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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 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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2
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Xu Y, Aung HL, Hesam-Shariati N, Keay L, Sun X, Phu J, Honson V, Tully PJ, Booth A, Lewis E, Anderson CS, Anstey KJ, Peters R. Contrast Sensitivity, Visual Field, Color Vision, Motion Perception, and Cognitive Impairment: A Systematic Review. J Am Med Dir Assoc 2024; 25:105098. [PMID: 38908397 DOI: 10.1016/j.jamda.2024.105098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 02/07/2024] [Accepted: 05/12/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES To examine relationships between visual function (ie, contrast sensitivity, visual field, color vision, and motion perception) and cognitive impairment, including any definition of "cognitive impairment," mild cognitive impairment, or dementia. DESIGN Systematic review and meta-analyses. SETTING AND PARTICIPANTS Any settings; participants with (cases) or without (controls) cognitive impairment. METHODS We searched 4 databases (to January 2024) and included published studies that compared visual function between cases and controls. Standardized mean differences (SMD) with 95% CIs were calculated where data were available. Data were sufficient for meta-analyses when cases were people with dementia. The Joanna Briggs Institute checklists were used for quality assessment. RESULTS Fifty-one studies/69 reports were included. Cross-sectional evidence shows that people with dementia had worse contrast sensitivity function and color vision than controls: measured by contrast sensitivity (log units) on letter charts, SMD -1.22 (95% CI -1.98, -0.47), or at varied spatial frequencies, -0.92 (-1.28, -0.57); and by pseudoisochromatic plates, -1.04 (-1.59, -0.49); color arrangement, -1.30 (-2.31, -0.29); or matching tests, -0.51 (-0.78, -0.24). They also performed more poorly on tests of motion perception, -1.20 (-1.73, -0.67), and visual field: mean deviation, -0.87 (-1.29, -0.46), and pattern standard deviation, -0.69 (-1.24, -0.15). Results were similar when cases were limited to participants with clinically diagnosed Alzheimer disease. Sources of bias included lack of clarity on study populations or settings and definitions of cognitive impairment. The 2 included longitudinal studies with follow-ups of approximately 10 years were of good quality but reported inconsistent results. CONCLUSIONS AND IMPLICATIONS In the lack of longitudinal data, cross-sectional studies indicate that individuals with cognitive impairment have poorer visual function than those with normal cognition. Additional longitudinal data are needed to understand whether poor visual function precedes cognitive impairment and the most relevant aspects of visual function, dementia pathologies, and domains of cognition.
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Affiliation(s)
- Ying Xu
- Neuroscience Research Australia, Sydney, Australia; School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia; The George Institute for Global Health, UNSW Sydney, Sydney, Australia; Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; Ageing Futures Institute, UNSW Sydney, Sydney, Australia; Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Htein Linn Aung
- Neuroscience Research Australia, Sydney, Australia; Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Negin Hesam-Shariati
- Neuroscience Research Australia, Sydney, Australia; School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia
| | - Lisa Keay
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia; Ageing Futures Institute, UNSW Sydney, Sydney, Australia; School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Fundus Diseases, Shanghai, China; Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai, China; National Clinical Research Center for Ophthalmic Diseases, Shanghai, China
| | - Jack Phu
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia; Center for Eye Health, UNSW Sydney, Sydney, Australia; Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Concord Clinical School, Concord Repatriation General Hospital, Sydney, Australia
| | - Vanessa Honson
- School of Optometry and Vision Science, UNSW Sydney, Sydney, Australia
| | - Phillip J Tully
- School of Psychology, The University of New England, Armidale, Australia
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Ebony Lewis
- Neuroscience Research Australia, Sydney, Australia; School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia; Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; Ageing Futures Institute, UNSW Sydney, Sydney, Australia
| | - Craig S Anderson
- The George Institute for Global Health, UNSW Sydney, Sydney, Australia; Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; The George Institute China, Peking University Health Science Center, Beijing, China; Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kaarin J Anstey
- Neuroscience Research Australia, Sydney, Australia; School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia; Ageing Futures Institute, UNSW Sydney, Sydney, Australia
| | - Ruth Peters
- Neuroscience Research Australia, Sydney, Australia; School of Psychology, Faculty of Science, UNSW Sydney, Sydney, Australia; The George Institute for Global Health, UNSW Sydney, Sydney, Australia; Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; Ageing Futures Institute, UNSW Sydney, Sydney, Australia; School of Public Health, Imperial College London, London, United Kingdom
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3
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Ho K, Bodi NE, Sharma TP. Normal-Tension Glaucoma and Potential Clinical Links to Alzheimer's Disease. J Clin Med 2024; 13:1948. [PMID: 38610712 PMCID: PMC11012506 DOI: 10.3390/jcm13071948] [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: 02/19/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Glaucoma is a group of optic neuropathies and the world's leading cause of irreversible blindness. Normal-tension glaucoma (NTG) is a subtype of glaucoma that is characterized by a typical pattern of peripheral retinal loss, in which the patient's intraocular pressure (IOP) is considered within the normal range (<21 mmHg). Currently, the only targetable risk factor for glaucoma is lowering IOP, and patients with NTG continue to experience visual field loss after IOP-lowering treatments. This demonstrates the need for a better understanding of the pathogenesis of NTG and underlying mechanisms leading to neurodegeneration. Recent studies have found significant connections between NTG and cerebral manifestations, suggesting NTG as a neurodegenerative disease beyond the eye. Gaining a better understanding of NTG can potentially provide new Alzheimer's Disease diagnostics capabilities. This review identifies the epidemiology, current biomarkers, altered fluid dynamics, and cerebral and ocular manifestations to examine connections and discrepancies between the mechanisms of NTG and Alzheimer's Disease.
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Affiliation(s)
- Kathleen Ho
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Nicole E. Bodi
- Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Tasneem P. Sharma
- Eugene and Marilyn Glick Eye Institute, Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
- Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
- Stark Neurosciences Research Institute, Indianapolis, IN 46202, USA
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Fanlo-Zarazaga A, Echevarría JI, Pinilla J, Alejandre A, Pérez-Roche T, Gutiérrez D, Ortín M, Pueyo V. Validation of a New Digital and Automated Color Perception Test. Diagnostics (Basel) 2024; 14:396. [PMID: 38396435 PMCID: PMC10888327 DOI: 10.3390/diagnostics14040396] [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: 12/15/2023] [Revised: 01/21/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Although color vision deficiencies are very prevalent, there are no ideal methods for assessing color vision in all environments. We compared a new digital and automated method that quantifies color perception for the three protan, deutan, and tritan axes with two of the most commonly used color tests in daily practice: the Ishihara 38 plates test and the Farnsworth-Munsell 100-Hue test. One hundred patients underwent a triple examination composed of the new DIVE Color Test, the Ishihara test, and the Farnsworth-Munsell 100-Hue test. The DIVE Color Test was performed twice in forty participants to assess its repeatability. In the trichromatic group, the mean age stood at 20.57 ± 9.22 years compared with 25.99 ± 15.86 years in the dyschromatic group. The DIVE and Ishihara tests exhibited excellent agreement in identifying participants with color deficiency (Cohen's kappa = 1.00), while it was 0.81 when comparing DIVE and Farnsworth. The correlation between the global perception values of Farnsworth (TES) and DIVE (GCS) was 0.80. The repeatability of the DIVE Color Test was high according to Bland-Altman analysis with an intraclass correlation coefficient of 0.83. According to Ishihara, the DIVE Color Test proved to be an effective and reproducible tool for red-green color vision deficiency detection, capable of determining the severity of the defect in each of the three axes faster and more accurately than both Ishihara and Farnsworth.
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Affiliation(s)
- Alvaro Fanlo-Zarazaga
- Ophthalmology Department, Miguel Servet University Hospital, Isabel la Católica, 3, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), San Juan Bosco 13, 50009 Zaragoza, Spain
- DIVE Medical S.L., Paseo Miramón 170, 20014 San Sebastián, Spain
| | - José Ignacio Echevarría
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, María de Luna 1, 50018 Zaragoza, Spain
| | - Juan Pinilla
- Ophthalmology Department, Miguel Servet University Hospital, Isabel la Católica, 3, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Adrián Alejandre
- DIVE Medical S.L., Paseo Miramón 170, 20014 San Sebastián, Spain
| | - Teresa Pérez-Roche
- Ophthalmology Department, Miguel Servet University Hospital, Isabel la Católica, 3, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), San Juan Bosco 13, 50009 Zaragoza, Spain
| | - Diego Gutiérrez
- Instituto de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, María de Luna 1, 50018 Zaragoza, Spain
| | - Marta Ortín
- DIVE Medical S.L., Paseo Miramón 170, 20014 San Sebastián, Spain
| | - Victoria Pueyo
- Ophthalmology Department, Miguel Servet University Hospital, Isabel la Católica, 3, 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), San Juan Bosco 13, 50009 Zaragoza, Spain
- Department of Microbiology, Pediatrics, Radiology and Public Health, Faculty of Medicine, University of Zaragoza, Domingo Miral, s/n, 50009 Zaragoza, Spain
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Shen Z, Zhang S, Yu W, Yue M, Hong C. Optical Coherence Tomography Angiography: Revolutionizing Clinical Diagnostics and Treatment in Central Nervous System Disease. Aging Dis 2024:AD.2024.0112. [PMID: 38300645 DOI: 10.14336/ad.2024.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024] Open
Abstract
Optical coherence tomography angiography (OCTA), as a new generation of non-invasive and efficient fundus imaging technology, can provide non-invasive assessment of vascular lesions in the retina and choroid. In terms of anatomy and development, the retina is referred to as an extension of the central nervous system (CNS). CNS diseases are closely related to changes in fundus structure and blood vessels, and direct visualization of fundus structure and blood vessels provides an effective "window" for CNS research. This has important practical significance for identifying the characteristic changes of various CNS diseases on OCTA in the future, and plays a key role in promoting early screening, diagnosis, and monitoring of disease progression in CNS diseases. This article reviews relevant fundus studies by comparing and summarizing the unique advantages and existing limitations of OCTA in various CNS disease patients, in order to demonstrate the clinical significance of OCTA in the diagnosis and treatment of CNS diseases.
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Affiliation(s)
- Zeqi Shen
- Postgraduate training base Alliance of Wenzhou Medical University (Affiliated People's Hospital), Hangzhou, Zhejiang, China
| | - Sheng Zhang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Weitao Yu
- The Second School of Clinical Medicine, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Mengmeng Yue
- Postgraduate training base Alliance of Wenzhou Medical University (Affiliated People's Hospital), Hangzhou, Zhejiang, China
| | - Chaoyang Hong
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Liu X, Hike D, Choi S, Man W, Ran C, Zhou XA, Jiang Y, Yu X. Mapping the bioimaging marker of Alzheimer's disease based on pupillary light response-driven brain-wide fMRI in awake mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.20.572613. [PMID: 38187675 PMCID: PMC10769340 DOI: 10.1101/2023.12.20.572613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Pupil dynamics has emerged as a critical non-invasive indicator of brain state changes. In particular, pupillary-light-responses (PLR) in Alzheimer's disease (AD) patients may be used as biomarkers of brain degeneration. To characterize AD-specific PLR and its underlying neuromodulatory sources, we combined high-resolution awake mouse fMRI with real-time pupillometry to map brain-wide event-related correlation patterns based on illumination-driven pupil constriction ( P c ) and post-illumination pupil dilation recovery (amplitude, P d , and time, T ). The P c -driven differential analysis revealed altered visual signal processing coupled with reduced thalamocortical activation in AD mice compared with the wild-type normal mice. In contrast, the post-illumination pupil dilation recovery-based fMRI highlighted multiple brain areas related to AD brain degeneration, including the cingulate cortex, hippocampus, septal area of the basal forebrain, medial raphe nucleus, and pontine reticular nuclei (PRN). Also, brain-wide functional connectivity analysis highlighted the most significant changes in PRN of AD mice, which serves as the major subcortical relay nuclei underlying oculomotor function. This work combined non-invasive pupil-fMRI measurements in preclinical models to identify pupillary biomarkers based on neuromodulatory dysfunction coupled with AD brain degeneration.
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Donato L, Mordà D, Scimone C, Alibrandi S, D’Angelo R, Sidoti A. Bridging Retinal and Cerebral Neurodegeneration: A Focus on Crosslinks between Alzheimer-Perusini's Disease and Retinal Dystrophies. Biomedicines 2023; 11:3258. [PMID: 38137479 PMCID: PMC10741418 DOI: 10.3390/biomedicines11123258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
In the early stages of Alzheimer-Perusini's disease (AD), individuals often experience vision-related issues such as color vision impairment, reduced contrast sensitivity, and visual acuity problems. As the disease progresses, there is a connection with glaucoma and age-related macular degeneration (AMD) leading to retinal cell death. The retina's involvement suggests a link with the hippocampus, where most AD forms start. A thinning of the retinal nerve fiber layer (RNFL) due to the loss of retinal ganglion cells (RGCs) is seen as a potential AD diagnostic marker using electroretinography (ERG) and optical coherence tomography (OCT). Amyloid beta fragments (Aβ), found in the eye's vitreous and aqueous humor, are also present in the cerebrospinal fluid (CSF) and accumulate in the retina. Aβ is known to cause tau hyperphosphorylation, leading to its buildup in various retinal layers. However, diseases like AD are now seen as mixed proteinopathies, with deposits of the prion protein (PrP) and α-synuclein found in affected brains and retinas. Glial cells, especially microglial cells, play a crucial role in these diseases, maintaining immunoproteostasis. Studies have shown similarities between retinal and brain microglia in terms of transcription factor expression and morphotypes. All these findings constitute a good start to achieving better comprehension of neurodegeneration in both the eye and the brain. New insights will be able to bring the scientific community closer to specific disease-modifying therapies.
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Affiliation(s)
- Luigi Donato
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, 98122 Messina, Italy; (L.D.); (C.S.); (R.D.); (A.S.)
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology (I.E.ME.S.T.), 90139 Palermo, Italy;
| | - Domenico Mordà
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology (I.E.ME.S.T.), 90139 Palermo, Italy;
- Department of Veterinary Sciences, University of Messina, 98122 Messina, Italy
| | - Concetta Scimone
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, 98122 Messina, Italy; (L.D.); (C.S.); (R.D.); (A.S.)
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology (I.E.ME.S.T.), 90139 Palermo, Italy;
| | - Simona Alibrandi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, 98122 Messina, Italy; (L.D.); (C.S.); (R.D.); (A.S.)
- Department of Biomolecular Strategies, Genetics, Cutting-Edge Therapies, Euro-Mediterranean Institute of Science and Technology (I.E.ME.S.T.), 90139 Palermo, Italy;
| | - Rosalia D’Angelo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, 98122 Messina, Italy; (L.D.); (C.S.); (R.D.); (A.S.)
| | - Antonina Sidoti
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Division of Medical Biotechnologies and Preventive Medicine, University of Messina, 98122 Messina, Italy; (L.D.); (C.S.); (R.D.); (A.S.)
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Santos-Ortega Á, Alba-Linero C, Urbinati F, Rocha-de-Lossada C, Orti R, Reyes-Bueno JA, Garzón-Maldonado FJ, Serrano V, de Rojas-Leal C, de la Cruz-Cosme C, España-Contreras M, Rodríguez-Calvo-de-Mora M, García-Casares N. Structural and Functional Retinal Changes in Patients with Mild Cognitive Impairment with and without Diabetes. J Clin Med 2023; 12:7035. [PMID: 38002648 PMCID: PMC10672424 DOI: 10.3390/jcm12227035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Our objective is to analyze retinal changes using optical coherence tomography angiography (OCT-A) in patients with mild cognitive impairment (MCI) to characterize structural and vascular alterations. This cross-sectional study involved 117 eyes: 39 eyes from patients with MCI plus diabetes (DM-MCI), 39 eyes from patients with MCI but no diabetes (MCI); and 39 healthy control eyes (C). All patients underwent a visual acuity measurement, a structural OCT, an OCT-A, and a neuropsychological examination. Our study showed a thinning of retinal nerve fiber layer thickness (RNFL) and a decrease in macular thickness when comparing the MCI-DM group to the C group (p = 0.008 and p = 0.016, respectively). In addition, an increase in arteriolar thickness (p = 0.016), a reduction in superficial capillary plexus density (p = 0.002), and a decrease in ganglion cell thickness (p = 0.027) were found when comparing the MCI-DM group with the MCI group. Diabetes may exacerbate retinal vascular changes when combined with mild cognitive impairment.
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Affiliation(s)
| | - Carmen Alba-Linero
- Department of Ophthalmology, Hospital Universitario Virgen de la Victoria, 29010 Malaga, Spain
- Department of Ophthalmology, Faculty of Medicine, University of Malaga, 29016 Malaga, Spain;
| | - Facundo Urbinati
- Department of Ophthalmology, Hospital Regional Universitario, 29011 Malaga, Spain; (F.U.); (C.R.-d.-L.); (M.E.-C.); (M.R.-C.-d.-M.)
| | - Carlos Rocha-de-Lossada
- Department of Ophthalmology, Hospital Regional Universitario, 29011 Malaga, Spain; (F.U.); (C.R.-d.-L.); (M.E.-C.); (M.R.-C.-d.-M.)
- Qvision, Opththalmology Department, VITHAS Almería Hospital, 04120 Almería, Spain
- Ophthalmology Department, VITHAS Málaga, 29016 Malaga, Spain
- Department of Surgery, Faculty of Medicine, Ophthalmology Area Doctor Fedriani, University of Sevilla, 41004 Sevilla, Spain
| | - Rafael Orti
- Department of Ophthalmology, Faculty of Medicine, University of Malaga, 29016 Malaga, Spain;
| | | | - Francisco Javier Garzón-Maldonado
- Department of Neurology, Hospital Virgen de la Victoria, 29010 Malaga, Spain; (F.J.G.-M.); (V.S.); (C.d.R.-L.); (C.d.l.C.-C.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain;
| | - Vicente Serrano
- Department of Neurology, Hospital Virgen de la Victoria, 29010 Malaga, Spain; (F.J.G.-M.); (V.S.); (C.d.R.-L.); (C.d.l.C.-C.)
| | - Carmen de Rojas-Leal
- Department of Neurology, Hospital Virgen de la Victoria, 29010 Malaga, Spain; (F.J.G.-M.); (V.S.); (C.d.R.-L.); (C.d.l.C.-C.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain;
| | - Carlos de la Cruz-Cosme
- Department of Neurology, Hospital Virgen de la Victoria, 29010 Malaga, Spain; (F.J.G.-M.); (V.S.); (C.d.R.-L.); (C.d.l.C.-C.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain;
| | - Manuela España-Contreras
- Department of Ophthalmology, Hospital Regional Universitario, 29011 Malaga, Spain; (F.U.); (C.R.-d.-L.); (M.E.-C.); (M.R.-C.-d.-M.)
| | - Marina Rodríguez-Calvo-de-Mora
- Department of Ophthalmology, Hospital Regional Universitario, 29011 Malaga, Spain; (F.U.); (C.R.-d.-L.); (M.E.-C.); (M.R.-C.-d.-M.)
- Qvision, Opththalmology Department, VITHAS Almería Hospital, 04120 Almería, Spain
- Ophthalmology Department, VITHAS Málaga, 29016 Malaga, Spain
| | - Natalia García-Casares
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Malaga, Spain;
- Department of Medicine, Faculty of Medicine, University of Malaga, 29016 Malaga, Spain
- Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, 29016 Malaga, Spain
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9
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Chaitanuwong P, Singhanetr P, Chainakul M, Arjkongharn N, Ruamviboonsuk P, Grzybowski A. Potential Ocular Biomarkers for Early Detection of Alzheimer's Disease and Their Roles in Artificial Intelligence Studies. Neurol Ther 2023; 12:1517-1532. [PMID: 37468682 PMCID: PMC10444735 DOI: 10.1007/s40120-023-00526-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023] Open
Abstract
Alzheimer's disease (AD) is the leading cause of dementia worldwide. Early detection is believed to be essential to disease management because it enables physicians to initiate treatment in patients with early-stage AD (early AD), with the possibility of stopping the disease or slowing disease progression, preserving function and ultimately reducing disease burden. The purpose of this study was to review prior research on the use of eye biomarkers and artificial intelligence (AI) for detecting AD and early AD. The PubMed database was searched to identify studies for review. Ocular biomarkers in AD research and AI research on AD were reviewed and summarized. According to numerous studies, there is a high likelihood that ocular biomarkers can be used to detect early AD: tears, corneal nerves, retina, visual function and, in particular, eye movement tracking have been identified as ocular biomarkers with the potential to detect early AD. However, there is currently no ocular biomarker that can be used to definitely detect early AD. A few studies that used AI with ocular biomarkers to detect AD reported promising results, demonstrating that using AI with ocular biomarkers through multimodal imaging could improve the accuracy of identifying AD patients. This strategy may become a screening tool for detecting early AD in older patients prior to the onset of AD symptoms.
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Affiliation(s)
- Pareena Chaitanuwong
- Ophthalmology Department, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
- Department of Ophthalmology, Faculty of Medicine, Rangsit University, Bangkok, Thailand
| | - Panisa Singhanetr
- Mettapracharak Eye Institute, Mettapracharak (Wat Rai Khing) Hospital, Nakhon Pathom, Thailand
| | - Methaphon Chainakul
- Ophthalmology Department, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
- Department of Ophthalmology, Faculty of Medicine, Rangsit University, Bangkok, Thailand
| | - Niracha Arjkongharn
- Ophthalmology Department, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
- Department of Ophthalmology, Faculty of Medicine, Rangsit University, Bangkok, Thailand
| | - Paisan Ruamviboonsuk
- Ophthalmology Department, Rajavithi Hospital, Ministry of Public Health, Bangkok, Thailand
- Department of Ophthalmology, Faculty of Medicine, Rangsit University, Bangkok, Thailand
| | - Andrzej Grzybowski
- Institute of Research in Ophthalmology, Foundation for Ophthalmology Development, Mickiewicza 24/3B, 60-836, Poznan, Poland.
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10
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Piano MEF, Nguyen BN, Gocuk SA, Joubert L, McKendrick AM. Primary eyecare provision for people living with dementia: what do we need to know? Clin Exp Optom 2023; 106:711-725. [PMID: 36375138 DOI: 10.1080/08164622.2022.2140032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Dementia comprises a group of brain disorders characterised by loss of cognitive function. Sensory loss, predominantly vision (the focus of this review) and hearing, is a significant problem for people living with dementia. Eyecare practitioners such as optometrists therefore play an important role in identifying and addressing vision-related care needs. To support provision of high quality "dementia-friendly" eyecare, this scoping review summarises recent primary research findings and available clinical practice guidelines, to identify research gaps relating to vision and dementia, and make recommendations for future research and clinical practice. The review set a priori guidelines for the population, concept and context based on the review questions. Primary research papers (2016-2021) were included via 3-step search strategy: preliminary search to index terms, full search, search reference lists of included articles for further inclusions. Additionally, websites of eyecare professional bodies in English-speaking countries were searched to identify current clinical eyecare practice guidelines relating to dementia. Study characteristics (e.g. country, study design) were reported descriptively. Patterns within findings/recommendations from included sources were identified using thematic analysis and reported as themes. 1651 titles/abstracts and 161 full-text articles were screened for eligibility. Three clinical practice guidelines were also identified. The final review included 21 sources: 18 primary research papers and 3 clinical practice guidelines. The thematic analysis reported five key themes: Diagnosis/Screening, dementia progression, findings on clinical visual testing, tailored approach to care, improving care. This scoping review demonstrated limited information about current practices of optometrists working with people living with dementia. Recent evidence reinforces the continuing need for improved eyecare for people living with dementia, taking into account their specific needs with an individualised approach. Up-to-date practical recommendations are synthesised for eyecare providers before, during and after a consultation with a person living with dementia, to better support their care.
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Affiliation(s)
- Marianne E F Piano
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
- National Vision Research Institute, Australian College of Optometry, Carlton, Australia
| | - Bao N Nguyen
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Sena A Gocuk
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Lynette Joubert
- Department of Social Work, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
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11
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Zhang NK, Zhang SK, Zhang LI, Tao HW, Zhang GW. Sensory processing deficits and related cortical pathological changes in Alzheimer's disease. Front Aging Neurosci 2023; 15:1213379. [PMID: 37649717 PMCID: PMC10464619 DOI: 10.3389/fnagi.2023.1213379] [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: 04/27/2023] [Accepted: 07/24/2023] [Indexed: 09/01/2023] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disorder primarily affecting cognitive functions. However, sensory deficits in AD start to draw attention due to their high prevalence and early onsets which suggest that they could potentially serve as diagnostic biomarkers and even contribute to the disease progression. This literature review examines the sensory deficits and cortical pathological changes observed in visual, auditory, olfactory, and somatosensory systems in AD patients, as well as in various AD animal models. Sensory deficits may emerge at the early stages of AD, or even precede the cognitive decline, which is accompanied by cortical pathological changes including amyloid-beta deposition, tauopathy, gliosis, and alterations in neuronal excitability, synaptic inputs, and functional plasticity. Notably, these changes are more pronounced in sensory association areas and superficial cortical layers, which may explain the relative preservation of basic sensory functions but early display of deficits of higher sensory functions. We propose that sensory impairment and the progression of AD may establish a cyclical relationship that mutually perpetuates each condition. This review highlights the significance of sensory deficits with or without cortical pathological changes in AD and emphasizes the need for further research to develop reliable early detection and intervention through sensory systems.
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Affiliation(s)
- Nicole K. Zhang
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Selena K. Zhang
- Biomedical Engineering Program, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, United States
| | - Li I. Zhang
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Physiology & Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Huizhong W. Tao
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Physiology & Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Guang-Wei Zhang
- Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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12
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Elvira-Hurtado L, López-Cuenca I, de Hoz R, Salas M, Sánchez-Puebla L, Ramírez-Toraño F, Matamoros JA, Fernández-Albarral JA, Rojas P, Alfonsín S, Delgado-Losada ML, Ramírez AI, Salazar JJ, Maestu F, Gil P, Ramírez JM, Salobrar-García E. Alzheimer's disease: a continuum with visual involvements. Front Psychol 2023; 14:1124830. [PMID: 37484098 PMCID: PMC10359162 DOI: 10.3389/fpsyg.2023.1124830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Alzheimer's disease (AD) is the most common form of dementia affecting the central nervous system, and alteration of several visual structures has been reported. Structural retinal changes are usually accompanied by changes in visual function in this disease. The aim of this study was to analyse the differences in visual function at different stages of the pathology (family history group (FH+), mild cognitive impairment (MCI), mild AD and moderate AD) in comparison with a control group of subjects with no cognitive decline and no family history of AD. Methods We included 53 controls, 13 subjects with FH+, 23 patients with MCI, 25 patients with mild AD and, 21 patients with moderate AD. All were ophthalmologically healthy. Visual acuity (VA), contrast sensitivity (CS), colour perception, visual integration, and fundus examination were performed. Results The analysis showed a statistically significant decrease in VA, CS and visual integration score between the MCI, mild AD and moderate AD groups compared to the control group. In the CS higher frequencies and in the colour perception test (total errors number), statistically significant differences were also observed in the MCI, mild AD and moderate AD groups with respect to the FH+ group and also between the control and AD groups. The FH+ group showed no statistically significant difference in visual functions compared to the control group. All the test correlated with the Mini Mental State Examination score and showed good predictive value when memory decline was present, with better values when AD was at a more advanced stage. Conclusion Alterations in visual function appear in subjects with MCI and evolve when AD is established, being stable in the initial stages of the disease (mild AD and moderate AD). Therefore, visual psychophysical tests are a useful, simple and complementary tool to neuropsychological tests to facilitate diagnosis in the preclinical and early stages of AD.
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Affiliation(s)
- Lorena Elvira-Hurtado
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
| | - Inés López-Cuenca
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Rosa de Hoz
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Faculty of Optics and Optometry, Department of Immunology, Ophthalmology and ENT, University of Madrid, Madrid, Spain
| | - Mario Salas
- Memory Unit, Geriatrics Service, Hospital Clínico San Carlos, Madrid, Spain
| | - Lidia Sánchez-Puebla
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
| | - Federico Ramírez-Toraño
- Center for Cognitive and Computational Neuroscience, Laboratory of Cognitive and Computational Neuroscience, Complutense University of Madrid, Pozuelo de Alarcón, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Complutense University of Madrid, Pozuelo de Alarcón, Spain
| | - José A. Matamoros
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
| | - José A. Fernández-Albarral
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pilar Rojas
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
- Madrid Eye Institute, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Soraya Alfonsín
- Center for Cognitive and Computational Neuroscience, Laboratory of Cognitive and Computational Neuroscience, Complutense University of Madrid, Pozuelo de Alarcón, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Complutense University of Madrid, Pozuelo de Alarcón, Spain
| | - María Luisa Delgado-Losada
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Complutense University of Madrid, Pozuelo de Alarcón, Spain
| | - Ana I. Ramírez
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Faculty of Optics and Optometry, Department of Immunology, Ophthalmology and ENT, University of Madrid, Madrid, Spain
| | - Juan J. Salazar
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Faculty of Optics and Optometry, Department of Immunology, Ophthalmology and ENT, University of Madrid, Madrid, Spain
| | - Fernando Maestu
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Center for Cognitive and Computational Neuroscience, Laboratory of Cognitive and Computational Neuroscience, Complutense University of Madrid, Pozuelo de Alarcón, Spain
- Department of Experimental Psychology, Cognitive Psychology and Speech and Language Therapy, Complutense University of Madrid, Pozuelo de Alarcón, Spain
| | - Pedro Gil
- Memory Unit, Geriatrics Service, Hospital Clínico San Carlos, Madrid, Spain
- Department of Medicine, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - José M. Ramírez
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Faculty of Medicine, Department of Immunology, Ophthalmology and ENT, University of Madrid, Madrid, Spain
| | - Elena Salobrar-García
- Ramon Castroviejo Institute for Ophthalmic Research, Complutense University of Madrid, Madrid, Spain
- Health Research Institute of the Hospital Clínico San Carlos (IdISSC), Madrid, Spain
- Faculty of Optics and Optometry, Department of Immunology, Ophthalmology and ENT, University of Madrid, Madrid, Spain
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13
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Maran JJ, Adesina MM, Green CR, Kwakowsky A, Mugisho OO. The central role of the NLRP3 inflammasome pathway in the pathogenesis of age-related diseases in the eye and the brain. Ageing Res Rev 2023; 88:101954. [PMID: 37187367 DOI: 10.1016/j.arr.2023.101954] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/17/2023]
Abstract
With increasing age, structural changes occur in the eye and brain. Neuronal death, inflammation, vascular disruption, and microglial activation are among many of the pathological changes that can occur during ageing. Furthermore, ageing individuals are at increased risk of developing neurodegenerative diseases in these organs, including Alzheimer's disease (AD), Parkinson's disease (PD), glaucoma and age-related macular degeneration (AMD). Although these diseases pose a significant global public health burden, current treatment options focus on slowing disease progression and symptomatic control rather than targeting underlying causes. Interestingly, recent investigations have proposed an analogous aetiology between age-related diseases in the eye and brain, where a process of chronic low-grade inflammation is implicated. Studies have suggested that patients with AD or PD are also associated with an increased risk of AMD, glaucoma, and cataracts. Moreover, pathognomonic amyloid-β and α-synuclein aggregates, which accumulate in AD and PD, respectively, can be found in ocular parenchyma. In terms of a common molecular pathway that underpins these diseases, the nucleotide-binding domain, leucine-rich-containing family, and pyrin domain-containing-3 (NLRP3) inflammasome is thought to play a vital role in the manifestation of all these diseases. This review summarises the current evidence regarding cellular and molecular changes in the brain and eye with age, similarities between ocular and cerebral age-related diseases, and the role of the NLRP3 inflammasome as a critical mediator of disease propagation in the eye and the brain during ageing.
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Affiliation(s)
- Jack J Maran
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, New Zealand
| | - Moradeke M Adesina
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, New Zealand
| | - Colin R Green
- Department of Ophthalmology and the New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Andrea Kwakowsky
- Pharmacology and Therapeutics, School of Medicine, Galway Neuroscience Centre, University of Galway, Galway, Ireland
| | - Odunayo O Mugisho
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology and the New Zealand National Eye Centre, University of Auckland, New Zealand.
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14
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Ye Y, Xian Y, Liu F, Lu ZL, Zhou X, Zhao J. Characteristics and Related Parameters of Quick Contrast Sensitivity Function in Chinese Ametropia Children. Eye Contact Lens 2023; 49:224-233. [PMID: 37126017 PMCID: PMC10194057 DOI: 10.1097/icl.0000000000000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE To investigate the characteristics of quick contrast sensitivity function (qCSF) and its related parameters in Chinese ametropia children. METHODS This case series study enrolled 106 eyes of 53 children (male/female=29/24, age: 9.04±2.06 years). Examinations included manifest refraction, axial length, corneal curvature, and monocular and binocular qCSF readings without refractive correction (area under log CSF [AULCSF], CSF acuity, and contrast sensitivity [CS] at 1.0 to 18.0 cpd). The subjects were divided into groups according to age and refractive parameters for analysis. RESULTS The mean spherical equivalent (SE), AULCSF, and CSF acuity of the test eyes were -0.94±1.53 D, 0.44±0.33, and 8.50±5.97 cpd, respectively. In the monocular qCSF comparison, the refraction sphere (RS) was the major factor correlated with qCSF readings (B=0.186, P =0.009 for AULCSF; B=0.543, P =0.019 for CSF acuity; generalized linear model). The three groups stratified by RS/SE (<-1.00D, -1.00D to 0D, and >0D) showed significant differences in CS at medium spatial frequencies (3.0 and 6.0 cpd; all P <0.05). In the low RS/SE group (within -1 to 0 D), the CS at 12.0 cpd was significantly lower than that in the hyperopia group (all P <0.05). Binocular qCSF readings were significantly correlated with those of the eyes with lower RS (all P <0.05). CONCLUSION RS and SE are the major contributing factors of qCSF without refractive correction in children. The CS at medium spatial frequencies decrease significantly as the RS/SE increase. In low myopia children, the CS at medium and high spatial frequencies are significantly decreased, providing practical value in visual function screening in children.
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Affiliation(s)
- Yuhao Ye
- Department of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University) (Y.Y., Y.X., F.L., X.Z., J.Z.), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Shanghai, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000) (Y.Y., Y.X., F.L., X.Z., J.Z.)Division of Arts and Sciences (Z.-L.L.), NYU Shanghai, Shanghai, China; Center for Neural Science and Department of Psychology, New York University, New York; NYU-ECNU Institute of Brain and Cognitive Science, NYU Shanghai, Shanghai, China
| | - Yiyong Xian
- Department of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University) (Y.Y., Y.X., F.L., X.Z., J.Z.), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Shanghai, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000) (Y.Y., Y.X., F.L., X.Z., J.Z.)Division of Arts and Sciences (Z.-L.L.), NYU Shanghai, Shanghai, China; Center for Neural Science and Department of Psychology, New York University, New York; NYU-ECNU Institute of Brain and Cognitive Science, NYU Shanghai, Shanghai, China
| | - Fang Liu
- Department of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University) (Y.Y., Y.X., F.L., X.Z., J.Z.), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Shanghai, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000) (Y.Y., Y.X., F.L., X.Z., J.Z.)Division of Arts and Sciences (Z.-L.L.), NYU Shanghai, Shanghai, China; Center for Neural Science and Department of Psychology, New York University, New York; NYU-ECNU Institute of Brain and Cognitive Science, NYU Shanghai, Shanghai, China
| | - Zhong-Lin Lu
- Department of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University) (Y.Y., Y.X., F.L., X.Z., J.Z.), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Shanghai, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000) (Y.Y., Y.X., F.L., X.Z., J.Z.)Division of Arts and Sciences (Z.-L.L.), NYU Shanghai, Shanghai, China; Center for Neural Science and Department of Psychology, New York University, New York; NYU-ECNU Institute of Brain and Cognitive Science, NYU Shanghai, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University) (Y.Y., Y.X., F.L., X.Z., J.Z.), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Shanghai, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000) (Y.Y., Y.X., F.L., X.Z., J.Z.)Division of Arts and Sciences (Z.-L.L.), NYU Shanghai, Shanghai, China; Center for Neural Science and Department of Psychology, New York University, New York; NYU-ECNU Institute of Brain and Cognitive Science, NYU Shanghai, Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Eye & ENT Hospital, Fudan University, Shanghai, China; NHC Key Laboratory of Myopia (Fudan University) (Y.Y., Y.X., F.L., X.Z., J.Z.), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.Y., Y.X., F.L., X.Z., J.Z.), Shanghai, China; Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care (20DZ2255000) (Y.Y., Y.X., F.L., X.Z., J.Z.)Division of Arts and Sciences (Z.-L.L.), NYU Shanghai, Shanghai, China; Center for Neural Science and Department of Psychology, New York University, New York; NYU-ECNU Institute of Brain and Cognitive Science, NYU Shanghai, Shanghai, China
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15
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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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16
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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: 1] [Impact Index Per Article: 0.5] [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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17
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Huntington’s disease and neurovascular structure of retina. Neurol Sci 2022; 43:5933-5941. [DOI: 10.1007/s10072-022-06232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
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18
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Araya-Arriagada J, Garay S, Rojas C, Duran-Aniotz C, Palacios AG, Chacón M, Medina LE. Multiscale entropy analysis of retinal signals reveals reduced complexity in a mouse model of Alzheimer's disease. Sci Rep 2022; 12:8900. [PMID: 35614075 PMCID: PMC9132967 DOI: 10.1038/s41598-022-12208-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022] Open
Abstract
Alzheimer's disease (AD) is one of the most significant health challenges of our time, affecting a growing number of the elderly population. In recent years, the retina has received increased attention as a candidate for AD biomarkers since it appears to manifest the pathological signatures of the disease. Therefore, its electrical activity may hint at AD-related physiological changes. However, it is unclear how AD affects retinal electrophysiology and what tools are more appropriate to detect these possible changes. In this study, we used entropy tools to estimate the complexity of the dynamics of healthy and diseased retinas at different ages. We recorded microelectroretinogram responses to visual stimuli of different nature from retinas of young and adult, wild-type and 5xFAD-an animal model of AD-mice. To estimate the complexity of signals, we used the multiscale entropy approach, which calculates the entropy at several time scales using a coarse graining procedure. We found that young retinas had more complex responses to different visual stimuli. Further, the responses of young, wild-type retinas to natural-like stimuli exhibited significantly higher complexity than young, 5xFAD retinas. Our findings support a theory of complexity-loss with aging and disease and can have significant implications for early AD diagnosis.
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Affiliation(s)
- Joaquín Araya-Arriagada
- Escuela de Tecnología Médica, Facultad de Salud, Universidad Santo Tomás, Santiago, Chile
- Centro de Investigación e Innovación en Gerontología Aplicada (CIGAP), Facultad de Salud, Universidad Santo Tomás, Antofagasta, Chile
- Centro Interdisciplinario de Neurociencia de Valparaíso, Universidad de Valparaíso, Valparaíso, Chile
| | - Sebastián Garay
- Departamento de Ingeniería Informática, Universidad de Santiago de Chile, Santiago, Chile
| | - Cristóbal Rojas
- Instituto de Ingeniería Matemática y Computacional, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudia Duran-Aniotz
- Latin American Institute for Brain Health (BrainLat), Universidad Adolfo Ibanez, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), Universidad Adolfo Ibanez, Santiago, Chile
| | - Adrián G Palacios
- Centro Interdisciplinario de Neurociencia de Valparaíso, Universidad de Valparaíso, Valparaíso, Chile
- Instituto de Sistemas Complejos de Valparaíso, Valparaíso, Chile
| | - Max Chacón
- Departamento de Ingeniería Informática, Universidad de Santiago de Chile, Santiago, Chile
| | - Leonel E Medina
- Departamento de Ingeniería Informática, Universidad de Santiago de Chile, Santiago, Chile.
- Millennium Nucleus for Applied Control and Inverse Problems, Santiago, Chile.
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19
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Frame G, Schuller A, Smith MA, Crish SD, Dengler-Crish CM. Alterations in Retinal Signaling Across Age and Sex in 3xTg Alzheimer’s Disease Mice. J Alzheimers Dis 2022; 88:471-492. [PMID: 35599482 PMCID: PMC9398084 DOI: 10.3233/jad-220016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Visual disturbances often precede cognitive dysfunction in patients with Alzheimer’s disease (AD) and may coincide with early accumulation of amyloid-β (Aβ) protein in the retina. These findings have inspired critical research on in vivo ophthalmic Aβ imaging for disease biomarker detection but have not fully answered mechanistic questions on how retinal pathology affects visual signaling between the eye and brain. Objective: The goal of this study was to provide a functional and structural assessment of eye-brain communication between retinal ganglion cells (RGCs) and their primary projection target, the superior colliculus, in female and male 3xTg-AD mice across disease stages. Methods: Retinal electrophysiology, axonal transport, and immunofluorescence were used to determine RGC projection integrity, and retinal and collicular Aβ levels were assessed with advanced protein quantitation techniques. Results: 3xTg mice exhibited nuanced deficits in RGC electrical signaling, axonal transport, and synaptic integrity that exceeded normal age-related decrements in RGC function in age- and sex-matched healthy control mice. These deficits presented in sex-specific patterns among 3xTg mice, differing in the timing and severity of changes. Conclusion: These data support the premise that retinal Aβ is not just a benign biomarker in the eye, but may contribute to subtle, nuanced visual processing deficits. Such disruptions might enhance the biomarker potential of ocular amyloid and differentiate patients with incipient AD from patients experiencing normal age-related decrements in visual function.
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Affiliation(s)
- Gabrielle Frame
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
- Biomedical Sciences Graduate Program, Kent State University, Kent, OH, USA
| | - Adam Schuller
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Matthew A. Smith
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
- Rebecca D. Considine Research Institute, Akron Children’s Hospital, Akron, OH, USA
| | - Samuel D. Crish
- Department of Pharmaceutical Sciences, Northeast Ohio Medical University, Rootstown, OH, USA
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20
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Vidal KSM, Decleva D, Barboni MTS, Nagy BV, de Menezes PAH, Aher A, Coutinho AM, Squarzoni P, Faria DDP, Duran FLDS, Buchpiguel CA, Kremers J, Filho GB, Ventura DF. The Association Between Acquired Color Deficiency and PET Imaging of Neurodegeneration in Mild Cognitive Impairment and Alzheimer Disease. Invest Ophthalmol Vis Sci 2022; 63:20. [PMID: 35579902 PMCID: PMC9123488 DOI: 10.1167/iovs.63.5.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate color vision changes and retinal processing of chromatic and luminance pathways in subjects with Alzheimer disease (AD) and mild cognitive impairment (MCI) compared with a matched control group and whether such changes are associated with impaired brain glucose metabolism and β-amyloid deposition in the brain. Methods We evaluated 13 patients with AD (72.4 ± 7.7 years), 23 patients with MCI (72.5 ± 5.5 years), and 18 controls of comparable age (P = 0.44) using Cambridge color test and the heterochromatic flicker ERG (HF-ERG). The Cambridge color test was performed using the trivector protocol to estimate the protan, deutan and tritan color confusion axes. HF-ERG responses were measured at a frequency of 12 Hz, which ERGs reflect chromatic activity, and at 36 Hz, reflecting luminance pathway. A study subsample was performed using neuropsychological assessments and positron emission tomography. Results Patients with AD presented higher mean values indicating poorer color discrimination for protan (P = 0.04) and deutan (P = 0.001) axes compared with the controls. Along the tritan axis, both patients with AD and patients with MCI showed decreased color vision (P = 0.001 and P = 0.001) compared with controls. The analyses from the HF-ERG protocol revealed no differences between the groups (P = 0.31 and P = 0.41). Diffuse color vision loss was found in individuals with signs of neurodegeneration (protan P = 0.002, deutan P = 0.003 and tritan P = 0.01), but not in individuals with signs of β-amyloid deposition only (protan P = 0.39, deutan P = 0.48, tritan P = 0.63), regardless of their clinical classification. Conclusions Here, patients with AD and patients with MCI present acquired color vision deficiency that may be linked with impaired brain metabolism.
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Affiliation(s)
- Kallene Summer Moreira Vidal
- Laboratory of Vision, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Prevent Senior Private Health Operator, São Paulo, Brazil.,Young medical Leadership Program of National Academy of Medicine in Brazil, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego Decleva
- Laboratory of Vision, Institute of Psychology, University of São Paulo, São Paulo, Brazil
| | - Mirella Telles Salgueiro Barboni
- Laboratory of Vision, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Balàzs Vince Nagy
- Department of Mechatronics, Optics and Mechanical Engineering Informatics, University of Technology and Economics, Budapest, Hungary
| | | | - Avinash Aher
- Section for Retinal Physiology, University Hospital Erlangen, Erlangen, Germany
| | - Artur Martins Coutinho
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Medical School (FMUSP), University of São Paulo, São Paulo, Brazil.,Laboratory of Nuclear Medicine (LIM-43), Department of Radiology and Oncology, Medical School (FMUSP), University of São Paulo, São Paulo, Brazil
| | - Paula Squarzoni
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Medical School (FMUSP), University of São Paulo, São Paulo, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), Universidade de São Paulo, São Paulo, Brazil
| | - Daniele de Paula Faria
- Laboratory of Nuclear Medicine (LIM-43), Department of Radiology and Oncology, Medical School (FMUSP), University of São Paulo, São Paulo, Brazil
| | - Fabio Luis de Souza Duran
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Medical School (FMUSP), University of São Paulo, São Paulo, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Alberto Buchpiguel
- Laboratory of Nuclear Medicine (LIM-43), Department of Radiology and Oncology, Medical School (FMUSP), University of São Paulo, São Paulo, Brazil
| | - Jan Kremers
- Section for Retinal Physiology, University Hospital Erlangen, Erlangen, Germany
| | - Geraldo Busatto Filho
- Laboratory of Psychiatric Neuroimaging (LIM 21), Department of Psychiatry, Medical School (FMUSP), University of São Paulo, São Paulo, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), Universidade de São Paulo, São Paulo, Brazil
| | - Dora Fix Ventura
- Laboratory of Vision, Institute of Psychology, University of São Paulo, São Paulo, Brazil.,Núcleo de Apoio à Pesquisa em Neurociência Aplicada (NAPNA), Universidade de São Paulo, São Paulo, Brazil
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21
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Wu SZ, Nolan-Kenney R, Moehringer NJ, Hasanaj LF, Joseph BM, Clayton AM, Rucker JC, Galetta SL, Wisniewski TM, Masurkar AV, Balcer LJ. Exploration of Rapid Automatized Naming and Standard Visual Tests in Prodromal Alzheimer Disease Detection. J Neuroophthalmol 2022; 42:79-87. [PMID: 34029274 PMCID: PMC8595455 DOI: 10.1097/wno.0000000000001228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
BACKGROUND Visual tests in Alzheimer disease (AD) have been examined over the last several decades to identify a sensitive and noninvasive marker of the disease. Rapid automatized naming (RAN) tasks have shown promise for detecting prodromal AD or mild cognitive impairment (MCI). The purpose of this investigation was to determine the capacity for new rapid image and number naming tests and other measures of visual pathway structure and function to distinguish individuals with MCI due to AD from those with normal aging and cognition. The relation of these tests to vision-specific quality of life scores was also examined in this pilot study. METHODS Participants with MCI due to AD and controls from well-characterized NYU research and clinical cohorts performed high and low-contrast letter acuity (LCLA) testing, as well as RAN using the Mobile Universal Lexicon Evaluation System (MULES) and Staggered Uneven Number test, and vision-specific quality of life scales, including the 25-Item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) and 10-Item Neuro-Ophthalmic Supplement. Individuals also underwent optical coherence tomography scans to assess peripapillary retinal nerve fiber layer and ganglion cell/inner plexiform layer thicknesses. Hippocampal atrophy on brain MRI was also determined from the participants' Alzheimer disease research center or clinical data. RESULTS Participants with MCI (n = 14) had worse binocular LCLA at 1.25% contrast compared with controls (P = 0.009) and longer (worse) MULES test times (P = 0.006) with more errors in naming images (P = 0.009) compared with controls (n = 16). These were the only significantly different visual tests between groups. MULES test times (area under the receiver operating characteristic curve [AUC] = 0.79), MULES errors (AUC = 0.78), and binocular 1.25% LCLA (AUC = 0.78) showed good diagnostic accuracy for distinguishing MCI from controls. A combination of the MULES score and 1.25% LCLA demonstrated the greatest capacity to distinguish (AUC = 0.87). These visual measures were better predictors of MCI vs control status than the presence of hippocampal atrophy on brain MRI in this cohort. A greater number of MULES test errors (rs = -0.50, P = 0.005) and worse 1.25% LCLA scores (rs = 0.39, P = 0.03) were associated with lower (worse) NEI-VFQ-25 scores. CONCLUSIONS Rapid image naming (MULES) and LCLA are able to distinguish MCI due to AD from normal aging and reflect vision-specific quality of life. Larger studies will determine how these easily administered tests may identify patients at risk for AD and serve as measures in disease-modifying therapy clinical trials.
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Affiliation(s)
- Shirley Z Wu
- Departments of Neurology (SZW, RNK, NM, LH, BJ, AC, JCR, SLG, TMW, AVM, and LJB), Population Health (RNK and LJB), and Ophthalmology (SZW, JCR, SLG, and LJB), New York University Grossman School of Medicine, New York, New York
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22
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Deficits in color detection in patients with Alzheimer disease. PLoS One 2022; 17:e0262226. [PMID: 34982795 PMCID: PMC8726485 DOI: 10.1371/journal.pone.0262226] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/19/2021] [Indexed: 11/19/2022] Open
Abstract
Deficits in color vision and related retinal changes hold promise as early screening biomarkers in patients with Alzheimer’s disease. This study aimed to determine a cut-off score that can screen for Alzheimer’s dementia using a novel color vision threshold test named the red, green, and blue (RGB) modified color vision plate test (RGB-vision plate). We developed the RGB-vision plate consisting of 30 plates in which the red and green hues of Ishihara Plate No.22 were sequentially adjusted. A total of 108 older people participated in the mini-mental state examination (MMSE), Ishihara plate, and RGB-vision plate. For the analyses, the participants were divided into two groups: Alzheimer’s dementia (n = 42) and healthy controls (n = 38). K-means cluster analysis and ROC curve analysis were performed to identify the most appropriate cut-off score. As a result, the cut-off screening score for Alzheimer’s dementia on the RGB-vision plate was set at 25, with an area under the curve of 0.773 (p<0.001). Moreover, there was a negative correlation between the RGB-vision plate thresholds and MMSE scores (r = -0.36, p = 0.02). In conclusion, patients with Alzheimer’s dementia had a deficit in color vision. The RGB-vision plate is a potential early biomarker that may adequately detect Alzheimer’s dementia.
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23
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Vit JP, Fuchs DT, Angel A, Levy A, Lamensdorf I, Black KL, Koronyo Y, Koronyo-Hamaoui M. Visual-stimuli Four-arm Maze test to Assess Cognition and Vision in Mice. Bio Protoc 2021; 11:e4234. [PMID: 34909455 DOI: 10.21769/bioprotoc.4234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/02/2022] Open
Abstract
Visual impairments, notably loss of contrast sensitivity and color vision, were documented in Alzheimer's disease (AD) patients yet are critically understudied. This protocol describes a novel visual-stimuli four-arm maze (ViS4M; also called visual x-maze), which is a versatile x-shaped maze equipped with spectrum- and intensity-controlled light-emitting diode (LED) sources and dynamic grayscale objects. The ViS4M is designed to allow the assessment of color and contrast vision along with locomotor and cognitive functions in mice. In the color testing mode, the spectral distributions of the LED lights create four homogenous spaces that differ in chromaticity and luminance, corresponding to the mouse visual system. In the contrast sensitivity test, the four grayscale objects are placed in the middle of each arm, contrasting against the black walls and the white floors of the maze. Upon entering the maze, healthy wild-type (WT) mice tend to spontaneously alternate between arms, even under equiluminant conditions of illumination, suggesting that cognitively and visually intact mice use both color and brightness as cues to navigate the maze. Evaluation of the double-transgenic APPSWE/PS1ΔE9 mouse model of AD (AD+ mice) reveals substantial deficits to alternate in both color and contrast modes at an early age, when hippocampal-based memory and learning is still intact. Profiling of timespan, entries, and transition patterns between the different arms uncovers variable aging and AD-associated impairments in color discrimination and contrast sensitivity. The analysis of arm sequences of alternation reveals different pathways of exploration in young WT, old WT, and AD+ mice, which can be used as color and contrast imprints of functionally intact versus impaired mice. Overall, we describe the utility of a novel visual x-maze test to identify behavioral changes in mice related to cognition, as well as color and contrast vision, with high precision and reproducibility. Graphic abstract: Exploratory behavior of AD+ mice versus age- and sex-matched WT mice is tracked (top left: trajectory from a 5-min video file) in a novel visual-stimuli four-arm maze (ViS4M; also named visual x-maze) equipped with spectrum- and intensity-controlled LED sources or grayscale objects. Consecutive arm entries reveal that APPSWE/PS1ΔE9 (AD+) mice alternate less between arms, as opposed to WT mice. Sequence analysis, according to the three alternation pathways (depicted by white, yellow, and brown arrows) under different conditions of illumination, uncovers specific deficits linked to color vision in AD+ mice, evidenced by a color imprint chart.
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Affiliation(s)
- Jean-Philippe Vit
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Dieu-Trang Fuchs
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | | | | | | | - Keith L Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Yosef Koronyo
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Maya Koronyo-Hamaoui
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,Department of Biomedical Sciences, Division of Applied Cell Biology and Physiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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24
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Almario G, Piñero DP. Impact of Alzheimer's Disease in Ocular Motility and Visual Perception: A Narrative Review. Semin Ophthalmol 2021; 37:436-446. [PMID: 34779338 DOI: 10.1080/08820538.2021.2002371] [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: 10/19/2022]
Abstract
PURPOSE Alzheimer's disease (AD) is a neurodegenerative disease generating a progressive neuronal loss as well as cognitive deficiencies. This disease can be accompanied by ocular manifestations, including alterations in ocular motility and visual perception. The aim of the current review article was to collect all the information about these alterations and to analyze if there is scientific evidence supporting the potential use of these changes as biomarkers of the disease. METHODS A bibliographic search was performed using two different databases, Pubmed and Google Scholar, as well as a search of material in non-peer reviewed journals about Alzheimer's and Neurology. A total of 227 articles were found in the initial search, but only 76 were included considering their relevance according to the purpose of the reviewResults: This narrative review describes the findings obtained in this area to this date, confirming that deficiencies in saccades is the most common condition among AD patients. Furthermore, other visual alterations have also been reported in these patients, including a compromise of visual acuity and contrast sensitivity, fluctuations of colour vision, stereopsis impairment and visual field losses. Likewise, other complex visuo-spatial and visuo-perceptual impairments can be present. More studies are still needed to understand better what type of changes occurs in ocular alignment, binocularity, and fixation pattern in AD patients. CONCLUSIONS AD is associated to visual perception and ocular motility alterations. All the scientific information found in this review should be considered as a guide for designing future studies and to define adequate clinical protocols for the visual evaluation of patients with AD, considering the cognitive limitations that are normally present in this type of patients.
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Affiliation(s)
- Gemma Almario
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain.,Punto Óptico, Elche, Alicante, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain.,Department of Ophthalmology, Vithas Medimar International Hospital, Alicante, Spain
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25
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Shi H, Koronyo Y, Rentsendorj A, Fuchs DT, Sheyn J, Black KL, Mirzaei N, Koronyo-Hamaoui M. Retinal Vasculopathy in Alzheimer's Disease. Front Neurosci 2021; 15:731614. [PMID: 34630020 PMCID: PMC8493243 DOI: 10.3389/fnins.2021.731614] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 08/26/2021] [Indexed: 12/12/2022] Open
Abstract
The retina has been increasingly investigated as a site of Alzheimer’s disease (AD) manifestation for over a decade. Early reports documented degeneration of retinal ganglion cells and their axonal projections. Our group provided the first evidence of the key pathological hallmarks of AD, amyloid β-protein (Aβ) plaques including vascular Aβ deposits, in the retina of AD and mild cognitively impaired (MCI) patients. Subsequent studies validated these findings and further identified electroretinography and vision deficits, retinal (p)tau and inflammation, intracellular Aβ accumulation, and retinal ganglion cell-subtype degeneration surrounding Aβ plaques in these patients. Our data suggest that the brain and retina follow a similar trajectory during AD progression, probably due to their common embryonic origin and anatomical proximity. However, the retina is the only CNS organ feasible for direct, repeated, and non-invasive ophthalmic examination with ultra-high spatial resolution and sensitivity. Neurovascular unit integrity is key to maintaining normal CNS function and cerebral vascular abnormalities are increasingly recognized as early and pivotal factors driving cognitive impairment in AD. Likewise, retinal vascular abnormalities such as changes in vessel density and fractal dimensions, blood flow, foveal avascular zone, curvature tortuosity, and arteriole-to-venule ratio were described in AD patients including early-stage cases. A rapidly growing number of reports have suggested that cerebral and retinal vasculopathy are tightly associated with cognitive deficits in AD patients and animal models. Importantly, we recently identified early and progressive deficiency in retinal vascular platelet-derived growth factor receptor-β (PDGFRβ) expression and pericyte loss that were associated with retinal vascular amyloidosis and cerebral amyloid angiopathy in MCI and AD patients. Other studies utilizing optical coherence tomography (OCT), retinal amyloid-fluorescence imaging and retinal hyperspectral imaging have made significant progress in visualizing and quantifying AD pathology through the retina. With new advances in OCT angiography, OCT leakage, scanning laser microscopy, fluorescein angiography and adaptive optics imaging, future studies focusing on retinal vascular AD pathologies could transform non-invasive pre-clinical AD diagnosis and monitoring.
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Affiliation(s)
- Haoshen Shi
- 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
| | - 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
| | - Nazanin Mirzaei
- 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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26
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Majeed A, Marwick B, Yu H, Fadavi H, Tavakoli M. Ophthalmic Biomarkers for Alzheimer's Disease: A Review. Front Aging Neurosci 2021; 13:720167. [PMID: 34566623 PMCID: PMC8461312 DOI: 10.3389/fnagi.2021.720167] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by neuronal loss, extracellular amyloid-β (Aβ) plaques, and intracellular neurofibrillary tau tangles. A diagnosis is currently made from the presenting symptoms, and the only definitive diagnosis can be done post-mortem. Over recent years, significant advances have been made in using ocular biomarkers to diagnose various neurodegenerative diseases, including AD. As the eye is an extension of the central nervous system (CNS), reviewing changes in the eye's biology could lead to developing a series of non-invasive, differential diagnostic tests for AD that could be further applied to other diseases. Significant changes have been identified in the retinal nerve fiber layer (RNFL), cornea, ocular vasculature, and retina. In the present paper, we review current research and assess some ocular biomarkers' accuracy and reliability that could potentially be used for diagnostic purposes. Additionally, we review the various imaging techniques used in the measurement of these biomarkers.
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Affiliation(s)
- Ayesha Majeed
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Ben Marwick
- Medical School, University of Exeter, Exeter, United Kingdom
| | - Haoqing Yu
- Medical School, University of Exeter, Exeter, United Kingdom
| | | | - Mitra Tavakoli
- Medical School, University of Exeter, Exeter, United Kingdom
- Exeter Centre of Excellence for Diabetes Research, University of Exeter, Exeter, United Kingdom
- National Institute for Health Research, Exeter Clinical Research Facility, Exeter, United Kingdom
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Guo M, Schwartz TD, Dunaief JL, Cui QN. Myeloid cells in retinal and brain degeneration. FEBS J 2021; 289:2337-2361. [PMID: 34478598 PMCID: PMC8891394 DOI: 10.1111/febs.16177] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 12/11/2022]
Abstract
Retinal inflammation underlies multiple prevalent ocular and neurological diseases. Similar inflammatory processes are observed in glaucomatous optic neuropathy, age-related macular degeneration, retinitis pigmentosa, posterior uveitis, Alzheimer's disease, and Parkinson's disease. In particular, human and animal studies have demonstrated the important role microglia/macrophages play in initiating and maintaining a pro-inflammatory environment in degenerative processes impacting vision. On the other hand, microglia have also been shown to have a protective role in multiple central nervous system diseases. Identifying the mechanisms underlying cell dysfunction and death is the first step toward developing novel therapeutics for these diseases impacting the central nervous system. In addition to reviewing recent key studies defining important mediators of retinal inflammation, with an emphasis on translational studies that bridge this research from bench to bedside, we also highlight a promising therapeutic class of medications, the glucagon-like peptide-1 receptor agonists. Finally, we propose areas where additional research is necessary to identify mechanisms that can be modulated to shift the balance from a neurotoxic to a neuroprotective retinal environment.
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Affiliation(s)
- Michelle Guo
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Turner D Schwartz
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua L Dunaief
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
| | - Qi N Cui
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA, USA
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28
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Li ZB, Lin ZJ, Li N, Yu H, Wu YL, Shen X. Evaluation of retinal and choroidal changes in patients with Alzheimer's type dementia using optical coherence tomography angiography. Int J Ophthalmol 2021; 14:860-868. [PMID: 34150541 DOI: 10.18240/ijo.2021.06.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the changes in fundus parameters in patients with Alzheimer's type dementia (ATD) using optical coherence tomography angiography (OCTA), to record flash electroretinograms (ERG) using the RETeval system and to explore changes in retinal function. METHODS Twenty-nine patients with ATD and 26 age-matched normal subjects were enrolled. All subjects underwent OCTA scans to analyse the superficial retinal vessel parameters in the macular area, including the vessel length density, the vessel perfusion density and the area of foveal avascular zone (FAZ), as well as the choroidal thickness. The differences between the patients with ATD and the normal control group were compared and explored the relevant factors affecting vessel parameters. We also recorded the flash ERGs using the RETeval system and intended to explore changes in retinal function by analysing the ERG image amplitude in patients with ATD. RESULTS The vessel parameters [P vessel length density=0.005 and P vessel perfusion density=0.006) and average choroid thickness (P<0.001) in the macular area of the ATD group was less than the control group. The FAZ area was statistically significantly enlarged in the ATD group (P<0.001). These parameters were correlated with the Mini-Mental State Examination (MMSE) score and the Montreal Cognitive Assessment (MoCA). CONCLUSION Patients with ATD exhibit decreases in the parameters associated with fundus. In addition, these indicators significantly correlate with the MMSE score and the MoCA score. OCTA may be an adjunct tool with strong potential to track changes in the diagnosis and monitoring the progression of the disease.
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Affiliation(s)
- Ze-Bing Li
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Zhong-Jing Lin
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Na Li
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Huan Yu
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yan-Lin Wu
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Xi Shen
- Department of Ophthalmology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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29
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Jáñez-García L, Bachtoula O, Salobrar-García E, de Hoz R, Ramirez AI, Gil P, Ramirez JM, Jáñez-Escalada L. Roughness of retinal layers in Alzheimer's disease. Sci Rep 2021; 11:11804. [PMID: 34083574 PMCID: PMC8175587 DOI: 10.1038/s41598-021-91097-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/13/2021] [Indexed: 01/20/2023] Open
Abstract
There is growing evidence that thinned retinal regions are interspersed with thickened regions in all retinal layers of patients with Alzheimer's disease (AD), causing roughness to appear on layer thickness maps. The hypothesis is that roughness of retinal layers, assessed by the fractal dimension (FD) of their thickness maps, is an early biomarker of AD. Ten retinal layers have been studied in macular volumes of optical coherence tomography from 24 healthy volunteers and 19 patients with mild AD (Mini-Mental State Examination 23.42 ± 3.11). Results show that FD of retinal layers is greater in the AD group, the differences being statistically significant (p < 0.05). Correlation of layer FD with cognitive score, visual acuity and age reach statistical significance at 7 layers. Nearly all (44 out of 45) FD correlations among layers are positive and half of them reached statistical significance (p < 0.05). Factor analysis unveiled two independent factors identified as the dysregulation of the choroidal vascular network and the retinal inflammatory process. Conclusions: surface roughness is a holistic feature of retinal layers that can be assessed by the FD of their thickness maps and it is an early biomarker of AD.
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Affiliation(s)
- Lucía Jáñez-García
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Tecnología del Conocimiento, Universidad Complutense de Madrid, Madrid, Spain
| | - Omar Bachtoula
- Instituto de Tecnología del Conocimiento, Universidad Complutense de Madrid, Madrid, Spain
| | - Elena Salobrar-García
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, UCM, IdiSSC, Madrid, Spain
| | - Rosa de Hoz
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, UCM, IdiSSC, Madrid, Spain
| | - Ana I Ramirez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Óptica y Optometría, UCM, IdiSSC, Madrid, Spain
| | - Pedro Gil
- Unidad de Memoria, Servicio de Geriatría, Hospital Clínico San Carlos, Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - José M Ramirez
- Instituto de Investigaciones Oftalmológicas Ramón Castroviejo, Universidad Complutense de Madrid, Madrid, Spain.
- Departamento de Inmunología, Oftalmología y ORL, Facultad de Medicina (UCM), IdiSSC, Madrid, Spain.
| | - Luis Jáñez-Escalada
- Instituto de Tecnología del Conocimiento, Universidad Complutense de Madrid, Madrid, Spain.
- Departamento de Psicobiología y Metodología en Ciencias del Comportamiento, Universidad Complutense de Madrid, Madrid, Spain.
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30
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Chalkias IN, Tegos T, Topouzis F, Tsolaki M. Ocular biomarkers and their role in the early diagnosis of neurocognitive disorders. Eur J Ophthalmol 2021; 31:2808-2817. [PMID: 34000876 DOI: 10.1177/11206721211016311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Given the fact that different types of dementia can be diagnosed only postmortem or when the disease has progressed enough to cause irreversible damage to certain brain areas, there has been an increasing need for the development of sensitive and reliable methods that can detect early preclinical forms of dementia, before the symptoms have even appeared. Ideally, such a method would have the following characteristics: to be inexpensive, sensitive and specific, Non-invasive, fast and easily accessible. The ophthalmologic examination and especially the study of the retina, has caught the attention of many researchers, as it can provide a lot of information about the CNS and it fulfills many of the aforementioned criteria. Since the introduction of the non-invasive optical coherence tomography (OCT) and the newly developed modality OCT-angiography (OCT-A) that can demonstrate the structure and the microvasculature of the retina and choroid, respectively, there have been promising results regarding the value of the ophthalmologic examination in the early diagnosis of Alzheimer's disease. In this review paper, we summarize and discuss the ocular findings in patients with cognitive impairment disorders and we highlight the importance of the ophthalmologic examination to the diagnosis of these disorders.
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Affiliation(s)
- Ioannis-Nikolaos Chalkias
- 1st Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Makedonia Thraki, Greece
| | - Thomas Tegos
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Makedonia Thraki, Greece
| | - Fotis Topouzis
- 1st Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Makedonia Thraki, Greece
| | - Magda Tsolaki
- 1st Department of Neurology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Makedonia Thraki, Greece.,Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece
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31
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Srinivasan S, Efron N. Optical coherence tomography in the investigation of systemic neurologic disease. Clin Exp Optom 2021; 102:309-319. [DOI: 10.1111/cxo.12858] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/21/2018] [Accepted: 10/28/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sangeetha Srinivasan
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia,
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia,
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32
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Zhang Y, Wang Y, Shi C, Shen M, Lu F. Advances in retina imaging as potential biomarkers for early diagnosis of Alzheimer's disease. Transl Neurodegener 2021; 10:6. [PMID: 33517891 PMCID: PMC7849105 DOI: 10.1186/s40035-021-00230-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 01/07/2021] [Indexed: 12/20/2022] Open
Abstract
As the most common form of dementia, Alzheimer’s disease (AD) is characterized by progressive cognitive impairments and constitutes a major social burden. Currently, the invasiveness and high costs of tests have limited the early detection and intervention of the disease. As a unique window of the brain, retinal changes can reflect the pathology of the brain. In this review, we summarize current understanding of retinal structures in AD, mild cognitive impairment (MCI) and preclinical AD, focusing on neurodegeneration and microvascular changes measured using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) technologies. The literature suggests that the impairment of retinal microvascular network and neural microstructure exists in AD, MCI and even preclinical AD. These findings provide valuable insights into a better understanding of disease pathogenesis and demonstrate that retinal changes are potential biomarkers for early diagnosis of AD and monitoring of disease progression.
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Affiliation(s)
- Ying Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, 325027, China
| | - Yanjiang Wang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing, 400042, China
| | - Ce Shi
- School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, 325027, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, 325027, China.
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical College, Wenzhou, 325027, China.
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33
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Salobrar-García E, López-Cuenca I, Sánchez-Puebla L, de Hoz R, Fernández-Albarral JA, Ramírez AI, Bravo-Ferrer I, Medina V, Moro MA, Saido TC, Saito T, Salazar JJ, Ramírez JM. Retinal Thickness Changes Over Time in a Murine AD Model APP NL-F/NL-F. Front Aging Neurosci 2021; 12:625642. [PMID: 33542683 PMCID: PMC7852550 DOI: 10.3389/fnagi.2020.625642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Alzheimer's disease (AD) may present retinal changes before brain pathology, suggesting the retina as an accessible biomarker of AD. The present work is a diachronic study using spectral domain optical coherence tomography (SD-OCT) to determine the total retinal thickness and retinal nerve fiber layer (RNFL) thickness in an APPNL−F/NL−F mouse model of AD at 6, 9, 12, 15, 17, and 20 months old compared to wild type (WT) animals. Methods: Total retinal thickness and RNFL thickness were determined. The mean total retinal thickness was analyzed following the Early Treatment Diabetic Retinopathy Study sectors. RNFL was measured in six sectors of axonal ring scans around the optic nerve. Results: In the APPNL−F/NL−F group compared to WT animals, the total retinal thickness changes observed were the following: (i) At 6-months-old, a significant thinning in the outer temporal sector was observed; (ii) at 15-months-old a significant thinning in the inner temporal and in the inner and outer inferior retinal sectors was noticed; (iii) at 17-months-old, a significant thickening in the inferior and nasal sectors was found in both inner and outer rings; and (iv) at 20-months-old, a significant thinning in the inner ring of nasal, temporal, and inferior retina and in the outer ring of superior and temporal retina was seen. In RNFL thickness, there was significant thinning in the global analysis and in nasal and inner-temporal sectors at 6 months old. Thinning was also found in the supero-temporal and nasal sectors and global value at 20 months old. Conclusions: In the APPNL−F/NL−F AD model, the retinal thickness showed thinning, possibly produced by neurodegeneration alternating with thickening caused by deposits and neuroinflammation in some areas of the retina. These changes over time are similar to those observed in the human retina and could be a biomarker for AD. The APPNL−F/NL−F AD model may help us better understand the different retinal changes during the progression of AD.
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Affiliation(s)
- Elena Salobrar-García
- Ramon Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, Madrid, Spain.,Department of Immunology, Ophthalmology and Ear, Nose, and Throat, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Inés López-Cuenca
- Ramon Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, Madrid, Spain
| | - Lídia Sánchez-Puebla
- Ramon Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, Madrid, Spain
| | - Rosa de Hoz
- Ramon Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, Madrid, Spain.,Department of Immunology, Ophthalmology and Ear, Nose, and Throat, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - José A Fernández-Albarral
- Ramon Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, Madrid, Spain
| | - Ana I Ramírez
- Ramon Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, Madrid, Spain.,Department of Immunology, Ophthalmology and Ear, Nose, and Throat, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - Isabel Bravo-Ferrer
- Department of Pharmacology and Toxicology, Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.,Edinburgh Medical School, UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Violeta Medina
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - María A Moro
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Takaomi C Saido
- Laboratory for Proteolytic Neuroscience, Brain Science Institute, RIKEN, Wako, Japan
| | - Takashi Saito
- Department of Neurocognitive Science, Institute of Brain Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Juan J Salazar
- Ramon Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, Madrid, Spain.,Department of Immunology, Ophthalmology and Ear, Nose, and Throat, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid, Spain
| | - José M Ramírez
- Ramon Castroviejo Ophthalmological Research Institute, Complutense University of Madrid, Madrid, Spain.,Department of Immunology, Ophthalmology and ENT, School of Medicine, Complutense University of Madrid, Madrid, Spain
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34
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Vit JP, Fuchs DT, Angel A, Levy A, Lamensdorf I, Black KL, Koronyo Y, Koronyo-Hamaoui M. Color and contrast vision in mouse models of aging and Alzheimer's disease using a novel visual-stimuli four-arm maze. Sci Rep 2021; 11:1255. [PMID: 33441984 PMCID: PMC7806734 DOI: 10.1038/s41598-021-80988-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/31/2020] [Indexed: 12/14/2022] Open
Abstract
We introduce a novel visual-stimuli four-arm maze (ViS4M) equipped with spectrally- and intensity-controlled LED emitters and dynamic grayscale objects that relies on innate exploratory behavior to assess color and contrast vision in mice. Its application to detect visual impairments during normal aging and over the course of Alzheimer’s disease (AD) is evaluated in wild-type (WT) and transgenic APPSWE/PS1∆E9 murine models of AD (AD+) across an array of irradiance, chromaticity, and contrast conditions. Substantial color and contrast-mode alternation deficits appear in AD+ mice at an age when hippocampal-based memory and learning is still intact. Profiling of timespan, entries and transition patterns between the different arms uncovers variable AD-associated impairments in contrast sensitivity and color discrimination, reminiscent of tritanomalous defects documented in AD patients. Transition deficits are found in aged WT mice in the absence of alternation decline. Overall, ViS4M is a versatile, controlled device to measure color and contrast-related vision in aged and diseased mice.
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Affiliation(s)
- Jean-Philippe Vit
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA.,Biobehavioral Research Core, 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
| | - Ariel Angel
- Pharmaseed Ltd., 9 Hamazmera St., 74047, Ness Ziona, Israel
| | - Aharon Levy
- Pharmaseed Ltd., 9 Hamazmera St., 74047, Ness Ziona, Israel
| | | | - Keith L Black
- 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
| | - Maya Koronyo-Hamaoui
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Los Angeles, CA, 90048, USA. .,Department of Neurosurgery, Maxine Dunitz Neurosurgical Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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35
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Song A, Johnson N, Ayala A, Thompson AC. Optical Coherence Tomography in Patients with Alzheimer's Disease: What Can It Tell Us? Eye Brain 2021; 13:1-20. [PMID: 33447120 PMCID: PMC7802785 DOI: 10.2147/eb.s235238] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/09/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Although Alzheimer's disease (AD) is a leading cause of dementia worldwide, its clinical diagnosis remains a challenge. Optical coherence tomography (OCT) and OCT with angiography (OCTA) are non-invasive ophthalmic imaging tools with the potential to detect retinal structural and microvascular changes in patients with AD, which may serve as biomarkers for the disease. In this systematic review, we evaluate whether certain OCT and OCTA parameters are significantly associated with AD and mild cognitive impairment (MCI). METHODS PubMed database was searched using a combination of MeSH terms to identify studies for review. Studies were organized by participant diagnostic groups, type of imaging modality, and OCT/OCTA parameters of interest. Participant demographic data was also collected and baseline descriptive statistics were calculated for the included studies. RESULTS Seventy-one studies were included for review, representing a total of 6757 patients (2350 AD, 793 MCI, 2902 healthy controls (HC), and 841 others with a range of other neurodegenerative diagnoses). The mean baseline ages were 72.78±3.69, 71.52±2.88, 70.55±3.85 years for AD, MCI and HC groups, respectively. The majority of studies noted significant structural and functional decline in AD patients when compared to HC. Although analysis of MCI groups yielded more mixed results, a similar pattern of decline was often noted amongst patients with MCI relative to HC. OCT and OCTA measurements were also shown to correlate with established measures of AD such as neuropsychological testing or neuroimaging. CONCLUSION OCT and OCTA show great potential as non-invasive technologies for the diagnosis of AD. However, further research is needed to determine whether there are AD-specific patterns of structural or microvascular change in the retina and optic nerve that distinguish AD from other neurodegenerative diseases. Development of sensitive and specific OCT/OCTA parameters will be necessary before they can be used to detect AD in clinical settings.
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Affiliation(s)
- Ailin Song
- Duke University School of Medicine, Durham, NC, USA
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36
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Retinal Degeneration and Alzheimer's Disease: An Evolving Link. Int J Mol Sci 2020; 21:ijms21197290. [PMID: 33023198 PMCID: PMC7582766 DOI: 10.3390/ijms21197290] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 12/13/2022] Open
Abstract
Age-related macular degeneration (AMD) and glaucoma are degenerative conditions of the retina and a significant cause of irreversible blindness in developed countries. Alzheimer’s disease (AD), the most common dementia of the elderly, is often associated with AMD and glaucoma. The cardinal features of AD include extracellular accumulation of amyloid β (Aβ) and intracellular deposits of hyper-phosphorylated tau (p-tau). Neuroinflammation and brain iron dyshomeostasis accompany Aβ and p-tau deposits and, together, lead to progressive neuronal death and dementia. The accumulation of Aβ and iron in drusen, the hallmark of AMD, and Aβ and p-tau in retinal ganglion cells (RGC), the main retinal cell type implicated in glaucoma, and accompanying inflammation suggest overlapping pathology. Visual abnormalities are prominent in AD and are believed to develop before cognitive decline. Some are caused by degeneration of the visual cortex, while others are due to RGC loss or AMD-associated retinal degeneration. Here, we review recent information on Aβ, p-tau, chronic inflammation, and iron dyshomeostasis as common pathogenic mechanisms linking the three degenerative conditions, and iron chelation as a common therapeutic option for these disorders. Additionally discussed is the role of prion protein, infamous for prion disorders, in Aβ-mediated toxicity and, paradoxically, in neuroprotection.
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37
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Gavín A, Garcia-Martin E, Garcia-Campayo J, Viladés E, Orduna E, Satué M. The use of optical coherence tomography in the evaluation of patients with bipolar disorder. ACTA ACUST UNITED AC 2020; 96:141-151. [PMID: 32912807 DOI: 10.1016/j.oftal.2020.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022]
Abstract
Bipolar disorder (BD) is a mental disorder characterised by episodes of extremal mood changes. In recent years, some researchers found neurodegeneration in patients with BD using Magnetic Resonance Imaging. Evaluation of the optic nerve and the retinal layers using optical coherence tomography (OCT) has proved to be a useful, non-invasive tool for diagnosis and monitoring of neurodegenerative diseases. Accordingly, a decrease in the retinal nerve fibre layer and the ganglion cell complex measured by OCT was found in patients with BD in different studies, suggesting that BD is a neurodegenerative process in addition to a psychiatric disorder. Therefore, the neuro-ophthalmological evaluation of these patients could be used as a marker for diagnosis of this disease. This work analyses literature on retinal degeneration in bipolar disorder patients, and evaluates the ability of OCT devices in the detection of neuronal degeneration affecting the different retinal layers in these patients, and its possible role in the diagnosis and monitoring of the disease.
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Affiliation(s)
- A Gavín
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España.
| | - E Garcia-Martin
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España
| | - J Garcia-Campayo
- Servicio de Psiquiatría, Hospital Universitario Miguel Servet, Zaragoza, España; Departamento de Psicología y Sociología, facultad de ciencias sociales y humanas, Universidad de Zaragoza, Zaragoza, España
| | - E Viladés
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España
| | - E Orduna
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España
| | - M Satué
- Servicio de Oftalmología, Hospital Universitario Miguel Servet, Zaragoza, España; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Grupo de Investigación e Innovación Miguel Servet Oftalmología (GIMSO), Zaragoza, España
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38
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Wu SZ, Masurkar AV, Balcer LJ. Afferent and Efferent Visual Markers of Alzheimer's Disease: A Review and Update in Early Stage Disease. Front Aging Neurosci 2020; 12:572337. [PMID: 33061906 PMCID: PMC7518395 DOI: 10.3389/fnagi.2020.572337] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/20/2020] [Indexed: 01/06/2023] Open
Abstract
Vision, which requires extensive neural involvement, is often impaired in Alzheimer's disease (AD). Over the last few decades, accumulating evidence has shown that various visual functions and structures are compromised in Alzheimer's dementia and when measured can detect those with dementia from those with normal aging. These visual changes involve both the afferent and efferent parts of the visual system, which correspond to the sensory and eye movement aspects of vision, respectively. There are fewer, but a growing number of studies, that focus on the detection of predementia stages. Visual biomarkers that detect these stages are paramount in the development of successful disease-modifying therapies by identifying appropriate research participants and in identifying those who would receive future therapies. This review provides a summary and update on common afferent and efferent visual markers of AD with a focus on mild cognitive impairment (MCI) and preclinical disease detection. We further propose future directions in this area. Given the ease of performing visual tests, the accessibility of the eye, and advances in ocular technology, visual measures have the potential to be effective, practical, and non-invasive biomarkers of AD.
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Affiliation(s)
- Shirley Z. Wu
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, United States
| | - Arjun V. Masurkar
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
| | - Laura J. Balcer
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, United States
- Department of Ophthalmology, New York University Grossman School of Medicine, New York, NY, United States
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
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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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Gupta VB, Chitranshi N, den Haan J, Mirzaei M, You Y, Lim JK, Basavarajappa D, Godinez A, Di Angelantonio S, Sachdev P, Salekdeh GH, Bouwman F, Graham S, Gupta V. Retinal changes in Alzheimer's disease- integrated prospects of imaging, functional and molecular advances. Prog Retin Eye Res 2020; 82:100899. [PMID: 32890742 DOI: 10.1016/j.preteyeres.2020.100899] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/31/2022]
Abstract
Alzheimer's Disease (AD) is a devastating neurodegenerative disorder of the brain, clinically characterised by cognitive deficits that gradually worsen over time. There is, at present, no established cure, or disease-modifying treatments for AD. As life expectancy increases globally, the number of individuals suffering from the disease is projected to increase substantially. Cumulative evidence indicates that AD neuropathological process is initiated several years, if not decades, before clinical signs are evident in patients, and diagnosis made. While several imaging, cognitive, CSF and blood-based biomarkers have been proposed for the early detection of AD; their sensitivity and specificity in the symptomatic stages is highly variable and it is difficult to justify their use in even earlier, pre-clinical stages of the disease. Research has identified potentially measurable functional, structural, metabolic and vascular changes in the retina during early stages of AD. Retina offers a distinctively accessible insight into brain pathology and current and developing ophthalmic technologies have provided us with the possibility of detecting and characterising subtle, disease-related changes. Recent human and animal model studies have further provided mechanistic insights into the biochemical pathways that are altered in the retina in disease, including amyloid and tau deposition. This information coupled with advances in molecular imaging has allowed attempts to monitor biochemical changes and protein aggregation pathology in the retina in AD. This review summarises the existing knowledge that informs our understanding of the impact of AD on the retina and highlights some of the gaps that need to be addressed. Future research will integrate molecular imaging innovation with functional and structural changes to enhance our knowledge of the AD pathophysiological mechanisms and establish the utility of monitoring retinal changes as a potential biomarker for AD.
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Affiliation(s)
- Veer B Gupta
- School of Medicine, Deakin University, VIC, Australia
| | - Nitin Chitranshi
- Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Jurre den Haan
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands
| | - Mehdi Mirzaei
- Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Yuyi You
- Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Jeremiah Kh Lim
- Optometry and Vision Science, College of Nursing and Health Sciences, Bedford Park, South Australia, 5042, Australia
| | - Devaraj Basavarajappa
- Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Angela Godinez
- Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Silvia Di Angelantonio
- Center for Life Nanoscience, Istituto Italiano di Tecnologia, Rome, Italy; Department of Physiology and Pharmacology, Sapienza University of Rome, Rome, Italy
| | - Perminder Sachdev
- Centre for Healthy Brain and Ageing (CHeBA), School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ghasem H Salekdeh
- Department of Molecular Systems Biology, Cell Science Research Center, Royan, Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Femke Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, the Netherlands
| | - Stuart Graham
- Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia; Save Sight Institute, Sydney University, Sydney, NSW, 2000, Australia.
| | - Vivek Gupta
- Faculty of Medicine Health and Human Sciences, Macquarie University, North Ryde, NSW, 2109, Australia.
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Chibhabha F, Yaqi Y, Li F. Retinal involvement in Alzheimer's disease (AD): evidence and current progress on the non-invasive diagnosis and monitoring of AD-related pathology using the eye. Rev Neurosci 2020; 31:/j/revneuro.ahead-of-print/revneuro-2019-0119/revneuro-2019-0119.xml. [PMID: 32804680 DOI: 10.1515/revneuro-2019-0119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 06/04/2020] [Indexed: 12/22/2022]
Abstract
Alzheimer's disease (AD) is a common form of age-related dementia that mostly affects the aging population. Clinically, it is a disease characterized by impaired memory and progressive cognitive decline. Although the pathological hallmarks of AD have been traditionally described with a general confinement in the brain, recent studies have shown similar pathological changes in the retina, which is a developmental outgrowth of the forebrain. These AD-related neurodegenerative changes in the retina have been implicated to cause early visual problems in AD even before cognitive impairment becomes apparent. With recent advances in research, the commonly held view that AD-related cerebral pathology causes visual dysfunction through disruption of central visual pathways has been re-examined. Currently, several studies have already explored how AD manifests in the retina and the possibility of using the same retina as a window to non-invasively examine AD-related pathology in the brain. Non-invasive screening of AD through the retina has the potential to improve on early detection and management of the disease since the majority of AD cases are usually diagnosed very late. The purpose of this review is to provide evidence on the involvement of the retina in AD and to suggest a possible direction for future research into the non-invasive screening, diagnosis, and monitoring of AD using the retina.
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Affiliation(s)
- Fidelis Chibhabha
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou510080,China
- Department of Anatomy, Faculty of Medicine, Midlands State University, P. Bag 9055, Senga, Gweru, Zimbabwe
- and Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080,China
| | - Yang Yaqi
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou510080,China
- and Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080,China
| | - Feng Li
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou510080,China
- and Guangdong Provincial Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, 510080,China
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Wright LM, Stein TD, Jun G, Chung J, McConnell K, Fiorello M, Siegel N, Ness S, Xia W, Turner KL, Subramanian ML. Association of Cognitive Function with Amyloid-β and Tau Proteins in the Vitreous Humor. J Alzheimers Dis 2020; 68:1429-1438. [PMID: 30856114 DOI: 10.3233/jad-181104] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The eye may serve as source for diagnostic testing for early detection of Alzheimer's disease (AD). Examination of amyloid-β (Aβ) and tau protein content in human vitreous and its correlation to neuro-cognition may improve ocular-based AD detection methods. OBJECTIVE To evaluate levels of Aβ and tau protein in human vitreous humor and investigate the clinical predictive role of these proteins as early diagnostic markers of AD. METHODS A prospective, single-center, multi-surgeon cohort study. Vitreous humor samples from 80 eyes were measured quantitatively for Aβ40-42, pTau, and tTau. Linear regression was used to test associations between AD biomarker levels, Mini-Mental State Exam (MMSE), and serum apolipoprotein E (APOE) allele status, with adjustment for age, sex, and education level of patients. RESULTS Lower MMSE scores were significantly associated with lower levels of vitreous Aβ40 (p = 0.015), Aβ42 (p = 0.0066), and tTau (p = 0.0085), and these biomarkers were not associated with any pre-existing eye conditions. Presence of the ɛ4 allele and the ɛ2 allele approached significance with reduced Aβ40 level (p = 0.053) and increased p-Tau level (p = 0.056), respectively. CONCLUSION Patients with poor cognitive function have significantly lower vitreous humor levels of AD-related biomarkers Aβ40, Aβ42, and tTau. These biomarkers do not correlate with underlying eye conditions, suggesting their specificity in association with cognitive change. This is the first study to our knowledge to correlate cognition with AD-related proteins in the vitreous humor. Results suggest ocular proteins may have a role for early dementia detection in individuals at risk for AD.
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Affiliation(s)
- Lauren M Wright
- Department of Ophthalmology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Thor D Stein
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Department of Veterans Affairs Medical Center, Bedford, MA, USA.,VA Boston Healthcare System, Boston, MA, USA.,Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
| | - Gyungah Jun
- Department of Genetics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Jaeyoon Chung
- Department of Genetics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.,Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Kate McConnell
- Department of Ophthalmology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Marissa Fiorello
- Department of Ophthalmology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Nicole Siegel
- Department of Ophthalmology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Steven Ness
- Department of Ophthalmology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Weiming Xia
- Boston University Alzheimer's Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA.,Department of Pharmacology and Experimental Therapeutics, Veterans Affairs Medical Center, Bedford, MA, USA
| | - Kelley L Turner
- Department of Ophthalmology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Manju L Subramanian
- Department of Ophthalmology, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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Interplay between Oxidative Stress, Inflammation, and Amyloidosis in the Anterior Segment of the Eye; Its Pathological Implications. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:6286105. [PMID: 32566091 PMCID: PMC7291327 DOI: 10.1155/2020/6286105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/02/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022]
Abstract
There are different pathologies associated with amyloidogenic processes caused by the increase of reactive oxygen species (ROS) and the overactivation of inflammatory responses. These alterations are present in different regions of the anterior segment of the eye, and they have been associated with the development and progression of ocular pathologies, such as glaucoma, dry eye syndrome, keratitis, and cataracts among other pathologies. Aim. To discuss briefly the anatomical characteristics of the anterior segment of the eye and describe the interaction between oxidative stress (OS) and inflammatory responses, emphasizing the misfolding of several proteins leading to amyloidogenic processes occurring in the anterior segment and their implications in the development of ocular diseases. We performed a search on PubMed, CINAHL, and Embase using the MeSH terms “eye,” “anterior segment”, “inflammation”, “oxidative stress”, and “amyloidosis”. The search encompassed manuscripts published up to April 2019. A hundred forty-four published studies met the inclusion criteria. We present the current knowledge regarding the interaction between OS and the activation of inflammatory processes and how both can cause conformational changes in several peptides and proteins in each compartment of the anterior segment. However, we found that there is no consensus about which factor is the first to cause amyloidosis. Our conclusions suggest that there is an interplay among these factors forming a vicious cycle that leads to the loss of protein structure in ocular pathologies, and multifactorial therapies should be developed to avoid protein misfolding and to stop the progression of ocular pathologies.
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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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Hong SB, Ahn J, Yoo D, Shin JY, Jeon B, Lee JY. Contrast sensitivity impairment in drug-naïve Parkinson's disease patients associates with early cognitive decline. Neurol Sci 2020; 41:1837-1842. [PMID: 32062736 DOI: 10.1007/s10072-020-04289-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/10/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To investigate the contrast sensitivity function in drug-naïve Parkinson's disease (PD) patients and its predictive value with longitudinal follow-up data. METHODS We included newly diagnosed non-demented PD patients who performed contrast sensitivity test between 2013 and 2014. Contrast sensitivity function at drug-naïve state in PD patients was compared with age-matched normal control data of our center. Correlation between contrast sensitivity function and parkinsonian motor and non-motor features including the Mini-Mental State Exam (MMSE) score at the time of diagnosis were analyzed by linear regression. With longitudinal follow-up data after initiating anti-parkinsonian therapy, the risk conferred on subsequent visual hallucinations and cognitive impairment requiring anti-dementia drugs was analyzed by dichotomizing PD group based on the initial contrast sensitivity function. RESULTS Forty-eight patients were finally included, and mean follow-up periods were 43 months. Contrast sensitivity function in drug-naïve PD patients was significantly worse than controls. Contrast sensitivity function correlated with sleep disturbance (p = 0.001) and global cognitive status reflected by the MMSE score (p = 0.020). It also associated with further decline in the MMSE during the follow-ups (p = 0.029). Patients with below average contrast sensitivity function at the time of diagnosis showed higher risk of cognitive decline requiring anti-dementia drugs (adjusted odds ratio = 4.68, p = 0.04) and of visual hallucinations (adjusted odds ratio = 12.54, p = 0.04) than those above average function during the follow-up. CONCLUSION Contrast sensitivity impairment in drug-naïve PD patients associates with clinical demand for therapeutic intervention of cognitive decline as well as development of visual hallucinations in the early course of the disease.
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Affiliation(s)
- Sang Bin Hong
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center & Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Shindaebang-dong, Seoul, 07061, South Korea.,Department of Neurology, Seoul National University Hospital & Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
| | - Jeeyun Ahn
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center & Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Shindaebang-dong, Seoul, 07061, South Korea
| | - Dalla Yoo
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center & Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Shindaebang-dong, Seoul, 07061, South Korea.,Department of Neurology, Seoul National University Hospital & Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
| | - Joo Young Shin
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center & Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Shindaebang-dong, Seoul, 07061, South Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital & Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center & Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, Shindaebang-dong, Seoul, 07061, South Korea.
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Harper MM, Hedberg-Buenz A, Herlein J, Abrahamson EE, Anderson MG, Kuehn MH, Kardon RH, Poolman P, Ikonomovic MD. Blast-Mediated Traumatic Brain Injury Exacerbates Retinal Damage and Amyloidosis in the APPswePSENd19e Mouse Model of Alzheimer's Disease. Invest Ophthalmol Vis Sci 2019; 60:2716-2725. [PMID: 31247112 PMCID: PMC6735799 DOI: 10.1167/iovs.18-26353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Purpose Traumatic brain injury (TBI) is a risk factor for developing chronic neurodegenerative conditions including Alzheimer's disease (AD). The purpose of this study was to examine chronic effects of blast TBI on retinal ganglion cells (RGC), optic nerve, and brain amyloid load in a mouse model of AD amyloidosis. Methods Transgenic (TG) double-mutant APPswePSENd19e (APP/PS1) mice and nontransgenic (Non-TG) littermates were exposed to a single blast TBI (20 psi) at age 2 to 3 months. RGC cell structure and function was evaluated 2 months later (average age at endpoint = 4.5 months) using pattern electroretinogram (PERG), optical coherence tomography (OCT), and the chromatic pupil light reflex (cPLR), followed by histologic analysis of retina, optic nerve, and brain amyloid pathology. Results APP/PS1 mice exposed to blast TBI (TG-Blast) had significantly lower PERG and cPLR responses 2 months after injury compared to preblast values and compared to sham groups of APP/PS1 (TG-Sham) and nontransgenic (Non-TG-Sham) mice as well as nontransgenic blast-exposed mice (Non-TG-Blast). The TG-Blast group also had significantly thinner RGC complex and more optic nerve damage compared to all groups. No amyloid-β (Aβ) deposits were detected in retinas of APP/PS1 mice; however, increased amyloid precursor protein (APP)/Aβ-immunoreactivity was seen in TG-Blast compared to TG-Sham mice, particularly near blood vessels. TG-Blast and TG-Sham groups exhibited high variability in pathology severity, with a strong, but not statistically significant, trend for greater cerebral cortical Aβ plaque load in the TG-Blast compared to TG-Sham group. Conclusions When combined with a genetic susceptibility for developing amyloidosis of AD, blast TBI exposure leads to earlier RGC and optic nerve damage associated with modest but detectable increase in cerebral cortical Aβ pathology. These findings suggest that genetic risk factors for AD may increase the sensitivity of the retina to blast-mediated damage.
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Affiliation(s)
- Matthew M Harper
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Adam Hedberg-Buenz
- The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Molecular Physiology and Biophysics, The University of Iowa, Iowa City, Iowa, United States
| | - Judith Herlein
- The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Eric E Abrahamson
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.,Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, Pennsylvania, United States
| | - Michael G Anderson
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States.,Department of Molecular Physiology and Biophysics, The University of Iowa, Iowa City, Iowa, United States
| | - Markus H Kuehn
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Randy H Kardon
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Pieter Poolman
- Department of Ophthalmology and Visual Sciences, The University of Iowa, Iowa City, Iowa, United States.,The Iowa City VA Center for the Prevention and Treatment of Visual Loss, Iowa City, Iowa, United States
| | - Milos D Ikonomovic
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States.,Geriatric Research Education and Clinical Center, Pittsburgh VA Healthcare System, Pittsburgh, Pennsylvania, United States.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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47
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Yap TE, Balendra SI, Almonte MT, Cordeiro MF. Retinal correlates of neurological disorders. Ther Adv Chronic Dis 2019; 10:2040622319882205. [PMID: 31832125 PMCID: PMC6887800 DOI: 10.1177/2040622319882205] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 09/20/2019] [Indexed: 12/11/2022] Open
Abstract
Considering the retina as an extension of the brain provides a platform from which to study diseases of the nervous system. Taking advantage of the clear optical media of the eye and ever-increasing resolution of modern imaging techniques, retinal morphology can now be visualized at a cellular level in vivo. This has provided a multitude of possible biomarkers and investigative surrogates that may be used to identify, monitor and study diseases until now limited to the brain. In many neurodegenerative conditions, early diagnosis is often very challenging due to the lack of tests with high sensitivity and specificity, but, once made, opens the door to patients accessing the correct treatment that can potentially improve functional outcomes. Using retinal biomarkers in vivo as an additional diagnostic tool may help overcome the need for invasive tests and histological specimens, and offers the opportunity to longitudinally monitor individuals over time. This review aims to summarise retinal biomarkers associated with a range of neurological conditions including Alzheimer’s disease (AD), Parkinson’s disease (PD), multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS) and prion diseases from a clinical perspective. By comparing their similarities and differences according to primary pathological processes, we hope to show how retinal correlates can aid clinical decisions, and accelerate the study of this rapidly developing area of research.
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Affiliation(s)
- Timothy E Yap
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, UK
| | - Shiama I Balendra
- Glaucoma and Retinal Neurodegeneration Group, Department of Visual Neuroscience, UCL Institute of Ophthalmology, London, UK
| | - Melanie T Almonte
- The Imperial College Ophthalmic Research Group (ICORG), Imperial College London, UK
| | - M Francesca Cordeiro
- The Western Eye Hospital, Imperial College Healthcare NHS Trust (ICHNT), London, NW1 5QH, UK
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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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49
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Neurodegeneration in Patients with Type 2 Diabetes Mellitus without Diabetic Retinopathy. J Ophthalmol 2019; 2019:1825819. [PMID: 31485340 PMCID: PMC6702840 DOI: 10.1155/2019/1825819] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/22/2019] [Accepted: 07/01/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose To evaluate neurodegeneration in patients with type 2 diabetes mellitus (DM2) without diabetic retinopathy and to assess the possible role of systemic vascular complications in retinal changes. Methods Sixty eyes of 60 patients with DM2 and without any signs of diabetic retinopathy and 60 eyes of 60 healthy controls underwent retinal evaluation using Spectralis optical coherence tomography. Macular ganglion cell layer (GCL) and retinal nerve fiber layer (RNFL) were evaluated. Peripapillary RNFL thickness was assessed using Glaucoma and Axonal Analytics applications. Comparison between patients with the presence/absence of systemic vascular complications and different disease duration was made. Results Macular GCL was reduced in patients compared to controls (p < 0.001). Differences in the macular RNFL thickness were only observed in the outer inferior sector (p=0.033). A reduction in the peripapillary RNFL (average, inferior, and inferotemporal thickness, p < 0.05 for all three) was observed in patients using both applications. Patients with chronic systemic vascular complications presented a reduction in the temporal RNFL (p=0.019) compared to patients without complications. The superotemporal RNFL thickness was thinner in patients with longer disease duration. Conclusions Patients with type 2 DM without diabetic retinopathy and good metabolic control present neurodegeneration affecting neurons in the macular area and axons in different sectors of the optic disc. Systemic vascular complications contributed to further axonal damage in these patients, suggesting a possible role of subclinical ischaemia to retinal neurodegeneration in type 2 DM.
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50
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Chiquita S, Rodrigues-Neves AC, Baptista FI, Carecho R, Moreira PI, Castelo-Branco M, Ambrósio AF. The Retina as a Window or Mirror of the Brain Changes Detected in Alzheimer's Disease: Critical Aspects to Unravel. Mol Neurobiol 2019; 56:5416-5435. [PMID: 30612332 DOI: 10.1007/s12035-018-1461-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/17/2018] [Indexed: 11/24/2022]
Abstract
Alzheimer's disease is the most frequent cause of dementia worldwide, representing a global health challenge, with a massive impact on the quality of life of Alzheimer's disease patients and their relatives. The diagnosis of Alzheimer's disease constitutes a real challenge, because the symptoms manifest years after the first degenerative changes occurring in the brain and the diagnosis is based on invasive and/or expensive techniques. Therefore, there is an urgent need to identify new reliable biomarkers to detect Alzheimer's disease at an early stage. Taking into account the evidence for visual deficits in Alzheimer's disease patients, sometimes even before the appearance of the first disease symptoms, and that the retina is an extension of the brain, the concept of the retina as a window to look into the brain or a mirror of the brain has received increasing interest in recent years. However, only a few studies have assessed the changes occurring in the retina and the brain at the same time points. Unlike previous reviews on this subject, which are mainly focused on brain changes, we organized this review by comprehensively summarizing findings related with structural, functional, cellular, and molecular parameters in the retina reported in both Alzheimer's disease patients and animal models. Moreover, we separated the studies that assessed only the retina, and those that assessed both the retina and brain, which are few but allow establishing correlations between the retina and brain. This review also highlights some inconsistent results in the literature as well as relevant missing gaps in this field.
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Affiliation(s)
- Samuel Chiquita
- iCBR, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal
| | - Ana C Rodrigues-Neves
- iCBR, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal
| | - Filipa I Baptista
- iCBR, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal
| | - Rafael Carecho
- iCBR, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal
| | - Paula I Moreira
- CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal
- CNC, Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
- Institute of Physiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Miguel Castelo-Branco
- CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal
- CIBIT, Coimbra Institute for Biomedical Imaging and Translational Research, ICNAS, Institute of Nuclear Sciences Applied to Health, University of Coimbra, Coimbra, Portugal
| | - António F Ambrósio
- iCBR, Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- CNC.IBILI Consortium, University of Coimbra, Coimbra, Portugal.
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