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Research Article| Volume 423, 117383, April 15, 2021

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The relationship between cerebral and retinal microbleeds in cerebral amyloid angiopathy (CAA): A pilot study

  • Jessica Alber
    Correspondence
    Corresponding author at: Ryan Research Assistant, Professor of Neuroscience, Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881, USA.
    Affiliations
    Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA

    George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA

    Memory & Aging Program, Butler Hospital, Providence, RI, USA
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  • Edmund Arthur
    Affiliations
    Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA

    George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA

    Memory & Aging Program, Butler Hospital, Providence, RI, USA
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  • Danielle Goldfarb
    Affiliations
    Banner Alzheimer's Institute, Phoenix, AZ, USA
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  • Jonathan Drake
    Affiliations
    Department of Neurology, Rhode Island Hospital, Providence, RI, USA

    Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
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  • Jerrold L. Boxerman
    Affiliations
    Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA

    Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
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  • Brian Silver
    Affiliations
    Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA
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  • Brian R. Ott
    Affiliations
    Department of Neurology, Rhode Island Hospital, Providence, RI, USA

    Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA
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  • Lenworth N. Johnson
    Affiliations
    Department of Surgery (Ophthalmology), Alpert Medical School of Brown University, Providence, RI, USA
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  • Peter J. Snyder
    Affiliations
    Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston, RI, USA

    George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, RI, USA

    Department of Neurology, Alpert Medical School of Brown University, Providence, RI, USA

    Department of Surgery (Ophthalmology), Alpert Medical School of Brown University, Providence, RI, USA
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Published:March 01, 2021DOI:https://doi.org/10.1016/j.jns.2021.117383

      Highlights

      • No cost-effective, widely accessible biomarkers of cerebral amyloid angiopathy (CAA)
      • Retina holds potential as neurodegenerative disease biomarker
      • Trend level correlations between cerebral and retinal microbleeds in CAA
      • No group differences between CAA/controls on structural or angiographic retinal imaging
      • Results complicated by small N, systolic hypertension in CAA group

      Abstract

      Background

      The standard in vivo diagnostic imaging technique for cerebral amyloid angiopathy (CAA) is costly and thereby of limited utility for point-of-care diagnosis and monitoring of treatment efficacy. Recent recognition that retinal changes may reflect cerebral changes in neurodegenerative disease provides an ideal opportunity for development of accessible and cost-effective biomarkers for point-of-care use in the detection and monitoring of CAA. In this pilot study, we examined structural and angiographic retinal changes in CAA patients relative to a control group, and compared retinal and cerebral pathology in a group of CAA patients.

      Methods

      We used spectral domain optical coherence tomography (SD-OCT) to image the retina and compared retinal microbleeds to both cerebral microbleeds and white matter hyperintensities (WMH) in CAA patients, as seen on MRI. We compared retinal angiographic changes, along with structural retinal neuronal layer changes in CAA patients and cognitively normal older adults, and examined the relationship between retinal and cerebral microbleeds and cognition in CAA patients.

      Results

      We found a trend level correlation between retinal and cerebral microbleeds in CAA patients. Moreover, we found a significant correlation between retinal microbleeds and episodic memory performance in CAA patients. There were no significant group differences between CAA patients and cognitively normal older adults on retinal angiographic or structural measurements.

      Conclusion

      Retinal microbleeds may reflect degree of cerebral microbleed burden in CAA. This picture was complicated by systolic hypertension in the CAA group, which is a confounding factor for the interpretation of these data. Our results stimulate motivation for pursuit of a more comprehensive prospective study to determine the feasibility of retinal biomarkers in CAA.

      Keywords

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