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Retinale optische Kohärenztomographie-Biomarker bei demenziellen Erkrankungen

Retinal optical coherence tomography biomarkers in dementia

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Zusammenfassung

Hintergrund

Im Rahmen der Alterung der Gesellschaft ist von einer steigenden Prävalenz und Inzidenz verschiedener demenzieller Erkrankungen in der Bevölkerung auszugehen. Um Patient*innen frühzeitig identifizieren und einer Therapie zuführen zu können, sind flächendeckende, nichtinvasive und niederschwellig zu erreichende Screeningmethoden vonnöten. Diese stehen jedoch bis dato nicht zur Verfügung. Es wurde bereits eine Vielzahl potenzieller Biomarker in der hochauflösenden optischen Kohärenztomographie (OCT) identifiziert, die mit dem Vorliegen demenzieller Erkrankungen assoziiert zu sind.

Ziel der Arbeit

Er erfolgen eine Zusammenfassung von OCT-Biomarkern bei demenziellen Erkrankungen und eine Diskussion ihrer Eignung für flächendeckende Screeninguntersuchungen.

Methoden

Es erfolgte eine Literaturrecherche in PubMed bis März 2023 mit den Suchbegriffen „Dementia“, „mild cognitive impairment“, „OCT“, „OCT angiography“, „retinal biomarkers“. Relevante Publikationen wurden identifiziert und zusammengefasst.

Ergebnisse

In einer Vielzahl von Populations- und klinischen Studien konnten lediglich unspezifische Veränderung in der OCT und OCT-Angiographie (OCT-A) bei Patienten*innen mit (prä)demenziellen Erkrankungen nachgewiesen werden. Hierzu zählen die Reduktion der Dicke der peripapillären Nervenfaserschicht, des Ganglienzellkomplexes und der zentralen Netzhaut. Zudem zeigten sich in der OCT‑A eine reduzierte Gefäßdichte und eine vergrößerte foveale avaskuläre Zone (FAZ).

Schlussfolgerungen

Die bis dato identifizierten OCT-Biomarker sind unspezifisch, und bislang gibt es keine OCT- oder OCT-A-Signatur bestimmter Demenzformen. Größere, longitudinale Studien sind notwendig, um derartige Signaturen, die spezifischer sind, v. a. für Frühformen demenzieller Erkrankung zu entwickeln und ihren prognostischen Wert zu identifizieren. Erst dann ist ein Einsatz im Rahmen flächendeckender Screeninguntersuchungen denkbar.

Abstract

Background

Due to the general aging of society, the prevalence and incidence of dementia are expected to increase considerably. In order to timely identify patients and assess their need for treatment and/or supportive measures, comprehensive and easy access screening methods are required, which, however, are yet to be developed. To date, several biomarkers for the presence of dementia on high-resolution spectral domain optical coherence tomography (OCT) and OCT angiography (OCT-A) images were identified.

Aim

To summarize previously identified OCT biomarkers in dementia and to assess their suitability for comprehensive screening examinations.

Material and methods

A literature search was conducted on PubMed until March 2023 for the keywords “dementia”, “mild cognitive impairment”, “OCT”, “OCT angiography” and “retinal biomarkers”. Relevant publications were identified and summarized.

Results

Numerous unspecific alterations on OCT imaging and OCT‑A were identified in patients with (predementia) dementia according to many population and clinical studies. These include a reduced thickness of the peripapillary retinal nerve fiber layer, the ganglion cell complex and the central retinal region. Additionally, a reduced vascular density and an enlarged foveal avascular zone (FAZ) were identified on OCT‑A imaging.

Conclusion

The currently known OCT biomarkers are too unspecific, and there is to date no OCT or OCT-A-based signature distinguishing between different types of dementia. Further longitudinal studies with larger sample sizes are warranted to develop and evaluate such distinct OCT signatures for different types of dementia and their respective early disease stages and to assess their prognostic value. Only then is the inclusion in comprehensive screening investigations feasible.

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Authors and Affiliations

  1. Universitäts-Augenklinik Bonn, Ernst-Abbe-Str. 2, 53127, Bonn, Deutschland

    L. Goerdt & F. G. Holz

  2. Universitäts-Augenklinik Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    R. P. Finger

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Correspondence to L. Goerdt.

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L. Goerdt, F.G. Holz und R.P. Finger geben an, dass kein Interessenkonflikt besteht.

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Goerdt, L., Holz, F.G. & Finger, R.P. Retinale optische Kohärenztomographie-Biomarker bei demenziellen Erkrankungen. Ophthalmologie 121, 84–92 (2024). https://doi.org/10.1007/s00347-023-01947-w

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