Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 1;75(10):1256-1263.
doi: 10.1001/jamaneurol.2018.1563.

Association of Retinal Neurodegeneration on Optical Coherence Tomography With Dementia: A Population-Based Study

Unal Mutlu  1   2 , Johanna M Colijn  1   2 , M Arfan Ikram  1   3   4 , Pieter W M Bonnemaijer  1   2 , Silvan Licher  1 , Frank J Wolters  1 , Henning Tiemeier  1   5 , Peter J Koudstaal  1   4 , Caroline C W Klaver  1   2   6 , M Kamran Ikram  1   4
Affiliations

Association of Retinal Neurodegeneration on Optical Coherence Tomography With Dementia: A Population-Based Study

Unal Mutlu et al. JAMA Neurol. .

Abstract

Importance: Retinal structures may serve as a biomarker for dementia, but longitudinal studies examining this link are lacking.

Objective: To investigate the association of inner retinal layer thickness with prevalent and incident dementia in a general population of Dutch adults.

Design, setting, and participants: From September 2007 to June 2012, participants from the prospective population-based Rotterdam Study who were 45 years and older and had gradable retinal optical coherence tomography images and at baseline were free from stroke, Parkinson disease, multiple sclerosis, glaucoma, macular degeneration, retinopathy, myopia, hyperopia, and optic disc pathology were included. They were followed up until January 1, 2015, for the onset of dementia.

Exposures: Inner retinal layer thicknesses (ie, retinal nerve fiber layer [RNFL]) and ganglion cell-inner plexiform layer (GC-IPL) thicknesses measured on optical coherence tomography images.

Main outcomes and measures: Odds ratios and hazard ratios for incident dementia per SD decrease in retinal layer thickness adjusted for age, sex, education, and cardiovascular risk factors.

Results: Of 5065 individuals eligible for optical coherence tomography scanning, 3289 (64.9%) (mean [SD] age 68.9 [9.9] years, 1879 [57%] women) were included in the analysis. Of these 3289 individuals, 41 (1.2%) already had dementia. Thinner GC-IPL was associated with prevalent dementia (odds ratio per SD decrease in GC-IPL, 1.37 [95% CI, 0.99-1.90]). No association was found of RNFL with prevalent dementia. During 14 674 person-years of follow-up (mean [SD], 4.5 [1.6] years), 86 individuals (2.6%) developed dementia of whom 68 (2.1%) had Alzheimer disease. Thinner RNFL at baseline was associated with an increased risk of developing dementia (hazard ratio per SD decrease in RNFL, 1.44 [95% CI, 1.19-1.75]), which was similar for Alzheimer disease (hazard ratio, 1.43 [95% CI, 1.15-1.78]). No association was found between GC-IPL thickness and incident dementia (hazard ratio, 1.13 [95% CI, 0.90-1.43]).

Conclusions and relevance: Thinner RNFL is associated with an increased risk of dementia, including Alzheimer disease, suggesting that retinal neurodegeneration may serve as a preclinical biomarker for dementia.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of the Study Population
AMD indicates age-related macular degeneration; OCT, optical coherence tomography; RS, Rotterdam Study.
Figure 2.
Figure 2.. Output of the Retinal Optical Coherence Tomography
Focusing on the macula (A) and optic nerve (B), with corresponding cross-sectional view of the retina (C, and D, respectively). GC-IPL indicates ganglion cell–inner plexiform layer; RNFL, retinal nerve fiber layer.
See this image and copyright information in PMC

Comment in

References

    1. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013;9(1):63-75.e2. - PubMed
    1. Sperling RA, Aisen PS, Beckett LA, et al. . Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7(3):280-292. doi:10.1016/j.jalz.2011.03.003 - DOI - PMC - PubMed
    1. Koronyo-Hamaoui M, Koronyo Y, Ljubimov AV, et al. . Identification of amyloid plaques in retinas from Alzheimer’s patients and noninvasive in vivo optical imaging of retinal plaques in a mouse model. Neuroimage. 2011;54(suppl 1):S204-S217. doi:10.1016/j.neuroimage.2010.06.020 - DOI - PMC - PubMed
    1. Koronyo Y, Biggs D, Barron E, et al. . Retinal amyloid pathology and proof-of-concept imaging trial in Alzheimer’s disease. JCI Insight. 2017;2(16):93621. doi:10.1172/jci.insight.93621 - DOI - PMC - PubMed
    1. McGrory S, Cameron JR, Pellegrini E, et al. . The application of retinal fundus camera imaging in dementia: a systematic review. Alzheimers Dement (Amst). 2016;6:91-107. - PMC - PubMed

Publication types

MeSH terms