Moon Sangwoo, Jeon Sumin, Seo Sook Kyeong, Kim Da Eun, Jung Na-Yeon, Kim Seung Joo, Lee Myung Jun, Lee Jiwoong, Kim Eun-Joo
Department of Ophthalmology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan 49241, Republic of Korea.
Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan 49241, Republic of Korea.
J Clin Med. 2023 Feb 7;12(4):1310. doi: 10.3390/jcm12041310.
To evaluate whether an impaired anterior visual pathway (retinal structures with microvasculature) is associated with underlying beta-amyloid (Aβ) pathologies in patients with Alzheimer's disease dementia (ADD) and mild cognitive impairment (MCI), we compared retinal structural and vascular factors in each subgroup with positive or negative amyloid biomarkers. Twenty-seven patients with dementia, thirty-five with MCI, and nine with cognitively unimpaired (CU) controls were consecutively recruited. All participants were divided into positive Aβ (A+) or negative Aβ (A-) pathology based on amyloid positron emission tomography or cerebrospinal fluid Aβ. The retinal circumpapillary retinal nerve fiber layer thickness (cpRNFLT), macular ganglion cell/inner plexiform layer thickness (mGC/IPLT), and microcirculation of the macular superficial capillary plexus were measured using optical coherence tomography (OCT) and OCT angiography. One eye of each participant was included in the analysis. Retinal structural and vascular factors significantly decreased in the following order: dementia < MCI < CU controls. The A+ group had significantly lower microcirculation in the para- and peri-foveal temporal regions than did the A-. However, the structural and vascular parameters did not differ between the A+ and A- with dementia. The cpRNFLT was unexpectedly greater in the A+ than in the A- with MCI. mGC/IPLT was lower in the A+ CU than in the A- CU. Our findings suggest that retinal structural changes may occur in the preclinical and early stages of dementia but are not highly specific to AD pathophysiology. In contrast, decreased temporal macula microcirculation may be used as a biomarker for the underlying Aβ pathology.
为了评估在阿尔茨海默病性痴呆（ADD）和轻度认知障碍（MCI）患者中，受损的前视觉通路（具有微血管的视网膜结构）是否与潜在的β-淀粉样蛋白（Aβ）病变相关，我们比较了各亚组中具有阳性或阴性淀粉样蛋白生物标志物的视网膜结构和血管因素。连续招募了27例痴呆患者、35例MCI患者和9例认知未受损（CU）的对照者。所有参与者根据淀粉样蛋白正电子发射断层扫描或脑脊液Aβ被分为Aβ阳性（A+）或Aβ阴性（A-）病变组。使用光学相干断层扫描（OCT）和OCT血管造影测量视网膜视乳头周围视网膜神经纤维层厚度（cpRNFLT）、黄斑神经节细胞/内丛状层厚度（mGC/IPLT）以及黄斑浅表毛细血管丛的微循环。分析纳入了每位参与者的一只眼睛。视网膜结构和血管因素按以下顺序显著降低：痴呆组 < MCI组 < CU对照组。A+组在黄斑旁和黄斑周围颞侧区域的微循环显著低于A-组。然而，痴呆组中A+和A-之间的结构和血管参数没有差异。在MCI患者中，A+组的cpRNFLT意外地高于A-组。在CU患者中，A+组的mGC/IPLT低于A-组。我们的研究结果表明，视网膜结构变化可能发生在痴呆的临床前期和早期阶段，但并非高度特异性地针对AD病理生理学。相比之下，颞侧黄斑微循环减少可能用作潜在Aβ病变的生物标志物。
