Could Retinal Imaging in Midlife Help Predict ADRD Risk?

TOPLINE:

Poor retinal health in midlife was associated with significantly higher risk for Alzheimer’s disease and related dementias (ADRD) later in life, a new study showed. Investigators say the findings suggest retinal microvascular imaging may be an accessible and cost-effective screening tool for ADRD.

METHODOLOGY:

• Researchers investigated whether neuronal and microvascular measures of the retina can predict the risk for ADRD in 938 participants (5src.5% men) aged 45 years from a cohort study in New Zealand.
• Retinal measures included neuronal parameters (retinal nerve fiber layer and ganglion cell-inner plexiform layer) assessed using optical coherence tomography and microvascular parameters (arterioles and venules) assessed using digital fundus imaging.
• The analysis incorporated five risk indexes of ADRD: The cardiovascular risk factors, aging, and incidence of dementia index; lifestyle for brain health index; Australian National University Alzheimer’s Disease risk index; modifiable risk factors selected by the Lancet Commission on dementia; and Dunedin Alzheimer’s Disease and related dementias risk benchmark.

TAKEAWAY:

• Poorer retinal microvascular health, characterized by narrower arterioles and wider venules, showed a strong association with a greater ADRD risk (beta, src.16-src.31; P <.srcsrc1).
• Thinner retinal nerve fiber layers also demonstrated a modest association with a higher risk for ADRD.
• Retinal neuronal measures were associated with only one risk factor for ADRD — cardiometabolic risk — whereas microvascular retinal measures were associated with diverse risk factors, such as lifestyle, sensory function, psychosomatic, socioeconomic, cardiometabolic, subjective overall health, and inflammatory factors.

IN PRACTICE:

“Digital fundus imagery is an accessible, scalable modality that could provide insights into ADRD disease processes alongside other clinical data, potentially enhancing the ability to predict ADRD risk at the population level long before disease endpoints emerge,” the authors wrote.

SOURCE:

This study was led by Ashleigh Barrett-Young from the Department of Psychology at the University of Otago in Dunedin, New Zealand, and Aaron Reuben from the Department of Psychology at the University of Virginia in Charlottesville, Virginia. It was published online on March 3 in the Journal of Alzheimer’s Disease.

LIMITATIONS: 

This study was observational and could not establish causation. The cohort was predominantly New Zealand European/Pākehā, matching the ethnic composition of the South Island of New Zealand, indicating a need for replication in more diverse populations. Additionally, the cohort was not old enough to have developed ADRD, with the risk index outcome measures being predictive of the likelihood of future dementia rather than being direct measures of dementia pathology or endpoint disease.

DISCLOSURES:

The cohort used in this study received support from the New Zealand Health Research Council and the New Zealand Ministry of Business, Innovation, and Employment. Additional funding was received from the US-National Institutes of Aging and the UK Medical Research Council. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.