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A Breakthrough Observation in Diagnosing Cognitive Impairment by Dr. Delia Cabrera DeBuc

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A Breakthrough Observation in Diagnosing Cognitive Impairment by Dr. Delia Cabrera DeBuc

January 07
22:46 2019

The research paper titled, “Investigating Multimodal Diagnostic Eye Biomarkers of Cognitive Impairment by Measuring Vascular and Neurogenic Changes in the Retina” by Delia Cabrera DeBuc was written to scrutinize the association and the link between the retinal vascular complexity and neurodegenerative changes in patients with cognitive impairment (CI). This research, supported by the Finker Frenkel Legacy Foundation and the Alzheimer’s Association, was conducted using a low-cost multimodal approach.

According to the 2015 World Alzheimer Report, “there are approximately 46 million dementia patients worldwide”. This number is estimated to double every 20 years and the total worldwide dementia-related healthcare cost is $818 billion. According to the National Institute of Aging (NIA), U.S. Department of Health and Human Sciences, Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear in their mid-60s. It is believed that Alzheimer’s is the most common cause of dementia among other older adults with longer Parkinson’s disease (PD) duration and least common in individuals with multiple sclerosis (MS). “Dementia is the loss of cognitive functioning- thinking, remembering, and reasoning and behavioural abilities to such an extent that it interferes with a person’s daily life and activities.” Commonly, nuclear imaging (e.g., PET, MRI) and lumbar punctures used to help diagnose AD are expensive and invasive.

Cabrera DeBuc’s study, which appears in Frontiers in Physiology,  assessed that the retina shares an important pathogenic and structural-functional route with the central nervous system (CNS). Previous studies have shown the association between eye pathology and Alzheimer’s disease (AD), Parkinson’s disease (PD) and multiple sclerosis (MS) using unimodal biomarkers and either expensive ophthalmic imaging devices or standard fundus imaging. In these studies, the teams of researchers observed that neuronal loss in AD, PD and MS was correlated with macular and optic nerve parameters including ganglion cells, which showed similarity to neurons in the cerebral cortex. In general, the retinal neural loss has been related to neurodegeneration in patients suffering from these diseases.

According to Cabrera DeBuc and the team of researchers in the Bascom Palmer Eye Institute at the University of Miami in Miami, Florida, there must be vast research exploring the cognitive impairment non-invasively in the brain via the retina. “A multi-factorial disease like AD demands a multimodal approach to search for potential biomarkers of disease onset and progression,” says first author Cabrera DeBuc. The team of researchers feel that the investigation can lead to the role played by multimodal retinal biomarkers in the detection of cognitive decline. The researchers opine that the discovery of biomarkers is a complex process. The process demands considering multiple factors and approaches, which can aid in the prediction of risk or response to treatment and supplement the same with low false positives and false negative rates.

The central hypothesis of the research paper is the multivariate eye biomarkers reflect distinctive eye-brain signatures of cognitive impairment that may have some links with the onset and progression of cognitive decline. Cabrera DeBuc conducted the research in a systematic manner and therefore the quantification of the reticular vascular complexity along with its neural function was performed for each participant. The study was conducted using advanced retinal imaging (i.e., infrared based scanning laser ophthalmoscope), full-field electroretinogram (ERG) as well as visual performance exams.

The study was designed to obtain multiple retinal measures viz., structural and functional. This distinct design allowed Cabrera DeBuc and the team to find and study the relationship between various pieces of information, such as vessel caliber and tortuosity, vascular multifractal dimension, color vision deficiencies, bioelectrical activity of the retina etc. A further detailed explanation can be looked up in the research paper. However, Cabrera DeBuc found that the study had its own limitations. For example, the exclusion of eyes due to poor image quality, challenges associated with the structural and functional data with high quality (mainly in elderly patients with cognitive decline), the presence of confounding factors that limited the sample size etc. Nevertheless, although AD is the most common, progressive cause of dementia, Cabrera DeBuc’s research recruited subjects independently of their cognitive impairment’s causation. This helped the team to analyse the data in community settings for population health management.

The conclusions of the findings suggest that although it’s unfortunate that there is no successful treatment once dementia or early cognitive impairment becomes clinically apparent, a low cost non-invasive approach using the eye may facilitate that older people can reduce their risk of cognitive decline by making crucial lifestyle changes. Cabrera DeBuc’s work illustrates that there are multimodal retina markers that may be sensitive to cognitive impairment decline. This further supports the evidence that there is a statistical trend which points to the association formed between retinal neuronal dysfunction and microvasculature changes. A caveat has been mentioned as well. Since the study sample was small, Cabrera Debuc informs that the full extent of practical application in the clinical use must be determined.

Cabrera DeBuc and the team of researchers have written and conducted brilliant research. The clinical scientists too can add inputs to this excellent research. The team is still collecting data under this study and expect to explore the multiple relationships and statistical trends further with larger sample size. This will help in more accurate results and may help to monitor the effectiveness of the emerging therapies.

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