Department of Ophthalmology, Taipei Medical University-Shuang Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2023 Oct;122(10):1050-1060. doi: 10.1016/j.jfma.2023.04.001. Epub 2023 Apr 19.
BACKGROUND/PURPOSE: The small retinal vessels reflect cerebral microcirculation and its fractal dimension (D), representing the complexity of the retinal microcirculation. However, the connection between retinal circulation and cognitive function lacked consistent and longitudinal evidence. This study aimed to explore the association between retinal vascular complexity and cognitive impairment over time in non-demented community-dwelling older adults.
This four-year prospective cohort study (2015-2019) is part of the ongoing Taiwan Initiative for Geriatric Epidemiological Research (TIGER, 2011 to present). Of the 434 older adults (age >65) recruited, 207 participants were included for analysis. The retinal vascular D was assessed by baseline images from fundus photography (2015-2017). Global (Montreal Cognitive Assessment-Taiwanese version, MoCA-T) and domain-specific cognition were assessed at the baseline and 2-year follow-up (2017-2019). The multivariable linear regression models and generalized linear mixed models were used to evaluate the association of D with cognitive decline/impairment over time.
Decreased left retinal vascular complexity was associated with poor attention performance (β = -0.40). As follow-up time increased, decreased vascular complexity was associated with poor memory performance (right: β = -0.25; left: β = -0.19), and decreased right vascular complexity was associated with poor attention performance (β = -0.18).
Low retinal vascular complexity of the right or left eye may be differentially associated with cognitive domains in community-dwelling older adults over two years. The retinal vascular D of either eye may be served as a screening tool for detecting cognitive impairment in the preclinical phase of dementia.
背景/目的：小视网膜血管反映了脑微循环及其分形维数（D），代表了视网膜微循环的复杂性。然而，视网膜循环与认知功能之间的联系缺乏一致和纵向证据。本研究旨在探讨非痴呆社区居住的老年人中视网膜循环复杂性与认知障碍随时间变化的关系。
这是一项为期四年的前瞻性队列研究（2015-2019 年），是正在进行的台湾老年流行病学研究倡议（TIGER，2011 年至今）的一部分。在招募的 434 名老年人（年龄>65 岁）中，有 207 名参与者纳入分析。视网膜血管 D 通过眼底照相的基线图像进行评估（2015-2017 年）。在基线和 2 年随访（2017-2019 年）时评估全球认知（蒙特利尔认知评估-台湾版，MoCA-T）和特定领域认知。使用多变量线性回归模型和广义线性混合模型评估 D 与认知随时间下降/受损的关系。
左侧视网膜血管复杂性降低与注意力表现较差有关（β=-0.40）。随着随访时间的增加，血管复杂性降低与记忆表现较差有关（右侧：β=-0.25；左侧：β=-0.19），右侧血管复杂性降低与注意力表现较差有关（β=-0.18）。
右或左眼视网膜血管复杂性降低可能与社区居住的老年人在两年内的认知领域存在差异相关。视网膜血管 D 可能作为痴呆前临床阶段检测认知障碍的筛查工具。
