Department of Epidemiology, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA.
Department of Ophthalmology, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA.
J Am Geriatr Soc. 2021 Sep;69(9):2524-2535. doi: 10.1111/jgs.17272. Epub 2021 May 19.
Accumulated vascular damage contributes to the onset and progression of vascular dementia and possibly to Alzheimer's disease. Here we evaluate the feasibility and utility of using retinal imaging of microvascular markers to identify older adults at risk of cognitive disease.
The "Eye Determinants of Cognition" (EyeDOC) study recruited a biracial, population-based sample of participants from two sites: Jackson, MS, and Washington Co, MD. Optical coherence tomographic angiography (OCTA) was used to capture vessel density (VD) from a 6 × 6 mm scan of the macula in several vascular layers from 2017 to 2019. The foveal avascular zone (FAZ) area was also estimated. Image quality was assessed by trained graders at a reading center. A neurocognitive battery of 10 tests was administered at three time points from 2011 to 2019 and incident mild cognitive impairement (MCI)/dementia cases were ascertained. Linear mixed-effects models were used to evaluate associations of retinal vascular markers with cognitive factor score change over time.
Nine-hundred and seventy-six older adults (mean age of 78.7 (± 4.4) years, 44% black) were imaged. Gradable images were obtained in 55% (535/976), with low signal strength (66%) and motion artifact (22%) being the largest contributors to poor quality. Among the 297 participants with both high-quality images and no clinically significant retinal pathology, the average decline in global cognitive function factor score was -0.03 standard deviations per year. In adjusted analyses, no associations of VD or FAZ with longitudinal changes in either global cognitive function or with incident MCI/dementia were found.
In this large biracial community sample of older adults representative of the target population for retinal screening of cognitive risk, we found that obtaining high-quality OCTA scans was infeasible in a nearly half of older adults. Among the select sample of healthier older adults with scans, OCTA markers were not predictive of cognitive impairment.
血管损伤的积累导致血管性痴呆和可能的阿尔茨海默病的发生和进展。在这里，我们评估使用视网膜微血管标志物成像来识别认知疾病风险的老年人的可行性和实用性。
“眼部认知决定因素”（EyeDOC）研究从两个地点招募了一个具有双种族、基于人群的参与者样本：密西西比州杰克逊和马里兰州华盛顿县。从 2017 年到 2019 年，使用光学相干断层扫描血管造影术（OCTA）从黄斑的 6×6mm 扫描中捕获几个血管层的血管密度（VD）。还估计了中央无血管区（FAZ）面积。由阅读中心的训练有素的分级员评估图像质量。从 2011 年到 2019 年，进行了 10 项神经认知测试的测试，并确定了轻度认知障碍（MCI）/痴呆的发病病例。使用线性混合效应模型评估了视网膜血管标志物与认知因子评分随时间变化的相关性。
对 976 名年龄在 78.7（±4.4）岁的老年人进行了成像（44%为黑人）。获得了 55%（535/976）的可分级图像，低信号强度（66%）和运动伪影（22%）是图像质量差的最大原因。在 297 名具有高质量图像且无临床显著视网膜病变的参与者中，全球认知功能因子评分的平均下降速度为每年-0.03 个标准差。在调整分析中，VD 或 FAZ 与全球认知功能的纵向变化或与 MCI/dementia 的发生均无关联。
在这项针对认知风险视网膜筛查目标人群的大型双种族社区老年人的研究中，我们发现，近一半的老年人无法获得高质量的 OCTA 扫描。在具有扫描的选择性更健康的老年人样本中，OCTA 标志物不能预测认知障碍。
