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Gaire BP, Koronyo Y, Fuchs DT, Shi H, Rentsendorj A, Danziger R, Vit JP, Mirzaei N, Doustar J, Sheyn J, Hampel H, Vergallo A, Davis MR, Jallow O, Baldacci F, Verdooner SR, Barron E, Mirzaei M, Gupta VK, Graham SL, Tayebi M, Carare RO, Sadun AA, Miller CA, Dumitrascu OM, Lahiri S, Gao L, Black KL, Koronyo-Hamaoui M. Alzheimer's disease pathophysiology in the Retina. Prog Retin Eye Res 2024; 101:101273. [PMID: 38759947 PMCID: PMC11285518 DOI: 10.1016/j.preteyeres.2024.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 05/19/2024]
Abstract
The retina is an emerging CNS target for potential noninvasive diagnosis and tracking of Alzheimer's disease (AD). Studies have identified the pathological hallmarks of AD, including amyloid β-protein (Aβ) deposits and abnormal tau protein isoforms, in the retinas of AD patients and animal models. Moreover, structural and functional vascular abnormalities such as reduced blood flow, vascular Aβ deposition, and blood-retinal barrier damage, along with inflammation and neurodegeneration, have been described in retinas of patients with mild cognitive impairment and AD dementia. Histological, biochemical, and clinical studies have demonstrated that the nature and severity of AD pathologies in the retina and brain correspond. Proteomics analysis revealed a similar pattern of dysregulated proteins and biological pathways in the retina and brain of AD patients, with enhanced inflammatory and neurodegenerative processes, impaired oxidative-phosphorylation, and mitochondrial dysfunction. Notably, investigational imaging technologies can now detect AD-specific amyloid deposits, as well as vasculopathy and neurodegeneration in the retina of living AD patients, suggesting alterations at different disease stages and links to brain pathology. Current and exploratory ophthalmic imaging modalities, such as optical coherence tomography (OCT), OCT-angiography, confocal scanning laser ophthalmoscopy, and hyperspectral imaging, may offer promise in the clinical assessment of AD. However, further research is needed to deepen our understanding of AD's impact on the retina and its progression. To advance this field, future studies require replication in larger and diverse cohorts with confirmed AD biomarkers and standardized retinal imaging techniques. This will validate potential retinal biomarkers for AD, aiding in early screening and monitoring.
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Affiliation(s)
- Bhakta Prasad Gaire
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dieu-Trang Fuchs
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Haoshen Shi
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Altan Rentsendorj
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ron Danziger
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jean-Philippe Vit
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nazanin Mirzaei
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jonah Doustar
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Julia Sheyn
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Harald Hampel
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Andrea Vergallo
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Miyah R Davis
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ousman Jallow
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Filippo Baldacci
- Sorbonne University, Alzheimer Precision Medicine (APM), AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | | | - Ernesto Barron
- Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Los Angeles, CA, USA
| | - Mehdi Mirzaei
- Department of Clinical Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Vivek K Gupta
- Department of Clinical Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia
| | - Stuart L Graham
- Department of Clinical Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie University, Sydney, NSW, Australia; Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia
| | - Mourad Tayebi
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Roxana O Carare
- Department of Clinical Neuroanatomy, University of Southampton, Southampton, UK
| | - Alfredo A Sadun
- Department of Ophthalmology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA; Doheny Eye Institute, Los Angeles, CA, USA
| | - Carol A Miller
- Department of Pathology Program in Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Shouri Lahiri
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Liang Gao
- Department of Bioengineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Keith L Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Biomedical Sciences, Division of Applied Cell Biology and Physiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Berkowitz BA, Paruchuri A, Stanek J, Abdul-Nabi M, Podolsky RH, Bustos AH, Childers KL, Murphy GG, Stangis K, Roberts R. Biomarker evidence of early vision and rod energy-linked pathophysiology benefits from very low dose DMSO in 5xFAD mice. Acta Neuropathol Commun 2024; 12:85. [PMID: 38822433 PMCID: PMC11140992 DOI: 10.1186/s40478-024-01799-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024] Open
Abstract
Here, we test whether early visual and OCT rod energy-linked biomarkers indicating pathophysiology in nicotinamide nucleotide transhydrogenase (Nnt)-null 5xFAD mice also occur in Nnt-intact 5xFAD mice and whether these biomarkers can be pharmacologically treated. Four-month-old wild-type or 5xFAD C57BL/6 substrains with either a null (B6J) Nnt or intact Nnt gene (B6NTac) and 5xFAD B6J mice treated for one month with either R-carvedilol + vehicle or only vehicle (0.01% DMSO) were studied. The contrast sensitivity (CS), external limiting membrane-retinal pigment epithelium (ELM-RPE) thickness (a proxy for low pH-triggered water removal), profile shape of the hyperreflective band just posterior to the ELM (i.e., the mitochondrial configuration within photoreceptors per aspect ratio [MCP/AR]), and retinal laminar thickness were measured. Both wild-type substrains showed similar visual performance indices and dark-evoked ELM-RPE contraction. The lack of a light-dark change in B6NTac MCP/AR, unlike in B6J mice, is consistent with relatively greater mitochondrial efficiency. 5xFAD B6J mice, but not 5xFAD B6NTac mice, showed lower-than-WT CS. Light-adapted 5xFAD substrains both showed abnormal ELM-RPE contraction and greater-than-WT MCP/AR contraction. The inner retina and superior outer retina were thinner. Treating 5xFAD B6J mice with R-carvedilol + DMSO or DMSO alone corrected CS and ELM-RPE contraction but not supernormal MCP/AR contraction or laminar thinning. These results provide biomarker evidence for prodromal photoreceptor mitochondrial dysfunction/oxidative stress/oxidative damage, which is unrelated to visual performance, as well as the presence of the Nnt gene. This pathophysiology is druggable in 5xFAD mice.
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Affiliation(s)
- Bruce A Berkowitz
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA.
| | - Anuhya Paruchuri
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Josh Stanek
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Mura Abdul-Nabi
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
| | - Robert H Podolsky
- Biostatistics and Study Methodology, Children's National Hospital, Silver Spring, MD, USA
| | | | | | - Geoffrey G Murphy
- Department of Molecular and Integrative Physiology, Molecular Behavioral Neuroscience Institute, University of Michigan Medical School, Ann Arbor, MI, USA
- Michigan Neuroscience Institute, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Katherine Stangis
- Michigan Neuroscience Institute, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Robin Roberts
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University School of Medicine, 540 E. Canfield, Detroit, MI, 48201, USA
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Ávila FJ, Casado P, Marcellán MC, Remón L, Ares J, Collados MV, Otín S. Subjective Straylight Index: A Visual Test for Retinal Contrast Assessment as a Function of Veiling Glare. J Imaging 2024; 10:89. [PMID: 38667987 PMCID: PMC11051364 DOI: 10.3390/jimaging10040089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Spatial aspects of visual performance are usually evaluated through visual acuity charts and contrast sensitivity (CS) tests. CS tests are generated by vanishing the contrast level of the visual charts. However, the quality of retinal images can be affected by both ocular aberrations and scattering effects and none of those factors are incorporated as parameters in visual tests in clinical practice. We propose a new computational methodology to generate visual acuity charts affected by ocular scattering effects. The generation of glare effects on the visual tests is reached by combining an ocular straylight meter methodology with the Commission Internationale de l'Eclairage's (CIE) general disability glare formula. A new function for retinal contrast assessment is proposed, the subjective straylight function (SSF), which provides the maximum tolerance to the perception of straylight in an observed visual acuity test. Once the SSF is obtained, the subjective straylight index (SSI) is defined as the area under the SSF curve. Results report the normal values of the SSI in a population of 30 young healthy subjects (19 ± 1 years old), a peak centered at SSI = 0.46 of a normal distribution was found. SSI was also evaluated as a function of both spatial and temporal aspects of vision. Ocular wavefront measures revealed a statistical correlation of the SSI with defocus and trefoil terms. In addition, the time recovery (TR) after induced total disability glare and the SSI were related; in particular, the higher the RT, the greater the SSI value for high- and mid-contrast levels of the visual test. No relationships were found for low contrast visual targets. To conclude, a new computational method for retinal contrast assessment as a function of ocular straylight was proposed as a complementary subjective test for visual function performance.
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Affiliation(s)
- Francisco J. Ávila
- Departamento de Física Aplicada, Facultad de Ciencias, Universidad de Zaragoza, 50009 Zaragoza, Spain (L.R.); (J.A.)
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Wang S, Jiang X, Peng W, Yang S, Pi R, Zhou S. Acrolein Induces Retinal Abnormalities of Alzheimer's Disease in Mice. Int J Mol Sci 2023; 24:13576. [PMID: 37686379 PMCID: PMC10487815 DOI: 10.3390/ijms241713576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
It is reported that retinal abnormities are related to Alzheimer's disease (AD) in patients and animal models. However, it is unclear whether the retinal abnormities appear in the mouse model of sporadic Alzheimer's disease (sAD) induced by acrolein. We investigated the alterations of retinal function and structure, the levels of β-amyloid (Aβ) and phosphorylated Tau (p-Tau) in the retina, and the changes in the retinal vascular system in this mouse model. We demonstrated that the levels of Aβ and p-Tau were increased in the retinas of mice from the acrolein groups. Subsequently, a decreased amplitudes of b-waves in the scotopic and photopic electroretinogram (ERG), decreased thicknesses of the retinal nerve fiber layer (RNFL) in the retina, and slight retinal venous beading were found in the mice induced by acrolein. We propose that sAD mice induced by acrolein showed abnormalities in the retina, which may provide a valuable reference for the study of the retina in sAD.
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Affiliation(s)
- Shuyi Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xiuying Jiang
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan 528000, China
| | - Weijia Peng
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510006, China
| | - Shuangjian Yang
- Guangdong Provincial Institute for Vision and Eye Research, Guangzhou 510060, China
| | - Rongbiao Pi
- School of Medicine, Sun Yat-sen University, Shenzhen 528406, China
| | - Shiyou Zhou
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
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Zhao Y, Lesmes LA, Dorr M, Lu ZL. Collective endpoint of visual acuity and contrast sensitivity function from hierarchical Bayesian joint modeling. J Vis 2023; 23:13. [PMID: 37378989 DOI: 10.1167/jov.23.6.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Clinical trials typically analyze multiple endpoints for signals of efficacy. To improve signal detection for treatment effects using the high-dimensional data collected in trials, we developed a hierarchical Bayesian joint model (HBJM) to compute a five-dimensional collective endpoint (CE5D) of contrast sensitivity function (CSF) and visual acuity (VA). The HBJM analyzes row-by-row CSF and VA data across multiple conditions, and describes visual functions across a hierarchy of population, individuals, and tests. It generates joint posterior distributions of CE5D that combines CSF (peak gain, peak frequency, and bandwidth) and VA (threshold and range) parameters. The HBJM was applied to an existing dataset of 14 eyes, each tested with the quantitative VA and quantitative CSF procedures in four Bangerter foil conditions. The HBJM recovered strong correlations among CE5D components at all levels. With 15 qVA and 25 qCSF rows, it reduced the variance of the estimated components by 72% on average. Combining signals from VA and CSF and reducing noises, CE5D exhibited significantly higher sensitivity and accuracy in discriminating performance differences between foil conditions at both the group and test levels than the original tests. The HBJM extracts valuable information about covariance of CSF and VA parameters, improves precision of the estimated parameters, and increases the statistical power in detecting vision changes. By combining signals and reducing noise from multiple tests for detecting vision changes, the HBJM framework exhibits potential to increase statistical power for combining multi-modality data in ophthalmic trials.
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Affiliation(s)
- Yukai Zhao
- Center for Neural Science, New York University, New York, NY, USA
| | | | - Michael Dorr
- Adaptive Sensory Technology Inc., San Diego, CA, USA
| | - Zhong-Lin Lu
- Division of Arts and Sciences, NYU Shanghai, Shanghai, China
- Center for Neural Science and Department of Psychology, New York University, New York, NY, USA
- NYU-ECNU Institute of Brain and Cognitive Neuroscience, Shanghai, China
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Latina V, De Introna M, Caligiuri C, Loviglio A, Florio R, La Regina F, Pignataro A, Ammassari-Teule M, Calissano P, Amadoro G. Immunotherapy with Cleavage-Specific 12A12mAb Reduces the Tau Cleavage in Visual Cortex and Improves Visuo-Spatial Recognition Memory in Tg2576 AD Mouse Model. Pharmaceutics 2023; 15:pharmaceutics15020509. [PMID: 36839831 PMCID: PMC9965010 DOI: 10.3390/pharmaceutics15020509] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Tau-targeted immunotherapy is a promising approach for treatment of Alzheimer's disease (AD). Beyond cognitive decline, AD features visual deficits consistent with the manifestation of Amyloid β-protein (Aβ) plaques and neurofibrillary tangles (NFT) in the eyes and higher visual centers, both in animal models and affected subjects. We reported that 12A12-a monoclonal cleavage-specific antibody (mAb) which in vivo neutralizes the neurotoxic, N-terminal 20-22 kDa tau fragment(s)-significantly reduces the retinal accumulation in Tg(HuAPP695Swe)2576 mice of both tau and APP/Aβ pathologies correlated with local inflammation and synaptic deterioration. Here, we report the occurrence of N-terminal tau cleavage in the primary visual cortex (V1 area) and the beneficial effect of 12A12mAb treatment on phenotype-associated visuo-spatial deficits in this AD animal model. We found out that non-invasive administration of 12 A12mAb markedly reduced the pathological accumulation of both truncated tau and Aβ in the V1 area, correlated to significant improvement in visual recognition memory performance along with local increase in two direct readouts of cortical synaptic plasticity, including the dendritic spine density and the expression level of activity-regulated cytoskeleton protein Arc/Arg3.1. Translation of these findings to clinical therapeutic interventions could offer an innovative tau-directed opportunity to delay or halt the visual impairments occurring during AD progression.
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Affiliation(s)
- Valentina Latina
- European Brain Research Institute (EBRI), Viale Regina Elena 295, 00161 Rome, Italy
| | - Margherita De Introna
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), Via Fosso del Cavaliere 100, 00133 Rome, Italy
- IRCCS Santa Lucia Foundation (FSL), Centro di Ricerca Europeo sul Cervello (CERC), Via Fosso del Fiorano 64-65, 00143 Rome, Italy
| | - Chiara Caligiuri
- IRCCS Santa Lucia Foundation (FSL), Centro di Ricerca Europeo sul Cervello (CERC), Via Fosso del Fiorano 64-65, 00143 Rome, Italy
| | - Alessia Loviglio
- European Brain Research Institute (EBRI), Viale Regina Elena 295, 00161 Rome, Italy
| | - Rita Florio
- European Brain Research Institute (EBRI), Viale Regina Elena 295, 00161 Rome, Italy
| | - Federico La Regina
- European Brain Research Institute (EBRI), Viale Regina Elena 295, 00161 Rome, Italy
| | - Annabella Pignataro
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), Via Fosso del Cavaliere 100, 00133 Rome, Italy
- IRCCS Santa Lucia Foundation (FSL), Centro di Ricerca Europeo sul Cervello (CERC), Via Fosso del Fiorano 64-65, 00143 Rome, Italy
| | - Martine Ammassari-Teule
- IRCCS Santa Lucia Foundation (FSL), Centro di Ricerca Europeo sul Cervello (CERC), Via Fosso del Fiorano 64-65, 00143 Rome, Italy
- Institute of Biochemistry and Cell Biology (IBBC), National Research Council (CNR), Via Ercole Ramarini 32, 00015 Rome, Italy
| | - Pietro Calissano
- European Brain Research Institute (EBRI), Viale Regina Elena 295, 00161 Rome, Italy
| | - Giuseppina Amadoro
- European Brain Research Institute (EBRI), Viale Regina Elena 295, 00161 Rome, Italy
- Institute of Translational Pharmacology (IFT), National Research Council (CNR), Via Fosso del Cavaliere 100, 00133 Rome, Italy
- Correspondence: ; Tel.: +39-06-49255252
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Abraham AG, Hong C, Deal JA, Bettcher BM, Pelak VS, Gross A, Jiang K, Swenor B, Wittich W. Are cognitive researchers ignoring their senses? The problem of sensory deficit in cognitive aging research. J Am Geriatr Soc 2023; 71:1369-1377. [PMID: 36680402 DOI: 10.1111/jgs.18229] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 01/22/2023]
Abstract
Sensory impairments are common in older adult populations and have notable impacts on aging outcomes. Relationships between sensory and cognitive functions have been clearly established, though the mechanisms underlying those relationships are not fully understood. Given the growing burden of dementia, older adults with sensory deficits are an important and growing population to study in cognitive aging research. Yet, cognitive research sometimes excludes those with uncorrected significant/severe sensory deficits and often poorly or inconsistently assesses those deficits. Observational and interventional studies that exclude participants with sensory deficits will be limited in their generalizability to the narrower subset of the older adult population without vision or hearing impairment and may be missing an opportunity to study a growing population of older adults at higher risk of cognitive impairment. Strategies exist for adapting cognitive testing instruments, and inroads could be made into collecting normative data to inform ongoing research. Bringing together psychometricians with researchers who specialize in vision and hearing impairments could launch highly innovative research on both measurement methods and cognitive disease etiology, as sensory organs provide readily accessible neuronal and vascular beds that may show pathology earlier and elucidate innovative screening opportunities for early signs of cognitive disease.
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Affiliation(s)
- Alison G Abraham
- University of Colorado, Colorado School of Public Health, Department of Epidemiology, Aurora, Colorado, USA.,Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA.,Department of Ophthalmology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Chris Hong
- Johns Hopkins Zanvyl Krieger School of Arts and Sciences, Baltimore, Maryland, USA
| | - Jennifer A Deal
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Brianne M Bettcher
- Department of Ophthalmology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Victoria S Pelak
- Department of Ophthalmology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Alden Gross
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | - Kening Jiang
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
| | | | - Walter Wittich
- École d'optométrie, Université de Montréal, Montreal, Canada
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Papageorgiou E, Tsirelis D, Lazari K, Siokas V, Dardiotis E, Tsironi EE. Visual disorders and driving ability in persons with dementia: A mini review. Front Hum Neurosci 2022; 16:932820. [DOI: 10.3389/fnhum.2022.932820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022] Open
Abstract
BackgroundImpaired driving ability in patients with Alzheimer’s disease (AD) is associated with a decline in cognitive processes and a deterioration of their basic sensory visual functions. Although a variety of ocular abnormalities have been described in patients with AD, little is known about the impact of those visual disorders on their driving performance.AimAim of this mini-review is to provide an update on the driving ability of patients with dementia and summarize the primary visual disorders affecting their driving behavior.MethodsDatabases were screened for studies investigating dementia, associated visual abnormalities and driving ability.ResultsThere is consistent evidence that dementia affects driving ability. Patients with dementia present with a variety of visual disorders, such as visual acuity reduction, visual field defects, impaired contrast sensitivity, decline in color vision and age-related pathological changes, that may have a negative impact on their driving ability. However, there is a paucity in studies describing the impact of oculovisual decline on the driving ability of AD subjects. A bidirectional association between cognitive and visual impairment (VI) has been described.ConclusionGiven the bidirectional association between VI and dementia, vision screening and cognitive assessment of the older driver should aim to identify at-risk individuals and employ timely strategies for treatment of both cognitive and ocular problems. Future studies should characterize the basic visual sensory status of AD patients participating in driving studies, and investigate the impact of vision abnormalities on their driving performance.
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Vij R, Arora S. A systematic survey of advances in retinal imaging modalities for Alzheimer's disease diagnosis. Metab Brain Dis 2022; 37:2213-2243. [PMID: 35290546 DOI: 10.1007/s11011-022-00927-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/04/2022] [Indexed: 01/06/2023]
Abstract
Recent advances in retinal imaging pathophysiology have shown a new function for biomarkers in Alzheimer's disease diagnosis and prognosis. The significant improvements in Optical coherence tomography (OCT) retinal imaging have led to significant clinical translation, particularly in Alzheimer's disease detection. This systematic review will provide a comprehensive overview of retinal imaging in clinical applications, with a special focus on biomarker analysis for use in Alzheimer's disease detection. Articles on OCT retinal imaging in Alzheimer's disease diagnosis were identified in PubMed, Google Scholar, IEEE Xplore, and Research Gate databases until March 2021. Those studies using simultaneous retinal imaging acquisition were chosen, while those using sequential techniques were rejected. "Alzheimer's disease" and "Dementia" were searched alone and in combination with "OCT" and "retinal imaging". Approximately 1000 publications were searched, and after deleting duplicate articles, 145 relevant studies focused on the diagnosis of Alzheimer's disease utilizing retinal imaging were chosen for study. OCT has recently been demonstrated to be a valuable technique in clinical practice as according to this survey, 57% of the researchers employed optical coherence tomography, 19% used ocular fundus imaging, 13% used scanning laser ophthalmoscopy, and 11% have used multimodal imaging to diagnose Alzheimer disease. Retinal imaging has become an important diagnostic technique for Alzheimer's disease. Given the scarcity of available literature, it is clear that future prospective trials involving larger and more homogeneous groups are necessary, and the work can be expanded by evaluating its significance utilizing a machine-learning platform rather than simply using statistical methodologies.
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Affiliation(s)
- Richa Vij
- School of Computer Science & Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, 182320, India
| | - Sakshi Arora
- School of Computer Science & Engineering, Shri Mata Vaishno Devi University, Katra, Jammu and Kashmir, 182320, India.
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Fernandes Costa M, Dutra Henriques L, Côrrea Pinho O. Development of a Spatio-temporal Contrast Sensitivity Test for Clinical Use. J Ophthalmic Vis Res 2022; 17:69-77. [PMID: 35194498 PMCID: PMC8850854 DOI: 10.18502/jovr.v17i1.10172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose We developed a contrast sensitivity test that considers an integrative approach of spatial and temporal frequencies to evaluate the psychophysical channels in processing two-dimensional stimulus for clinical use. Our new procedure provides a more efficient isolation of the magnocellular and parvocellular visual pathways supporting spatiotemporal contrast sensitivity processing. Methods We evaluated 36 participants of both sexes aged 18–30 years with 20/20 or better best-corrected visual acuity. Two spatial frequencies (0.5 cycles per degree [cpd] and 10 cpd), being in one of the three temporal frequencies (0.5 cycle per second [cps], 7.5 cps, and 15 cps), were presented in a high-resolution gamma corrected monitor. A two-alternative forced-choice procedure was conducted, and the staircase method was used to calculate the contrast sensitivity. Reliability was assessed using a retest procedure within a month (±5 days) under the same conditions. Results Results showed statistical significance in 0.5 cpd and 10 cpd spatial frequencies for 0.5 cps (F = 77.36; p< 0.001), 7.5 cps (F = 778.37; p< 0.001), and 15 cps (F = 827.23; p < 0.001) with a very high (η² = 0.89) effect size. No statistical differences were found between the first and second sessions for all spatial frequencies. For reliability, a significantly high correlation and high internal consistency were found in all spatiotemporal conditions. The limits were calculated for normality. Conclusion We developed an approach to investigate the spatiotemporal integration of contrast sensitivity designed for clinical purposes. The relative contribution of the low spatial frequencies/high temporal frequencies and the high spatial frequencies/low temporal frequencies of the psychophysical channels can also be evaluated separately.
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Affiliation(s)
- Marcelo Fernandes Costa
- Laboratório da Visão, Departamento de Psicologia Experimental, Instituto de Psicologia, Universidade de São Paulo, São Paulo, Brazil.,Núcleo de Neurociências Aplicada, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo Dutra Henriques
- Laboratório da Visão, Departamento de Psicologia Experimental, Instituto de Psicologia, Universidade de São Paulo, São Paulo, Brazil
| | - Otávio Côrrea Pinho
- Laboratório da Visão, Departamento de Psicologia Experimental, Instituto de Psicologia, Universidade de São Paulo, São Paulo, Brazil
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11
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Boosting Familiarity-Based Memory Decisions in Alzheimer's Disease: The Importance of Metacognition. J Int Neuropsychol Soc 2021; 27:239-248. [PMID: 32972480 DOI: 10.1017/s1355617720000910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Recent studies in Alzheimer's disease (AD) have suggested that AD patients are not always able to rely on their feeling of familiarity to improve their memory decisions to the same extent as healthy participants. This underuse of familiarity in AD could result from a learned reinterpretation of fluency as a poor cue for memory that would prevent them to attribute a feeling of fluency to a previous encounter. The primary goal of this study was to determine whether AD patients could relearn the association between processing fluency and past exposure after being repeatedly exposed to situations where using this association improves the accuracy of their memory decisions. METHOD Thirty-nine patients with probable AD were recruited and asked to complete several recognition tests. During these tests, participants were put either in a condition where the positive contingency between fluent processing and previous encounters with an item was systematically confirmed (intervention condition) or in a condition where there was no correlation between fluency and prior exposure (control condition). The efficacy of the intervention was evaluated at three time points (baseline, posttest, and 3-month follow-up). RESULTS Our results indicated that all AD patients do not benefit to the same extent from the training. Two variables appeared to influence the likelihood that participants increase and maintain their reliance on the fluency cues after the intervention: the ability to detect the fluency manipulation and the preservation of implicit metacognitive skills. CONCLUSION These findings indicate the importance of metacognition for inferential attribution processes in memory.
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12
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Zhao A, Fang F, Li B, Chen Y, Qiu Y, Wu Y, Xu W, Deng Y. Visual Abnormalities Associate With Hippocampus in Mild Cognitive Impairment and Early Alzheimer's Disease. Front Aging Neurosci 2021; 12:597491. [PMID: 33551787 PMCID: PMC7862343 DOI: 10.3389/fnagi.2020.597491] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/28/2020] [Indexed: 01/29/2023] Open
Abstract
Background and Objective: Alzheimer's disease (AD) has been shown to affect vision in human patients and animal models. This study was conducted to explore ocular abnormalities in the primary visual pathway and their relationship with hippocampal atrophy in patients with AD and mild cognitive impairment (MCI). The aim of this study was to investigate the potential value of ocular examinations as a biomarker during the AD progression. Methods: Patients with MCI (n = 23) or AD (n = 17) and age-matched cognitively normal controls (NC; n = 19) were enrolled. Pattern visual-evoked potentials (PVEP), flash electroretinogram (FERG) recordings and optical coherence tomography (OCT) were performed for all participants. Hippocampal volumes were measured by 3T magnetic resonance imaging. Cognitive function was assessed by Mini Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog). Pearson correlation was employed to analyze the potential associations between ocular abnormalities and hippocampal volumes. Hierarchical regression models were conducted to determine associations between cognitive performances and ocular abnormalities as well as hippocampal volumes after adjusting for confounding factors including age, sex, cognitive reserve, and APOE4 status. Results: PVEP amplitude of P100 waveform was significantly decreased in AD patients compared to MCI and normal individuals. In FERG test, delayed latencies of rod response, rod cone response and 3.0 flicker time were found in cognitively impaired groups, indicating dysfunctions of both the rod and cone systems in the disease progression. OCT test revealed reduced macular retinal nerve fiber layer (m-RNFL) thickness in MCI and AD patients, which significantly correlated with brain structure of hippocampus particularly vulnerable during the progression of AD. Interestingly, P100 amplitude showed a significant association with hippocampal volumes even after adjusting confounding factors including age, sex, and cognitive reserve. Hierarchical regression analysis further demonstrated that m-RNFL thickness, as well as hippocampal volumes, significantly associated with ADAS-cog scores. Conclusion: P100 amplitude and m-RNFL thickness showed significant correlations with brain structure involved in AD-related neurodegeneration, and therefore proved to be potential indicators of brain imaging pathologies.
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Affiliation(s)
- Aonan Zhao
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Fang
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Binyin Li
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Chen
- Department of Ophthalmology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinghui Qiu
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanli Wu
- Department of Ophthalmology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Xu
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yulei Deng
- Department of Neurology, Institute of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurology, Ruijin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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13
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Mirzaei N, Shi H, Oviatt M, Doustar J, Rentsendorj A, Fuchs DT, Sheyn J, Black KL, Koronyo Y, Koronyo-Hamaoui M. Alzheimer's Retinopathy: Seeing Disease in the Eyes. Front Neurosci 2020; 14:921. [PMID: 33041751 PMCID: PMC7523471 DOI: 10.3389/fnins.2020.00921] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/10/2020] [Indexed: 01/18/2023] Open
Abstract
The neurosensory retina emerges as a prominent site of Alzheimer's disease (AD) pathology. As a CNS extension of the brain, the neuro retina is easily accessible for noninvasive, high-resolution imaging. Studies have shown that along with cognitive decline, patients with mild cognitive impairment (MCI) and AD often suffer from visual impairments, abnormal electroretinogram patterns, and circadian rhythm disturbances that can, at least in part, be attributed to retinal damage. Over a decade ago, our group identified the main pathological hallmark of AD, amyloid β-protein (Aβ) plaques, in the retina of patients including early-stage clinical cases. Subsequent histological, biochemical and in vivo retinal imaging studies in animal models and in humans corroborated these findings and further revealed other signs of AD neuropathology in the retina. Among these signs, hyperphosphorylated tau, neuronal degeneration, retinal thinning, vascular abnormalities and gliosis were documented. Further, linear correlations between the severity of retinal and brain Aβ concentrations and plaque pathology were described. More recently, extensive retinal pericyte loss along with vascular platelet-derived growth factor receptor-β deficiency were discovered in postmortem retinas of MCI and AD patients. This progressive loss was closely associated with increased retinal vascular amyloidosis and predicted cerebral amyloid angiopathy scores. These studies brought excitement to the field of retinal exploration in AD. Indeed, many questions still remain open, such as queries related to the temporal progression of AD-related pathology in the retina compared to the brain, the relations between retinal and cerebral changes and whether retinal signs can predict cognitive decline. The extent to which AD affects the retina, including the susceptibility of certain topographical regions and cell types, is currently under intense investigation. Advances in retinal amyloid imaging, hyperspectral imaging, optical coherence tomography, and OCT-angiography encourage the use of such modalities to achieve more accurate, patient- and user-friendly, noninvasive detection and monitoring of AD. In this review, we summarize the current status in the field while addressing the many unknowns regarding Alzheimer's retinopathy.
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Affiliation(s)
- Nazanin Mirzaei
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Haoshen Shi
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Mia Oviatt
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Jonah Doustar
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Altan Rentsendorj
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Dieu-Trang Fuchs
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Julia Sheyn
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Keith L. Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States
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14
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Donnelly R, Wei C, Morrison-Koechl J, Keller H. The effect of blue dishware versus white dishware on food intake and eating challenges among residents living with dementia: a crossover trial. BMC Res Notes 2020; 13:353. [PMID: 32703270 PMCID: PMC7379787 DOI: 10.1186/s13104-020-05195-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 07/17/2020] [Indexed: 11/15/2022] Open
Abstract
Objective Residents living with dementia (RLWD) often experience changes in their visual perception, which could reduce food intake. Inadequate food intake is known to cause malnutrition, which increases the risk of hospitalization, morbidity, and mortality. This study evaluated the effectiveness of using blue dishware compared to white dishware to improve food intake and mitigate eating challenges among 18 RLWD (mean age 84.6 ± 7.9 years, 72.2% female). Results A within-within person crossover design determined differences in food intake and eating challenges between blue and white dishware conditions. Five participants responded to the blue dishware and increased their average food intake by ≥ 10%. Responders were not different from non-responders in terms of demographic or health characteristics. The proportion of eating challenges experienced was not significantly different between the blue and white dishware conditions. Percent food intake was significantly greater at lunch (83.5 ± 19.0%) compared to dinner (75.8 ± 22.1%; p < 0.0001), regardless of dishware condition. However, there were no significant differences for food intake between the dishware conditions, even after matching food choices. Promoting food intake and reducing eating challenges in RLWD likely needs multi-component interventions targeting meal quality, meal access, and mealtime experience. Trial registration ClincialTrials.gov Identifier: NCT04298788. Retrospectively registered: 6 March 2020, https://clinicaltrials.gov/ct2/show/NCT04298788?term=NCT04298788&draw=2&rank=1.
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Affiliation(s)
- Rachael Donnelly
- University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | - Cindy Wei
- University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
| | | | - Heather Keller
- University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada. .,Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON, N2J 0E2, Canada.
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15
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Davidson PSR, Vidjen P, Trincao-Batra S, Collin CA. Older Adults' Lure Discrimination Difficulties on the Mnemonic Similarity Task Are Significantly Correlated With Their Visual Perception. J Gerontol B Psychol Sci Soc Sci 2020; 74:1298-1307. [PMID: 30407604 DOI: 10.1093/geronb/gby130] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Pattern separation in memory encoding entails creating and storing distinct, detailed representations to facilitate storage and retrieval. The Mnemonic Similarity Task (MST; Stark, S. M., Yassa, M. A., Lacy, J. W., & Stark, C. E. [2013]. A task to assess behavioral pattern separation [BPS] in humans: Data from healthy aging and mild cognitive impairment. Neuropsychologia, 51, 2442-2449) has been used to argue that normal aging leads to pattern separation decline. We sought to replicate previous reports of age-related difficulty on this behavioral pattern separation estimate and to examine its neuropsychological correlates, specifically long-term memory function, executive function, and visual perception. METHODS We administered an object version of the MST to 31 young adults and 38 older adults. It involved a single-probe recognition memory test in which some of the originally studied objects had been replaced with perceptually similar lures, and participants had to identify each as old, a lure, or new. RESULTS Despite their corrected item recognition scores being superior to those of the young adults, the older adults had significantly greater difficulty than the young in discriminating the similar-looking lures from the original items. Interestingly, this lure discrimination difficulty was significantly correlated with visual perception rather than with long-term memory or executive function. DISCUSSION These results suggest that although adult age differences on the MST are reliable, care should be taken to separate perceptual from memory discrimination difficulties as the reason.
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Affiliation(s)
- Patrick S R Davidson
- School of Psychology, University of Ottawa, Ontario, Canada.,Bruyère Research Institute, University of Ottawa, Ontario, Canada.,Canadian Partnership for Stroke Recovery, University of Ottawa, Ontario, Canada
| | - Petar Vidjen
- School of Psychology, University of Ottawa, Ontario, Canada
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16
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Singh AK, Verma S. Use of ocular biomarkers as a potential tool for early diagnosis of Alzheimer's disease. Indian J Ophthalmol 2020; 68:555-561. [PMID: 32174567 PMCID: PMC7210832 DOI: 10.4103/ijo.ijo_999_19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/10/2019] [Accepted: 10/26/2019] [Indexed: 02/05/2023] Open
Abstract
Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide which unfortunately has no known effective cure to date. Despite many clinical trials indicating the effectiveness of preclinical treatment, a sensitive tool for screening of AD is yet to be developed. Due to multiple similarities between ocular and the brain tissue, the eye is being explored by researchers for this purpose, with utmost attention focused on the retinal tissue. Besides visual functional impairment, neuronal degeneration and apoptosis, retinal nerve fiber degeneration, increase in the cup-to-disc ratio, and retinal vascular thinning and tortuosity are the changes observed in the retinal tissue which are related to AD. Studies have shown that targeting these changes in the retina is an effective way of reducing the degeneration of retinal neuronal tissue. Similar mechanisms of neurodegeneration have been demonstrated in the brain and the eyes of AD patients. Multiple studies are underway to investigate the potential of diagnosing AD and detection of amyloid-β (Aβ) levels in the retinal tissue. Since the tissues in the anterior segment of the eye are more accessible for in vivo imaging and examination, they have more potential as screening biomarkers. This article provides a concise review of available literature on the ocular biomarkers in anterior and posterior segments of the eye including the cornea, aqueous humour (AH), crystalline lens, and retina in AD. This review will also highlight the newer technological tools available for the detection of potential biomarkers in the eye for early diagnosis of AD.
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Affiliation(s)
- Ajay K Singh
- Consultant and Anterior Segment Surgeon, Department of Ophthalmology, Asian Institute of Medical Sciences, Faridabad, Haryana, India
| | - Shilpa Verma
- WNS Global Services Pvt. Ltd., Gurugram, Haryana, India
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17
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Risacher SL, WuDunn D, Tallman EF, West JD, Gao S, Farlow MR, Brosch JR, Apostolova LG, Saykin AJ. Visual contrast sensitivity is associated with the presence of cerebral amyloid and tau deposition. Brain Commun 2020; 2:fcaa019. [PMID: 32309804 PMCID: PMC7151662 DOI: 10.1093/braincomms/fcaa019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/07/2019] [Accepted: 02/20/2020] [Indexed: 11/25/2022] Open
Abstract
Visual deficits are common in neurodegenerative diseases including Alzheimer’s disease. We sought to determine the association between visual contrast sensitivity and neuroimaging measures of Alzheimer’s disease-related pathophysiology, including cerebral amyloid and tau deposition and neurodegeneration. A total of 74 participants (7 Alzheimer’s disease, 16 mild cognitive impairment, 20 subjective cognitive decline, 31 cognitively normal older adults) underwent the frequency doubling technology 24-2 examination, a structural MRI scan and amyloid PET imaging for the assessment of visual contrast sensitivity. Of these participants, 46 participants (2 Alzheimer’s disease, 9 mild cognitive impairment, 12 subjective cognitive decline, 23 cognitively normal older adults) also underwent tau PET imaging with [18F]flortaucipir. The relationships between visual contrast sensitivity and cerebral amyloid and tau, as well as neurodegeneration, were assessed using partial Pearson correlations, covaried for age, sex and race and ethnicity. Voxel-wise associations were also evaluated for amyloid and tau. The ability of visual contrast sensitivity to predict amyloid and tau positivity were assessed using forward conditional logistic regression and receiver operating curve analysis. All analyses first were done in the full sample and then in the non-demented at-risk individuals (subjective cognitive decline and mild cognitive impairment) only. Significant associations between visual contrast sensitivity and regional amyloid and tau deposition were observed across the full sample and within subjective cognitive decline and mild cognitive impairment only. Voxel-wise analysis demonstrated strong associations of visual contrast sensitivity with amyloid and tau, primarily in temporal, parietal and occipital brain regions. Finally, visual contrast sensitivity accurately predicted amyloid and tau positivity. Alterations in visual contrast sensitivity were related to cerebral deposition of amyloid and tau, suggesting that this measure may be a good biomarker for detecting Alzheimer’s disease-related pathophysiology. Future studies in larger patient samples are needed, but these findings support the power of these measures of visual contrast sensitivity as a potential novel, inexpensive and easy-to-administer biomarker for Alzheimer’s disease-related pathology in older adults at risk for cognitive decline.
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Affiliation(s)
- Shannon L Risacher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Darrell WuDunn
- Department of Ophthalmology, UF College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Eileen F Tallman
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John D West
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sujuan Gao
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Martin R Farlow
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jared R Brosch
- Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Liana G Apostolova
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA.,Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew J Saykin
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana Alzheimer Disease Center, Indiana University School of Medicine, Indianapolis, IN, USA
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18
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Ramzaoui H, Faure S, Spotorno S. Alzheimer's Disease, Visual Search, and Instrumental Activities of Daily Living: A Review and a New Perspective on Attention and Eye Movements. J Alzheimers Dis 2019; 66:901-925. [PMID: 30400086 DOI: 10.3233/jad-180043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Many instrumental activities of daily living (IADLs), like cooking and managing finances and medications, involve finding efficiently and in a timely manner one or several objects within complex environments. They may thus be disrupted by visual search deficits. These deficits, present in Alzheimer's disease (AD) from its early stages, arise from impairments in multiple attentional and memory mechanisms. A growing body of research on visual search in AD has examined several factors underlying search impairments in simple arrays. Little is known about how AD patients search in real-world scenes and in real settings, and about how such impairments affect patients' functional autonomy. Here, we review studies on visuospatial attention and visual search in AD. We then consider why analysis of patients' oculomotor behavior is promising to improve understanding of the specific search deficits in AD, and of their role in impairing IADL performance. We also highlight why paradigms developed in research on real-world scenes and real settings in healthy individuals are valuable to investigate visual search in AD. Finally, we indicate future research directions that may offer new insights to improve visual search abilities and autonomy in AD patients.
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Affiliation(s)
- Hanane Ramzaoui
- Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales, Université Côte d'Azur, France
| | - Sylvane Faure
- Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales, Université Côte d'Azur, France
| | - Sara Spotorno
- School of Psychology, University of Aberdeen, UK.,Institute of Neuroscience and Psychology, University of Glasgow, UK
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19
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Salobrar-García E, de Hoz R, Ramírez AI, López-Cuenca I, Rojas P, Vazirani R, Amarante C, Yubero R, Gil P, Pinazo-Durán MD, Salazar JJ, Ramírez JM. Changes in visual function and retinal structure in the progression of Alzheimer's disease. PLoS One 2019; 14:e0220535. [PMID: 31415594 PMCID: PMC6695171 DOI: 10.1371/journal.pone.0220535] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Alzheimer's Disease (AD) can cause degeneration in the retina and optic nerve either directly, as a result of amyloid beta deposits, or secondarily, as a result of the degradation of the visual cortex. These effects raise the possibility that tracking ophthalmologic changes in the retina can be used to assess neurodegeneration in AD. This study aimed to detect retinal changes and associated functional changes in three groups of patients consisting of AD patients with mild disease, AD patients with moderate disease and healthy controls by using non-invasive psychophysical ophthalmological tests and optical coherence tomography (OCT). METHODS We included 39 patients with mild AD, 21 patients with moderate AD and 40 age-matched healthy controls. Both patients and controls were ophthalmologically healthy. Visual acuity, contrast sensitivity, colour perception, visual integration, and choroidal thicknesses were measured. In addition, OCT and OCT angiography (OCTA) were applied. FINDINGS Visual acuity, contrast sensitivity, colour perception, and visual integration were significantly lower in AD patients than in healthy controls. Compared to healthy controls, macular thinning in the central region was significant in the mild AD patients, while macular thickening in the central region was found in the moderate AD group. The analysis of macular layers revealed significant thinning of the retinal nerve fibre layer, the ganglion cell layer and the outer plexiform layer in AD patients relative to controls. Conversely, significant thickening was observed in the outer nuclear layer of the patients. However, mild AD was associated with significant thinning of the subfovea and the nasal and inferior sectors of the choroid. Significant superonasal and inferotemporal peripapillary thinning was observed in patients with moderate disease. CONCLUSIONS The first changes in the mild AD patients appear in the psychophysical tests and in the central macula with a decrease in the central retinal thickness. When there was a disease progression to moderate AD, psychophysical tests remained stable with respect to the decrease in mild AD, but significant thinning in the peripapillary retina and thickening in the central retina appeared. The presence of AD is best indicated based on contrast sensitivity.
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Affiliation(s)
- Elena Salobrar-García
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa de Hoz
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana I. Ramírez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - Inés López-Cuenca
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Pilar Rojas
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Servicio de Oftalmología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ravi Vazirani
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Carla Amarante
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Raquel Yubero
- Unidad de Memoria, Servicio de Geriatría, Hospital Clínico San Carlos, Madrid, Spain
| | - Pedro Gil
- Unidad de Memoria, Servicio de Geriatría, Hospital Clínico San Carlos, Madrid, Spain
| | - María D. Pinazo-Durán
- Unidad de Investigación Oftalmológica «Santiago Grisolia»/FISABIO, Valencia, Spain
- Grupo de Oftalmobiología Celular y Molecular, Facultad de Medicina y Odontología, Universidad de Valencia, Valencia, Spain
| | - Juan J. Salazar
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, Universidad Complutense de Madrid, Madrid, Spain
| | - José M. Ramírez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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20
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Davies-Kershaw HR, Hackett RA, Cadar D, Herbert A, Orrell M, Steptoe A. Vision Impairment and Risk of Dementia: Findings from the English Longitudinal Study of Ageing. J Am Geriatr Soc 2018; 66:1823-1829. [PMID: 30098017 DOI: 10.1111/jgs.15456] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/18/2018] [Accepted: 04/21/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To determine whether vision impairment is independently associated cross-sectionally and longitudinally with dementia. DESIGN Retrospective cohort study. SETTING English Longitudinal Study of Ageing. PARTICIPANTS Individuals aged 50 and older MEASUREMENTS: Cross-sectional association between self-rated vision (poor or blind, moderate, normal) and dementia was analyzed, adjusting for potential confounders (sex, wealth, education, cardiovascular risk factors) using multivariable logistic regression. We also modelled the adjusted longitudinal association between vision impairment and dementia over an average of 11 years of follow-up using Cox proportional hazards regression for individuals aged 50 to 69 and those aged 70 and older. RESULTS After adjustment for confounders, participants who rated their vision as moderate were 2.0 (95% confidence interval (CI)=1.4-3.1) times as likely as those with normal vision to have dementia, and those who rated their vision as poor were 4.0 (95% CI=2.6-6.1) times as likely. Longitudinally, individuals aged 50 to 69 who rated their vision as moderate (1.8, 95% CI=1.0-3.0) or poor (3.6, 95% CI=1.1-11.8) were at greater risk of developing dementia than those who rated their vision as normal. There was no significant difference in risk in those aged 70 and older. CONCLUSION Our study confirms and extends findings from other countries, demonstrating cross-sectional associations between moderate and poor self-rated vision and dementia in England in all participants aged 50 and older and longitudinally over an 11-year period in those aged 50 to 69. These results help establish vision loss as a risk factor for dementia, although it is unclear why. Research is needed to determine whether screening and treatment for vision loss may slow cognitive decline.
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Affiliation(s)
- Hilary R Davies-Kershaw
- Department of Behavioural Science and Health, University College London, London, United Kingdom.,School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Ruth A Hackett
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Dorina Cadar
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Annie Herbert
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Martin Orrell
- School of Health Sciences, University of Surrey, Guildford, United Kingdom.,Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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21
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Colligris P, Perez de Lara MJ, Colligris B, Pintor J. Ocular Manifestations of Alzheimer's and Other Neurodegenerative Diseases: The Prospect of the Eye as a Tool for the Early Diagnosis of Alzheimer's Disease. J Ophthalmol 2018; 2018:8538573. [PMID: 30151279 PMCID: PMC6091327 DOI: 10.1155/2018/8538573] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/07/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022] Open
Abstract
Dementia, including Alzheimer's disease (AD), is a major disorder, leading to several ocular manifestations amongst the elderly population. These visual disorders may be due to retinal nerve degenerative changes, including nerve fibre layer thinning, degeneration of retinal ganglion cells, and changes to vascular parameters. There is no cure for Alzheimer's, but medicines can slow down the development of many of the classic symptoms, such as loss of memory and communication skills, mood swings, and depression. The disease diagnosis is difficult, and it is only possible through PET scans of the brain, detecting evidence of the accumulation of amyloid and tau. PET is expensive and invasive, requiring the injection of radioactive tracers, which bind with these proteins and glow during scanning. Recently, scientists developed promising eye-scan techniques that may detect Alzheimer's disease at its earliest stage, before major symptoms appear, leading to improved management of the disease symptoms. In this review, we are discussing the visual abnormalities of Alzheimer's and other neurodegenerative diseases, focused on ocular functional-visual-structural biomarkers, retinal pathology, and potential novel diagnostic tools.
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Affiliation(s)
- Pade Colligris
- Universidad Alfonso X, Madrid, Spain
- Ocupharm Diagnostics SL, Madrid, Spain
| | | | - Basilio Colligris
- Ocupharm Diagnostics SL, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Jesus Pintor
- Ocupharm Diagnostics SL, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
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22
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Ward ME, Gelfand JM, Lui LY, Ou Y, Green AJ, Stone K, Pedula KL, Cummings SR, Yaffe K. Reduced contrast sensitivity among older women is associated with increased risk of cognitive impairment. Ann Neurol 2018; 83:730-738. [PMID: 29518257 PMCID: PMC5947874 DOI: 10.1002/ana.25196] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/05/2018] [Accepted: 03/07/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Several cross-sectional studies have reported an association between visual contrast sensitivity (a functional measure of low contrast vision) and poor cognitive performance or dementia, but no studies have investigated this association prospectively in a population-based cohort with final adjudication of mild cognitive impairment (MCI)/dementia. METHODS In a prospective, community-based study of aging women (Study of Osteoporotic Fractures), we analyzed whether visual contrast sensitivity was associated with increased risk of MCI or dementia and/or worse performance on various cognitive tests assessed 10 years later. Contrast sensitivity was assessed at baseline in each eye using a VISTECH VCTS 6500 wall chart. MCI/dementia was adjudicated by an expert panel. Multivariate logistic and linear regression models were analyzed. RESULTS Of 1,352 white (88.2%) and African American (11.8%) women with a mean age of 77.7 years (standard deviation = 3.3), 536 (39.6%) went on to develop MCI/dementia over 10 years. MCI/dementia risk was more than doubled (odds ratio = 2.16, 95% confidence interval = 1.58-2.96) in women with the lowest quartile of contrast sensitivity compared to the highest (p < 0.0001 for the linear trend). Reduced baseline contrast sensitivity was also associated with lower performance on several cognitive measures assessed 10 years later. INTERPRETATION Among older women, reduced contrast sensitivity is associated with a greater risk of MCI/dementia. These findings suggest that visual system neurodegeneration or dysfunction may parallel or precede dementia-related cortical or subcortical degeneration, and that contrast sensitivity testing may be useful in identifying aging adults at high risk for dementia. Ann Neurol 2018;83:730-738.
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Affiliation(s)
- Michael E. Ward
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Jeffrey M. Gelfand
- Division of Neuroinflammation and Glial Biology, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, CA
| | - Li-Yung Lui
- Research Institute, California Pacific Medical Center, San Francisco, CA
| | - Yvonne Ou
- Department of Ophthalmology, University of California San Francisco, CA
| | - Ari J. Green
- Division of Neuroinflammation and Glial Biology, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, CA
- Department of Ophthalmology, University of California San Francisco, CA
| | - Katie Stone
- Research Institute, California Pacific Medical Center, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Kathryn L. Pedula
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Steven R. Cummings
- Department of Medicine, University of California, San Francisco, California and California Pacific Medical Center, San Francisco, CA
| | - Kristine Yaffe
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California
- Departments of Psychiatry and Epidemiology, University of California, San Francisco and the San Francisco VA Medical Center, San Francisco, California
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23
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Chidlow G, Wood JPM, Manavis J, Finnie J, Casson RJ. Investigations into Retinal Pathology in the Early Stages of a Mouse Model of Alzheimer's Disease. J Alzheimers Dis 2018; 56:655-675. [PMID: 28035930 PMCID: PMC5271427 DOI: 10.3233/jad-160823] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
There is increasing recognition that visual performance is impaired in early stages of Alzheimer’s disease (AD); however, no consensus exists as to the mechanisms underlying this visual dysfunction, in particular regarding the timing, nature, and extent of retinal versus cortical pathology. If retinal pathology presents sufficiently early, it offers great potential as a source of novel biomarkers for disease diagnosis. The current project utilized an array of immunochemical and molecular tools to perform a characterization of retinal pathology in the early stages of disease progression using a well-validated mouse model of AD (APPSWE/PS1ΔE9). Analytical endpoints included examination of aberrant amyloid and tau in the retina, quantification of any neuronal degeneration, delineation of cellular stress responses of neurons and particularly glial cells, and investigation of oxidative stress. Brain, eyes, and optic nerves were taken from transgenic and wild-type mice of 3 to 12 months of age and processed for immunohistochemistry, qPCR, or western immunoblotting. The results revealed robust expression of the human APP transgene in the retinas of transgenic mice, but a lack of identifiable retinal pathology during the period when amyloid deposits were dramatically escalating in the brain. We were unable to demonstrate the presence of amyloid plaques, dystrophic neurites, neuronal loss, macro- or micro-gliosis, aberrant cell cycle re-entry, oxidative stress, tau hyperphosphorylation, or upregulations of proinflammatory cytokines or stress signaling molecules in the retina. The overall results do not support the hypothesis that detectable retinal pathology occurs concurrently with escalating amyloid deposition in the brains of APPSWE/PS1ΔE9 mice.
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Affiliation(s)
- Glyn Chidlow
- Ophthalmic Research Laboratories, Hanson Institute Centre for Neurological Diseases, Adelaide, SA, Australia.,Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, SA, Australia
| | - John P M Wood
- Ophthalmic Research Laboratories, Hanson Institute Centre for Neurological Diseases, Adelaide, SA, Australia.,Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Jim Manavis
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - John Finnie
- School of Medicine, University of Adelaide, Adelaide, SA, Australia.,SA Pathology, Hanson Institute Centre for Neurological Diseases, Adelaide, SA, Australia
| | - Robert J Casson
- Ophthalmic Research Laboratories, Hanson Institute Centre for Neurological Diseases, Adelaide, SA, Australia.,Department of Ophthalmology and Visual Sciences, University of Adelaide, Adelaide, SA, Australia
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24
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Porter G, Wattam-Bell J, Bayer A, Haworth J, Braddick O, Atkinson J, Tales A. Different trajectories of decline for global form and global motion processing in aging, mild cognitive impairment and Alzheimer's disease. Neurobiol Aging 2017; 56:17-24. [PMID: 28482210 DOI: 10.1016/j.neurobiolaging.2017.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 02/06/2017] [Accepted: 03/05/2017] [Indexed: 12/23/2022]
Abstract
The visual processing of complex motion is impaired in Alzheimer's disease (AD). However, it is unclear whether these impairments are biased toward the motion stream or part of a general disruption of global visual processing, given some reports of impaired static form processing in AD. Here, for the first time, we directly compared the relative preservation of motion and form systems in AD, mild cognitive impairment, and healthy aging, by measuring coherence thresholds for well-established global rotational motion and static form stimuli known to be of equivalent complexity. Our data confirm a marked motion-processing deficit specific to some AD patients, and greater than any form-processing deficit for this group. In parallel, we identified a more gradual decline in static form recognition, with thresholds raised in mild cognitive impairment patients and slightly further in the AD group compared with controls. We conclude that complex motion processing is more vulnerable to decline in dementia than complex form processing, perhaps owing to greater reliance on long-range neural connections heavily targeted by AD pathology.
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Affiliation(s)
- Gillian Porter
- School of Psychology, University of Bristol, Bristol, UK.
| | - John Wattam-Bell
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Antony Bayer
- Department of Geriatric Medicine, Cardiff University, Cardiff, UK
| | - Judy Haworth
- South Glos Memory Services, Avon and Wiltshire Mental Health Partnership, Bristol, UK
| | - Oliver Braddick
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Janette Atkinson
- Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Andrea Tales
- School of Psychology, University of Bristol, Bristol, UK; Department of Psychology, University of Swansea, Swansea, UK
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25
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Kaubrys G, Bukina V, Bingelytė I, Taluntis V. Perception of Fechner Illusory Colors in Alzheimer Disease Patients. Med Sci Monit 2016; 22:4670-4678. [PMID: 27902677 PMCID: PMC5134362 DOI: 10.12659/msm.902061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 11/22/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Alzheimer disease (AD) primarily affects cognition. A variety of visual disorders was established in AD. Fechner illusory colors are produced by a rotating disk with a black and white pattern. The purpose of our research was to explore the perception of illusory colors in AD. MATERIAL AND METHODS W recruited 40 AD patients (MMSE ≥14) and 40 normal controls (CG group) matched by age, education, gender in this prospective, cross-sectional, case-control study. An achromatic Benham's disk attached to a device to control the speed and direction of rotation was used to produce illusory colors. Primary, secondary, and tertiary RGB system colors were used for matching of illusory and physical colors. RESULTS Subjects in the AD group perceived less illusory colors in 5 arcs (p<0.05) of the 8 arcs assessed. The biggest difference was found between AD and CG groups for pure blue (χ²=26.87, p<0.001 clockwise, χ²=22.75, p<0.001 counter-clockwise). Groups did not differ in perception of pure yellow opponent colors (p>0.05). Mixed colors of the blue-yellow axis were perceived less often in AD, but more frequently than pure blue (#0000FF). The sequence of colors on Benham's disk followed a complex pattern, different from the order of physical spectral colors and opponent processes-based colors. CONCLUSIONS AD patients retained reduced perception of illusory colors. The perception of pure blue illusory color is almost absent in AD. The asymmetrical shift to the yellow opponent is observed in AD with red prevailing over green constituent. This may indicate cortical rather than retinal impairment.
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Affiliation(s)
- Gintaras Kaubrys
- Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Lithuania
| | - Vera Bukina
- Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Lithuania
| | - Ieva Bingelytė
- Department of Internal Diseases, Family Medicine and Oncology, Center of Family Medicine, Vilnius University, Vilnius, Lithuania
| | - Vladas Taluntis
- Department of Electronic Systems, Faculty of Electronics, Vilnius Gediminas Technical University, Vilnius, Lithuania
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26
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Javaid FZ, Brenton J, Guo L, Cordeiro MF. Visual and Ocular Manifestations of Alzheimer's Disease and Their Use as Biomarkers for Diagnosis and Progression. Front Neurol 2016; 7:55. [PMID: 27148157 PMCID: PMC4836138 DOI: 10.3389/fneur.2016.00055] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/29/2016] [Indexed: 12/21/2022] Open
Abstract
Alzheimer's disease (AD) is the most common form of dementia affecting the growing aging population today, with prevalence expected to rise over the next 35 years. Clinically, patients exhibit a progressive decline in cognition, memory, and social functioning due to deposition of amyloid β (Aβ) protein and intracellular hyperphosphorylated tau protein. These pathological hallmarks of AD are measured either through neuroimaging, cerebrospinal fluid analysis, or diagnosed post-mortem. Importantly, neuropathological progression occurs in the eye as well as the brain, and multiple visual changes have been noted in both human and animal models of AD. The eye offers itself as a transparent medium to cerebral pathology and has thus potentiated the development of ocular biomarkers for AD. The use of non-invasive screening, such as retinal imaging and visual testing, may enable earlier diagnosis in the clinical setting, minimizing invasive and expensive investigations. It also potentially improves disease management and quality of life for AD patients, as an earlier diagnosis allows initiation of medication and treatment. In this review, we explore the evidence surrounding ocular changes in AD and consider the biomarkers currently in development for early diagnosis.
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Affiliation(s)
- Fatimah Zara Javaid
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Jonathan Brenton
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Li Guo
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
| | - Maria F. Cordeiro
- Glaucoma and Retinal Degeneration Research Group, Visual Neurosciences, UCL Institute of Ophthalmology, London, UK
- Western Eye Hospital, Imperial College Healthcare NHS Trust, London, UK
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Abstract
Glaucoma is a group of optic neuropathies that is more prevalent among the elderly population and commonly associates with comorbidities, including mental disorders in that population. This article reviews the relationship between glaucoma and mental disorders. In it, we discuss the coexistence of glaucoma and mental illnesses, including Alzheimer's disease, depression, and personality disorder. We also focus on the proper treatment approaches for glaucoma patients with mental comorbidity and poor treatment adherence. We summarize some cautiously recommended psychotherapeutic medications, while also discussing the psychologically adverse effects of antiglaucoma medications.
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28
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Salobrar-Garcia E, de Hoz R, Rojas B, Ramirez AI, Salazar JJ, Yubero R, Gil P, Triviño A, Ramirez JM. Ophthalmologic Psychophysical Tests Support OCT Findings in Mild Alzheimer's Disease. J Ophthalmol 2015; 2015:736949. [PMID: 26106485 PMCID: PMC4461784 DOI: 10.1155/2015/736949] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/20/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To analyze in mild Alzheimer's disease (MAD) patients, GDS-4 (Reisberg Scale), whether or not some psychophysical tests (PTs) support OCT macular findings in the same group of MAD patients reported previously. Methods. Twenty-three MAD patients and 28 age-matched control subjects with mean Mini Mental State Examination of 23.3 and 28.2, respectively, with no ocular disease or systemic disorders affecting vision were included. Best-corrected visual acuity (VA), contrast sensitivity (CS) (3, 6, 12, and 18 cpds), color perception (CP), and perception digital test (PDT) were tested in one eye of each patient. Results. In comparison with the controls, MAD patients presented (i) a significant decrease in VA, PDT, and CS for all spatial frequencies analyzed, especially the higher ones, and (ii) a significant increase in unspecific errors on the blue axis (P < 0.05 in all instances). In MAD patients, a wide aROC curve was plotted in all PTs. Conclusions. In MAD, CS, VA, and the tritan axis in CP were impaired. The PTs with the greatest predictive value are the higher spatial frequencies in CS and tritan unspecific errors in CP. PT abnormalities are consistent with the structural findings reported in the same MAD patients using OCT.
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Affiliation(s)
- Elena Salobrar-Garcia
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa de Hoz
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Facultad de Óptica, Universidad Complutense de Madrid, Madrid, Spain
| | - Blanca Rojas
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Ana I. Ramirez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Facultad de Óptica, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan J. Salazar
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Facultad de Óptica, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Pedro Gil
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
- Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto Triviño
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - José M. Ramirez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Abstract
Purpose
– Government guidelines promote service user consultation without providing extensive advice on people in later dementia. “Seen as too difficult to involve, they are effectively excluded from […] influenc(ing) service provision”, especially institutional care residents (Clare and Cox, 2003, p. 936). This hard-to-reach group presents methodological challenges. The purpose of this paper is to explore innovative approaches, offering even those with fragmented or lost speech the opportunity to contribute to decisions about their care.
Design/methodology/approach
– This specialist dementia home consultation included staff and every resident, irrespective of the level of their communication impairment. Consultation on potential colour schemes took the form of a ballot. Staff helped develop an unpatronising, person-centred approach. Visual aids supported communication, de-emphasising the spoken word and promoting inclusion.
Findings
– The majority of residents appeared to express an opinion on the potential decor. Others chose a colour while not necessarily grasping the context. The approach engaged all except four.
Research limitations/implications
– Even people with moderate/advanced dementia may be enabled to participate in consultation. Further research needs to refine methodology to include everyone and clarify the interpretation of results.
Practical implications
– Service providers may widen their expectations of inclusivity in consultation exercises.
Originality/value
– This consultation is important to researchers and practitioners because it explores ways of communicating, which avoid privileging the spoken word, revealing seldom-recognised abilities in people with moderate/advanced dementia.
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30
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Lawrence V, Murray J. Promoting independent living among people with dementia and sight loss. ACTA ACUST UNITED AC 2013. [DOI: 10.1179/csm.2009.3.3.261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Alzheimer's disease: screening biomarkers using frequency doubling technology visual field. ISRN NEUROLOGY 2013; 2013:989583. [PMID: 24187629 PMCID: PMC3800662 DOI: 10.1155/2013/989583] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/06/2013] [Indexed: 11/26/2022]
Abstract
This study was to investigate the feasibility of frequency doubling technology (FDT) visual field testing in Alzheimer's disease (AD) in order to identify early biomarkers of AD in patients already diagnosed with AD and compare the findings to participants not having Alzheimer's disease. This biomarker would be useful in a battery of tests for the early identification of those with AD. It was not the intent to correlate the visual system biomarker with severity of disease, but to determine if the biomarker was present in pass or fail screening criteria. The study showed with very strong significance that the FDT can identify biomarkers of those with AD compared to an age-matched population that does not have AD. FDT is a simple test to take and administer and has been used to screen for eye and retinal diseases such as glaucoma, retinal macular degeneration, and diabetic retinopathy. The results obtained in the FDT readout are analyzed and compared to the age normative database within the system. The FDT ability to screen for AD biomarker in the visual system was significant in those with AD compared to the controls, and the deficits were not related to any ocular pathology.
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Chang LYL, Lowe J, Ardiles A, Lim J, Grey AC, Robertson K, Danesh-Meyer H, Palacios AG, Acosta ML. Alzheimer's disease in the human eye. Clinical tests that identify ocular and visual information processing deficit as biomarkers. Alzheimers Dement 2013; 10:251-61. [PMID: 24011928 DOI: 10.1016/j.jalz.2013.06.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/21/2013] [Accepted: 06/03/2013] [Indexed: 12/19/2022]
Abstract
Alzheimer's disease (AD) is the most common form of dementia with progressive deterioration of memory and cognition. Complaints related to vision are common among AD patients. Several changes in the retina, lens, and in the vasculature have been noted in the AD eye that may be the cause of visual symptoms experienced by the AD patient. Anatomical changes have been detected within the eye before signs of cognitive impairment and memory loss are apparent. Unlike the brain, the eye is a unique organ that can be visualized noninvasively at the cellular level because of its transparent nature, which allows for inexpensive testing of biomarkers in a clinical setting. In this review, we have searched for candidate biomarkers that could enable diagnosis of AD, covering ocular neurodegeneration associated with functional tests. We explore the evidence that suggests that inexpensive, noninvasive clinical tests could be used to detect AD ocular biomarkers.
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Affiliation(s)
- Lily Y L Chang
- Department of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand; New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer Lowe
- Department of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand
| | - Alvaro Ardiles
- Centro Interdisciplinario de Neurociencia de Valparaíso, Universidad de Valparaíso, Valparaíso, Chile
| | - Julie Lim
- Department of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand; New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Angus C Grey
- Department of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand; New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Ken Robertson
- Department of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand; New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Helen Danesh-Meyer
- New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand; Department of Ophthalmology, The University of Auckland, Auckland, New Zealand
| | - Adrian G Palacios
- Centro Interdisciplinario de Neurociencia de Valparaíso, Universidad de Valparaíso, Valparaíso, Chile
| | - Monica L Acosta
- Department of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand; New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand.
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Abstract
Visual spatial impairment is often an early symptom of neurodegenerative disease; however, this multi-faceted domain of cognition is not well-assessed by most typical dementia evaluations. Neurodegenerative diseases cause circumscribed atrophy in distinct neural networks, and accordingly, they impact visual spatial cognition in different and characteristic ways. Anatomically-focused visual spatial assessment can assist the clinician in making an early and accurate diagnosis. This article will review the literature on visual spatial cognition in neurodegenerative disease clinical syndromes, and where research is available, by neuropathologic diagnoses. Visual spatial cognition will be organized primarily according to the following schemes: bottom-up/top-down processing, dorsal/ventral stream processing, and egocentric/allocentric frames of reference.
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Affiliation(s)
- Katherine L Possin
- Department of Neurology, University of California, San Francisco, CA, USA.
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Swindell WR, Ensrud KE, Cawthon PM, Cauley JA, Cummings SR, Miller RA. Indicators of "healthy aging" in older women (65-69 years of age). A data-mining approach based on prediction of long-term survival. BMC Geriatr 2010; 10:55. [PMID: 20716351 PMCID: PMC2936300 DOI: 10.1186/1471-2318-10-55] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 08/17/2010] [Indexed: 12/16/2022] Open
Abstract
Background Prediction of long-term survival in healthy adults requires recognition of features that serve as early indicators of successful aging. The aims of this study were to identify predictors of long-term survival in older women and to develop a multivariable model based upon longitudinal data from the Study of Osteoporotic Fractures (SOF). Methods We considered only the youngest subjects (n = 4,097) enrolled in the SOF cohort (65 to 69 years of age) and excluded older SOF subjects more likely to exhibit a "frail" phenotype. A total of 377 phenotypic measures were screened to determine which were of most value for prediction of long-term (19-year) survival. Prognostic capacity of individual predictors, and combinations of predictors, was evaluated using a cross-validation criterion with prediction accuracy assessed according to time-specific AUC statistics. Results Visual contrast sensitivity score was among the top 5 individual predictors relative to all 377 variables evaluated (mean AUC = 0.570). A 13-variable model with strong predictive performance was generated using a forward search strategy (mean AUC = 0.673). Variables within this model included a measure of physical function, smoking and diabetes status, self-reported health, contrast sensitivity, and functional status indices reflecting cumulative number of daily living impairments (HR ≥ 0.879 or RH ≤ 1.131; P < 0.001). We evaluated this model and show that it predicts long-term survival among subjects assigned differing causes of death (e.g., cancer, cardiovascular disease; P < 0.01). For an average follow-up time of 20 years, output from the model was associated with multiple outcomes among survivors, such as tests of cognitive function, geriatric depression, number of daily living impairments and grip strength (P < 0.03). Conclusions The multivariate model we developed characterizes a "healthy aging" phenotype based upon an integration of measures that together reflect multiple dimensions of an aging adult (65-69 years of age). Age-sensitive components of this model may be of value as biomarkers in human studies that evaluate anti-aging interventions. Our methodology could be applied to data from other longitudinal cohorts to generalize these findings, identify additional predictors of long-term survival, and to further develop the "healthy aging" concept.
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Affiliation(s)
- William R Swindell
- Department of Pathology, University of Michigan, School of Medicine, Ann Arbor, MI 48109-2200, USA.
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Sartucci F, Borghetti D, Bocci T, Murri L, Orsini P, Porciatti V, Origlia N, Domenici L. Dysfunction of the magnocellular stream in Alzheimer's disease evaluated by pattern electroretinograms and visual evoked potentials. Brain Res Bull 2010; 82:169-76. [PMID: 20385208 DOI: 10.1016/j.brainresbull.2010.04.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2009] [Revised: 03/07/2010] [Accepted: 04/01/2010] [Indexed: 01/26/2023]
Abstract
BACKGROUND Visuo-spatial disturbances could represent a clinical feature of early stage Alzheimer's disease (AD). The magnocellular (M) pathway has anatomo-physiological characteristic which make it more suitable for detecting form, motion and depth compared with parvocellular one (P). OBJECTIVE Aim of our study was to evaluate specific visual subsystem involvement in a group of AD patients, recording isoluminant chromatic and luminance pattern electroretinograms and pattern visual evoked potentials. MATERIAL AND METHODS data were obtained from 15 AD patients (9 females and 6 males, mean age+/-1SD: 77.6+/-4.01 years) not yet undergoing any treatment, and from 10 age-matched healthy controls. Diagnosis of probable AD was clinically and neuroradiologically established. PERGs were recorded monocularly in response to equiluminant red-green (R-G), blue-yellow (B-Y) and luminance yellow-black (Y-Bk) horizontal square gratings of 0.3c/deg and 90% contrast, reversed at 1Hz. VEPs were recorded in response to full-field (14 deg) equiluminant chromatic R-G, B-Y and luminance Y-Bk sinusoidal gratings of 2c/deg, presented in onset (300ms)-offset (700ms) mode, at the contrast levels of 90%. RESULTS All data were retrieved in terms of peak-amplitude and latency and assessed using the Student's t-test for paired data. Temporal differences of PERGs and VEPs, evoked by Y-Bk grating in AD patients compared with controls, suggest a specific impairment of the magnocellular stream. CONCLUSIONS Our study support the hypothesis that the impairment of the PERGs and VEPs arising from the magnocellular streams of visual processing may indicate a primary dysfunction of the M-pathways in AD.
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Affiliation(s)
- F Sartucci
- Department of Neuroscience, Unit of Neurology, Pisa University Medical School, Pisa, Italy.
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Rogers MAM, Langa KM. Untreated poor vision: a contributing factor to late-life dementia. Am J Epidemiol 2010; 171:728-35. [PMID: 20150357 DOI: 10.1093/aje/kwp453] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Ophthalmologic abnormalities have been described in patients with dementia, but the extent to which poor vision and treatment for visual disorders affect cognitive decline is not well defined. Linked data from the Health and Retirement Study and Medicare files (1992-2005) were used to follow the experiences of 625 elderly US study participants with normal cognition at baseline. The outcome was a diagnosis of dementia, cognitively impaired but no dementia, or normal cognition. Poor vision was associated with development of dementia (P = 0.0048); individuals with very good or excellent vision at baseline had a 63% reduced risk of dementia (95% confidence interval (CI): 20, 82) over a mean follow-up period of 8.5 years. Participants with poorer vision who did not visit an ophthalmologist had a 9.5-fold increased risk of Alzheimer disease (95% CI: 2.3, 39.5) and a 5-fold increased risk of cognitively impaired but no dementia (95% CI: 1.6, 15.9). Poorer vision without a previous eye procedure increased the risk of Alzheimer disease 5-fold (95% CI: 1.5, 18.8). For Americans aged 90 years or older, 77.9% who maintained normal cognition had received at least one previous eye procedure compared with 51.7% of those with Alzheimer disease. Untreated poor vision is associated with cognitive decline, particularly Alzheimer disease.
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Affiliation(s)
- Mary A M Rogers
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109-0429, USA.
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Kantrowitz JT, Butler PD, Schecter I, Silipo G, Javitt DC. Seeing the world dimly: the impact of early visual deficits on visual experience in schizophrenia. Schizophr Bull 2009; 35:1085-94. [PMID: 19793795 PMCID: PMC2762627 DOI: 10.1093/schbul/sbp100] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Deficits in early visual processing are well documented in schizophrenia, using methods such as contrast sensitivity. Higher, integrative stages of functioning, such as susceptibility to visual illusions, have been evaluated less extensively. For example, patients show increased susceptibility to (ie, are more easily affected by) the Muller-Lyer illusion but decreased susceptibility (ie, are less easily affected by) to stereopsis based upon binocular disparity. The basis for pattern of illusion response and interaction between sensory and integrative stages of processing, however, is unclear. We tested a group of 38 patients and 28 control subjects in contrast sensitivity, the Muller-Lyer and Poggendorff illusions, as well as a subgroup in stereopsis and the Ponzo illusion, Sander parallelogram, and Hermann grid illusions. We predicted that patients would be more susceptible to tests that become more apparent with increased contrast (Muller-Lyer illusion), less susceptible to tests that become less apparent with increased contrast (stereopsis, Ponzo illusion, Hermann grid), and equally susceptible to contrast-insensitive tests (Poggendorff illusion). Additionally, the Hermann grid was tested at varying levels of contrast. Patients demonstrated significant deficits in contrast sensitivity, especially to brief, low spatial frequency stimuli, and the predicted differential response to the tested illusions. Additionally, poor performance on stereopsis and the Hermann grid significantly correlated with decreased contrast sensitivity (all P's <.01). Muller-Lyer illusion and stereopsis performance were also inversely related (P < .01). This study replicates and expands upon previous findings with visual illusions. Our results offer a unifying explanation for disparate studies and suggest that deficits in early sensory gain affect subsequent integrative processes.
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Affiliation(s)
- Joshua T. Kantrowitz
- Department of Life Sciences, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY,Department of Psychiatry, New York University School of Medicine, New York, NY,To whom correspondence should be addressed; tel: 845-398-5513, fax: 845-398-6545, e-mail:
| | - Pamela D. Butler
- Department of Life Sciences, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY,Department of Psychiatry, New York University School of Medicine, New York, NY
| | - Isaac Schecter
- Department of Life Sciences, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY
| | - Gail Silipo
- Department of Life Sciences, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY
| | - Daniel C. Javitt
- Department of Life Sciences, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY,Department of Psychiatry, New York University School of Medicine, New York, NY
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Elliott AF, McGwin G, Owsley C. Vision-enhancing interventions in nursing home residents and their short-term effect on physical and cognitive function. J Am Geriatr Soc 2008; 57:202-8. [PMID: 19170783 DOI: 10.1111/j.1532-5415.2008.02099.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effect of vision-enhancing interventions (cataract surgery or refractive error correction) on physical function and cognitive status in nursing home residents. DESIGN Longitudinal cohort study. SETTING Seventeen nursing homes in Birmingham, Alabama. PARTICIPANTS A total of 187 English-speaking adults aged 55 and older. INTERVENTION Participants took part in one of two vision-enhancing interventions: cataract surgery or refractive error correction. Each group was compared against a control group (persons eligible for but who declined cataract surgery or who received delayed correction of refractive error). MEASUREMENTS Physical function (ability to perform activities of daily living and mobility) was assessed using a series of self-report and certified nursing assistant ratings at baseline and at 2 months for the refractive error correction group and at 4 months for the cataract surgery group. The Mini Mental State Examination was also administered. RESULTS No significant differences existed within or between groups from baseline to follow-up on any of the measures of physical function. Mental status scores significantly declined from baseline to follow-up for the immediate (P=.05) and delayed (P<.02) refractive error correction groups and for the cataract surgery control group (P=.05). CONCLUSION Vision-enhancing interventions did not lead to short-term improvements in physical functioning or cognitive status in this sample of elderly nursing home residents.
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Affiliation(s)
- Amanda F Elliott
- Department of Ophthalmology, University of Alabama at Birmingham, Alabama 35294, USA.
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Designing care environments for persons with Alzheimer's disease: visuoperceptual considerations. ACTA ACUST UNITED AC 2008. [DOI: 10.1017/s0959259808002645] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This article provides information about the projected need for specialist dementia care environments in the United Kingdom. It summarizes the adverse effects of poorly designed environments and acknowledges that, despite a range of residential models, none has been shown or agreed to be the best. It considers current efforts in the UK that might influence future care environments positively.
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Abstract
Deficits in visual cognition in Alzheimer's disease (AD) arise from neuropathological changes in higher-order association areas of the cortex and from defective input from lower-level visual processing areas. We investigated whether enhanced signal strength may lead to improvement of visual cognition in AD. We tested 35 individuals with probable AD, 35 age-matched elderly control (EC) and 58 young control (YC) adults on letter identification, word reading, picture naming, discrimination of unfamiliar faces, and pattern completion. The contrast sensitivity step-difference across an independent sample of AD and EC groups was used in calculating an image filter, from which we produced stimulus-strength conditions of low-degraded, medium-normal, and high-enhanced. Using this filter we created a hypothetical proximal-strength equivalence between AD at medium strength and EC at low strength, and between AD at high strength and EC at medium strength. For letter identification, word reading, picture naming, and face discrimination, medium strength elicited AD accuracy levels and reaction times that were similar to those of EC at low strength. On picture naming, increased strength reduced perceptual-type errors for EC and AD and random errors for AD. For word reading, high strength elicited AD accuracy levels and reaction times that were equivalent to those of EC at medium strength. We saw no effect of signal-strength manipulation on performance of pattern completion, possibly owing to the complex cognitive demands of that task or to the inadequacy of the filter for its images. The results indicate that putative AD-EC differences in cognition directly reflect contrast sensitivity differences between the groups. Enhancement of stimulus strength can ameliorate vision-based deficits and lead to improvement in some aspects of cognitive performance. These results suggest new non-pharmacological avenues to explore in the attempt to improve cognition in elderly adults and especially in individuals with AD.
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Bush ALH, Allen PA, Kaut KP, Ogrocki PK. Influence of mild cognitive impairment on visual word recognition. AGING NEUROPSYCHOLOGY AND COGNITION 2007; 14:329-52. [PMID: 17612812 DOI: 10.1080/13825580600630278] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The present study examined the effects of normal aging and mild cognitive impairment (MCI) on visual word recognition. Madden et al. (1999) reported evidence of general slowing of cognitive processes in Alzheimer's disease (AD) patients relative to younger adults and healthy older adults using a lexical decision task. It was of interest to determine whether similar effects would be observed in MCI patients relative to healthy younger and older adults. We extended the lexical decision task paradigm developed by Allen et al. (2004b) on younger adults to an examination of the effect(s) of MCI on visual word recognition. Results from the present study showed that healthy older adults and MCI patients performed similarly. That is, both groups took longer than younger adults to process words presented in mixed-case than in consistent-case letters. Mild cognitive impairment patients, however, responded significantly more slowly than healthy older adults across all lexical decision task conditions and showed a trend toward larger case-mixing effects than healthy older adults, which suggests that MCI may result in poorer analytic processing ability. Based on the current findings, evidence of a generalized slowing of cognitive processes using a standard lexical decision task can be expanded to include not only AD patients, but also the preclinical stages of the disease as well.
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Affiliation(s)
- Aryn L H Bush
- University of Akron, Department of Psychology, OH 44325-4301, USA
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Cronin-Golomb A, Panizzon MS, Lyons MJ, Franz CE, Grant MD, Jacobson KC, Eisen SA, Laudate TM, Kremen WS. Genetic influence on contrast sensitivity in middle-aged male twins. Vision Res 2007; 47:2179-86. [PMID: 17604073 PMCID: PMC2020833 DOI: 10.1016/j.visres.2007.04.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 04/03/2007] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
Abstract
Contrast sensitivity is strongly associated with daily functioning among older adults, but the genetic and environmental contributions to this ability are unknown. Using the classical twin method, we addressed this issue by examining contrast sensitivity at five spatial frequencies (1.5-18 cycles per degree) in 718 middle-aged male twins from the Vietnam Era Twin Study of Aging (VETSA). Heritability estimates were modest (14-38%), whereas individual-specific environmental influences accounted for 62-86% of the variance. Identifying the types of individual-specific events that impact contrast sensitivity may suggest interventions to modulate this ability and thereby improve overall quality of life as adults age.
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Affiliation(s)
- Alice Cronin-Golomb
- Department of Psychology, Boston University, 648 Beacon St., 2nd floor, Boston, MA 02215, USA.
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43
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Wylie SA, Ridderinkhof KR, Eckerle MK, Manning CA. Inefficient response inhibition in individuals with mild cognitive impairment. Neuropsychologia 2007; 45:1408-19. [PMID: 17178419 DOI: 10.1016/j.neuropsychologia.2006.11.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2006] [Revised: 11/02/2006] [Accepted: 11/10/2006] [Indexed: 11/16/2022]
Abstract
Individuals diagnosed with mild cognitive impairment (MCI) show primary deficits in memory and are at increased risk for developing Alzheimer's disease (AD). In light of recent evidence that executive cognitive deficits are common in AD and may be detectable in individuals diagnosed with MCI, we extend these findings to the investigation of response inhibition, an essential aspect of executive cognitive control. Twenty MCI patients and 20 healthy controls (HC) completed an arrow version of the flanker task [Eriksen, B. A., & Eriksen, C. W. (1974). Effects of noise letters upon the identification of target letters in a non-search task. Perception & Psychophysics, 16, 143-149] in which participants responded to a target arrow surrounded by distractors (i.e., flankers) that signaled a same (congruent) or a conflicting (incongruent) response. Reaction time (RT) increased in both groups when flankers signaled an incongruent response, but more so among MCI patients. MCI patients taking a cholinesterase inhibitor showed smaller flanker interference effects than those not taking this medication. Analysis of the flanker effect as a function of the entire RT distribution indicated that MCI patients show increasing interference at the slowest segments of the distribution, a finding that implicates deficient inhibition of the incongruent response [Ridderinkhof, K. R. (2002). Activation and suppression in conflict tasks: Empirical clarification through distributional analyses. In W. Prinz & B. Hommel (Eds.), Common mechanisms in perception and action. Attention & performance, Vol. XIX (pp. 494-519). Oxford: Oxford University Press]. These results suggest that deficits in response inhibition are detectable in MCI patients and merit further investigation as to whether these changes aid prediction of which MCI patients convert to AD.
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Affiliation(s)
- S A Wylie
- Neurology Department, University of Virginia Health Systems, 500 Ray C. Hunt Drive, Charlottesville, VA 22908, USA.
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44
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Viggiano MP, Gori G, Zaccara G, Righi S, Vannucci M, Giovannelli F. Category-specific visual identification of filtered objects in Alzheimer's disease. Arch Gerontol Geriatr 2006; 44:125-39. [PMID: 16762429 DOI: 10.1016/j.archger.2006.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 04/03/2006] [Accepted: 04/07/2006] [Indexed: 11/18/2022]
Abstract
The category-specific deficit in object identification as function of spatial frequency (SF) content and priming effect was investigated. Twenty-two patients with Alzheimer Disease (AD) and 24 control subjects performed an object identification task. The objects belonged to living and nonliving categories. In the study phase an episodic trace of objects was created. In the identification phase, each object was revealed in a sequence of frames wherein the object was represented by an increasingly less and less filtered image up to complete version. A recall phase followed immediately after the identification phase. While the priming was preserved in mild-AD but not in moderate-AD, no difference was observed in the recall task. Moreover, although patients showed a decline in performance for both categories compared to controls, this decline was more rapid for living things especially in patients with more severe disease. Present results indicate a semantic memory deficit along with a disruption of perceptual representation. Data were discussed referring to perceptual/functional, domain-specific knowledge, and prefrontal cortex (PFC) theories.
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Affiliation(s)
- Maria Pia Viggiano
- Dipartimento di Psicologia, Università degli Study di Firenze, via S.Niccolò 93, 50125 Firenze, Italy.
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Burbacher TM, Grant KS, Mayfield DB, Gilbert SG, Rice DC. Prenatal methylmercury exposure affects spatial vision in adult monkeys. Toxicol Appl Pharmacol 2006; 208:21-8. [PMID: 16164958 DOI: 10.1016/j.taap.2005.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Revised: 01/19/2005] [Accepted: 01/22/2005] [Indexed: 11/25/2022]
Abstract
Decades of research have demonstrated that exposure to methylmercury (MeHg), a ubiquitous environmental pollutant, can have both early and long-term neurobehavioral consequences in exposed offspring. The present study assessed visual functioning in adult macaque monkeys (Macaca fascicularis) exposed in utero to 0, 50, 70, or 90 microg/kg/day of MeHg hydroxide. Twenty-one full-term, normal birth weight offspring (9 controls, 12 exposed) were tested at approximately 11-14.5 years of age on a visual contrast sensitivity task. A forced-choice tracking procedure was utilized with spatial frequencies of 1, 4, 10, and 20 cycles per degree of visual angle. On each test session, a single spatial frequency was presented across five levels of contrast, each differing by 3 dB. Methylmercury-exposed monkeys exhibited reduced contrast sensitivity thresholds, particularly at the higher spatial frequencies. The degree of visual impairment was not related to MeHg body burden or clearance and almost half of the exposed animals were unimpaired. The results from this study demonstrate that chronic in utero MeHg exposure, at subclinical levels, is associated with permanent adverse effects on spatial vision in adult monkeys.
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Affiliation(s)
- Thomas M Burbacher
- Department of Environmental and Occupational Health Sciences, Box 357234, University of Washington, Seattle, WA 98195, USA.
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von Gunten A, Bouras C, Kövari E, Giannakopoulos P, Hof PR. Neural substrates of cognitive and behavioral deficits in atypical Alzheimer's disease. ACTA ACUST UNITED AC 2006; 51:176-211. [PMID: 16413610 DOI: 10.1016/j.brainresrev.2005.11.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2005] [Revised: 11/04/2005] [Accepted: 11/11/2005] [Indexed: 12/11/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder characterized by a progressive cognitive decline that typically affects first memory and later executive functions, language, and visuospatial skills. This sequence of cognitive deterioration is thought to reflect the progressive invasion of the cerebral cortex by the two major pathological hallmarks of AD, neurofibrillary tangles (NFT) and senile plaques (SP), as well as degree of neuronal and synaptic loss. In atypical AD, prominent and early deficits are found in language, motor abilities, frontal and executive capacities, or visuospatial skills. These atypical clinical features are associated with an unusual pattern of NFT or SP formation that predominantly involves cortical areas usually spared in the course of the degenerative process. In an attempt to classify this highly heterogeneous subgroup, the present article provides an overview of clinicopathological analyses in patients with atypical progression of AD symptomatology with special reference to the relationship between specific cognitive and behavioral deficits and hierarchical patterns of AD lesion distribution within the cerebral cortex. On the basis of these representative examples of a cortical circuit-based approach to explore the mechanisms giving rise to AD neuropsychological expression, we also critically discuss the possibility to develop a matrix linking clinical presentations to degeneration of forward and backward long corticocortical pathways in this disorder.
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Affiliation(s)
- Armin von Gunten
- Division of Old Age Psychiatry, Department of Psychiatry-CHUV, Prilly-Lausanne, Switzerland.
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Turner TH. The pointillism method for creating stimuli suitable for use in computer-based visual contrast sensitivity testing. J Neurosci Methods 2005; 142:219-29. [PMID: 15698662 DOI: 10.1016/j.jneumeth.2004.08.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Revised: 08/12/2004] [Accepted: 08/19/2004] [Indexed: 11/19/2022]
Abstract
An increasingly large corpus of clinical and experimental neuropsychological research has demonstrated the utility of measuring visual contrast sensitivity. Unfortunately, existing means of measuring contrast sensitivity can be prohibitively expensive, difficult to standardize, or lack reliability. Additionally, most existing tests do not allow full control over important characteristics, such as off-angle rotations, waveform, contrast, and spatial frequency. Ideally, researchers could manipulate characteristics and display stimuli in a computerized task designed to meet experimental needs. Thus far, 256-bit color limitation in standard cathode ray tube (CRT) monitors has been preclusive. To this end, the pointillism method (PM) was developed. Using MATLAB software, stimuli are created based on both mathematical and stochastic components, such that differences in regional luminance values of the gradient field closely approximate the desired contrast. This paper describes the method and examines its performance in sine and square-wave image sets from a range of contrast values. Results suggest the utility of the method for most experimental applications. Weaknesses in the current version, the need for validation and reliability studies, and considerations regarding applications are discussed. Syntax for the program is provided in an appendix, and a version of the program independent of MATLAB is available from the author.
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Affiliation(s)
- Travis H Turner
- Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, CA, USA.
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Dutton GN. Cognitive vision, its disorders and differential diagnosis in adults and children: knowing where and what things are. Eye (Lond) 2003; 17:289-304. [PMID: 12724689 DOI: 10.1038/sj.eye.6700344] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
As ophthalmologists we need a basic model of how the higher visual system works and its common disorders. This presentation aims to provide an outline of such a model. Our ability to survey a visual scene, locate and recognise an object of interest, move towards it and pick it up, recruits a number of complex cognitive higher visual pathways, all of which are susceptible to damage. The visual map in the mind needs to be co-located with reality and is primarily plotted by the posterior parietal lobes, which interact with the frontal lobes to choose the object of interest. Neck and extraocular muscle proprioceptors are probably responsible for maintaining this co-location when the head and eyes move with respect to the body, and synchronous input from both eyes is needed for correct localisation of moving targets. Recognition of what is being looked at is brought about by comparing the visual input with the "image libraries" in the temporal lobes. Once an object is recognised, its choice is mediated by parietal and frontal lobe tissue. The parietal lobes determine the visual coordinates and plan the visually guided movement of the limbs to pick it up, and the frontal lobes participate in making the choice. The connection between the occipital lobes and the parietal lobes is known as the dorsal stream, and the connection between the occipital lobes and the temporal lobes, comprises the ventral stream. Both disorders of neck and extraocular muscle proprioception, and disorders leading to asynchronous input along the two optic nerves are "peripheral" causes of impaired visually guided movement, while bilateral damage to the parietal lobes can result in central impairment of visually guided movement, or optic ataxia. Damage to the temporal lobes can result in impaired recognition, problems with route finding and poor visual memory. Spontaneous activity in the temporal lobes can result in formed visual hallucinations, in patients with impaired central visual function, particularly the elderly. Deficits in cognitive visual function can occur in different combinations in both children and adults depending on the nature and distribution of the underlying brain damage. In young children the potential for recovery can lead to significant improvement in parietal lobe function with time. Patients with these disorders need an understanding of their deficits and a structured positive approach to their rehabilitation.
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Affiliation(s)
- G N Dutton
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Great Western Road, Glasgow G12 0YN, Scotland, UK
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Anstey KJ, Luszcz MA, Sanchez L. Two-year decline in vision but not hearing is associated with memory decline in very old adults in a population-based sample. Gerontology 2001; 47:289-93. [PMID: 11490149 DOI: 10.1159/000052814] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Recent cross-sectional research in cognitive aging has demonstrated a robust association between visual acuity, auditory thresholds and cognitive performance in old age. However, the nature of the association is still unclear, particularly with respect to whether sensory and cognitive function are causally related. OBJECTIVE This study aimed to determine whether marked declines in performance on screening measures of either visual acuity or auditory thresholds have an effect on cognitive decline over 2 years. METHODS The sample from the Australian Longitudinal Study of Ageing (n = 2,087) were assessed in 1992 and 1994 on measures of sensory and cognitive function as part of a larger clinical assessment. A quasi-experimental design involving comparison of extreme groups using repeated measures MANCOVA with age as a covariate was used. RESULTS Group performance on measures of hearing, memory, verbal ability and processing speed declined significantly. Decline in visual acuity had a significant effect on memory decline, but not on decline in verbal ability or processing speed. Decline in hearing was not associated with decline in any cognitive domain. CONCLUSION The common association between visual acuity, auditory thresholds and cognitive function observed in cross-sectional studies appears to be disassociated in longitudinal studies.
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Affiliation(s)
- K J Anstey
- Prince of Wales Medical Research Institute, University of New South Wales, Sydney, Australia.
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