Eye Determinants of Cognition (EyeDOC) Study

项目摘要 眼认知决定因素（EyeDOC）研究 理由：痴呆症和轻度认知障碍（MCI）在我们的国家造成巨大的健康和社会成本。 美国人口老龄化。虽然已知脑神经缺失会导致阿尔茨海默氏痴呆症，但血管性 这些疾病可能在很大程度上导致痴呆及其前体MCI的总负担。小血管 脑血管变化与认知障碍的关系最为密切， 大脑成像。然而，眼相干断层扫描（OCT）的最新技术进步提供了 视网膜神经节细胞的微血管病理学和神经变性的精确测量， 提供反映潜在大脑过程的敏感生物标志物。 设计：EyeDOC研究将嵌入社区神经认知研究中的动脉粥样硬化风险 （ARIC-NCS），从两个ARIC-NCS现场（杰克逊 MS和华盛顿县，MD）参加一项全面的视力评估， 视网膜的OCT成像。EyeDOC访视将在ARIC NCS访视6后3个月内进行，并在 ARIC NCS访视7，利用研究的广泛神经认知测试和纵向设计。 暴露：EyeDOC将为丰富的ARIC NCS数据提供新的眼部测量方法，包括： A.以黄斑神经节细胞复合体[GCC]丢失/变薄为标志的神经变性程度 而视网膜神经纤维层就在视神经头外面 B。微血管病变的程度以较低的黄斑血管密度， 黄斑无灌注和较低的平均黄斑血流[血流指数]。 结局：ARIC-NCS提供的晚期认知结局包括： A.整体认知能力、执行功能/处理速度、记忆力和语言能力下降- 在V5、V6和V7中使用神经认知测试进行评估。 B。MCI的发生率，在V5时约20%的队列中诊断出MCI，预计 由于队列的年龄增长，V6和V7的影响百分比更大。 目的：我们将评估1）视网膜神经退行性指标与MCI事件的关系， 与阿尔茨海默病一致的认知下降模式和2）视网膜微血管异常 伴有轻度认知障碍和认知能力下降，与脑小血管疾病一致。因此 主要重点将是NFL变薄对记忆力下降的影响以及毛细血管减少的影响。 血流和非灌注区的执行功能/处理速度下降。 总结：EyeDOC研究将证明视网膜生物标志物的潜力，以告知病因， 观察到的认知变化，并为OCT用作有效筛查提供了概念证明 用于确定认知老化的根本原因的工具。

PROJECT SUMMARY Eye Determinants of Cognition (EyeDOC) Study Rationale: Dementia and mild cognitive impairment (MCI) pose enormous health and societal costs in our aging US population. While cerebral neural loss is known to contribute to Alzheimer's dementia, vascular diseases may contribute substantially to the total burden of dementia and its precursor, MCI. Small-vessel cerebrovascular changes, which are most strongly associated with cognitive impairments, are difficult to detect with brain imaging. However, recent technological advances in ocular coherence tomography (OCT) provide refined measures of the microvascular pathology and neurodegeneration of retinal ganglion cells which may provide sensitive biomarkers reflecting underlying cerebral processes. Design: The EyeDOC study will be nested in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS), recruiting 1,000 participants (50% African-American) from two ARIC-NCS field sites (Jackson MS and Washington County, MD) to take part in a comprehensive vision assessment with photographic and OCT imaging of the retina. The EyeDOC visit will occur within 3 months of the ARIC NCS visit 6, and prior to ARIC NCS visit 7, capitalizing on the study's extensive neurocognitive testing and longitudinal design. Exposures: EyeDOC will contribute novel ocular measures to the rich ARIC NCS data including: A. Degree of neurodegeneration marked by loss/thinning of the macular ganglion cell complex [GCC] and the retinal nerve fiber layer [NFL] just outside the optic nerve head B. Degree of microvascular pathology marked by a lower macular vessel density, enlarged area of macular non-perfusion and lower average macular blood flow [flow index]. Outcomes: The late life cognitive outcomes available from ARIC-NCS include: A. Decline in global cognitive ability, executive function/processing speed, memory, and language – assessed using neurocognitive testing in V5, V6 and V7. B. Incidence of MCI, which was diagnosed in approximately 20% of the cohort in V5 and is expected to affect a larger percentage at V6 and V7 due to advancing age of the cohort. Aims: We will assess the relationships of 1) retinal neurodegenerative measures with incident MCI and a pattern of cognitive decline consistent with Alzheimer's disease and 2) retinal microvascular abnormalities with incident MCI and a pattern of cognitive decline consistent with cerebral small vessel disease. Thus, the primary focus will be the impact of NFL thinning on a decline in memory and the impact of reduced capillary blood flow and non-perfusion area on a decline in executive function/processing speed. Summary: The EyeDOC study will demonstrate the potential of retinal biomarkers to inform the etiology of observed cognitive changes and provide a proof of concept for OCT to be used as an effective screening tool for determining the underlying cause(s) of cognitive aging.