Alzheimer's disease (AD) is a rising healthcare challenge worldwide. There is currently no simple and affordable test to accurately detect AD at scale. In this work we propose a novel deep learning framework (Eye-AD) to detect Early-onset Alzheimer's Disease (EOAD) and Mild Cognitive Impairment (MCI), using retinal microvasculature and choriocapillaris acquired from optical coherence tomography angiography (OCTA). The proposed Eye-AD model is a multilevel graph representation approach, which utilizes the intra- and inter-instance relationships of different retinal layers.
We used a total of 5,751 OCTA images obtained from 1,671 participants of a retrospective, multi-centre study to train, validate and test the Eye-AD model. The experimental results demonstrate the superior performance of our model in both EOAD detection (internal data: AUC = 0.9355, external data: AUC = 0.9007) and MCI detection (internal data: AUC =0.8630, external data: AUC = 0.8037). Furthermore, we explored the associations between retinal structural biomarkers in OCTA images and EOAD/MCI, and the results align well with the conclusions drawn from our deep learning interpretability analysis. Our findings provide further evidence that retinal OCTA imaging, coupled with artificial intelligence, will serve as a rapid, non-invasive and affordable approach for AD-related diseases detection and risk assessment.