Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Department of Ophthalmology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Alzheimers Res Ther. 2024 Mar 25;16(1):64. doi: 10.1186/s13195-024-01431-w.
Posterior cortical atrophy (PCA) is a form of dementia that frequently displays significant visual dysfunction and relatively preserved cognitive and executive functions, thus hindering early diagnosis and treatment. This study aimed to investigate possible fundus markers in PCA patients and compare them with those of typical Alzheimer's disease (AD) patients to seek potential diagnostic patterns.
Age-matched PCA and AD patients and healthy controls (HC) completed optometry, intraocular pressure measurement, neuropsychologic assessments, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) examination in one visit. Overall, six outcomes of thicknesses of various retinal layers and seven outcomes of the retinal microvascular network were calculated. After adjusting for age, sex, and years of education, the OCT and OCTA results were analyzed using analysis of covariance and generalized linear models. Correlation analyses were performed using Spearman correlation, and ROC curves were plotted.
Twelve PCA patients, nineteen AD patients, and thirty HC, aged 45-80 years were included. Fifty HC, thirty AD, and twenty PCA eyes were available for foveal avascular zone (FAZ) area analysis; forty-nine HC, thirty-four AD, and eighteen PCA eyes were available for OCT and OCTA assessments. PCA patients had thinner retinal nerve fiber layer and ganglion cell layer + inner plexiform layer than HC in the 0-3 mm circle and 1-3 mm ring. Few structural differences were observed between the AD group and the other two groups. The flow area of the superficial capillary plexus and the intermediate capillary plexus was smaller in the PCA group than in the HC group in the 0-1 mm circle, 0-3 mm circle. MMSE performed better than any combination of optical parameters in identifying AD and PCA from HC (AUC = 1), while the combination of MoCA, retinal thickness and vascular density of ICP in the 1-3 mm ring, with flow area of ICP in the 0-1 mm circle showed the strongest ability to distinguish PCA from AD (AUC = 0.944).
PCA patients exhibited similar impairment patterns to AD patients in the fundus structure and microvascular network. OCTA may aid in the non-invasive detection of AD and PCA, but still remains to be substantiated.
后部皮质萎缩（PCA）是一种痴呆症，常表现出明显的视觉功能障碍和相对保留的认知和执行功能，从而阻碍了早期诊断和治疗。本研究旨在探讨 PCA 患者可能存在的眼底标志物，并与典型阿尔茨海默病（AD）患者进行比较，以寻求潜在的诊断模式。
在一次就诊中，年龄匹配的 PCA 和 AD 患者以及健康对照者（HC）完成了验光、眼压测量、神经心理学评估、光学相干断层扫描（OCT）和光学相干断层扫描血管造影（OCTA）检查。总共计算了各种视网膜层厚度的六个结果和视网膜微血管网络的七个结果。在调整年龄、性别和受教育年限后，使用协方差分析和广义线性模型分析 OCT 和 OCTA 结果。使用 Spearman 相关分析进行相关性分析，并绘制 ROC 曲线。
纳入了 12 名 PCA 患者、19 名 AD 患者和 30 名 HC，年龄 45-80 岁。50 名 HC、30 名 AD 和 20 名 PCA 眼可用于分析黄斑中心凹无血管区（FAZ）面积；49 名 HC、34 名 AD 和 18 名 PCA 眼可用于 OCT 和 OCTA 评估。与 HC 相比，PCA 患者在 0-3mm 圆和 1-3mm 环中视网膜神经纤维层和节细胞层+内丛状层较薄。AD 组与其他两组之间观察到的结构差异很少。与 HC 相比，在 0-1mm 圆和 0-3mm 圆中，PCA 组浅层毛细血管丛和中层毛细血管丛的血流面积较小。MMSE 在识别 AD 和 PCA 与 HC 方面优于任何光学参数组合（AUC=1），而 MoCA、1-3mm 环中 ICP 的视网膜厚度和血管密度以及 0-1mm 圆中 ICP 的血流面积的组合对区分 PCA 与 AD 具有最强的能力（AUC=0.944）。
PCA 患者的眼底结构和微血管网络表现出与 AD 患者相似的损伤模式。OCTA 可能有助于 AD 和 PCA 的非侵入性检测，但仍有待证实。
