Investigation of Possible Correlation Between Retinal Neurovascular Biomarkers and Early Cognitive Impairment in Patients With Chronic Kidney Disease

Abstract

Purpose To investigate the association between retinal neurovascular biomarkers and early cognitive impairment among patients with chronic kidney disease (CKD). Methods Patients with CKD stage ≥3 were evaluated using the standardized Mini-Mental State Examination (MMSE). Patients were classified as having a low (<24), middle (24 to 27), and high (>27) MMSE level. Retinal nerve fiber layer thickness, ganglion cell complex (GCC) thickness, GCC global loss volume, and GCC focal loss volume were measured using optical coherence tomography (OCT). Superficial vascular plexus vessel density, deep vascular plexus vessel density (DVP-VD), and size of the foveal avascular zone were obtained by OCT angiography. Results The study enrolled 177 patients with a mean ± SD age of 64.7 ± 6.6 years. The mean ± SD MMSE score was 27.25 ± 2.30. Thirteen, 65, and 99 patients were classified as having a low, middle, and high MMSE level, respectively. The patients with a high MMSE level were younger, had more years of education, had less severe CKD, and had higher DVP-VD than patients with a low MMSE level. The multivariable regression revealed that age (coefficient, 0.294; 95% confidence interval [CI], 0.195–0.393; P = 0.041), years of education (coefficient, 0.294; 95% CI, 0.195–0.393; P < 0.001), estimated glomerular filtration rate (coefficient, 0.019; 95% CI, 0.004–0.035; P = 0.016), and DVP-VD (coefficient, 0.109; 95% CI, 0.007–0.212; P = 0.037) were independent factors associated with MMSE score. Conclusions Retinal DVP-VD was associated with early cognitive impairment among patients with CKD. Translational Relevance DVP-VD measured by OCT angiography may facilitate early detection of cognitive impairment.

A Systematic Review on Retinal Biomarkers to Diagnose Dementia from OCT/OCTA Images

“…Also, aMCI and non-amnestic MCI groups in [63] had a similar pRNFL-Avg thickness variations, and negligible differences. Furthermore, another study by [19] [63,72,81]. Specifically, the pRNFL-Avg thickness variations in [72] were insignificant when comparing MCI, dementia, and HCs in [72], and when correlating MCI, AD, DLB, VCID, FTD, and HCs.…”

“…Some research works use the commercial software which accompanies the OCT/OCTA machine. For instance, both [19,35] extracted OCT and OCTA parameters automatically by a commercial RTVue XR software and Optovue AngioVue system (software ReVue XR). In addition, the AngioAnalytics™ software was used by [36] to compute VD and FD for retinal vasculature as well as the perimeter and Acircularity Index for FAZ.…”

“…Briefly, to extract vascular parameters around the fovea, a series of steps are taken to obtain an OCTA En Face image. Firstly, a selection A-SD [16][17][18] √ × × × A-SD [19,20] × × √ × A-SD [21] × × × √ H-SD [22] × √ × × H-SD [23] √ × × × C-HD [24][25][26] √ × × × H-SD, Heidelberg SD-OCT; C-HD, Cirrus HD-OCT; A-HD, RTVue-XR Avanti SD-OCT of retinal layers is made, for instance, from the ILM to the OPL to obtain the IVC. Next, the volumetric 3D OCTA of the selected layers is projected into a 2D image known as the En Face OCTA.…”

Decreased Vessel Density in Retinal Capillary Plexus and Thinner Ganglion Cell Complex Associated With Cognitive Impairment

“…Numerous studies using OCT have shown that a relatively thinner ganglion cell complex (GCC) or retinal nerve fiber layer (RNFL) was associated with cognitive impairment ( Cheung et al, 2015 ; Jones-Odeh and Hammond, 2015 ; Ko et al, 2018 ; Ito et al, 2020 ). However, only case-control and hospital-based studies using OCTA have investigated the vascular alternations in patients with AD using OCTA ( Zhang et al, 2020 ; Cheung et al, 2021 ; Peng et al, 2021 ). Findings from those studies were inconsistent and the effects of important sub-categorizations (i.e., sex, diabetes, hypertension) remain unknown ( Rifai et al, 2021 ).…”

Kidney Function Impacts Plasma Alzheimer’s Biomarkers in a Cognitively Normal Multi- Ethnic Cohort

“…In fact, the ongoing AHEAD clinical trial is launching an examination of plasma amyloid as a potential screening tool for this prevention trial. Chronic Kidney Disease (CKD) has well-established links with cognitive aging [25][26][27] . In our prior work, lower eGFR (estimated glomerular ltration rate) was associated with poorer neuropsychological functioning among community-dwelling Mexican Americans 27 .…”