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Chan VTT, Ran AR, Wagner SK, Hui HYH, Hu X, Ko H, Fekrat S, Wang Y, Lee CS, Young AL, Tham CC, Tham YC, Keane PA, Milea D, Chen C, Wong TY, Mok VCT, Cheung CY. Value Proposition of Retinal Imaging in Alzheimer's Disease Screening: A Review of Eight Evolving Trends. Prog Retin Eye Res 2024:101290. [PMID: 39173942 DOI: 10.1016/j.preteyeres.2024.101290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 08/13/2024] [Accepted: 08/15/2024] [Indexed: 08/24/2024]
Abstract
Alzheimer's disease (AD) is the leading cause of dementia worldwide. Current diagnostic modalities of AD generally focus on detecting the presence of amyloid β and tau protein in the brain (for example, positron emission tomography [PET] and cerebrospinal fluid testing), but these are limited by their high cost, invasiveness, and lack of expertise. Retinal imaging exhibits potential in AD screening and risk stratification, as the retina provides a platform for the optical visualization of the central nervous system in vivo, with vascular and neuronal changes that mirror brain pathology. Given the paradigm shift brought by advances in artificial intelligence and the emergence of disease-modifying therapies, this article aims to summarize and review the current literature to highlight 8 trends in an evolving landscape regarding the role and potential value of retinal imaging in AD screening.
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Affiliation(s)
- Victor T T Chan
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Siegfried K Wagner
- NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Herbert Y H Hui
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaoyan Hu
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ho Ko
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR China; Gerald Choa Neuroscience Institute, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR China
| | - Sharon Fekrat
- Departments of Ophthalmology and Neurology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Yaxing Wang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital University of Medical Science, Beijing, China
| | - Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, USA
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yih Chung Tham
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Pearse A Keane
- NIHR Biomedical Research Center at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Dan Milea
- Singapore National Eye Centre, Singapore
| | - Christopher Chen
- Memory Aging & Cognition Centre, National University Health System, Singapore; Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Vincent C T Mok
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR China; Gerald Choa Neuroscience Institute, Margaret K.L. Cheung Research Centre for Management of Parkinsonism, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Li Ka Shing Institute of Health Science, Lau Tat-chuen Research Centre of Brain Degenerative Diseases in Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong SAR, China.
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Chen JS, Copado IA, Vallejos C, Kalaw FGP, Soe P, Cai CX, Toy BC, Borkar D, Sun CQ, Shantha JG, Baxter SL. Variations in Electronic Health Record-Based Definitions of Diabetic Retinopathy Cohorts: A Literature Review and Quantitative Analysis. OPHTHALMOLOGY SCIENCE 2024; 4:100468. [PMID: 38560278 PMCID: PMC10973665 DOI: 10.1016/j.xops.2024.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 04/04/2024]
Abstract
Purpose Use of the electronic health record (EHR) has motivated the need for data standardization. A gap in knowledge exists regarding variations in existing terminologies for defining diabetic retinopathy (DR) cohorts. This study aimed to review the literature and analyze variations regarding codified definitions of DR. Design Literature review and quantitative analysis. Subjects Published manuscripts. Methods Four graders reviewed PubMed and Google Scholar for peer-reviewed studies. Studies were included if they used codified definitions of DR (e.g., billing codes). Data elements such as author names, publication year, purpose, data set type, and DR definitions were manually extracted. Each study was reviewed by ≥ 2 authors to validate inclusion eligibility. Quantitative analyses of the codified definitions were then performed to characterize the variation between DR cohort definitions. Main Outcome Measures Number of studies included and numeric counts of billing codes used to define codified cohorts. Results In total, 43 studies met the inclusion criteria. Half of the included studies used datasets based on structured EHR data (i.e., data registries, institutional EHR review), and half used claims data. All but 1 of the studies used billing codes such as the International Classification of Diseases 9th or 10th edition (ICD-9 or ICD-10), either alone or in addition to another terminology for defining disease. Of the 27 included studies that used ICD-9 and the 20 studies that used ICD-10 codes, the most common codes used pertained to the full spectrum of DR severity. Diabetic retinopathy complications (e.g., vitreous hemorrhage) were also used to define some DR cohorts. Conclusions Substantial variations exist among codified definitions for DR cohorts within retrospective studies. Variable definitions may limit generalizability and reproducibility of retrospective studies. More work is needed to standardize disease cohorts. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Jimmy S Chen
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Ivan A Copado
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Cecilia Vallejos
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Fritz Gerald P Kalaw
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Priyanka Soe
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - Cindy X Cai
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Brian C Toy
- Department of Ophthalmology, Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Durga Borkar
- Department of Ophthalmology, Duke Eye Center, Duke University, Durham, North Carolina
| | - Catherine Q Sun
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Jessica G Shantha
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, California
- Department of Ophthalmology, University of California San Francisco, San Francisco, California
| | - Sally L Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- UCSD Health Department of Biomedical Informatics, University of California San Diego, La Jolla, California
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Gabitto MI, Travaglini KJ, Rachleff VM, Kaplan ES, Long B, Ariza J, Ding Y, Mahoney JT, Dee N, Goldy J, Melief EJ, Brouner K, Campos J, Carr AJ, Casper T, Chakrabarty R, Clark M, Compos J, Cool J, Valera Cuevas NJ, Dalley R, Darvas M, Ding SL, Dolbeare T, Mac Donald CL, Egdorf T, Esposito L, Ferrer R, Gala R, Gary A, Gloe J, Guilford N, Guzman J, Ho W, Jarksy T, Johansen N, Kalmbach BE, Keene LM, Khawand S, Kilgore M, Kirkland A, Kunst M, Lee BR, Malone J, Maltzer Z, Martin N, McCue R, McMillen D, Meyerdierks E, Meyers KP, Mollenkopf T, Montine M, Nolan AL, Nyhus J, Olsen PA, Pacleb M, Pham T, Pom CA, Postupna N, Ruiz A, Schantz AM, Sorensen SA, Staats B, Sullivan M, Sunkin SM, Thompson C, Tieu M, Ting J, Torkelson A, Tran T, Wang MQ, Waters J, Wilson AM, Haynor D, Gatto N, Jayadev S, Mufti S, Ng L, Mukherjee S, Crane PK, Latimer CS, Levi BP, Smith K, Close JL, Miller JA, Hodge RD, Larson EB, Grabowski TJ, Hawrylycz M, Keene CD, Lein ES. Integrated multimodal cell atlas of Alzheimer's disease. RESEARCH SQUARE 2023:rs.3.rs-2921860. [PMID: 37292694 PMCID: PMC10246227 DOI: 10.21203/rs.3.rs-2921860/v1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Alzheimer's disease (AD) is the most common cause of dementia in older adults. Neuropathological and imaging studies have demonstrated a progressive and stereotyped accumulation of protein aggregates, but the underlying molecular and cellular mechanisms driving AD progression and vulnerable cell populations affected by disease remain coarsely understood. The current study harnesses single cell and spatial genomics tools and knowledge from the BRAIN Initiative Cell Census Network to understand the impact of disease progression on middle temporal gyrus cell types. We used image-based quantitative neuropathology to place 84 donors spanning the spectrum of AD pathology along a continuous disease pseudoprogression score and multiomic technologies to profile single nuclei from each donor, mapping their transcriptomes, epigenomes, and spatial coordinates to a common cell type reference with unprecedented resolution. Temporal analysis of cell-type proportions indicated an early reduction of Somatostatin-expressing neuronal subtypes and a late decrease of supragranular intratelencephalic-projecting excitatory and Parvalbumin-expressing neurons, with increases in disease-associated microglial and astrocytic states. We found complex gene expression differences, ranging from global to cell type-specific effects. These effects showed different temporal patterns indicating diverse cellular perturbations as a function of disease progression. A subset of donors showed a particularly severe cellular and molecular phenotype, which correlated with steeper cognitive decline. We have created a freely available public resource to explore these data and to accelerate progress in AD research at SEA-AD.org.
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Affiliation(s)
| | | | - Victoria M. Rachleff
- Allen Institute for Brain Science, Seattle, WA, 98109
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | | | - Brian Long
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jeanelle Ariza
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Yi Ding
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Nick Dee
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jeff Goldy
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Erica J. Melief
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | | | - John Campos
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | | | - Tamara Casper
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Michael Clark
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jazmin Compos
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jonah Cool
- Chan Zuckerberg Initiative, Redwood City, CA 94063
| | | | - Rachel Dalley
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Martin Darvas
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Song-Lin Ding
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Tim Dolbeare
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Tom Egdorf
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Luke Esposito
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Rohan Gala
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Amanda Gary
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jessica Gloe
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | - Windy Ho
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Tim Jarksy
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | - Lisa M. Keene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Sarah Khawand
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Mitch Kilgore
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Amanda Kirkland
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Michael Kunst
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Brian R. Lee
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Zoe Maltzer
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Naomi Martin
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Rachel McCue
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | - Kelly P. Meyers
- Kaiser Permanente Washington Research Institute, Seattle, WA, 98101
| | | | - Mark Montine
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Amber L. Nolan
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Julie Nyhus
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Paul A. Olsen
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Maiya Pacleb
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Thanh Pham
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Nadia Postupna
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Augustin Ruiz
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Aimee M. Schantz
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | | | - Brian Staats
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Matt Sullivan
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | - Michael Tieu
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Jonathan Ting
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Amy Torkelson
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Tracy Tran
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Jack Waters
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Angela M. Wilson
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - David Haynor
- Department of Radiology, University of Washington, Seattle, WA 98014
| | - Nicole Gatto
- Kaiser Permanente Washington Research Institute, Seattle, WA, 98101
| | - Suman Jayadev
- Department of Neurology, University of Washington, Seattle, WA 98104
| | - Shoaib Mufti
- Allen Institute for Brain Science, Seattle, WA, 98109
| | - Lydia Ng
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | - Paul K. Crane
- Department of Medicine, University of Washington, Seattle, WA 98104
| | - Caitlin S. Latimer
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Boaz P. Levi
- Allen Institute for Brain Science, Seattle, WA, 98109
| | | | | | | | | | - Eric B. Larson
- Department of Medicine, University of Washington, Seattle, WA 98104
| | | | | | - C. Dirk Keene
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98104
| | - Ed S. Lein
- Allen Institute for Brain Science, Seattle, WA, 98109
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Lee CS, Krakauer C, Su YR, Walker RL, Blazes M, McCurry SM, Bowen JD, McCormick WC, Lee AY, Boyko EJ, O'Hare AM, Larson EB, Crane PK. Diabetic Retinopathy and Dementia Association, Beyond Diabetes Severity. Am J Ophthalmol 2023; 249:90-98. [PMID: 36513155 PMCID: PMC10106379 DOI: 10.1016/j.ajo.2022.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To investigate whether associations between diabetic retinopathy (DR) and dementia and Alzheimer's disease (AD) remain significant after controlling for several measures of diabetes severity. DESIGN Retrospective cohort study. METHODS Adult Changes in Thought (ACT) is a prospective cohort study of adults aged ≥65 years, randomly selected and recruited from the membership rolls of Kaiser Permanente Washington, who are dementia free at enrollment and followed biennially until incident dementia. The ACT participants were included in this study if they had type 2 diabetes mellitus at enrollment or developed it during follow-up, and data were collected through September, 2018 (3516 person-years of follow-up). Diabetes was defined by ≥ 2 diabetes medication fills in 1 year. Diagnosis of DR was based on International Classification of Diseases Ninth and Tenth Revision codes. Estimates of microalbuminuria, long-term glycemia, and renal function from longitudinal laboratory records were used as indicators of diabetes severity. Alzheimer's disease and dementia were diagnosed using research criteria at expert consensus meetings. RESULTS A total of 536 participants (median baseline age 75 [interquartile range 71-80], 54% women) met inclusion criteria. Significant associations between DR >5 years duration with dementia (hazard ratio 1.81 [95% CI 1.23, 2.65]) and AD (1.80 [1.15, 2.82]) were not altered by adjustment for estimates of microalbuminuria, long-term glycemia, and renal function (dementia: 1.69 [1.14, 2.50]; AD: 1.73 [1.10, 2.74]). CONCLUSIONS Among people with type 2 diabetes, DR itself appears to be an important biomarker of dementia risk in addition to glycemia and renal complications.
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Affiliation(s)
- Cecilia S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.); Roger and Angie Karalis Johnson Retina Center, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.).
| | - Chloe Krakauer
- Department of Biostatistics, University of Washington, Seattle, Washington, USA (C.K.); Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA (C.K., Y-R.S., R.L.W., E.B.L.)
| | - Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA (C.K., Y-R.S., R.L.W., E.B.L.)
| | - Rod L Walker
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA (C.K., Y-R.S., R.L.W., E.B.L.)
| | - Marian Blazes
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.); Roger and Angie Karalis Johnson Retina Center, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.)
| | - Susan M McCurry
- School of Nursing, University of Washington, Seattle, Washington, USA (S.M.M.)
| | - James D Bowen
- Department of Neurology, Swedish Medical Center, Seattle, Washington, USA (J.D.B.)
| | - Wayne C McCormick
- Department of Medicine, University of Washington, Seattle, Washington, USA (W.C.M., E.J.B, E.B.L., P.K.C.)
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.); Roger and Angie Karalis Johnson Retina Center, Seattle, Washington, USA (C.S.L., M.B., A.Y.L.)
| | - Edward J Boyko
- Department of Medicine, University of Washington, Seattle, Washington, USA (W.C.M., E.J.B, E.B.L., P.K.C.); Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA (E.J.B., A.M.O)
| | - Ann M O'Hare
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington, USA (E.J.B., A.M.O)
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA (C.K., Y-R.S., R.L.W., E.B.L.); Department of Medicine, University of Washington, Seattle, Washington, USA (W.C.M., E.J.B, E.B.L., P.K.C.)
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA (W.C.M., E.J.B, E.B.L., P.K.C.)
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Allen RS, Khayat CT, Feola AJ, Win AS, Grubman AR, Chesler KC, He L, Dixon JA, Kern TS, Iuvone PM, Thule PM, Pardue MT. Diabetic rats with high levels of endogenous dopamine do not show retinal vascular pathology. Front Neurosci 2023; 17:1125784. [PMID: 37034167 PMCID: PMC10073440 DOI: 10.3389/fnins.2023.1125784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/21/2023] [Indexed: 04/11/2023] Open
Abstract
Purpose Limited research exists on the time course of long-term retinal and cerebral deficits in diabetic rodents. Previously, we examined short term (4-8 weeks) deficits in the Goto-Kakizaki (GK) rat model of Type II diabetes. Here, we investigated the long-term (1-8 months) temporal appearance of functional deficits (retinal, cognitive, and motor), retinal vascular pathology, and retinal dopamine levels in the GK rat. Methods In GK rats and Wistar controls, retinal neuronal function (electroretinogram), cognitive function (Y-maze), and motor function (rotarod) were measured at 1, 2, 4, 6, and 8 months of age. In addition, we evaluated retinal vascular function (functional hyperemia) and glucose and insulin tolerance. Retinas from rats euthanized at ≥8 months were assessed for vascular pathology. Dopamine and DOPAC levels were measured via HPLC in retinas from rats euthanized at 1, 2, 8, and 12 months. Results Goto-Kakizaki rats exhibited significant glucose intolerance beginning at 4 weeks and worsening over time (p < 0.001). GK rats also showed significant delays in flicker and oscillatory potential implicit times (p < 0.05 to p < 0.001) beginning at 1 month. Cognitive deficits were observed beginning at 6 months (p < 0.05), but no motor deficits. GK rats showed no deficits in functional hyperemia and no increase in acellular retinal capillaries. Dopamine levels were twice as high in GK vs. Wistar retinas at 1, 2, 8, and 12 months (p < 0.001). Conclusion As shown previously, retinal deficits were detectable prior to cognitive deficits in GK rats. While retinal neuronal function was compromised, retinal vascular pathology was not observed, even at 12+ months. High endogenous levels of dopamine in the GK rat may be acting as an anti-angiogenic and providing protection against vascular pathology.
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Affiliation(s)
- Rachael S. Allen
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Cara T. Khayat
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States
| | - Andrew J. Feola
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- Department of Ophthalmology, Emory University, Atlanta, GA, United States
| | - Alice S. Win
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Allison R. Grubman
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States
- Department of Ophthalmology, Emory University, Atlanta, GA, United States
| | - Kyle C. Chesler
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Li He
- Department of Ophthalmology, Emory University, Atlanta, GA, United States
- Department of Pharmacology and Chemical Biology, Emory University, Atlanta, GA, United States
| | - Jendayi A. Dixon
- Department of Ophthalmology, Emory University, Atlanta, GA, United States
| | - Timothy S. Kern
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, United States
- Veterans Administration Medical Center Research Service, Cleveland, OH, United States
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, United States
| | - P. Michael Iuvone
- Department of Ophthalmology, Emory University, Atlanta, GA, United States
- Department of Pharmacology and Chemical Biology, Emory University, Atlanta, GA, United States
| | - Peter M. Thule
- Section Endocrinology and Metabolism, Atlanta VA Medical Center, Emory University School of Medicine, Decatur, GA, United States
| | - Machelle T. Pardue
- Atlanta VA Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
- Department of Ophthalmology, Emory University, Atlanta, GA, United States
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6
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Chai YH, Zhang YP, Qiao YS, Gong HJ, Xu H, She HC, Patel I, Liu W, Stehouwer CDA, Zhou JB, Simó R. Association Between Diabetic Retinopathy, Brain Structural Abnormalities, and Cognitive Impairment for Accumulated Evidence in Observational Studies. Am J Ophthalmol 2022; 239:37-53. [PMID: 35063409 DOI: 10.1016/j.ajo.2022.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the association between diabetic retinopathy (DR) and cerebral disease or cognitive impairment. DESIGN Systematic review and meta-analysis. METHOD The hypothesis was formulated prior to data collection. Cross-sectional studies and cohort studies that assessed the association between any measure of DR and cerebral small vessel disease or any type of cognitive impairment in diabetic participants were included. The data were independently extracted by two investigators. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines RESULTS: A total of 27 studies were included. The combined odds ratio of 5 cross-sectional/cohort studies that reported that the associations between DR and cerebral structural changes was 1.75 (95% confidence interval [CI]: 1.36-2.25). The combined hazard ratio of 4 cohort studies that examined the association between DR and cognitive impairment events was 1.47 (95% CI: 1.22-1.78). The combined odds ratio of 14 cross-sectional/cohort studies that examined the association between DR and different cognitive impairment events was 1.43 (95% CI: 1.06-1.93). The overall coefficient (β) of 4 studies that examined the relationship between DR and specific cognitive performance was 0.09 (95% CI: 0.00-0.18). Considering the quality of the data, we have performed subgroup analysis in studies scored >7 and studies scored ≤7, respectively, according to the Newcastle-Ottawa scale. CONCLUSION The present meta-analysis suggests that DR is associated with an increased risk of structural abnormalities in the brain and cognitive impairment. This association remained significant after adjusting for blood glucose, and the presence of hypertension, indicating that DR is an important danger signal for cerebral abnormalities.
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Affiliation(s)
- Yin-He Chai
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yong-Peng Zhang
- Beijing Tongren Eye Center (Y.P.Z., H.C.S.), Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu-Shun Qiao
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hong-Jian Gong
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui Xu
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hai-Cheng She
- Beijing Tongren Eye Center (Y.P.Z., H.C.S.), Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ikramulhaq Patel
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Coen D A Stehouwer
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases (C.D.A.S.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jian-Bo Zhou
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Rafael Simó
- Department of Endocrinology and Nutrition (R.S.), Vall d'Hebron University Hospital, Autonomous University, Barcelona, Spain; Diabetes and Metabolism Research Unit (R.S.), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) (R.S.), Instituto de Salud Carlos III (ICSIII), Madrid, Spain
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Hwang PH, Longstreth W, Thielke SM, Francis CE, Carone M, Kuller LH, Fitzpatrick AL. Ophthalmic conditions associated with dementia risk: The Cardiovascular Health Study. Alzheimers Dement 2021; 17:1442-1451. [PMID: 33788406 PMCID: PMC8527838 DOI: 10.1002/alz.12313] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ophthalmic conditions and dementia appear to overlap and may share common pathways, but research has not differentiated dementia subtypes. METHODS Diagnoses of cataracts, age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma were based on medical histories and International Classification of Diseases, Ninth Revision (ICD-9) codes for 3375 participants from the Cardiovascular Health Study. Dementia, including Alzheimer's disease (AD) and vascular dementia (VaD), was classified using standardized research criteria. RESULTS Cataracts were associated with AD (hazard ratio [HR] = 1.34; 95% confidence interval [CI] = 1.01-1.80) and VaD/mixed dementia (HR = 1.41; 95% CI = 1.02-1.95). AMD was associated with AD only (HR = 1.87; 95% CI = 1.13-3.09), whereas DR was associated with VaD/mixed dementia only (HR = 2.63; 95% CI = 1.10-6.27). DISCUSSION Differential associations between specific ophthalmic conditions and dementia subtypes may elucidate pathophysiologic pathways. Lack of association between glaucoma and dementia was most surprising from these analyses.
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Affiliation(s)
- Phillip H. Hwang
- Department of Epidemiology, University of Washington, Seattle, WA, USA;,Corresponding author contact information: University of Washington, Department of Epidemiology, 3980 15 Avenue Northeast, Box 351619, Seattle, WA 98195, , Phone: (206) 331-8633
| | - W.T. Longstreth
- Department of Epidemiology, University of Washington, Seattle, WA, USA;,Department of Neurology, University of Washington, Seattle, WA, USA
| | - Stephen M. Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA;,Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, WA, USA
| | | | - Marco Carone
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Lewis H. Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Annette L. Fitzpatrick
- Department of Epidemiology, University of Washington, Seattle, WA, USA;,Department of Global Health, University of Washington, Seattle, WA, USA;,Department of Family Medicine, University of Washington, Seattle, WA, USA
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8
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Fereshetian S, Agranat JS, Siegel N, Ness S, Stein TD, Subramanian ML. Protein and Imaging Biomarkers in the Eye for Early Detection of Alzheimer's Disease. J Alzheimers Dis Rep 2021; 5:375-387. [PMID: 34189409 PMCID: PMC8203283 DOI: 10.3233/adr-210283] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/28/2022] Open
Abstract
Alzheimer's disease (AD) is one of the most common causes of dementia worldwide. Although no formal curative therapy exists for the treatment of AD, considerable research has been performed to identify biomarkers for early detection of this disease, and thus improved subsequent management. Given that the eye can be examined and imaged non-invasively with relative ease, it has emerged as an exciting area of research for evidence of biomarkers and to aid in the early diagnosis of AD. This review explores the current understanding of both protein and retinal imaging biomarkers in the eye. Herein, primary findings in the literature regarding AD biomarkers associated with the lens, retina, and other ocular structures are reviewed.
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Affiliation(s)
- Shaunt Fereshetian
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
| | - Joshua S. Agranat
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - Nicole Siegel
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - Steven Ness
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
| | - Thor D. Stein
- Boston University Alzheimer’s Disease and CTE Center, Boston University School of Medicine, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- VA Boston Healthcare System, Boston, MA, USA
- Department of Veterans Affairs Medical Center, Bedford, MA, USA
| | - Manju L. Subramanian
- Boston University School of Medicine, Department of Ophthalmology, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
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9
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Guo GY, Zhang LJ, Li B, Liang RB, Ge QM, Shu HY, Li QY, Pan YC, Pei CG, Shao Y. Altered spontaneous brain activity in patients with diabetic optic neuropathy: A resting-state functional magnetic resonance imaging study using regional homogeneity. World J Diabetes 2021; 12:278-291. [PMID: 33758647 PMCID: PMC7958477 DOI: 10.4239/wjd.v12.i3.278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/30/2020] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Diabetes is a common chronic disease. Given the increasing incidence of diabetes, more individuals are affected by diabetic optic neuropathy (DON), which results in decreased vision. Whether DON leads to abnormalities of other visual systems, including the eye, the visual cortex, and other brain regions, remains unknown.
AIM To investigate the local characteristics of spontaneous brain activity using regional homogeneity (ReHo) in patients with DON.
METHODS We matched 22 patients with DON with 22 healthy controls (HCs). All subjects underwent resting-state functional magnetic resonance imaging. The ReHo technique was used to record spontaneous changes in brain activity. Receiver operating characteristic (ROC) curves were applied to differentiate between ReHo values for patients with DON and HCs. We also assessed the correlation between Hospital Anxiety and Depression Scale scores and ReHo values in DON patients using Pearson correlation analysis.
RESULTS ReHo values of the right middle frontal gyrus (RMFG), left anterior cingulate (LAC), and superior frontal gyrus (SFG)/left frontal superior orbital gyrus (LFSO) were significantly lower in DON patients compared to HCs. Among these, the greatest difference was observed in the RMFG. The result of the ROC curves suggest that ReHo values in altered brain regions may help diagnose DON, and the RMFG and LAC ReHo values are more clinically relevant than SFG/LFSO. We also found that anxiety and depression scores of the DON group were extremely negatively correlated with the LAC ReHo values (r = -0.9336, P < 0.0001 and r = -0.8453,P < 0.0001, respectively).
CONCLUSION Three different brain regions show ReHo changes in DON patients, and these changes could serve as diagnostic and/or prognostic biomarkers to further guide the prevention and treatment of DON patients.
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Affiliation(s)
- Gui-Ying Guo
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Li-Juan Zhang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Rong-Bin Liang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Hui-Ye Shu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Qiu-Yu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yi-Cong Pan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Chong-Gang Pei
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
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10
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Abstract
It is often said that substantial retinal ganglion cells are lost before glaucomatous damage is detected by standard automated perimetry. There are 4 key articles referenced to support this belief. To test the hypothesis that the 4 key articles are incorrectly cited, the publications in the first 6 months of 2019 that reference 1 or more of these 4 articles were examined. In particular, the degree to which the quotes from these 2019 publications accurately reflected the evidence in the 4 key articles was assessed. These quotes are inadequately supported by the data, and in some cases even by the conclusions found in the abstracts of the key articles. This is despite several review articles that have questioned the evidence in these key articles. Further, a case can be made that the evidence in the key articles better supports the opposite conclusion. That is, the data suggest that sensitivity loss can be seen on standard automated perimetry before retinal ganglion cells are missing.
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Affiliation(s)
- Donald C Hood
- Department of Psychology and Ophthalmology, Columbia University
- Bernard and Shirlee Brown Glaucoma Research Laboratory, Department of Ophthalmology, Columbia University Medical Center, Edward S. Harkness Eye Institute, New York, NY
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