The application of optical coherence tomography angiography in cerebral small vessel disease, ischemic stroke, & dementia: a systematic review. Link to paper in Frontiers Neurology. Authors Jun-Fang Zhang, Stewart Wiseman, Maria C. Valdés-Hernández, Fergus N. Doubal, Baljean Dhillon, Yun-Cheng Wu & Joanna M. Wardlaw Abstract Objective: To investigate the application of optical coherence tomography angiography (OCTA) in cerebral small vessel disease (SVD), ischemic stroke & dementia. Methods: We conducted a systematic search in MEDLINE (from inception) & EMBASE (from 1980) to end 2019 for human studies that measured retinal parameters in cerebral SVD, ischemic stroke, & dementia using OCTA. Results: Fourteen articles (n = 989) provided relevant data. Ten studies included patients with Alzheimer disease (AD) & mild cognitive impairment (n = 679), two investigated pre-symptomatic AD participants (n = 154), & two investigated monogenic SVD patients with cerebral autosomal dominant arteriopathy with subcortical infarcts & leukoencephalopathy (n = 32) & Fabry disease (n = 124). Methods to reduce bias & risk factor adjustment were poorly reported. Substantial methodological variations between studies precluded a formal meta-analysis. Quantitative measurements revealed significant yet inconclusive changes in foveal avascular zone, perfusion density, & vessel density (VD) in AD, presymptomatic AD, & SVD patients. Two (n = 160) of three studies (n = 192) showed association between decreased VD & increased white matter hyperintensities. In three (n = 297) of seven studies (n = 563), better cognitive function was associated with increased VD. One study (n = 52) suggested increased VD was associated with increased ganglion cell–inner plexiform layer thickness in AD yet with no covariate adjustment. Conclusions: Changes in retinal microvasculature identified using OCTA are associated with monogenic SVD & different stages of AD, but data are limited & partly confounded by methodological differences. Larger studies with risk factors adjustment & more consistent OCTA methods are needed to fully exploit this technology. Keywords Alzheimer's disease Cerebral small vessel disease Dementia Ischemic stroke Optical coherence tomography angiography Retinal vasculature Related links Link to paper in Frontiers Neurology Professor Joanna Wardlaw Dr Fergus Doubal Dr Maria Valdés-Hernández Dr Stewart Wiseman Eyes / retinal Small vessel disease (SVD) Stroke Dementia Social media tags & titles Featured paper: The application of optical coherence tomography angiography in cerebral small vessel disease, ischemic stroke, & dementia: a systematic review. @FrontNeurol @fergusdoubal @EdinUniBrainSci #Alzheimers #SVD Publication date 10 Sep, 2020
