与对照参与者相比，阿尔茨海默病和轻度认知障碍中的视网膜微血管和神经退行性变化
Retinal Microvascular and Neurodegenerative Changes in Alzheimer's Disease and Mild Cognitive Impairment Compared with Control Participants.
作者信息
Yoon Stephen P, Grewal Dilraj S, Thompson Atalie C, Polascik Bryce W, Dunn Cynthia, Burke James R, Fekrat Sharon
机构信息
Department of Ophthalmology, Duke University, Durham, North Carolina.
Department of Neurology, Duke University, Durham, North Carolina.
出版信息
Ophthalmol Retina. 2019 Jun;3(6):489-499. doi: 10.1016/j.oret.2019.02.002. Epub 2019 Mar 11.
PURPOSE
Evaluate and compare the retinal microvasculature in the superficial capillary plexus (SCP) in Alzheimer's disease (AD), mild cognitive impairment (MCI), and cognitively intact controls using OCT angiography. OCT parameters were also compared.
DESIGN
Cross-sectional study.
PARTICIPANTS
Seventy eyes from 39 AD participants, 72 eyes from 37 MCI participants, and 254 eyes from 133 control participants were enrolled.
METHODS
Participants were imaged using Zeiss Cirrus HD-5000 with AngioPlex (Carl Zeiss Meditec, Dublin, CA) and underwent cognitive evaluation with Mini-Mental State Examination.
MAIN OUTCOME MEASURES
Vessel density (VD) and perfusion density (PD) in the SCP within the Early Treatment Diabetic Retinopathy Study 6-mm circle, 3-mm circle, and 3-mm ring were compared between groups. Foveal avascular zone (FAZ) area, central subfield thickness (CST), macular ganglion cell-inner plexiform layer (GC-IPL) thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness were also compared.
RESULTS
Alzheimer's participants showed significantly decreased SCP VD and PD in the 3-mm ring (P = 0.001 and P = 0.002, respectively) and 3-mm circle (P = 0.003 and P = 0.004, respectively) and decreased SCP VD in the 6-mm circle (P = 0.047) compared with MCI and significantly decreased SCP VD and PD in the 3-mm ring (P = 0.008 and P = 0.004, respectively) and 3-mm circle (P = 0.015 and P = 0.009, respectively) and SCP PD in the 6-mm circle (P = 0.033) when compared with cognitively intact controls. There was no difference in SCP VD or PD between MCI and controls (P > 0.05). FAZ area and CST did not differ significantly between groups (P > 0.05). Alzheimer's participants showed significantly decreased GC-IPL thickness over the inferior (P = 0.032) and inferonasal (P = 0.025) sectors compared with MCI and significantly decreased GC-IPL thickness over the entire (P = 0.012), superonasal (P = 0.041), inferior (P = 0.004), and inferonasal (P = 0.006) sectors compared to controls. MCI participants showed significantly decreased temporal RNFL thickness (P = 0.04) compared with controls.
CONCLUSIONS
Alzheimer's participants showed significantly reduced macular VD, PD, and GC-IPL thickness compared with MCI and controls. Changes in the retinal microvasculature may mirror small vessel cerebrovascular changes in AD.
目的
使用光学相干断层扫描血管造影术评估和比较阿尔茨海默病（AD）、轻度认知障碍（MCI）和认知功能正常的对照者的视网膜浅表毛细血管丛（SCP）中的视网膜微血管系统。还比较了光学相干断层扫描（OCT）参数。
设计
横断面研究。
参与者
纳入了39名AD参与者的70只眼、37名MCI参与者的72只眼和133名对照参与者的254只眼。
方法
使用配备AngioPlex的蔡司Cirrus HD-5000（卡尔蔡司医疗技术公司，加利福尼亚州都柏林）对参与者进行成像，并采用简易精神状态检查表进行认知评估。
主要观察指标
比较各组在糖尿病视网膜病变早期治疗研究6毫米圆、3毫米圆和3毫米环内SCP的血管密度（VD）和灌注密度（PD）。还比较了中心凹无血管区（FAZ）面积、中心子区域厚度（CST）、黄斑神经节细胞-内丛状层（GC-IPL）厚度和视乳头周围视网膜神经纤维层（RNFL）厚度。
结果
与MCI相比，AD参与者在3毫米环（分别为P = 0.001和P = 0.002）和3毫米圆（分别为P = 0.003和P = 0.004）中的SCP VD和PD显著降低，在6毫米圆中的SCP VD降低（P = 0.047）；与认知功能正常的对照者相比，AD参与者在3毫米环（分别为P = 0.008和P = 0.004）和3毫米圆（分别为P = 0.015和P = 0.009）中的SCP VD和PD以及在6毫米圆中的SCP PD显著降低（P = 0.033）。MCI与对照者之间的SCP VD或PD无差异（P>0.05）。各组之间的FAZ面积和CST无显著差异（P>0.05）。与MCI相比，AD参与者在下方（P = 0.032）和鼻下（P = 0.025）扇形区域的GC-IPL厚度显著降低；与对照者相比，AD参与者在整个（P = 0.012）、鼻上（P = 0.041）、下方（P = 0.004）和鼻下（P = 0.006）扇形区域的GC-IPL厚度显著降低。与对照者相比，MCI参与者的颞侧RNFL厚度显著降低（P = 0.04）。
结论
与MCI和对照者相比，AD参与者的黄斑VD、PD和GC-IPL厚度显著降低。视网膜微血管系统的变化可能反映了AD中小血管脑血管的变化。
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