Lee Moon J, Abraham Alison G, Swenor Bonnielin K, Sharrett A Richey, Ramulu Pradeep Y
Medical Student, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Associate Professor, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Curr Glaucoma Pract. 2018 Jan-Apr;12(1):10-18. doi: 10.5005/jp-journals-10028-1238. Epub 2018 Mar 1.
This review aims to critically analyze the current literature on the relationship of optical coherence tomography (OCT) measures to cognition and dementia.
Optical coherence tomography, a noninvasive method of imaging neuroretinal layers, and OCT angiography, a highly precise method of examining retinal vasculature, have widely been used to aid in the diagnosis and monitoring of a variety of ocular diseases. There is now an increasing body of evidence relating the structural and microvascular changes of the retina to cognitive impairment.
In general, several studies have found decreased retinal nerve fiber layer (RNFL) thickness in Alzheimer's disease (AD) and mild cognitive impairment (MCI) and an association between RNFL thickness and continuous measures of cognitive ability, though findings were inconsistent across studies. In many studies, associations were found for specific regions of the RNFL but not with overall thickness. Studies linking OCT measures to non-Alzheimer's dementia were lacking, and limited work has been done on persons with past cognitive decline but who remain cognitively normal (the ideal stage at which to target treatment). Common limitations of prior studies include a failure to account for intraocular pressure (IOP) and axial length.
Current research suggests a potential association between retinal findings observed on OCT and cognitive impairment. Methodologically robust research accounting for important covariates and looking at changes in OCT and/ or cognition is needed to better characterize the association between OCT and cognitive ability.
Further research is warranted to determine whether OCT findings can help identify the etiology of cognitive decline and/or serve as objective markers of AD. If this is the case, OCT may also help identify the presence of disease processes in cognitively normal individuals. Lee MJ, Abraham AG, Swenor BK, Sharrett AR, Ramulu PY. Application of Optical Coherence Tomography in the Detection and Classification of Cognitive Decline. J Curr Glaucoma Pract 2018;12(1):10-18.
本综述旨在批判性地分析当前关于光学相干断层扫描（OCT）测量与认知及痴呆关系的文献。
光学相干断层扫描是一种对神经视网膜层进行成像的非侵入性方法，而OCT血管造影是一种检查视网膜血管系统的高精度方法，已广泛用于辅助多种眼部疾病的诊断和监测。现在有越来越多的证据表明视网膜的结构和微血管变化与认知障碍有关。
总体而言，多项研究发现阿尔茨海默病（AD）和轻度认知障碍（MCI）患者的视网膜神经纤维层（RNFL）厚度降低，且RNFL厚度与认知能力的连续测量之间存在关联，不过各研究结果并不一致。在许多研究中，发现RNFL的特定区域存在关联，但与总厚度无关。缺乏将OCT测量与非阿尔茨海默病痴呆相关联的研究，且针对既往有认知衰退但仍认知正常（理想的治疗靶点阶段）的人群所做的工作有限。既往研究的常见局限性包括未考虑眼内压（IOP）和眼轴长度。
当前研究表明OCT观察到的视网膜表现与认知障碍之间可能存在关联。需要进行方法学上稳健的研究，考虑重要的协变量，并观察OCT和/或认知的变化，以更好地表征OCT与认知能力之间的关联。
有必要进一步研究以确定OCT结果是否有助于识别认知衰退的病因和/或作为AD的客观标志物。如果是这样，OCT也可能有助于识别认知正常个体中疾病过程的存在。李MJ、亚伯拉罕AG、斯韦诺尔BK、沙雷特AR、拉穆卢PY。光学相干断层扫描在认知衰退检测和分类中的应用。《当代青光眼实践杂志》2018年；12(1):10 - 18。
