Abstract
Thinner retinal nerve fiber layer (RNFL) has been reported in Alzheimer’s disease (AD) patient. However, whether changes in RNFL thickness can predict the cognitive deterioration remains unknown. We therefore set out a prospective clinical investigation to determine the potential association between the attenuation of RNFL thickness and the deterioration of cognitive function over a period of 25 months. We assessed cognitive function using the Repeatable Battery for the Assessment of Neuropsychological Status and measured RNFL thickness employing optical coherence tomography in 78 participants (mean age 72.31 ± 3.98 years, 52% men). The participants were categorized as stable participants whose cognitive status remained no change (N = 60) and converted participants whose cognitive status deteriorated (N = 18). We found that there was an association between the attenuation of superior quadrant RNFL thickness and the deterioration of cognitive function in the stable participants. In the converted participants, however, there was an inverse association between the reduction of inferior quadrant RNFL thickness and decline of cognitive functions [scores of list recall (R = -0.670, P = 0.002), adjusted (R = -0.493, P = 0.031)]. These data showed that less reduction in the inferior quadrant of RNFL thickness might indicate a higher risk for the patients to develop cognitive deterioration. These findings have established a system to embark a larger scale study to further test whether changes in RNFL thickness can serve as a biomarker of AD, and would lead to mechanistic studies to determine the cellular mechanisms of cognitive deterioration.
Highlights
Alzheimer’s disease (AD), one of the greatest public health problems in the world, begins with a long asymptomatic period when only its neuropathogenesis is progressing (Jack et al, 2010)
The retinal nerve fiber layer (RNFL) thickness in healthy old adults is heterogeneous (Poinoosawmy et al, 1997; Parikh et al, 2007), it www.frontiersin.org is important to assess the changes in RNFL thickness over time and to determine the potential association between the changes in RNFL thickness and the changes in cognitive function
Whereas the more attenuation of RNFL thickness in the superior quadrant may predict greater cognitive deterioration in the participants who maintain stable cognitive function, the less attenuation of RNFL thickness in the inferior quadrant may predict greater cognitive deterioration in the participants who have converted from normal cognition to mild cognitive impairment (MCI) or from MCI to dementia
Summary
Alzheimer’s disease (AD), one of the greatest public health problems in the world, begins with a long asymptomatic period (pre-clinical stage of AD) when only its neuropathogenesis is progressing (Jack et al, 2010). Individuals with evidence of such neuropathogenesis, which could potentially be demonstrated by biomarkers, are at an increased risk to develop cognitive impairment and dementia (Price and Morris, 1999). Reduction in RNFL thickness is a potential early biomarker of AD (Ho et al, 2012). It has been reported that subjects with AD or mild cognitive impairment (MCI) may have thinner RNFL as compared to age-matched control subjects (Tsai et al, 1991; Hedges et al, 1996; Paquet et al, 2007; Kesler et al, 2011). Whether the reduction of RNFL thickness over time can predict the progress of cognitive deterioration, remains to be investigated
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