

Nancy Cruz ◽

Pedro J. Modrego ◽

Raul Lopez-Anton ◽

Javier Santabárbara ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Optical Coherence Tomography ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Optical Coherence

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Parafoveal vessel loss and correlation between peripapillary vessel density and cognitive performance in amnestic mild cognitive impairment and early Alzheimer’s Disease on optical coherence tomography angiography

PLoS ONE ◽

10.1371/journal.pone.0214685 ◽

2019 ◽

Vol 14 (4) ◽

pp. e0214685 ◽

Cited By ~ 20

Author(s):

Yi Stephanie Zhang ◽

Nina Zhou ◽

Brianna Marie Knoll ◽

Sahej Samra ◽

Mallory R. Ward ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Optical Coherence Tomography ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Performance ◽

Optical Coherence Tomography Angiography ◽

Amnestic Mild Cognitive Impairment ◽

Vessel Density ◽

Optical Coherence ◽

Early Alzheimer’S Disease

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Comparison of Retinal Microvasculature in Patients With Alzheimer's Disease and Primary Open-Angle Glaucoma by Optical Coherence Tomography Angiography

Investigative Opthalmology & Visual Science ◽

10.1167/iovs.19-27028 ◽

2019 ◽

Vol 60 (10) ◽

pp. 3447 ◽

Cited By ~ 18

Author(s):

Przemyslaw Zabel ◽

Jakub J. Kaluzny ◽

Monika Wilkosc-Debczynska ◽

Martyna Gebska-Toloczko ◽

Karolina Suwala ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Optical Coherence Tomography ◽

Optical Coherence Tomography Angiography ◽

Primary Open Angle Glaucoma ◽

Open Angle Glaucoma ◽

Optical Coherence ◽

Open Angle ◽

Retinal Microvasculature

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Retinal microvascular attenuation in mental cognitive impairment and Alzheimer's disease by optical coherence tomography angiography

Acta Ophthalmologica ◽

10.1111/aos.14381 ◽

2020 ◽

Vol 98 (6) ◽

Cited By ~ 10

Author(s):

Jing Wu ◽

Xiaojun Zhang ◽

Guliqiwaer Azhati ◽

Tingting Li ◽

Guoxing Xu ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Optical Coherence Tomography ◽

Cognitive Impairment ◽

Optical Coherence Tomography Angiography ◽

Optical Coherence

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The Role of Optical Coherence Tomography in Identifying Retinal Biomarkers in FTD: A Review

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001041 ◽

2021 ◽

pp. 10.1212/CPJ.0000000000001041

Author(s):

Omar Moinuddin ◽

Nikhila S Khandwala ◽

Kelly Z Young ◽

Sanjana K Sathrasala ◽

Sami J Barmada ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Optical Coherence Tomography ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Patient Care ◽

Frontotemporal Dementia ◽

Narrative Review ◽

Optical Coherence ◽

Retinal Thinning

AbstractPurposeof Review: Frontotemporal dementia (FTD) is often misdiagnosed or recognized late. Clinical heterogeneity and overlap with other dementias impede accurate diagnosis. FTD biomarkers are limited, expensive and invasive. We present a narrative review of the current literature focused on optical coherence tomography (OCT) to identify retinal biomarkers of dementia, discuss OCT findings in FTD, and explore the implications of an FTD-specific ocular biomarker for research and patient care.Recent Findings:Recent studies suggest that outer retinal thinning detected via OCT may function as a novel ocular biomarker of FTD. The degree and rate of inner retinal thinning may correlate with disease severity and progression. In Alzheimer’s disease (AD), OCT demonstrates thinning of the inner retina, which may differentiate this condition from FTD.Methods:We conducted a comprehensive search of the literature and reviewed published OCT findings in FTD, AD, and mild cognitive impairment, as well as reports on biomarkers of FTD and AD utilized in the research and patient care settings. Three of the authors (OM, NSK, and KZY) independently conducted literature searches using PubMed® to identify studies published before May 01, 2020 using the following search terminology: “Alzheimer’s disease,” “Alzheimer’s dementia,” “Frontotemporal dementia,” “FTD,” “mild cognitive impairment,” “dementia biomarkers,” and “neurodegeneration biomarkers.” Search results were then refined using one or more of the following keywords: “optical coherence tomography,” “optical coherence tomography angiography,” “retinal imaging,” and “retinal thinning.” The selection of published works for inclusion in this narrative review was then limited to full-text manuscripts written in English based on consensus agreement of the authors.Summary:FTD diagnosis is imprecise, emphasizing the need for improved state and trait biomarkers. OCT imaging of the retina holds considerable potential for establishing effective ocular biomarkers for FTD.

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