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Abstract
PURPOSE OF REVIEW The incidence of Alzheimer's disease is increasing. Premortem diagnosis of Alzheimer's disease is now possible but require invasive and expensive testing such as PET amyloid beta binding and/or spinal fluid amyloid beta levels. There is a great need for minimally invasive and inexpensive biomarkers to allow for early diagnosis and intervention. RECENT FINDINGS There has been a large volume of literature assessing ocular biomarkers for Alzheimer's disease. Much of the research to date has significant limitations, including sample size, variable diagnostic criteria for Alzheimer's disease, lack of biomarker assessment, and focus on patients with well established dementia. Work that is more recent has included individuals with early and preclinical Alzheimer's disease with biomarkers included in the design. These studies have shown consistent features of visual pathway involvement in Alzheimer's disease, even in the earliest and preclinical stages. SUMMARY It is possible that in the future, ocular biomarkers (particularly retinal imaging techniques) may be part of a multimodality alogorithm screening for preclinical Alzheimer's disease, perhaps combined with other methods, such as blood-based biomarkers.
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Appaji A, Nagendra B, Chako DM, Padmanabha A, Hiremath CV, Jacob A, Varambally S, Kesavan M, Venkatasubramanian G, Rao SV, Webers CAB, Berendschot TTJM, Rao NP. Retinal vascular abnormalities in schizophrenia and bipolar disorder: A window to the brain. Bipolar Disord 2019; 21:634-641. [PMID: 31009139 DOI: 10.1111/bdi.12779] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The examination of retinal microvascular abnormalities through fundus photography is currently the best available non-invasive technique for assessment of cerebral vascular status. Several studies in the last decade have reported higher incidences of adverse cerebrovascular events in Schizophrenia (SCZ) and bipolar disorder (BD). However, retinal microvasculature abnormalities in SCZ and BD have remained under-explored, and no study has compared this aspect of SCZ and BD till date. METHODS Retinal Images of 100 SCZ patients, BD patients, and healthy volunteers each were acquired by trained individuals using a non-mydriatic camera with a 40-degree field of view. The retinal images were quantified using a valid semi-automated method. The average of left and right eye diameters of the venules and arterioles passing through the extended zone between 0.5 and 2 disc diameters from the optic disc were calculated. RESULTS The groups differed significantly with respect to average diameters of both retinal venules (P < 0.001) and retinal arterioles (P < 0.001), after controlling for age and sex. Both SCZ and BD patients had significantly narrower arterioles and wider venules compared to HV. There were also significant differences between SCZ and BD patients; patients with BD had narrower arterioles and wider venules. CONCLUSION Considering the affordability and easy accessibility of the investigative procedure, retinal microvascular examination could serve as a potential screening tool to identify individuals at risk for adverse cerebrovascular events. The findings of the current study also provide a strong rationale for further systematic examination of retinal vascular abnormalities in SCZ and BD.
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Affiliation(s)
- Abhishek Appaji
- Department of Medical Electronics, BMS College of Engineering, Bangalore, India.,University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Bhargavi Nagendra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Dona M Chako
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ananth Padmanabha
- Department of Medical Electronics, BMS College of Engineering, Bangalore, India
| | - Chaitra V Hiremath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Arpitha Jacob
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shivarama Varambally
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Muralidharan Kesavan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Shyam V Rao
- Department of Medical Electronics, BMS College of Engineering, Bangalore, India.,University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Carroll A B Webers
- University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Tos T J M Berendschot
- University Eye Clinic Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Cheng DL, Thompson L, Snyder PJ. A Potential Association Between Retinal Changes, Subjective Memory Impairment, and Anxiety in Older Adults at Risk for Alzheimer's Disease: A 27-Month Pilot Study. Front Aging Neurosci 2019; 11:288. [PMID: 31736739 PMCID: PMC6830450 DOI: 10.3389/fnagi.2019.00288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/07/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction The utility of subjective memory impairment (SMI) as a risk marker for preclinical Alzheimer's disease (AD) remains unclear; however, recent studies have identified a correlation between retinal biomarkers and onset of preclinical disease. This study examines the relationship between retinal biomarkers that have been associated with cerebral amyloid, an early hallmark of AD, and SMI scores in patients at risk for developing AD. Methods Forty-nine cognitively normal subjects were followed over 27 months and evaluated using a combination of neuropsychological, psychological, and retinal imaging instruments. Subjective memory testing was conducted using the memory assessment clinic questionnaire (MACQ) and Depression, Anxiety, and Stress Scales (DASS). Multivariate linear analysis was conducted using STATA software. Results Positive correlations were found between retinal nerve fiber layer (RNFL) volume and scores obtained from the MAC-Q at 27 months (MAC-Q_27), the DASS questionnaire for anxiety at 27 months (DASS-A_27), and the change in DASS-A over 27 months (dDASSA). There was also a significant positive correlation between these variables and the change in RNFL thickness over 27 months (dRNFL). MACQ_27, DASSA_27, and dDASS-A accounted for 35.7% of RFNL variance at 27 months and 21.5% of dRFNL variance. Discussion These findings suggest that worse subjective memory complaints and anxiety scores may be associated with one of the most commonly used structural anatomical retinal markers of early disease burden in AD. If so, these results lend support to SMI as a valid risk marker for later cognitive decline.
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Affiliation(s)
- Derrick L Cheng
- The Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Louisa Thompson
- Department of Neurology, Alpert Medical School, Brown University, Providence, RI, United States
| | - Peter J Snyder
- Department of Neurology, Alpert Medical School, Brown University, Providence, RI, United States.,The Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, United States
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McGrory S, Ballerini L, Okely JA, Ritchie SJ, Doubal FN, Doney ASF, Dhillon B, Starr JM, MacGillivray TJ, Trucco E, Wardlaw JM, Deary IJ. Retinal microvascular features and cognitive change in the Lothian-Birth Cohort 1936. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2019; 11:500-509. [PMID: 31338413 PMCID: PMC6625967 DOI: 10.1016/j.dadm.2019.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction We test whether measures of the retinal vasculature are associated with cognitive functioning and cognitive change. Methods Retinal images from a narrow-age cohort were analyzed using Vessel Assessment and Measurement Platform for Images of the Retina, producing a comprehensive range of quantitative measurements of the retinal vasculature, at mean age 72.5 years (SD = 0.7). Cognitive ability and change were measured using a battery of multiple measures of memory, visuospatial, processing speed, and crystallized cognitive abilities at mean ages 73, 76, and 79 years. We applied multivariate growth curve models to test the association between retinal vascular measurements with cognitive abilities and their changes. Results Almost all associations were nonsignificant. In our most parsimonious model, venular asymmetry factor was associated with speed at age 73. Discussion Our null findings suggest that the quantitative retinal parameters applied in this study are not significantly associated with cognitive functioning or cognitive change.
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Affiliation(s)
- Sarah McGrory
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Lucia Ballerini
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Judith A Okely
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Center for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Stuart J Ritchie
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Fergus N Doubal
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Alex S F Doney
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
| | - Baljean Dhillon
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Center for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Thomas J MacGillivray
- VAMPIRE project, Center for Clinical Brain Sciences, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE Project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Joanna M Wardlaw
- Center for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK.,UK Dementia Research Institute at the University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Center for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK
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Ludyga S, Köchli S, Pühse U, Gerber M, Hanssen H. Effects of a school-based physical activity program on retinal microcirculation and cognitive function in adolescents. J Sci Med Sport 2019; 22:672-676. [DOI: 10.1016/j.jsams.2018.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/01/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022]
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Yoon SP, Grewal DS, Thompson AC, Polascik BW, Dunn C, Burke JR, Fekrat S. Retinal Microvascular and Neurodegenerative Changes in Alzheimer's Disease and Mild Cognitive Impairment Compared with Control Participants. Ophthalmol Retina 2019; 3:489-499. [PMID: 31174670 PMCID: PMC6586560 DOI: 10.1016/j.oret.2019.02.002] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/30/2018] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Stephen P Yoon
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Dilraj S Grewal
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Atalie C Thompson
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Bryce W Polascik
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Cynthia Dunn
- Department of Neurology, Duke University, Durham, North Carolina
| | - James R Burke
- Department of Neurology, Duke University, Durham, North Carolina
| | - Sharon Fekrat
- Department of Ophthalmology, Duke University, Durham, North Carolina.
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McGrory S, Ballerini L, Doubal FN, Staals J, Allerhand M, Valdes-Hernandez MDC, Wang X, MacGillivray T, Doney ASF, Dhillon B, Starr JM, Bastin ME, Trucco E, Deary IJ, Wardlaw JM. Retinal microvasculature and cerebral small vessel disease in the Lothian Birth Cohort 1936 and Mild Stroke Study. Sci Rep 2019; 9:6320. [PMID: 31004095 PMCID: PMC6474900 DOI: 10.1038/s41598-019-42534-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/28/2019] [Indexed: 01/06/2023] Open
Abstract
Research has suggested that the retinal vasculature may act as a surrogate marker for diseased cerebral vessels. Retinal vascular parameters were measured using Vessel Assessment and Measurement Platform for Images of the Retina (VAMPIRE) software in two cohorts: (i) community-dwelling older subjects of the Lothian Birth Cohort 1936 (n = 603); and (ii) patients with recent minor ischaemic stroke of the Mild Stroke Study (n = 155). Imaging markers of small vessel disease (SVD) (white matter hyperintensities [WMH] on structural MRI, visual scores and volume; perivascular spaces; lacunes and microbleeds), and vascular risk measures were assessed in both cohorts. We assessed associations between retinal and brain measurements using structural equation modelling and regression analysis. In the Lothian Birth Cohort 1936 arteriolar fractal dimension accounted for 4% of the variance in WMH load. In the Mild Stroke Study lower arteriolar fractal dimension was associated with deep WMH scores (odds ratio [OR] 0.53; 95% CI, 0.32–0.87). No other retinal measure was associated with SVD. Reduced fractal dimension, a measure of vascular complexity, is related to SVD imaging features in older people. The results provide some support for the use of the retinal vasculature in the study of brain microvascular disease.
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Affiliation(s)
- Sarah McGrory
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. .,Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - Lucia Ballerini
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Fergus N Doubal
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Julie Staals
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Mike Allerhand
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | | | - Xin Wang
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom MacGillivray
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Alex S F Doney
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
| | - Baljean Dhillon
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Mark E Bastin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK.,UK Dementia Research Institute at the University of Edinburgh, Chancellor's Building, Edinburgh, UK
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Srinidhi CL, P A, Rajan J. Automated Method for Retinal Artery/Vein Separation via Graph Search Metaheuristic Approach. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2019; 28:2705-2718. [PMID: 30605099 DOI: 10.1109/tip.2018.2889534] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Separation of the vascular tree into arteries and veins is a fundamental prerequisite in the automatic diagnosis of retinal biomarkers associated with systemic and neurodegenerative diseases. In this paper, we present a novel graph search metaheuristic approach for automatic separation of arteries/veins (A/V) from color fundus images. Our method exploits local information to disentangle the complex vascular tree into multiple subtrees, and global information to label these vessel subtrees into arteries and veins. Given a binary vessel map, a graph representation of the vascular network is constructed representing the topological and spatial connectivity of the vascular structures. Based on the anatomical uniqueness at vessel crossing and branching points, the vascular tree is split into multiple subtrees containing arteries and veins. Finally, the identified vessel subtrees are labeled with A/V based on a set of handcrafted features trained with random forest classifier. The proposed method has been tested on four different publicly available retinal datasets with an average accuracy of 94.7%, 93.2%, 96.8% and 90.2% across AV-DRIVE, CT-DRIVE. INSPIRE-AVR and WIDE datasets, respectively. These results demonstrate the superiority of our proposed approach in outperforming state-ofthe- art methods for A/V separation.
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Hughes TM, Sink KM, Williamson JD, Hugenschmidt CE, Wagner BC, Whitlow CT, Xu J, Smith SC, Launer LJ, Barzilay JI, Ismail-Beigi F, Bryan RN, Hsu FC, Bowden DW, Maldjian JA, Divers J, Freedman BI. Relationships between cerebral structure and cognitive function in African Americans with type 2 diabetes. J Diabetes Complications 2018; 32:916-921. [PMID: 30042057 PMCID: PMC6138531 DOI: 10.1016/j.jdiacomp.2018.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Relationships between cognitive function and brain structure remain poorly defined in African Americans with type 2 diabetes. METHODS Cognitive testing and cerebral magnetic resonance imaging in African Americans from the Diabetes Heart Study Memory IN Diabetes (n = 480) and Action to Control Cardiovascular Risk in Diabetes MIND (n = 104) studies were examined for associations. Cerebral gray matter volume (GMV), white matter volume (WMV) and white matter lesion volume (WMLV) and cognitive performance (Mini-mental State Exam [MMSE and 3MSE], Digit Symbol Coding (DSC), Stroop test, and Rey Auditory Verbal Learning Test) were recorded. Multivariable models adjusted for age, sex, BMI, scanner, intracranial volume, education, diabetes duration, HbA1c, LDL-cholesterol, smoking, hypertension and cardiovascular disease assessed associations between cognitive tests and brain volumes by study and meta-analysis. RESULTS Mean(SD) participant age was 60.1(7.9) years, diabetes duration 12.1(7.7) years, and HbA1c 8.3(1.7)%. In the fully-adjusted meta-analysis, lower GMV associated with poorer global performance on MMSE/3MSE (β̂ = 7.1 × 10-3, SE 2.4 × 10-3, p = 3.6 × 10-3), higher WMLV associated with poorer performance on DSC (β̂ = -3 × 10-2, SE 6.4 × 10-3, p = 5.2 × 10-5) and higher WMV associated with poorer MMSE/3MSE performance (β̂ = -7.1 × 10-3, SE = 2.4 × 10-3, p = 3.6 × 10-3). CONCLUSIONS In African Americans with diabetes, smaller GMV and increased WMLV associated with poorer performance on tests of global cognitive and executive function. These data suggest that WML burden and gray matter atrophy associate with cognitive performance independent of diabetes-related factors in this population.
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Affiliation(s)
- Timothy M Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Kaycee M Sink
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeff D Williamson
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Christina E Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Benjamin C Wagner
- Department of Radiology, Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | - Jianzhao Xu
- Departments of Biochemistry & Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - S Carrie Smith
- Departments of Biochemistry & Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Lenore J Launer
- National Institutes of Health, National Institute on Aging, Laboratory of Epidemiology, Demography, and Biometry, Bethesda, MD, USA.
| | | | - Faramarz Ismail-Beigi
- Department of Internal Medicine, Division of Endocrinology, University of Cincinnati, Veterans Administration Medical Center, Cincinnati, OH.
| | - R Nick Bryan
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - Fang-Chi Hsu
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Donald W Bowden
- Departments of Biochemistry & Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Joseph A Maldjian
- Department of Radiology, Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Jasmin Divers
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Barry I Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Lee CS, Larson EB, Gibbons LE, Lee AY, McCurry SM, Bowen JD, McCormick WC, Crane PK. Associations between recent and established ophthalmic conditions and risk of Alzheimer's disease. Alzheimers Dement 2018; 15:34-41. [PMID: 30098888 DOI: 10.1016/j.jalz.2018.06.2856] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/14/2018] [Accepted: 06/06/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Identifying ophthalmic diseases associated with increased risk of Alzheimer's disease (AD) may enable better screening and understanding of those at risk of AD. METHODS Diagnoses of glaucoma, age-related macular degeneration (AMD), and diabetic retinopathy (DR) were based on International Classification of Diseases, 9th revision, codes for 3877 participants from the Adult Changes in Thought study. The adjusted hazard ratio for developing probable or possible AD for recent (within 5 years) and established (>5 years) diagnoses were assessed. RESULTS Over 31,142 person-years of follow-up, 792 AD cases occurred. The recent and established hazard ratio were 1.46 (P = .01) and 0.87 (P = .19) for glaucoma, 1.20 (P = .12) and 1.50 (P < .001) for AMD, and 1.50 (P = .045) and 1.50 (P = .03) for DR. DISCUSSION Increased AD risk was found for recent glaucoma diagnoses, established AMD diagnoses, and both recent and established DR. People with certain ophthalmic conditions may have increased AD risk.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA.
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Laura E Gibbons
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Susan M McCurry
- School of Nursing, University of Washington, Seattle, WA, USA
| | - James D Bowen
- Department of Neurology, Swedish Medical Center, Seattle, WA, USA
| | | | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
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Dumitrascu OM, Demaerschalk BM, Valencia Sanchez C, Almader-Douglas D, O'Carroll CB, Aguilar MI, Lyden PD, Kumar G. Retinal Microvascular Abnormalities as Surrogate Markers of Cerebrovascular Ischemic Disease: A Meta-Analysis. J Stroke Cerebrovasc Dis 2018; 27:1960-1968. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.02.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/17/2018] [Accepted: 02/19/2018] [Indexed: 01/11/2023] Open
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Srinidhi CL, Aparna P, Rajan J. A visual attention guided unsupervised feature learning for robust vessel delineation in retinal images. Biomed Signal Process Control 2018. [DOI: 10.1016/j.bspc.2018.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Liao H, Zhu Z, Peng Y. Potential Utility of Retinal Imaging for Alzheimer's Disease: A Review. Front Aging Neurosci 2018; 10:188. [PMID: 29988470 PMCID: PMC6024140 DOI: 10.3389/fnagi.2018.00188] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/05/2018] [Indexed: 01/18/2023] Open
Abstract
The ensuing upward shift in demographic distribution due to the increase in life expectancy has resulted in a rising prevalence of Alzheimer's disease (AD). The heavy public burden of AD, along with the urgent to prevent and treat the disease before the irreversible damage to the brain, calls for a sensitive and specific screening technology to identify high-risk individuals before cognitive symptoms arise. Even though current modalities, such as positron emission tomography (PET) and cerebrospinal fluid (CSF) biomarker, showed their potential clinical uses in early detection of AD, the high cost, narrow isotope availability of PET probes and invasive characteristics of CSF biomarker limited their broad utility. Therefore, additional tools for detection of AD are needed. As a projection of the central nervous system (CNS), the retina has been described as a "window to the brain" and a novel marker for AD. Low cost, easy accessibility and non-invasive features make retina tests suitable for large-scale population screening and investigations of preclinical AD. Furthermore, a number of novel approaches in retina imaging, such as optical coherence tomography (OCT), have been developed and made it possible to visualize changes in the retina at a very fine resolution. In this review, we outline the background for AD to accelerate the adoption of retina imaging for the diagnosis and management of AD in clinical practice. Then, we focus on recent findings on the application of retina imaging to investigate AD and provide suggestions for future research directions.
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Affiliation(s)
- Huan Liao
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhuoting Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ying Peng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Van Aart CJC, Nawrot TS, Sioen I, De Boever P, Zaqout M, De Henauw S, Michels N. Longitudinal association between psychosocial stress and retinal microvasculature in children and adolescents. Psychoneuroendocrinology 2018; 92:50-56. [PMID: 29626707 DOI: 10.1016/j.psyneuen.2018.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Retinal microvessels provides a window to assess the microcirculation of heart and brain, and might reflect cardio- or cerebrovascular disease risk. Limited information exist on the relation between psychosocial stress and the microcirculation, even though psychosocial stress might trigger vascular diseases. This study investigates whether childhood psychosocial stress is a predictor of retinal microvasculature. METHODS We followed-up 182 Belgian children, aged 5.7-11.3 years at baseline (53.3% boys). Information about psychosocial stress was obtained using emotional, behavioral and negative life events questionnaires and hair cortisol, an objective stress marker. Retinal photographs were used to calculate vessel diameters, bifurcation angles and optimality deviation with semiautomated software. Cross-sectional and longitudinal associations were explored using multivariable regression analysis with retinal parameters in 2015 as outcome, while adjusting for age, sex, socioeconomic status, cardiovascular parameters and lifestyle factors. RESULTS Feelings of happiness, sadness and negative life events were associated with retinal vascular diameter, but behavior and hair cortisol were not. High stress levels over a 4-year time period (less happy, sadder and higher total negative emotions) were associated with larger venules (β = 0.21-0.43) and children who experienced more negative life events had smaller arterioles (β = -0.15). No consistent patterns were seen with bifurcation angles and optimality deviation. CONCLUSION Based on the results, we conclude that high levels of childhood psychosocial stress unfavorably affect the retinal vascular diameters, potentially reflecting the microvasculature of the heart and brain. It seems this might even be independent of lifestyle and BMI, but further research on mechanisms is necessary.
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Affiliation(s)
- Carola J C Van Aart
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium.
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Belgium; Department of Public Health and Primary Care, Leuven University, Belgium
| | - Isabelle Sioen
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Faculty of Bioscience Engineering, Department of Food Technology, Safety and Health, Ghent University, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Belgium; Environmental Risk and Health Unit, Flemish Institute for Technological Research (VITO), Belgium
| | - Mahmoud Zaqout
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| | - Stefaan De Henauw
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Department of Health Sciences, Vesalius, University College Ghent, Belgium
| | - Nathalie Michels
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
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Nunley KA, Metti AL, Klein R, Klein BE, Saxton JA, Orchard TJ, Costacou T, Aizenstein HJ, Rosano C. Long-term changes in retinal vascular diameter and cognitive impairment in type 1 diabetes. Diab Vasc Dis Res 2018; 15:223-232. [PMID: 29488397 DOI: 10.1177/1479164118758581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess associations between cognitive impairment and longitudinal changes in retinal microvasculature, over 18 years, in adults with type 1 diabetes. RESEARCH DESIGN AND METHODS Participants of the Pittsburgh Epidemiology of Diabetes Complications Study received ≥3 fundus photographs between baseline (1986-1988) and time of cognitive assessment (2010-2015: N = 119; 52% male; mean age and type 1 diabetes duration 43 and 34 years, respectively). Central retinal arteriolar equivalent and central retinal venular equivalent were estimated via computer-based methods; overall magnitude and speed of narrowing were quantified as cumulative average and slope, respectively. Median regression models estimated associations of central retinal arteriolar equivalent and central retinal venular equivalent measures with cognitive impairment status, adjusted for type 1 diabetes duration. Interactions with HbA1c, proliferative retinopathy and white matter hyperintensities were assessed. RESULTS Compared with participants without cognitive impairment, those with clinically relevant cognitive impairment experienced 1.8% greater and 31.1% faster central retinal arteriolar equivalent narrowing during prior years (t = -2.93, p = 0.004 and t = -3.97, p < 0.0001, respectively). Interactions with HbA1c, proliferative retinopathy and white matter hyperintensities were not significant. No associations were found between central retinal arteriolar equivalent at baseline, at time of cognitive testing, or any central retinal venular equivalent measures, and cognitive impairment. CONCLUSION Long-term arterial retinal changes could indicate type 1 diabetes-related cognitive impairment. Studies examining longitudinal central retinal arteriolar equivalent changes as early biomarkers of cognitive impairment risk are warranted.
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Affiliation(s)
- Karen A Nunley
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea L Metti
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ronald Klein
- 2 Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Barbara E Klein
- 2 Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Judith A Saxton
- 3 Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Trevor J Orchard
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tina Costacou
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Howard J Aizenstein
- 4 Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Caterina Rosano
- 1 Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Deal JA, Sharrett AR, Rawlings AM, Gottesman RF, Bandeen-Roche K, Albert M, Knopman D, Selvin E, Wasserman BA, Klein B, Klein R. Retinal signs and 20-year cognitive decline in the Atherosclerosis Risk in Communities Study. Neurology 2018; 90:e1158-e1166. [PMID: 29490915 PMCID: PMC5880633 DOI: 10.1212/wnl.0000000000005205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 12/19/2017] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To test the hypothesis that retinal vascular signs are associated with greater cognitive decline over 20 years in 12,317 men and women 50 to 73 years of age at baseline. METHODS A composite cognitive score was created with 3 neuropsychological tests measured at 3 time points (1990-1992 to 2011-2013). Retinal signs were measured with fundus photography (1993-1995). Differences in cognitive change by retinal signs status were estimated with linear mixed models. Cognitive scores were imputed for living participants with incomplete cognitive testing. RESULTS In multivariable-adjusted analyses that controlled for attrition, loss of vascular integrity (retinopathy and its components) was associated with greater 20-year decline (difference in 20-year cognitive change for moderate/severe vs no retinopathy -0.53 SD, 95% confidence interval -0.74 to -0.33). Estimated differences were similar in participants with and without diabetes mellitus and in white and black participants. CONCLUSIONS Retinopathy was associated with accelerated rates of 20-year cognitive decline. These findings support the exploration of more sensitive measures in the eye such as optical coherence tomography angiography, which may provide surrogate indexes of microvascular lesions relevant to cognitive decline in older adults.
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Affiliation(s)
- Jennifer A Deal
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison.
| | - A Richey Sharrett
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Andreea M Rawlings
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Rebecca F Gottesman
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Karen Bandeen-Roche
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Marilyn Albert
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - David Knopman
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Elizabeth Selvin
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Bruce A Wasserman
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Barbara Klein
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
| | - Ronald Klein
- From the Departments of Epidemiology (J.A.D., A.R.S., A.M.R., R.F.G., E.S.), Neurology (R.F.G., M.A.), Biostatistics (K.B.-R.), and Radiology and Radiological Sciences (B.A.W.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.K.), Mayo Clinic, Rochester, MN; and Department of Ophthalmology and Visual Sciences (B.K., R.K.), University of Wisconsin School of Medicine and Public Health, Madison
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McGrory S, Taylor AM, Pellegrini E, Ballerini L, Kirin M, Doubal FN, Wardlaw JM, Doney ASF, Dhillon B, Starr JM, Trucco E, Deary IJ, MacGillivray TJ. Towards Standardization of Quantitative Retinal Vascular Parameters: Comparison of SIVA and VAMPIRE Measurements in the Lothian Birth Cohort 1936. Transl Vis Sci Technol 2018; 7:12. [PMID: 29600120 PMCID: PMC5868859 DOI: 10.1167/tvst.7.2.12] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 02/14/2018] [Indexed: 12/22/2022] Open
Abstract
Purpose Semiautomated software applications derive quantitative retinal vascular parameters from fundus camera images. However, the extent of agreement between measurements from different applications is unclear. We evaluate the agreement between retinal measures from two software applications, the Singapore "I" Vessel Assessment (SIVA) and the Vessel Assessment and Measurement Platform for Images of the Retina (VAMPIRE), and examine respective associations between retinal and systemic outcomes. Method Fundus camera images from 665 Lothian Birth Cohort 1936 participants were analyzed with SIVA and VAMPIRE. Intraclass correlation coefficients (ICC) and Bland-Altman plots assessed agreement between retinal parameters: measurements of vessel width, fractal dimension, and tortuosity. Retinal-systemic variable associations were assessed with Pearson's correlation, and intersoftware correlation magnitude differences were examined with Williams's test. Results ICC values indicated poor to limited agreement for all retinal parameters (0.159-0.410). Bland-Altman plots revealed proportional bias in the majority, and systematic bias in all measurements. SIVA and VAMPIRE measurements were associated most consistently with systemic variables relating to blood pressure (SIVA r's from -0.122 to -0.183; VAMPIRE r's from -0.078 to -0.177). Williams's tests indicated significant differences in the magnitude of association between retinal and systemic variables for 7 of 77 comparisons (P < 0.05). Conclusions Agreement between two common software applications was poor. Further studies are required to determine whether associations with systemic variables are software-dependent. Translational Relevance Standardization of the measurement of retinal vascular parameters is warranted to ensure that they are reliable and application-independent. This would be an important step towards realizing the potential of the retina as a source of imaging-derived biomarkers that are clinically useful.
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Affiliation(s)
- Sarah McGrory
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Adele M Taylor
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Enrico Pellegrini
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Lucia Ballerini
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mirna Kirin
- Faculty of Medicine, University of Split, Split, Croatia
| | - Fergus N Doubal
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute at the University of Edinburgh, Chancellor's Building, Edinburgh, UK.,Scottish Imaging Network, a Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Alex S F Doney
- Division of Cardiovascular and Diabetes Medicine, Medical Research Institute, Ninewells Hospital and Medical School, Dundee, UK
| | - Baljean Dhillon
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Thomas J MacGillivray
- VAMPIRE project, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Birkhoff W, de Vries J, Dent G, Verma A, Kerkhoffs J, van Meurs A, de Kam M, Moerland M, Burggraaf J. Retinal microcirculation imaging in sickle cell disease patients. Microvasc Res 2018; 116:1-5. [DOI: 10.1016/j.mvr.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/24/2023]
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Qiu C, Ding J, Sigurdsson S, Fisher DE, Zhang Q, Eiriksdottir G, Klein R, van Buchem MA, Gudnason V, Cotch MF, Launer LJ. Differential associations between retinal signs and CMBs by location: The AGES-Reykjavik Study. Neurology 2017; 90:e142-e148. [PMID: 29237799 PMCID: PMC5772152 DOI: 10.1212/wnl.0000000000004792] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 09/28/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To test the hypothesis that age-related macular degeneration (AMD) and retinal microvascular signs are differentially associated with lobar and deep cerebral microbleeds (CMBs). METHODS CMBs in lobar regions indicate cerebral amyloid angiopathy (CAA). β-Amyloid deposits are implicated in both CAA and AMD. Deep CMBs are associated with hypertension, a major risk factor for retinal microvascular damage. This population-based cohort study included 2,502 participants in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study who undertook binocular digital retinal photographs at baseline (2002-2006) to assess retinal microvascular signs and AMD and brain MRI scan at both baseline and follow-up (2007-2011) to assess CMBs. We assessed retinal microvascular lesion burden by counting the 3 retinal microvascular signs (focal arteriolar narrowing, arteriovenous nicking, and retinopathy) concurrently present in the participant. We used multiple logistic models to examine the association of baseline retinal pathology to incident CMBs detected at follow-up. RESULTS During an average 5.2 years of follow-up, 461 people (18.3%) developed new CMBs, including 293 in exclusively lobar regions and 168 in deep regions. Pure geographic atrophy was significantly associated with strictly lobar CMBs (multivariable-adjusted odds ratio 2.59, 95% confidence interval [CI] 1.01-6.65) but not with deep CMBs. Concurrently having ≥2 retinal microvascular signs was associated with a 3-fold (95% CI 1.73-5.20) increased likelihood for deep CMBs but not exclusively lobar CMBs. CONCLUSIONS Retinal microvascular signs and pure geographic atrophy may be associated with deep and exclusively lobar CMBs, respectively, in older people. These results have implications for further research to define the role of small vessel disease in cognitive impairment.
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Affiliation(s)
- Chengxuan Qiu
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik.
| | - Jie Ding
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik
| | - Sigurdur Sigurdsson
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik
| | - Diana E Fisher
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik
| | - Qian Zhang
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik
| | - Gudny Eiriksdottir
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik
| | - Ronald Klein
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik
| | - Mark A van Buchem
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik
| | - Vilmundur Gudnason
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik
| | - Mary Frances Cotch
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik
| | - Lenore J Launer
- From the Intramural Research Program (C.Q., J.D., Q.Z., L.J.L.), Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIH, Bethesda, MD; Aging Research Center (C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Sweden; Icelandic Heart Association (S.S., G.E., V.G.), Kopavogur; Division of Epidemiology and Clinical Research (D.E.F., M.F.C.), National Eye Institute, NIH, Bethesda, MD; Ophthalmology and Visual Sciences (R.K.), University of Wisconsin Madison; Department of Radiology (M.A.v.B.), Leiden University Medical Centre, the Netherlands; and Faculty of Medicine (V.G.), University of Iceland, Reykjavik.
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71
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Goldstein BI. Bipolar Disorder and the Vascular System: Mechanisms and New Prevention Opportunities. Can J Cardiol 2017; 33:1565-1576. [DOI: 10.1016/j.cjca.2017.10.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
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Chan VTT, Tso THK, Tang F, Tham C, Mok V, Chen C, Wong TY, Cheung CY. Using Retinal Imaging to Study Dementia. J Vis Exp 2017. [PMID: 29155753 DOI: 10.3791/56137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The retina offers a unique "window" to study pathophysiological processes of dementia in the brain, as it is an extension of the central nervous system (CNS) and shares prominent similarities with the brain in terms of embryological origin, anatomical features and physiological properties. The vascular and neuronal structure in the retina can now be visualized easily and non-invasively using retinal imaging techniques, including fundus photography and optical coherence tomography (OCT), and quantified semi-automatically using computer-assisted analysis programs. Studying the associations between vascular and neuronal changes in the retina and dementia could improve our understanding of dementia and, potentially, aid in diagnosis and risk assessment. This protocol aims to describe a method of quantifying and analyzing retinal vasculature and neuronal structure, which are potentially associated with dementia. This protocol also provides examples of retinal changes in subjects with dementia, and discusses technical issues and current limitations of retinal imaging.
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Affiliation(s)
- Victor T T Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
| | - Tiffany H K Tso
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
| | - Fangyao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
| | - Clement Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong
| | - Vincent Mok
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong; Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong; Gerald Choa Neuroscience Centre, The Chinese University of Hong Kong
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System; Department of Pharmacology, National University of Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre; Duke-NUS Medical School, National University of Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong;
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Provost EB, Int Panis L, Saenen ND, Kicinski M, Louwies T, Vrijens K, De Boever P, Nawrot TS. Recent versus chronic fine particulate air pollution exposure as determinant of the retinal microvasculature in school children. ENVIRONMENTAL RESEARCH 2017; 159:103-110. [PMID: 28783615 DOI: 10.1016/j.envres.2017.07.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/31/2017] [Accepted: 07/13/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Microvascular changes may represent an underlying mechanism through which exposure to fine particulate matter with a diameter ≤ 2.5µm (PM2.5) contributes to age-related disease development. We investigated the effect of recent and chronic exposure to PM2.5 on the microcirculation, exemplified by retinal vessel diameters, using repeated measurements in 8- to 12-year-old children. METHODS 221 children (49.1% girls; mean age 9.9 years) were examined repeatedly (25 one, 124 two, and 72 three times) adding up to 489 retinal vessel examinations. Same-day exposure to PM2.5 was measured at school. In addition, recent (same and previous day) and chronic (yearly mean) exposure was modelled at the child's residence using a high-resolution interpolation model. Residential proximity to major roads was also assessed. Changes in retinal vessel diameters associated with recent and chronic exposures were estimated using mixed models, while adjusting for other known covariates such as sex, age, BMI, blood pressure and birth weight. RESULTS Each 10µg/m³ increment in same-day exposure to PM2.5 measured at school was associated with 0.35µm (95% CI: 0.09-0.61µm) narrower retinal arterioles and 0.35µm (-0.03 to 0.73µm) wider venules. Children living 100m closer to a major road had 0.30µm (0.05-0.54µm) narrower arterioles. CONCLUSIONS Blood vessel diameters of the retinal microcirculation of healthy school-aged children respond to same-day PM2.5 exposure. Furthermore, children living closer to major roads had smaller arteriolar diameters. Our results suggest that the microcirculation, with retinal microvasculature as a proxy in this study, is a pathophysiological target for air pollution in children.
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Affiliation(s)
- Eline B Provost
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Luc Int Panis
- Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium; School for Mobility, Hasselt University, Hasselt, Belgium
| | - Nelly D Saenen
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Michal Kicinski
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tijs Louwies
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Karen Vrijens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Department of Public Health & Primary Care, Leuven University, Leuven, Belgium.
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The Study of Neurocognitive Outcomes, Radiological and Retinal Effects of Aspirin in Sleep Apnoea- rationale and methodology of the SNORE-ASA study. Contemp Clin Trials 2017; 64:101-111. [PMID: 29097299 DOI: 10.1016/j.cct.2017.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/25/2017] [Accepted: 10/29/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE Sleep disordered breathing (SDB) is highly prevalent in older adults. Increasing evidence links SDB to the risk of dementia, mediated via a number of pathways, some of which may be attenuated by low-dose aspirin. This study will evaluate, in a healthy older cohort, the prospective relationship between SDB and cognitive function, changes in retinal and cerebral microvasculature, and determine whether low-dose aspirin ameliorates the effects of SDB on these outcomes over 3years. DESIGN SNORE-ASA is a sub-study of the ASPirin in Reducing Events in the Elderly (ASPREE) randomised, multi-centre, placebo-controlled trial evaluating the effect of daily 100mg aspirin on disability-free and dementia-free survival in the healthy older adult aged 70 and over. At baseline, 1400 ASPREE participants successfully underwent a home sleep study with a home sleep study screening device for SDB; and 296 underwent both 1.5 Tesla brain magnetic resonance imaging (MRI) and retinal vascular imaging (RVI). Cognitive testing, brain MRI and RVI is being repeated after 3years. PRIMARY OUTCOME MEASURES Change in the modified mini-mental state examination score. Secondary outcome measures are changes in other cognitive tests, and changes in abnormal parameters on RVI and volume of white matter hyper-intensities on brain MRI. CONCLUSION Identifying preventive therapies for delaying the onset of dementia is of paramount importance. The results of this study will help clarify the impact of the SDB on risk of cognitive decline and cerebral small vessel disease, and whether low-dose aspirin can ameliorate cognitive decline in the setting of SDB. SNORE-ASA TRIAL REGISTRATION ACTRN12612000891820: The Principal ASPREE study is registered with the International Standardized Randomized Controlled Trials Register, ASPirin in Reducing Events in the Elderly, Number: ISRCTN83772183 and clinicaltrials.gov Number NCT01038583.
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Naiberg MR, Hatch JK, Selkirk B, Fiksenbaum L, Yang V, Black S, Kertes PJ, Goldstein BI. Retinal photography: A window into the cardiovascular-brain link in adolescent bipolar disorder. J Affect Disord 2017; 218:227-237. [PMID: 28477501 DOI: 10.1016/j.jad.2017.04.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/21/2017] [Accepted: 04/28/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The burden of cardiovascular disease in bipolar disorder (BD) exceeds what can be explained by traditional cardiovascular risk factors (CVRFs), lifestyle, and/or medications. Moreover, neurocognitive deficits are a core feature of BD, and are also related to CVRFs. We examined retinal vascular photography, a proxy for cerebral microvasculature, in relation to CVRFs, peripheral microvascular function, and neurocognition among BD adolescents. METHODS Subjects were 30 adolescents with BD and 32 healthy controls (HC). Retinal photography was conducted using a Topcon TRC 50 DX, Type IA camera, following pupil dilation. Retinal arteriolar and venular caliber was measured, from which the arterio-venular ratio (AVR) was computed. All measures were conducted masked to participant diagnosis. Peripheral arterial tonometry measured endothelial function. Neurocognition was assessed using the Cambridge Neuropsychological Tests Automated Battery. RESULTS AVR was not significantly different between groups (Cohen's d=0.18, p=0.103). Higher diastolic blood pressure (BP) was associated with lower (worse) AVR in BD (r=-0.441, p=0.015) but not HC (r=-0.192, p=0.293). Similarly, in the BD group only, higher (better) endothelial function was associated with higher AVR (r=0.375, p=0.041). Hierarchical regression models confirmed that, independent of covariates, retinal vascular caliber was significantly associated with diastolic BP and endothelial function in BD. Within the BD group, mood scores were significantly negatively correlated with AVR (β=-0.451, p=0.044). LIMITATIONS This study's limitations include a small sample size, a cross-sectional study design, and a heterogeneous sample. CONCLUSION Retinal photography may offer unique insights regarding the cardiovascular and neurocognitive burden of BD. Larger longitudinal studies are warranted.
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Affiliation(s)
- Melanie R Naiberg
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Jessica K Hatch
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Beth Selkirk
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Lisa Fiksenbaum
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Victor Yang
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Sandra Black
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Sunnybrook Health Sciences Centre, Department of Medicine (Neurology), Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Peter J Kertes
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Benjamin I Goldstein
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada.
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Ţălu Ş, Stach S, Călugăru DM, Lupaşcu CA, Nicoară SD. Analysis of normal human retinal vascular network architecture using multifractal geometry. Int J Ophthalmol 2017; 10:434-438. [PMID: 28393036 PMCID: PMC5360780 DOI: 10.18240/ijo.2017.03.17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 08/18/2016] [Indexed: 02/07/2023] Open
Abstract
AIM To apply the multifractal analysis method as a quantitative approach to a comprehensive description of the microvascular network architecture of the normal human retina. METHODS Fifty volunteers were enrolled in this study in the Ophthalmological Clinic of Cluj-Napoca, Romania, between January 2012 and January 2014. A set of 100 segmented and skeletonised human retinal images, corresponding to normal states of the retina were studied. An automatic unsupervised method for retinal vessel segmentation was applied before multifractal analysis. The multifractal analysis of digital retinal images was made with computer algorithms, applying the standard box-counting method. Statistical analyses were performed using the GraphPad InStat software. RESULTS The architecture of normal human retinal microvascular network was able to be described using the multifractal geometry. The average of generalized dimensions (Dq ) for q=0, 1, 2, the width of the multifractal spectrum (Δα=αmax - αmin ) and the spectrum arms' heights difference (|Δf|) of the normal images were expressed as mean±standard deviation (SD): for segmented versions, D0 =1.7014±0.0057; D1 =1.6507±0.0058; D2 =1.5772±0.0059; Δα=0.92441±0.0085; |Δf|= 0.1453±0.0051; for skeletonised versions, D0 =1.6303±0.0051; D1 =1.6012±0.0059; D2 =1.5531±0.0058; Δα=0.65032±0.0162; |Δf|= 0.0238±0.0161. The average of generalized dimensions (Dq ) for q=0, 1, 2, the width of the multifractal spectrum (Δα) and the spectrum arms' heights difference (|Δf|) of the segmented versions was slightly greater than the skeletonised versions. CONCLUSION The multifractal analysis of fundus photographs may be used as a quantitative parameter for the evaluation of the complex three-dimensional structure of the retinal microvasculature as a potential marker for early detection of topological changes associated with retinal diseases.
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Affiliation(s)
- Ştefan Ţălu
- Discipline of Descriptive Geometry and Engineering Graphics, Department of AET, Faculty of Mechanical Engineering, Technical University of Cluj-Napoca, 103-105 B-dul Muncii St., Cluj-Napoca 400641, Cluj, Romania
| | - Sebastian Stach
- Department of Biomedical Computer Systems, Institute of Informatics, Faculty of Computer Science and Materials Science, University of Silesia, Będzińska 39, 41-205 Sosnowiec, Poland
| | - Dan Mihai Călugăru
- Discipline of Ophthalmology, Department of Surgical Specialties and Medical Imaging, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babeş St., Cluj-Napoca 400012, Cluj, Romania
| | - Carmen Alina Lupaşcu
- Department of Mathematics and Informatics, University of Palermo, Via Archirafi 34, Palermo 90123, Italy
| | - Simona Delia Nicoară
- Discipline of Ophthalmology, Department of Surgical Specialties and Medical Imaging, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 8 Victor Babeş St., Cluj-Napoca 400012, Cluj, Romania
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Georgakis MK, Synetos A, Mihas C, Karalexi MA, Tousoulis D, Seshadri S, Petridou ET. Left ventricular hypertrophy in association with cognitive impairment: a systematic review and meta-analysis. Hypertens Res 2017; 40:696-709. [DOI: 10.1038/hr.2017.11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 12/03/2016] [Accepted: 12/21/2016] [Indexed: 02/06/2023]
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Cheung CYL, Ikram MK, Chen C, Wong TY. Imaging retina to study dementia and stroke. Prog Retin Eye Res 2017; 57:89-107. [PMID: 28057562 DOI: 10.1016/j.preteyeres.2017.01.001] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/07/2016] [Accepted: 01/01/2017] [Indexed: 02/07/2023]
Abstract
With increase in life expectancy, the number of persons suffering from common age-related brain diseases, including neurodegenerative (e.g., dementia) and cerebrovascular (e.g., stroke) disease is expected to rise substantially. As current neuro-imaging modalities such as magnetic resonance imaging may not be able to detect subtle subclinical changes (resolution <100-500 μm) in dementia and stroke, there is an urgent need for other complementary techniques to probe the pathophysiology of these diseases. The retina - due to its anatomical, embryological and physiological similarities with the brain - offers a unique and accessible "window" to study correlates and consequences of subclinical pathology in the brain. Retinal components such as the microvasculature and retinal ganglion cell axons can now be visualized non-invasively using different retinal imaging techniques e.g., ocular fundus photography and optical coherence tomography. Advances in retinal imaging may provide new and potentially important insights into cerebrovascular neurodegenerative processes in addition to what is currently possible with neuro-imaging. In this review, we present an overview of the current literature on the application of retinal imaging in the study of dementia and stroke. We discuss clinical implications of these studies, novel state-of-the-art retinal imaging techniques and future directions aimed at evaluating whether retinal imaging can be an additional investigation tool in the study of dementia and stroke.
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Affiliation(s)
- Carol Yim-Lui Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
| | - M Kamran Ikram
- Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Departments of Neurology & Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Christopher Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore; Department of Pharmacology, National University of Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore
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Abstract
PURPOSE OF REVIEW Hypertension is the primary risk factor for cardiovascular disease and mortality that consists a major public health issue worldwide. Hypertension triggers a series of pathophysiological ocular modifications affecting significantly the retinal, choroidal, and optic nerve circulations that result in a range of ocular effects.The retina is the only place in the body where microvasculature can be directly inspected, providing valuable information on hypertension related systemic risks.The aim of this review is to provide an update on latest advances regarding the detection and significance of hypertension related eye signs. RECENT FINDINGS It's been shown that measurable retinal microvascular changes may precede progression of systemic microvascular disease.Last years, there are emerging advances in the field retinal imaging and computer software analysis that have enabled the objective and accurate assessment of retinal vascular caliber, while in association with latest epidemiological studies several other retinal vascular features have been recognized, such as vascular length-to-diameter ratio, and wall-to-lumen ratio that may also be associated to hypertension.Additionally, recent genetic studies have provided some insight to vascular pathophysiological processes having correlated new chromosome's loci to hypertensive retinopathy signs. SUMMARY Assessment of hypertensive retinopathy signs may convey additional prognostic information on the risk of end-organ damage and may alert for urgent systemic management or even preventive systemic therapies. Further development of retinal vascular imaging and computerized system may provide a significant tool to improve the diagnosis, prognosis, and management of hypertension in clinical practice.
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80
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McGrory S, Cameron JR, Pellegrini E, Warren C, Doubal FN, Deary IJ, Dhillon B, Wardlaw JM, Trucco E, MacGillivray TJ. The application of retinal fundus camera imaging in dementia: A systematic review. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 6:91-107. [PMID: 28229127 PMCID: PMC5312461 DOI: 10.1016/j.dadm.2016.11.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction The ease of imaging the retinal vasculature, and the evolving evidence suggesting this microvascular bed might reflect the cerebral microvasculature, presents an opportunity to investigate cerebrovascular disease and the contribution of microvascular disease to dementia with fundus camera imaging. Methods A systematic review and meta-analysis was carried out to assess the measurement of retinal properties in dementia using fundus imaging. Results Ten studies assessing retinal properties in dementia were included. Quantitative measurement revealed significant yet inconsistent pathologic changes in vessel caliber, tortuosity, and fractal dimension. Retinopathy was more prevalent in dementia. No association of age-related macular degeneration with dementia was reported. Discussion Inconsistent findings across studies provide tentative support for the application of fundus camera imaging as a means of identifying changes associated with dementia. The potential of fundus image analysis in differentiating between dementia subtypes should be investigated using larger well-characterized samples. Future work should focus on refining and standardizing methods and measurements.
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Affiliation(s)
- Sarah McGrory
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - James R Cameron
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; Anne Rowling Regenerative Neurology Clinic, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Enrico Pellegrini
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Claire Warren
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Fergus N Doubal
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK; Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Baljean Dhillon
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK; Scottish Imaging Network: A Platform for Scientific Excellence (SINAPSE) Collaboration, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE Project and Computer Vision and Image Processing Group School of Science and Engineering (Computing), University of Dundee, Dundee, UK
| | - Thomas J MacGillivray
- Centre for Clinical Brain Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK; VAMPIRE Project and Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, UK
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81
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Jinnouchi H, Kitamura A, Yamagishi K, Kiyama M, Imano H, Okada T, Cui R, Umesawa M, Muraki I, Hayama-Terada M, Kawasaki R, Sankai T, Ohira T, Iso H. Retinal Vascular Changes and Prospective Risk of Disabling Dementia: the Circulatory Risk in Communities Study (CIRCS). J Atheroscler Thromb 2016; 24:687-695. [PMID: 27904027 PMCID: PMC5517542 DOI: 10.5551/jat.37291] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIM To investigate the association of retinal vascular changes with a risk of dementia in longitudinal population-based study. METHODS We performed a nested case-control study of 3,718 persons, aged 40-89 years, enrolled between 1983 and 2004. Retinal vascular changes were observed in 351 cases with disabling dementia (average period before the onset, 11.2 years) and in 702 controls matched for sex, age, and baseline year. Incidence of disabling dementia was defined as individuals who received cares for disabilities including dementia-related symptoms and/or behavioral disturbance. Conditional logistic regression analysis was used to calculate odds ratio (OR) and multivariable adjusted OR (Models 1 and 2) for incidence of disabling dementia according to each retinal vascular change. Regarding confounding variables, Model 1 included overweight status, hypertension, hyperglycemia, dyslipidemia, and smoking status, whereas Model 2 also included incidence of stroke prior to disabling dementia for further analysis. RESULTS The proportion of cases (controls) with retinal vascular changes was 23.1 (15.7)% for generalized arteriolar narrowing, 7.7 (7.5)% for focal arteriolar narrowing, 15.7 (11.8)% for arteriovenous nicking, 10.5 (9.3)% for increased arteriolar wall reflex, and 11.4 (9.8)% for any other retinopathy. Generalized arteriolar narrowing was associated with an increased risk of disabling dementia: crude OR, 1.66 (95% confidence interval, 1.19-2.31); Model 1: OR, 1.58 (1.12-2.23); Model 2: OR, 1.48 (1.04-2.10). The number of retinal abnormalities was associated in a dose-response manner with the risk. CONCLUSION Generalized arteriolar narrowing and total number of retinal abnormalities may be useful markers for identifying persons at higher risks of disabling dementia.
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Affiliation(s)
- Hiroshige Jinnouchi
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Akihiko Kitamura
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine.,Osaka Center for Cancer and Cardiovascular Disease Prevention.,Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
| | - Kazumasa Yamagishi
- Osaka Center for Cancer and Cardiovascular Disease Prevention.,Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Disease Prevention
| | - Hironori Imano
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Takeo Okada
- Osaka Center for Cancer and Cardiovascular Disease Prevention
| | - Renzhe Cui
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
| | - Mitsumasa Umesawa
- Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba.,Department of Public Health, Dokkyo Medical University School of Medicine
| | - Isao Muraki
- Osaka Center for Cancer and Cardiovascular Disease Prevention
| | | | - Ryo Kawasaki
- Department of Public Health, Yamagata University Graduate School of Medical Science
| | - Tomoko Sankai
- Department of Community Health, Faculty of Medicine, University of Tsukuba
| | - Tetsuya Ohira
- Department of Epidemiology, Fukushima Medical University School of Medicine
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine
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Ryan CM, Klein BEK, Lee KE, Cruickshanks KJ, Klein R. Associations between recent severe hypoglycemia, retinal vessel diameters, and cognition in adults with type 1 diabetes. J Diabetes Complications 2016; 30:1513-1518. [PMID: 27601058 PMCID: PMC5050129 DOI: 10.1016/j.jdiacomp.2016.08.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Accepted: 08/09/2016] [Indexed: 01/21/2023]
Abstract
AIMS Mild cognitive dysfunction has been identified in children and adults with type 1 diabetes, but most studies have failed to find a relationship between severe hypoglycemia and cognition, despite reports of such associations in older adults with type 2 diabetes. Focusing on older adults with type 1 diabetes, we examined the associations between cognitive performance and recent episodes of severe hypoglycemia, retinal vessel diameters and the presence of micro- and macrovascular complications. METHODS Cognitive functioning was assessed in 244 participants enrolled in the Wisconsin Epidemiologic Study of Diabetic Retinopathy. The mean (SD; range) age at assessment in 2012-14 was 55.2 (8.3; 37-82) years and the mean (SD) duration of diabetes was 41.1 (5.6) years. Three cognitive domains were assessed in this cross-sectional study: mental efficiency and executive function, nonverbal memory, and verbal memory. RESULTS Multivariate modeling demonstrated that although age and/or education are most strongly associated with performance on measures of mental efficiency, three diabetes-related variables were also associated with poorer test scores: an episode of severe hypoglycemia in the past year (β=-0.360 [95% CI, -0.672, -0.047]), retinal arteriolar and venular diameters (β=0.140 [95% CI, 0.062, 0.219]; β=-0.127 [95% CI -0.207, -0.047]), and carotid artery plaque (β=-0.372 [95% CI -0.741, -0.003]). In addition, recent severe hypoglycemia was associated with poorer nonverbal memory (β=-0.522 [95% CI, -0.849, -0.194]). CONCLUSIONS For middle-aged and older adults with long-duration type 1 diabetes, poorer cognition was associated with a recent episode of severe hypoglycemia as well as with the presence of micro- and/or macrovascular conditions. Given the increasing numbers of aging adults with type 1 diabetes, future longitudinal studies are needed to identify causality and to determine whether diabetes management techniques that reduce the onset or severity of vascular complications and hypoglycemia can also reduce the risk of cognitive dysfunction in this population.
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Affiliation(s)
- Christopher M Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
| | - Barbara E K Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Kristine E Lee
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Karen J Cruickshanks
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States; Department of Population Health Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
| | - Ronald Klein
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, United States
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McGrory S, Taylor AM, Kirin M, Corley J, Pattie A, Cox SR, Dhillon B, Wardlaw JM, Doubal FN, Starr JM, Trucco E, MacGillivray TJ, Deary IJ. Retinal microvascular network geometry and cognitive abilities in community-dwelling older people: The Lothian Birth Cohort 1936 study. Br J Ophthalmol 2016; 101:993-998. [PMID: 28400371 PMCID: PMC5530803 DOI: 10.1136/bjophthalmol-2016-309017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 11/05/2022]
Abstract
Aim To examine the relationship between retinal vascular morphology and cognitive abilities in a narrow-age cohort of community-dwelling older people. Methods Digital retinal images taken at age ∼73 years from 683 participants of the Lothian Birth Cohort 1936 (LBC1936) were analysed with Singapore I Vessel Assessment (SIVA) software. Multiple regression models were applied to determine cross-sectional associations between retinal vascular parameters and general cognitive ability (g), memory, processing speed, visuospatial ability, crystallised cognitive ability and change in IQ from childhood to older age. Results After adjustment for cognitive ability at age 11 years and cardiovascular risk factors, venular length-to-diameter ratio was nominally significantly associated with processing speed (β=−0.116, p=0.01) and g (β=−0.079, p=0.04). Arteriolar length-to-diameter ratio was associated with visuospatial ability (β=0.092, p=0.04). Decreased arteriolar junctional exponent deviation and increased arteriolar branching coefficient values were associated with less relative decline in IQ between childhood and older age (arteriolar junctional exponent deviation: β=−0.101, p=0.02; arteriolar branching coefficient: β=0.089, p=0.04). Data are presented as standardised β coefficients (β) reflecting change in cognitive domain score associated with an increase of 1 SD unit in retinal parameter. None of these nominally significant associations remained significant after correction for multiple statistical testing. Conclusions Retinal parameters contributed <1% of the variance in the majority of associations observed. Whereas retinal analysis may have potential for early detection of some types of age-related cognitive decline and dementia, our results present little evidence that retinal vascular features are associated with non-pathological cognitive ageing.
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Affiliation(s)
- Sarah McGrory
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adele M Taylor
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Mirna Kirin
- Faculty of Medicine, University of Split, Split, Croatia
| | - Janie Corley
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Alison Pattie
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network: A Platform for Scientific Excellence Collaboration, Edinburgh, UK
| | - Baljean Dhillon
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network: A Platform for Scientific Excellence Collaboration, Edinburgh, UK
| | - Fergus N Doubal
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Thomas J MacGillivray
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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Renin-angiotensin system as a potential therapeutic target in stroke and retinopathy: experimental and clinical evidence. Clin Sci (Lond) 2016; 130:221-38. [PMID: 26769658 DOI: 10.1042/cs20150350] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As our knowledge expands, it is now clear that the renin-angiotensin (Ang) system (RAS) mediates functions other than regulating blood pressure (BP). The RAS plays a central role in the pathophysiology of different neurovascular unit disorders including stroke and retinopathy. Moreover, the beneficial actions of RAS modulation in brain and retina have been documented in experimental research, but not yet exploited clinically. The RAS is a complex system with distinct yet interconnected components. Understanding the different RAS components and their functions under brain and retinal pathological conditions is crucial to reap their benefits. The aim of the present review is to provide an experimental and clinical update on the role of RAS in the pathophysiology and treatment of stroke and retinopathy. Combining the evidence from both these disorders allows a unique opportunity to move both fields forward.
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85
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Angiographic evidence of proliferative retinopathy predicts neuropsychiatric morbidity in diabetic patients. Psychoneuroendocrinology 2016; 67:163-70. [PMID: 26907995 DOI: 10.1016/j.psyneuen.2016.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/09/2016] [Accepted: 02/11/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Diabetic retinopathy (DR) is a common vasculopathy categorized as either non-proliferative (NPDR) or proliferative (PDR),characterized by dysfunctional blood-retinal barrier (BRB) and diagnosed using fluorescein angiography (FA). Since the BRB is similar in structure and function to the blood-brain barrier (BBB) and BBB dysfunction plays a key role in the pathogenesis of brain disorders, we hypothesized that PDR, the severe form of DR, is likely to mirror BBB damage and to predict a worse neuropsychiatric outcome. METHODS A retrospective cohort study was conducted among subjects with diabetes (N=2982) with FA-confirmed NPDR (N=2606) or PDR (N=376). Incidence and probability to develop brain pathologies and mortality were investigated in a 10-year follow-up study. We used Kaplan-Meier, Cox and logistic regression analyses to examine association between DR severity and neuropsychiatric morbidity adjusting for confounders. RESULTS Patients with PDR had significantly higher rates of all-cause brain pathologies (P<0.001), specifically stroke (P=0.005), epilepsy (P=0.006) and psychosis (P=0.024), and a shorter time to develop any neuropsychiatric event (P<0.001) or death (P=0.014) compared to NPDR. Cox adjusted hazard ratio for developing all-cause brain impairments was higher for PDR (HR=1.37, 95% CI 1.16-1.61, P<0.001) which was an independent predictor for all-cause brain impairments (OR 1.30, 95% CI 1.04-1.64, P=0.022), epilepsy (OR 2.16, 95% CI 1.05-4.41, P=0.035) and mortality (HR=1.35, 95% CI 1.06-1.70, P=0.014). CONCLUSIONS This is the first study to confirm that angiography-proven microvasculopathy identifies patients at high risk for neuropsychiatric morbidity and mortality.
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Roy PK, Bhuiyan A, Lee K, Wong TY, Ramamohanarao K. A novel computer aided quantification method of focal arteriolar narrowing using colour retinal image. Comput Biol Med 2016; 74:18-29. [PMID: 27160638 DOI: 10.1016/j.compbiomed.2016.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 04/24/2016] [Accepted: 04/26/2016] [Indexed: 11/25/2022]
Abstract
We present a novel method for the quantification of focal arteriolar narrowing (FAN) in human retina, a precursor for hypertension, stroke and other cardiovascular diseases. A reliable and robust arteriolar boundary mapping method is proposed where intensity, gradient and spatial prior knowledge about the arteriolar shape is incorporated into a graph based optimization method to obtain the arteriolar boundary. Following the mapping of the arteriolar boundaries, arteriolar widths are analysed to quantify the severity of focal arteriolar narrowing (FAN). We evaluate our proposed method on a dataset of 116 retinal arteriolar segments which are manually graded by two expert graders. The experimental results indicate a strong correlation between the quantified FAN measurement scores provided by our method and two experts graded FAN severity levels. Our proposed FAN measurement score: percent narrowing (PN) shows high correlation (Spearman correlation coefficient of 0.82(p<0.0001) for grader-1 and 0.84(p<0.0001) for grade-2) with the manually graded FAN severity levels provided by two expert graders. In addition to that, the proposed method shows better reproducibility (Spearman correlation coefficient ρ=0.92(p<0.0001)) compared to two expert graders ( [Formula: see text] (p<0.0001) and [Formula: see text] ) in two successive sessions. The quantitative measurements provided by the proposed method can help us to establish a more reliable link between FAN and known systemic and eye diseases.
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Affiliation(s)
- Pallab Kanti Roy
- Department of Computing and Information Systems, The University of Melbourne, Australia.
| | - Alauddin Bhuiyan
- Department of Computing and Information Systems, The University of Melbourne, Australia
| | - Kim Lee
- Centre for Eye Research Australia, Melbourne, Australia
| | - Tien Yin Wong
- Department of Ophthalmology, National University of Singapore, Singapore
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Mutlu U, Adams HHH, Hofman A, Lugt AVD, Klaver CCW, Vernooij MW, Ikram MK, Ikram MA. Retinal Microvascular Calibers Are Associated With Enlarged Perivascular Spaces in the Brain. Stroke 2016; 47:1374-6. [PMID: 26979867 DOI: 10.1161/strokeaha.115.012438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/11/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Perivascular enlargement in the brain is a putative imaging marker for microvascular brain damage, but this link has not yet been confirmed using direct in vivo visualization of small vessels. We investigated the relation between microvascular calibers on retinal imaging and enlarged perivascular spaces (ePVSs) on brain magnetic resonance imaging. METHODS We included 704 participants from the Rotterdam study. Retinal arteriolar and venular calibers were measured semiautomatically on fundus photographs. ePVSs were counted in the centrum semiovale, basal ganglia, hippocampus, and mesencephalon, using a standardized rating method. We determined the association between retinal microvascular calibers and ePVSs with negative binomial regression models, adjusting for age, sex, the other vascular caliber, structural brain magnetic resonance imaging markers, and cardiovascular risk factors. RESULTS Both narrower arteriolar and wider venular calibers were associated with more ePVSs in the centrum semiovale and hippocampal region. Rate ratios (95% confidence interval) for arterioles in the centrum semiovale and hippocampus were 1.07 (1.01-1.14) and 1.13 (1.04-1.22), respectively, and for venules 1.08 (1.01-1.16) and 1.09 (1.00-1.18), respectively. These associations were independent from other brain magnetic resonance imaging markers and cardiovascular risk factors. CONCLUSIONS Retinal microvascular calibers are related to ePVSs, confirming the putative link between microvascular damage and ePVSs.
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Affiliation(s)
- Unal Mutlu
- From the Departments of Epidemiology (U.M., H.H.H.A., A.H., C.C.W.K., M.W.V., M.K.I., M.A.I.), Ophthalmology (U.M., C.C.W.K.), Radiology (H.H.H.A., A.v.d.L., M.W.V., M.A.I.), Neurology (M.A.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands (M.K.I.)
| | - Hieab H H Adams
- From the Departments of Epidemiology (U.M., H.H.H.A., A.H., C.C.W.K., M.W.V., M.K.I., M.A.I.), Ophthalmology (U.M., C.C.W.K.), Radiology (H.H.H.A., A.v.d.L., M.W.V., M.A.I.), Neurology (M.A.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands (M.K.I.)
| | - Albert Hofman
- From the Departments of Epidemiology (U.M., H.H.H.A., A.H., C.C.W.K., M.W.V., M.K.I., M.A.I.), Ophthalmology (U.M., C.C.W.K.), Radiology (H.H.H.A., A.v.d.L., M.W.V., M.A.I.), Neurology (M.A.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands (M.K.I.)
| | - Aad van der Lugt
- From the Departments of Epidemiology (U.M., H.H.H.A., A.H., C.C.W.K., M.W.V., M.K.I., M.A.I.), Ophthalmology (U.M., C.C.W.K.), Radiology (H.H.H.A., A.v.d.L., M.W.V., M.A.I.), Neurology (M.A.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands (M.K.I.)
| | - Caroline C W Klaver
- From the Departments of Epidemiology (U.M., H.H.H.A., A.H., C.C.W.K., M.W.V., M.K.I., M.A.I.), Ophthalmology (U.M., C.C.W.K.), Radiology (H.H.H.A., A.v.d.L., M.W.V., M.A.I.), Neurology (M.A.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands (M.K.I.)
| | - Meike W Vernooij
- From the Departments of Epidemiology (U.M., H.H.H.A., A.H., C.C.W.K., M.W.V., M.K.I., M.A.I.), Ophthalmology (U.M., C.C.W.K.), Radiology (H.H.H.A., A.v.d.L., M.W.V., M.A.I.), Neurology (M.A.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands (M.K.I.)
| | - M Kamran Ikram
- From the Departments of Epidemiology (U.M., H.H.H.A., A.H., C.C.W.K., M.W.V., M.K.I., M.A.I.), Ophthalmology (U.M., C.C.W.K.), Radiology (H.H.H.A., A.v.d.L., M.W.V., M.A.I.), Neurology (M.A.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands (M.K.I.)
| | - M Arfan Ikram
- From the Departments of Epidemiology (U.M., H.H.H.A., A.H., C.C.W.K., M.W.V., M.K.I., M.A.I.), Ophthalmology (U.M., C.C.W.K.), Radiology (H.H.H.A., A.v.d.L., M.W.V., M.A.I.), Neurology (M.A.I.), Erasmus MC, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA (A.H.); Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore (M.K.I.); and Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands (M.K.I.).
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Associations between Retinal Markers of Microvascular Disease and Cognitive Impairment in Newly Diagnosed Type 2 Diabetes Mellitus: A Case Control Study. PLoS One 2016; 11:e0147160. [PMID: 26771382 PMCID: PMC4714814 DOI: 10.1371/journal.pone.0147160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate associations between retinal microvascular changes and cognitive impairment in newly diagnosed type 2 diabetes mellitus. DESIGN Case control study. SETTING A primary care cohort with newly diagnosed type 2 diabetes mellitus. METHODS For this analysis, we compared 69 cases with lowest decile scores (for the cohort) on the Modified Telephone Interview for Cognitive Status and 68 controls randomly selected from the remainder of the cohort. Retinal images were rated and the following measures compared between cases and controls: retinal vessel calibre, arterio-venous ratio, retinal fractal dimension, and simple and curvature retinal vessel tortuosity. RESULTS Total and venular (but not arteriolar) simple retinal vessel tortuosity levels were significantly higher in cases than controls (t = 2.45, p = 0.015; t = 2.53, p = 0.013 respectively). The associations persisted after adjustment for demographic factors, retinopathy, neuropathy, obesity and blood pressure. There were no other significant differences between cases and controls in retinal measures. CONCLUSIONS A novel association was found between higher venular tortuosity and cognitive impairment in newly diagnosed type 2 diabetes mellitus. This might be accounted for by factors such as hypoxia, thrombus formation, increased vasoendothelial growth factor release and inflammation affecting both the visible retinal and the unobserved cerebral microvasculature.
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Serum Levels of ApoA1 and ApoA2 Are Associated with Cognitive Status in Older Men. BIOMED RESEARCH INTERNATIONAL 2015; 2015:481621. [PMID: 26682220 PMCID: PMC4670907 DOI: 10.1155/2015/481621] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Revised: 11/04/2015] [Accepted: 11/08/2015] [Indexed: 01/02/2023]
Abstract
Background. Advancing age, chronic inflammation, oxidative damage, and disorders of lipid metabolism are positively linked to the late-life cognitive impairment. Serum biomarkers may be associated with the cognitive status in older men. Methods. 440 old male subjects with different cognitive functions were recruited to investigate probable serum markers. Pearson Chi-Squared test, univariate analysis, and multivariate logistic regression analysis were performed to evaluate biomarkers which may be associated with cognitive status. Results. Levels of fundus atherosclerosis (AS) (P < 0.001), age (P < 0.001), serum biomarkers peroxidase (POD) (P = 0.026) and interleukin-6 (IL-6) (P = 0.001), serum levels of high-density lipoprotein cholesterol (HDL-C) (P < 0.001), apolipoprotein A2 (ApoA2) (P = 0.001), and ApoC2 (P = 0.005) showed significant differences. Compared to group 3, ApoA1 in group 1 (OR = 1.30, 95% CI 1.01–1.67) and group 2 (OR = 1.47, 95% CI 1.11–1.94) were higher, while ApoA2 were lower (group 1: OR = 0.43, 95% CI 0.18–1.02; group 2: OR = 0.21, 95% CI 0.08–0.54) after adjusting for control variables. Conclusion. The results demonstrated that age, AS levels, POD, IL-6, HDL-C, ApoA2, and ApoC2 were significantly related to cognitive status. Moreover, ApoA1 and ApoA2 were independently associated with cognitive impairment and late-life dementia.
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Abstract
Antiaging therapies show promise in model organism research. Translation to humans is needed to address the challenges of an aging global population. Interventions to slow human aging will need to be applied to still-young individuals. However, most human aging research examines older adults, many with chronic disease. As a result, little is known about aging in young humans. We studied aging in 954 young humans, the Dunedin Study birth cohort, tracking multiple biomarkers across three time points spanning their third and fourth decades of life. We developed and validated two methods by which aging can be measured in young adults, one cross-sectional and one longitudinal. Our longitudinal measure allows quantification of the pace of coordinated physiological deterioration across multiple organ systems (e.g., pulmonary, periodontal, cardiovascular, renal, hepatic, and immune function). We applied these methods to assess biological aging in young humans who had not yet developed age-related diseases. Young individuals of the same chronological age varied in their "biological aging" (declining integrity of multiple organ systems). Already, before midlife, individuals who were aging more rapidly were less physically able, showed cognitive decline and brain aging, self-reported worse health, and looked older. Measured biological aging in young adults can be used to identify causes of aging and evaluate rejuvenation therapies.
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91
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Exalto LG, Biessels GJ, Karter AJ, Huang ES, Quesenberry CP, Whitmer RA. Severe diabetic retinal disease and dementia risk in type 2 diabetes. J Alzheimers Dis 2015; 42 Suppl 3:S109-17. [PMID: 24625797 DOI: 10.3233/jad-132570] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Persons with type 2 diabetes are at an increased risk of dementia compared to those without, but the etiology of this increased risk is unclear. OBJECTIVE Cerebral microvascular disease may mediate the link between diabetes and dementia. Given the anatomical and physiological similarities between cerebral and retinal microvessels, we examined the longitudinal association between diabetic retinal disease and dementia in patients with type 2 diabetes. METHODS Longitudinal cohort study of 29,961 patients with type 2 diabetes aged ≥60 years. Electronic medical records were used to collect diagnoses and treatment of severe diabetic retinal disease (i.e., diabetic proliferative retinopathy and macular edema) between 1996-1998 and dementia diagnoses for the next ten years (1998-2008). The association between diabetic retinal disease and dementia was evaluated by Cox proportional hazard models adjusted for sociodemographics, as well as diabetes-specific (e.g., diabetes duration, pharmacotherapy, HbA1c, hypoglycemia, hyperglycemia) and vascular (e.g., vascular disease, smoking, body mass index) factors. RESULTS 2,008 (6.8%) patients had severe diabetic retinal disease at baseline and 5,173 (17.3%) participants were diagnosed with dementia during follow-up. Those with diabetic retinal disease had a 42% increased risk of incident dementia (demographics adjusted Hazards Ratio (HR) = 1.42, 95% Confidence Interval (CI) 1.27, 1.58); further adjustment for diabetes-specific (HR 1.29; 95% CI 1.14, 1.45) and vascular-related disease conditions (HR 1.35; 95% CI 1.21, 1.52) attenuated the relation slightly. CONCLUSION Diabetic patients with severe diabetic retinal disease have an increased risk of dementia. This may reflect a causal link between microvascular disease and dementia.
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Affiliation(s)
- Lieza G Exalto
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Geert Jan Biessels
- Department of Neurology, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Elbert S Huang
- Department of Internal Medicine, University of Chicago, Chicago, IL, USA
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Williams MA, McGowan AJ, Cardwell CR, Cheung CY, Craig D, Passmore P, Silvestri G, Maxwell AP, McKay GJ. Retinal microvascular network attenuation in Alzheimer's disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2015; 1:229-235. [PMID: 26634224 PMCID: PMC4629099 DOI: 10.1016/j.dadm.2015.04.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cerebral small-vessel disease has been implicated in the development of Alzheimer's disease (AD). The retinal microvasculature enables the noninvasive visualization and evaluation of the systemic microcirculation. We evaluated retinal microvascular parameters in a case-control study of AD patients and cognitively normal controls. METHODS Retinal images were computationally analyzed and quantitative retinal parameters (caliber, fractal dimension, tortuosity, and bifurcation) measured. Regression models were used to compute odds ratios (OR) and confidence intervals (CI) for AD with adjustment for confounders. RESULTS Retinal images were available in 213 AD participants and 294 cognitively normal controls. Persons with lower venular fractal dimension (OR per standard deviation [SD] increase, 0.77 [CI: 0.62-0.97]) and lower arteriolar tortuosity (OR per SD increase, 0.78 [CI: 0.63-0.97]) were more likely to have AD after appropriate adjustment. DISCUSSION Patients with AD have a sparser retinal microvascular network and retinal microvascular variation may represent similar pathophysiological events within the cerebral microvasculature of patients with AD.
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Affiliation(s)
| | - Amy J McGowan
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Carol Y Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore ; Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, National University of Singapore, Singapore, Singapore
| | - David Craig
- Southern Health and Social Care Trust, Craigavon Hospital, Craigavon, UK
| | - Peter Passmore
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Giuliana Silvestri
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | | | - Gareth J McKay
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Li LJ, Aris I, Su LL, Tint MT, Cheung CYL, Ikram MK, Gluckman P, Godfrey KM, Tan KH, Yeo G, Yap F, Kwek K, Saw SM, Chong YS, Wong TY, Lee YS. Associations of maternal retinal vasculature with subsequent fetal growth and birth size. PLoS One 2015; 10:e0118250. [PMID: 25909909 PMCID: PMC4409150 DOI: 10.1371/journal.pone.0118250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/18/2014] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We aimed to study the maternal retinal microvasculature at mid-trimester and its relationship with subsequent fetal growth and birth size. METHODS We recruited 732 pregnant women aged 18-46 years in the first trimester with singleton pregnancies. All had retinal photography and fetal scan performed at 26-28 weeks gestation, and subsequent fetal scan at 32-34 weeks gestation. Infant anthropometric measurements were done at birth. Retinal microvasculature was measured using computer software from the retinal photographs. RESULTS In multiple linear regression models, each 10 μm narrowing in maternal retinal arteriolar caliber was associated with decreases of 1.36 mm in fetal head circumference at 32-34 weeks gestation, as well as decreases of 1.50 mm and 2.30 mm in infant head circumference and birth length at delivery, respectively. Each standard deviation decrease in maternal retinal arteriolar fractal dimension was associated with decreases of 1.55 mm in fetal head circumference at 32-34 weeks gestation, as well as decreases of 1.08 mm and 46.42 g in infant head circumference and birth weight at delivery, respectively. CONCLUSIONS Narrower retinal arteriolar caliber and a sparser retinal vascular network in mothers, reflecting a suboptimal uteroplacental microvasculature during mid-pregnancy, were associated with poorer fetal growth and birth size.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Izzuddin Aris
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lin Lin Su
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mya Thway Tint
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carol Yim-Lui Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- DUKE-NUS Graduate Medical School, Singapore
| | - M. Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Departments of Epidemiology & Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Memory Aging & Cognition Centre, National University Health System, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton, Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | | | - George Yeo
- KK Women’s and Children’s Hospital, Singapore
| | - Fabian Yap
- KK Women’s and Children’s Hospital, Singapore
| | - Kenneth Kwek
- Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton, Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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95
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Tălu S, Vlăduţiu C, Lupaşcu CA. Characterization of human retinal vessel arborisation in normal and amblyopic eyes using multifractal analysis. Int J Ophthalmol 2015; 8:996-1002. [PMID: 26558216 PMCID: PMC4631015 DOI: 10.3980/j.issn.2222-3959.2015.05.26] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/22/2014] [Indexed: 02/05/2023] Open
Abstract
AIM To characterize the human retinal vessel arborisation in normal and amblyopic eyes using multifractal geometry and lacunarity parameters. METHODS Multifractal analysis using a box counting algorithm was carried out for a set of 12 segmented and skeletonized human retinal images, corresponding to both normal (6 images) and amblyopia states of the retina (6 images). RESULTS It was found that the microvascular geometry of the human retina network represents geometrical multifractals, characterized through subsets of regions having different scaling properties that are not evident in the fractal analysis. Multifractal analysis of the amblyopia images (segmented and skeletonized versions) show a higher average of the generalized dimensions (Dq ) for q=0, 1, 2 indicating a higher degree of the tree-dimensional complexity associated with the human retinal microvasculature network whereas images of healthy subjects show a lower value of generalized dimensions indicating normal complexity of biostructure. On the other hand, the lacunarity analysis of the amblyopia images (segmented and skeletonized versions) show a lower average of the lacunarity parameter Λ than the corresponding values for normal images (segmented and skeletonized versions). CONCLUSION The multifractal and lacunarity analysis may be used as a non-invasive predictive complementary tool to distinguish amblyopic subjects from healthy subjects and hence this technique could be used for an early diagnosis of patients with amblyopia.
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Affiliation(s)
- Stefan Tălu
- Discipline of Descriptive Geometry and Engineering Graphics, Department of Automotive Engineering and Transportation, Faculty of Mechanical Engineering, Technical University of Cluj-Napoca, Cluj-Napoca 400641, Cluj, Romania
| | - Cristina Vlăduţiu
- Discipline of Ophthalmology, Department of Surgical Specialties and Medical Imaging, Faculty of Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400012, Cluj, Romania
| | - Carmen A Lupaşcu
- Department of Mathematics and Informatics, University of Palermo, Palermo 90123, Italy
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96
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Geijselaers SLC, Sep SJS, Stehouwer CDA, Biessels GJ. Glucose regulation, cognition, and brain MRI in type 2 diabetes: a systematic review. Lancet Diabetes Endocrinol 2015; 3:75-89. [PMID: 25163604 DOI: 10.1016/s2213-8587(14)70148-2] [Citation(s) in RCA: 243] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Type 2 diabetes is associated with cognitive dysfunction and structural brain changes. Abnormalities in glucose regulation are involved in several complications related to type 2 diabetes, but their role in these cerebral complications is unclear. We systematically reviewed studies of the association between glucose regulation (glycaemia, hypoglycaemic events, insulin concentration, insulin resistance, and glucose-lowering treatment) and cognitive function and brain abnormalities on MRI in people with type 2 diabetes. The 86 papers included showed that glycaemia, particularly high HbA1c concentration and glucose variability, are negatively associated with cognitive function in people with type 2 diabetes without dementia. However, the strength of this association is weak, and HbA1c generally accounted for less than 10% of the variance in cognition. Importantly, few studies have measured long-term cerebral outcomes, such as dementia and structural brain changes on MRI, and the effect of glucose-lowering treatment on these outcomes. More randomised controlled trials are needed to establish the effect of glucose-lowering treatment on long-term cognitive function in people with type 2 diabetes.
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Affiliation(s)
- Stefan L C Geijselaers
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Simone J S Sep
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Center, Maastricht, Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
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97
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Jung HW, Kim SW, Yoon SJ, Choi JY, Kim KI, Kim CH. Associations Between Frailty, Retinal Microvascular Changes, and Cerebral White Matter Abnormalities in Korean Older Adults. J Am Geriatr Soc 2014; 62:2209-10. [DOI: 10.1111/jgs.13114] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hee-Won Jung
- Department of Internal Medicine; Seoul National University; Bundang Hospital; Seongnam Korea
- College of Medicine; Seoul National University; Seoul Korea
| | - Sun-Wook Kim
- Department of Internal Medicine; Seoul National University; Bundang Hospital; Seongnam Korea
- College of Medicine; Seoul National University; Seoul Korea
| | - Sol-Ji Yoon
- Department of Internal Medicine; Seoul National University; Bundang Hospital; Seongnam Korea
- College of Medicine; Seoul National University; Seoul Korea
| | - Jung-Yeon Choi
- Department of Internal Medicine; Seoul National University; Bundang Hospital; Seongnam Korea
- College of Medicine; Seoul National University; Seoul Korea
| | - Kwang-il Kim
- Department of Internal Medicine; Seoul National University; Bundang Hospital; Seongnam Korea
- College of Medicine; Seoul National University; Seoul Korea
| | - Cheol-Ho Kim
- Department of Internal Medicine; Seoul National University; Bundang Hospital; Seongnam Korea
- College of Medicine; Seoul National University; Seoul Korea
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98
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Pinhas A, Razeen M, Dubow M, Gan A, Chui TY, Shah N, Mehta M, Gentile RC, Weitz R, Walsh JB, Sulai YN, Carroll J, Dubra A, Rosen RB. Assessment of perfused foveal microvascular density and identification of nonperfused capillaries in healthy and vasculopathic eyes. Invest Ophthalmol Vis Sci 2014; 55:8056-66. [PMID: 25414179 DOI: 10.1167/iovs.14-15136] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To analyze the foveal microvasculature of young healthy eyes and older vasculopathic eyes, imaged using in vivo adaptive optics scanning light ophthalmoscope fluorescein angiography (AOSLO FA). METHODS AOSLO FA imaging of the superficial retinal microvasculature within an 800-μm radius from the foveal center was performed using simultaneous confocal infrared (IR) reflectance (790 nm) and fluorescence (488 nm) channels. Corresponding IR structural and FA perfusion maps were compared with each other to identify nonperfused capillaries adjacent to the foveal avascular zone. Microvascular densities were calculated from skeletonized FA perfusion maps. RESULTS Sixteen healthy adults (26 eyes; mean age 25 years, range, 21-29) and six patients with a retinal vasculopathy (six eyes; mean age 55 years, range, 44-70) were imaged. At least one nonperfused capillary was observed in five of the 16 healthy nonfellow eyes and in four of the six vasculopathic eyes. Compared with healthy eyes, capillary nonperfusion in the vasculopathic eyes was more extensive. Microvascular density of the 16 healthy nonfellow eyes was 42.0 ± 4.2 mm(-1) (range, 33-50 mm(-1)). All six vasculopathic eyes had decreased microvascular densities. CONCLUSIONS AOSLO FA provides an in vivo method for estimating foveal microvascular density and reveals occult nonperfused retinal capillaries. Nonperfused capillaries in healthy young adults may represent a normal variation and/or an early sign of pathology. Although limited, the normative data presented here is a step toward developing clinically useful microvascular parameters for ocular and/or systemic diseases.
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Affiliation(s)
- Alexander Pinhas
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Moataz Razeen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States Alexandria Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Michael Dubow
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Alexander Gan
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Toco Y Chui
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Nishit Shah
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Mitul Mehta
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Ronald C Gentile
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States Department of Ophthalmology, Winthrop-University Hospital, Mineola, New York, United States
| | - Rishard Weitz
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Joseph B Walsh
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States
| | - Yusufu N Sulai
- The Institute of Optics, University of Rochester, Rochester, New York, United States
| | - Joseph Carroll
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Alfredo Dubra
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Richard B Rosen
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, United States Icahn School of Medicine at Mount Sinai, New York, New York, United States
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99
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Bůžková P, Barzilay JI, Fink HA, Robbins JA, Cauley JA, Fitzpatrick AL. Ratio of urine albumin to creatinine attenuates the association of dementia with hip fracture risk. J Clin Endocrinol Metab 2014; 99:4116-23. [PMID: 25148233 PMCID: PMC4223436 DOI: 10.1210/jc.2014-2409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Microvascular disease is a leading cause of cognitive impairment. Approximately 50% of people with a hip fracture have cognitive impairment. OBJECTIVE We tested the hypothesis that microvascular diseases of the brain (lacunar infarcts and white matter disease [WMD]), kidney (albuminuria [≥ 30 mg/g creatinine] and albumin creatinine ratio [ACR]), and eye (retinal vascular disorders) attenuate the association of cognitive impairment with hip fracture risk. SETTING The Cardiovascular Health Cognition Study. PATIENTS Three thousand, one-hundred six participants (mean age, ∼ 79 y; 8.84 y median follow-up) with cognitive testing. Subsets received ACR testing (n=2389), brain magnetic resonance imaging scans (n = 2094), and retinal photography (n = 1098). MAIN OUTCOME MEASURE Incident hip fracture. RESULTS There were 488 participants (16%) with mild cognitive impairment (MCI) and 564 (18%) with dementia. There were 337 incident hip fractures, of which 19% occurred in participants with MCI and 26% in participants with dementia. Adjusted hazard ratios (HR) and 95% confidence interval for hip fracture in participants with MCI were 2.45 (1.67-3.61) and for dementia 2.35 (1.57-3.52). With doubling of ACR, the HR for fracture was attenuated in participants with dementia compared with participants with normal cognition [interaction HR 0.70 (0.55-0.91)]. No such effect was found in participants with MCI. Albuminuria, lacunar infarcts, WMD, and retinal vascular disease (RVD) did not modify the association of dementia or MCI with hip fracture risk. CONCLUSIONS ACR attenuates part of the risk of hip fracture in people with dementia, suggesting that these disorders share a common pathogenesis.
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Affiliation(s)
- Petra Bůžková
- Department of Biostatistics (P.B.), University of Washington, Seattle, Washington 98115; Division of Endocrinology, Kaiser Permanente of Georgia and the Division of Endocrinology (J.I.B.), Emory University School of Medicine, Atlanta, Georgia 30096; Geriatric Research Education & Clinical Center (H.A.F.), Veterans Affair Medical Center, Minneapolis, Minnesota 55417; Department of Medicine (J.A.R.), University of California, Davis, Sacramento, California; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh 15261, Pennsylvania; and Department of Epidemiology (A.L.F.), University of Washington, Seattle, Washington 98115
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100
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Heringa SM, Walraven I, Moll AC, van den Berg E, Nijpels G, Stehouwer CDA, Reijmer YD, Kappelle LJ, Dekker JM, Biessels GJ. Vascular retinopathy in relation to cognitive functioning in an older population--the Hoorn Study. J Am Geriatr Soc 2014; 62:977-9. [PMID: 24828928 DOI: 10.1111/jgs.12815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sophie M Heringa
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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