Microvascular network alterations in the retina of patients with Alzheimer's disease

CYL Cheung, YT Ong, Kamran Ikram, SY Ong, X Li, Saima Hilal, JAS Catindig, N Venketasubramanian, P Yap, D Seow, CP Chen, TY (Tien Yin) Wong

Research output: Contribution to journalArticleAcademicpeer-review

188 Citations (Scopus)


Background: Although cerebral small-vessel disease has been implicated in the development of Alzheimer's disease (AD), the cerebral microcirculation is difficult to visualize directly in vivo. Because the retina provides a noninvasive window to assess the microcirculation, we determined whether quantitatively measured retinal microvascular parameters are associated with AD. Methods: We conducted a case-control study (case:control matching approximate to 1:2). Retinal photographs were analyzed using a computer program, and a spectrum of quantitative retinal microvascular parameters (caliber, fractal dimension, tortuosity, and bifurcation) were measured. Logistic regression models were used to compute the odds ratio (OR) and 95% confidence interval for AD adjusting for age, gender, ethnicity, smoking, hypertension, diabetes, hypercholesterolemia, and history of myocardial infarction. Results: We included 136 demented patients with AD and 290 age-gender-race-matched controls. Persons with narrower venular caliber (OR per standard deviation [SD] decrease, 2.01 [1.27-3.19]), decreased arteriolar and venular fractal dimension (OR per SD decrease 1.35 [1.08-1.68], 1.47 [1.17-1.84], respectively) and increased arteriolar and venular tortuosity (OR per SD increase, 1.84 [1.40-2.31], 1.94 [1.48-2.53], respectively) were more likely to have AD. These associations still persisted when only AD cases without a history of cerebrovascular disease were included. Conclusions: Patients with AD have altered microvascular network in the retina (narrower retinal venules and a sparser and more tortuous retinal vessels) compared with matched nondemented controls. These changes in retinal microvasculature may reflect similar pathophysiological processes in cerebral microvasculature in the brains of patients with AD. (C) 2014 The Alzheimer's Association. All rights reserved.
Original languageUndefined/Unknown
Pages (from-to)135-142
Number of pages8
JournalAlzheimers & Dementia
Issue number2
Publication statusPublished - 2014

Cite this