Retinal Microperimetry: A New Tool for Identifying Patients With Type 2 Diabetes at Risk for Developing Alzheimer Disease

Ciudin, Andreea; Simó‐Servat, Olga; Hernández, Cristina; Arcos, Gabriel; Diego, Susana; Sanabria, Ángela; Sotolongo, Oscar; Hernández, Isabel; Boada, Merçé; Simó, Rafael

doi:10.2337/db17-0382

Cited by 35 publications

(33 citation statements)

References 38 publications

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“…In fact, the AUROC of BCEA95 for identifying young morbidly patients with cognitive impairment was 0.807 (CI 95%: 0.592-0.947). We previously reported that retinal sensitivity evaluated by retinal microperimetry was able to identify T2D subjects with cognitive impairment [16]. It should be noted that in this previous study, the T2D patients with Alzheimer's disease and with mild cognitive Impairment were not obese but were insulin resistant.…”

Section: Discussionmentioning

confidence: 57%

Retinal Microperimetry: A Useful Tool for Detecting Insulin Resistance-Related Cognitive Impairment in Morbid Obesity

Ciudin

Ortiz

Fidilio

et al. 2019

JCM

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Background: There is clear association between type 2 diabetes (T2D) and cognitive decline. Retinal microperimetry is a useful tool for detecting cognitive impairment in T2D. Morbid obesity (MO) has been associated with cognitive impairment. Insulin resistance (IR) seems a major determinant, but the data are unclear. The aim of this study was to evaluate the cognitive impairment in MO as well as the utility of retinal microperimetry in identifying these alterations. Methods: In total, 50 consecutive patients with MO were matched by age and gender with 30 healthy controls. All patients underwent cognitive evaluation (Montreal Cognitive Assessment Test-MoCA) and retinal microperimetry, using MAIA microperimeter 3rd generation. Retinal sensitivity and gaze fixation parameters were used for the evaluation of the analysis. Results: MO patients showed a significantly lower neurocognitive performance than the controls: MoCA score 24.94 ± 2.74 vs. 28.95 ± 1.05, p < 0.001. Cognitive function inversely correlated with the HOMA-IR (r = −0.402, p = 0.007). The AUROC for cognitive impairment using microperimetry was 0.807, CI 95% (0.592–0.947), p = 0.017. Conclusions: (1) Systemic insulin resistance is a major underlying mechanism accounting for the higher prevalence of cognitive impairment detected in young MO subjects. (2) Retinal microperimetry is a useful tool for identifying MO patients with cognitive impairment.

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Section: Discussionmentioning

confidence: 57%

Retinal Microperimetry: A Useful Tool for Detecting Insulin Resistance-Related Cognitive Impairment in Morbid Obesity

Ciudin

Ortiz

Fidilio

et al. 2019

JCM

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“…Independent of the fixation and any other eye movement, retinal microperimetry is a strong candidate examination for monitoring AD. It has been indicated that retinal sensitivity evaluated by retinal microperimetry correlated with brain neurodegeneration and could be a novel biomarker for predicting the risk of developing AD among type 2 diabetes patients ( Ciudin et al, 2017 ). Some recent studies have documented more sensitivity of microperimetry in identifying early functional changes of the retina than ERG ( Wu et al, 2014 ).…”

Section: Functional Imaging Methodsmentioning

confidence: 99%

Potential Utility of Retinal Imaging for Alzheimer’s Disease: A Review

Liao

Zhu

Peng

2018

Front. Aging Neurosci.

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The ensuing upward shift in demographic distribution due to the increase in life expectancy has resulted in a rising prevalence of Alzheimer’s disease (AD). The heavy public burden of AD, along with the urgent to prevent and treat the disease before the irreversible damage to the brain, calls for a sensitive and specific screening technology to identify high-risk individuals before cognitive symptoms arise. Even though current modalities, such as positron emission tomography (PET) and cerebrospinal fluid (CSF) biomarker, showed their potential clinical uses in early detection of AD, the high cost, narrow isotope availability of PET probes and invasive characteristics of CSF biomarker limited their broad utility. Therefore, additional tools for detection of AD are needed. As a projection of the central nervous system (CNS), the retina has been described as a “window to the brain” and a novel marker for AD. Low cost, easy accessibility and non-invasive features make retina tests suitable for large-scale population screening and investigations of preclinical AD. Furthermore, a number of novel approaches in retina imaging, such as optical coherence tomography (OCT), have been developed and made it possible to visualize changes in the retina at a very fine resolution. In this review, we outline the background for AD to accelerate the adoption of retina imaging for the diagnosis and management of AD in clinical practice. Then, we focus on recent findings on the application of retina imaging to investigate AD and provide suggestions for future research directions.

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“…Functional assessment of the retina could also be used as an indirect method to explore events in the brain. In a recent prospective study, retinal sensitivity assessed by microperimetry significantly correlated with variables related to brain neurodegeneration and cognitive status [ 84 ]. This pilot study suggested that the assessment of retinal sensitivity by microperimetry could be a useful biomarker for identifying individuals with type 2 diabetes who are at risk of developing Alzheimer’s disease.…”

Section: Retinal Neurodegeneration Is a Biomarker Of Neurodegenerativmentioning

confidence: 99%

Neurodegeneration in diabetic retinopathy: does it really matter?

2018

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The concept of diabetic retinopathy as a microvascular disease has evolved, in that it is now considered a more complex diabetic complication in which neurodegeneration plays a significant role. In this article we provide a critical overview of the role of microvascular abnormalities and neurodegeneration in the pathogenesis of diabetic retinopathy. A special emphasis is placed on the pathophysiology of the neurovascular unit (NVU), including the contributions of microvascular and neural elements. The potential mechanisms linking retinal neurodegeneration and early microvascular impairment, and the effects of neuroprotective drugs are summarised. Additionally, we discuss how the assessment of retinal neurodegeneration could be an important index of cognitive status, thus helping to identify individuals at risk of dementia, which will impact on current procedures for diabetes management. We conclude that glial, neural and microvascular dysfunction are interdependent and essential for the development of diabetic retinopathy. Despite this intricate relationship, retinal neurodegeneration is a critical endpoint and neuroprotection, itself, can be considered a therapeutic target, independently of its potential impact on microvascular disease. In addition, interventional studies targeting pathogenic pathways that impact the NVU are needed. Findings from these studies will be crucial, not only for increasing our understanding of diabetic retinopathy, but also to help to implement a timely and efficient personalised medicine approach for treating this diabetic complication.Electronic supplementary materialThe online version of this article (10.1007/s00125-018-4692-1) contains a slideset of the figures for download, which is available to authorised users.

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Retinal Microperimetry: A New Tool for Identifying Patients With Type 2 Diabetes at Risk for Developing Alzheimer Disease

Cited by 35 publications

References 38 publications

Retinal Microperimetry: A Useful Tool for Detecting Insulin Resistance-Related Cognitive Impairment in Morbid Obesity

Retinal Microperimetry: A Useful Tool for Detecting Insulin Resistance-Related Cognitive Impairment in Morbid Obesity

Potential Utility of Retinal Imaging for Alzheimer’s Disease: A Review

Neurodegeneration in diabetic retinopathy: does it really matter?

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