TY - JOUR
T1 - Cognitive decline in older adults
T2 - What can we learn from optical coherence tomography (OCT)-based retinal vascular imaging?
AU - Abraham, Alison G.
AU - Guo, Xinxing
AU - Arsiwala, Lubaina T.
AU - Dong, Yanan
AU - Sharrett, A. Richey
AU - Huang, David
AU - You, Qisheng
AU - Liu, Liang
AU - Lujan, Brandon J.
AU - Tomlinson, Alexander
AU - Mosley, Thomas
AU - Coresh, Josef
AU - Jia, Yali
AU - Mihailovic, Aleksandra
AU - Ramulu, Pradeep Y.
N1 - Funding Information:
We are grateful to the dedicated ARIC and EyeDOC participants and staff, who made this research possible. The EyeDOC website is located at: https://www.hopkinsmedicine.org/wilmer/research/dana-center/research/eyedoc.html. The Eye Determinants of Cognition (EyeDOC) study is supported by NIA, 1R01AG052412. The Atherosclerosis Risk in Communities study is carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). Neurocognitive data is collected by U01 2U01HL096812, 2U01HL096814, 2U01HL096899, 2U01HL096902, and 2U01HL096917 from the NIH (NHLBI, NINDS, NIA and NIDCD), and with previous brain MRI examinations funded by R01-HL70825 from the NHLBI. David Huang has significant financial interests in Optovue, a company that may have a commercial interest in the results of this research and technology. These potential conflicts of interest have been reviewed and managed by OHSU. Financial interests in Optovue include patent royalty, stock ownership, research grant, and material support. No conflicting relationship exists for any other author. Alison G. Abraham, Pradeep Y. Ramulu, A. Richey Sharrett, Xinxing Guo, Josef Coresh, and Thomas Mosley were involved in data collection; David Huang, Qisheng You, Liang Liu, Alexander Tomlinson, and Yali Jia were responsible for imaging protocols, image processing, and image data quality. Alison G. Abraham, Xinxing Guo, Lubaina T. Arsiwala, and Xinxing Guo were responsible for data management, data quality assurance, and analysis. Alison G. Abraham, Pradeep Y. Ramulu, Aleksandra Mihailovic, A. Richey Sharrett, Xinxing Guo, Lubaina T. Arsiwala, and YaNan Dong were responsible for the interpretation of results and writing. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2021 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.
PY - 2021/9
Y1 - 2021/9
N2 - Introduction: Accumulated vascular damage contributes to the onset and progression of vascular dementia and possibly to Alzheimer's disease. Here we evaluate the feasibility and utility of using retinal imaging of microvascular markers to identify older adults at risk of cognitive disease. Methods: The “Eye Determinants of Cognition” (EyeDOC) study recruited a biracial, population-based sample of participants from two sites: Jackson, MS, and Washington Co, MD. Optical coherence tomographic angiography (OCTA) was used to capture vessel density (VD) from a 6 × 6 mm scan of the macula in several vascular layers from 2017 to 2019. The foveal avascular zone (FAZ) area was also estimated. Image quality was assessed by trained graders at a reading center. A neurocognitive battery of 10 tests was administered at three time points from 2011 to 2019 and incident mild cognitive impairement (MCI)/dementia cases were ascertained. Linear mixed-effects models were used to evaluate associations of retinal vascular markers with cognitive factor score change over time. Results: Nine-hundred and seventy-six older adults (mean age of 78.7 (± 4.4) years, 44% black) were imaged. Gradable images were obtained in 55% (535/976), with low signal strength (66%) and motion artifact (22%) being the largest contributors to poor quality. Among the 297 participants with both high-quality images and no clinically significant retinal pathology, the average decline in global cognitive function factor score was −0.03 standard deviations per year. In adjusted analyses, no associations of VD or FAZ with longitudinal changes in either global cognitive function or with incident MCI/dementia were found. Conclusions: In this large biracial community sample of older adults representative of the target population for retinal screening of cognitive risk, we found that obtaining high-quality OCTA scans was infeasible in a nearly half of older adults. Among the select sample of healthier older adults with scans, OCTA markers were not predictive of cognitive impairment.
AB - Introduction: Accumulated vascular damage contributes to the onset and progression of vascular dementia and possibly to Alzheimer's disease. Here we evaluate the feasibility and utility of using retinal imaging of microvascular markers to identify older adults at risk of cognitive disease. Methods: The “Eye Determinants of Cognition” (EyeDOC) study recruited a biracial, population-based sample of participants from two sites: Jackson, MS, and Washington Co, MD. Optical coherence tomographic angiography (OCTA) was used to capture vessel density (VD) from a 6 × 6 mm scan of the macula in several vascular layers from 2017 to 2019. The foveal avascular zone (FAZ) area was also estimated. Image quality was assessed by trained graders at a reading center. A neurocognitive battery of 10 tests was administered at three time points from 2011 to 2019 and incident mild cognitive impairement (MCI)/dementia cases were ascertained. Linear mixed-effects models were used to evaluate associations of retinal vascular markers with cognitive factor score change over time. Results: Nine-hundred and seventy-six older adults (mean age of 78.7 (± 4.4) years, 44% black) were imaged. Gradable images were obtained in 55% (535/976), with low signal strength (66%) and motion artifact (22%) being the largest contributors to poor quality. Among the 297 participants with both high-quality images and no clinically significant retinal pathology, the average decline in global cognitive function factor score was −0.03 standard deviations per year. In adjusted analyses, no associations of VD or FAZ with longitudinal changes in either global cognitive function or with incident MCI/dementia were found. Conclusions: In this large biracial community sample of older adults representative of the target population for retinal screening of cognitive risk, we found that obtaining high-quality OCTA scans was infeasible in a nearly half of older adults. Among the select sample of healthier older adults with scans, OCTA markers were not predictive of cognitive impairment.
KW - Alzheimer's disease
KW - cognitive disease
KW - optical coherence tomography angiography (OCTA)
KW - retinal markers
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U2 - 10.1111/jgs.17272
DO - 10.1111/jgs.17272
M3 - Article
C2 - 34009667
AN - SCOPUS:85106056673
SN - 0002-8614
VL - 69
SP - 2524
EP - 2535
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 9
ER -