Multi-modal retinal biomarkers for vascular dementia: developing enabling image analysis tools

痴呆症是一种毁灭性的疾病。它对受影响的个人，他们的家庭，更广泛的社会产生了灾难性的影响，并为NHS增加了沉重的成本。检测受试者在未来患痴呆症的风险增加，并在痴呆症的最早阶段检测不良风险，可能会提供机会，以保护脑功能和延缓疾病进展。越来越多的人认识到，脑血管变性在痴呆症的发展中起着重要作用。因此，尽早识别可能出现这种退化的患者是很重要的，因为他们可能需要特殊的治疗，疾病的进展可能会被推迟。还有强有力的临床证据表明，大脑血管与视网膜中的血管有关，视网膜是负责人类视觉第一阶段的眼睛部分。高街眼镜商定期检查视网膜，因此视网膜图像（眼底摄影和光学相干断层扫描，现在都可以在单个设备上使用）可以提供一种廉价的非侵入性程序，能够捕获痴呆症的早期迹象或那些处于痴呆症高危状态的人。该系统将利用现有的广泛考试，并可立即部署。因此，视网膜测试对痴呆症体征的潜在影响将是巨大的。中心问题是视网膜是否可以提供（a）未来痴呆风险的可靠生物标志物（体征），和（B）认知下降或脑血管变性的疾病进展的敏感生物标志物。我们的目的是开发基于图像分析的技术，以识别这些生物标志物，使用易于获得的视网膜特征（支持无创，廉价，易于获得和高特异性测试）和联合脑视网膜特征（由脑和视网膜小血管的亲和力激发的更大范围的研究）。我们将与邓迪和爱丁堡大学医院的专家单位合作，在试点研究中验证这些技术，包括眼科、脑成像、认知老化和认知流行病学。我们的研究得到了阿尔茨海默氏症协会的支持。

Dementia is a devastating disease. It has catastrophic implications for affected individuals, their family, wider society, and heavy, increasing costs for the NHS. Detecting subjects at increased risk of developing dementia in the future, and detecting adverse risk at the earliest stages of dementia, may present opportunities to preserve brain function and delay disease progression. There is increasing recognition that degeneration of brain blood vessels plays a role in the development of dementia. It is therefore important to identify patients likely to present such degeneration as early as possible, as they may require special treatment and the disease progress can be delayed.There is also strong clinical evidence that the brain blood vessels are related to those in the retina, the part of the eye responsible for the first stage of human vision. The retina is checked routinely by high-street opticians, hence retinal images (fundus photography and optical coherence tomography, now both available on a single device) could provide an inexpensive, non-invasive procedure capable of capturing early signs of dementia or those at high risk of developing dementia. It would exploit widely available existing examinations and be deployable immediately. Hence the potential impact of a retinal test for dementia signs would be huge. The central question is whether the retina can provide (a) reliable biomarkers (signs) for future risk of dementia, and (b) sensitive biomarkers of disease progression of either cognitive decline or brain vessels degeneration. Our purpose is to develop enabling technologies based on image analysis to identify such biomarkers, using easily accessible retinal features (supporting an uninvasive, inexpensive, easily accessible and high-specificity test), and joint brain-retina features (a larger-scope investigation motivated by the affinity of small vessels of brain and retina). We shall validate the technologies in a pilot study in collaboration with the specialist units at the University Hospitals of Dundee and Edinburgh, including ophthalmology, brain imaging, and cognitive ageing and cognitive epidemiology. Our research is supported by the Alzheimer's Society.