Alzheimer Disease Clinical Trial
Official title:
Optical Coherence Tomography in Cerebral Amyloidosis
In this observational study, the investigators aim to evaluate whether changes in the retinal
and choroidal circulation, as assessed by Optical Coherence Tomography (OCT) and the
quantification of retinal amyloid deposits using auto-fluorescence and hyperspectral retinal
imaging, are correlated with the degree and subtype of dementia and with the presence or
absence of a positive amyloid scan.
For this purpose, patients with established Alzheimer's Disease (AD) and Lewy Body Dementia
(LBD), as well as amyloid positive and amyloid negative Mild Cognitive Impairment (MCI) and
aged matched cognitively intact patients will be included in this cross-sectional study.
Being a direct extension of the central nervous system and the only place in the human body
where the vessels of the central circulation can be visualized directly, the eye provides a
unique window to investigate the central circulatory system. Several studies have
demonstrated that retinal blood vessels show structural and functional alterations in
patients with dementia. These measurements are based on fundus pictures and are hence limited
to the larger retinal vessels.
Until recently, intravenous injection of a contrast agent was necessary to visualize the
retinal microvasculature in detail. While indispensable for the diagnosis of some ocular
vascular diseases (arterial/venous occlusion, neovascularization,…) the invasiveness of
fluorescein angiography (and the risk of an allergic reaction) limits its use as a screening
tool to detect alterations in the microvascular network of the retina and choroid.
Optical coherence tomography (OCT) is a non-invasive diagnostic tool capable of generating
cross-sectional coupes of the retina and choroid. Novel algorithms allow to render a
3-dimensional model of the ocular microcirculation based merely on the motion contrast of the
circulating blood. Since OCT is fast, easy to perform and completely non-invasive, this
technique lends itself for screening purposes.
Auto-fluorescence retinal imaging is an imaging modality that is commonly used in
ophthalmological practice to assess retinal pigment epithelium and photoreceptor function by
quantifying the relative amount of auto-fluorescent lipofuscin. The images can be acquired
using the OCT device but require pupil dilation. Using visible light of 488nm, it is a safe
imaging technique with no short or late term side-effects to the patient. A recent study has
described abnormal auto-fluorescence patterns in patients with cerebral amyloid deposition.
Hyperspectral fundus photography is comparable to regular fundus photography but uses an
image sensor that can acquire images at multiple different wavelengths (unlike the classical
red-green-blue colour sensors that are used in conventional cameras). Apart from a different
image sensor, the device is identical to a regular fundus camera. Recent studies have emerged
that describe a unique hyperspectral signature of aggregated retinal amyloid deposits.
The proposed study aims to investigate whether retinal or choroidal vascular parameters
measured using OCT and the quantification of retinal amyloid deposits using auto-fluorescence
and hyperspectral retinal imaging, could be useful to identify different subpopulations of
cognitive intact, MCI and dementia patients.
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