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Corinne Gonzalez; Ophthalmologic exam in Age Macular Degeneration-Alzheimer Disease: its interest in detection, follow-up of AMD, of Alzheimer disease, its relevance to highlight the links and correlations between AMD and AD. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4119.
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To evaluate the importance of ophthalmologic exam in AMD and AD, the impact of AMD on Alzheimer disease and vice versa, and their relationship and in-between correlation.
PATIENTS: AMD patients: 240 patients, 3 Groups A, B, C. A: 70 AMD patients with first stage AMD (drusen, drusenoid PED, pigment, small atrophic areas), B: 64 Atrophy AMD patients with predominant atrophic areas, C:106 Neovascular AMD patients, with Neovascular AMD. AD patients: 240 patients, 4 groups I,II,III,IV .I: 70 Normal or no significative patients; II: 127 MCI patients,( 4 subgroups: mild, moderate, intense , severe); III : 29 Early AD; IV:14 AD. EXAM: ophthalmologic exam included ETDRS visual acuity (VA), complete ophthalmic examination, Fundus examination, autofluorescence imaging (FAF),(Region Finder Software, particularly for atrophic areas), optical coherence tomography ( Spectral Domain OCT) (OCT en face software, in particular), and fluorescein angiography (FA) and ICG when Neovascular complication (Spectralis HRA-OCT). Cognitive evaluation is done with MMSE: Mini Mental State Examination (Folstein, GRECO), score allow to determine various groups and subgroups. Each AMD patient, more than ophthalmologic exam would have cognitive evaluation. Each AD patients, more than cognitive exam, would have ophthalmologic evaluation.
AMD patients;73% patients in group A, 77,5% in group B, 63% in group C have mild cognitive impairment (MCI).In MCI subgroups, results are progressively decreasing and similar in group A and B, lower and homogeneous in group B. Cognitive impairment differ between AMD subgroups. It’s moderate in group A (normal score:37%), higher in group B and C, and more in group B( normal score:22,5%) than in group C (normal score:34%) , but early AD is only present in group C (3%).AD patients;43% patients with cognitive impairment present AMD. AMD ophthalmologic signs are predictive and precursor for AD. Fundus examination and even more (FAF , OCT) are useful and needed to enhance AD screening and follow-up as to detect AMD in AD patients.
The AMD-AD correlation allows us to improve detection, follow-up, screening of both AMD and AD pathologies and furthermore progress in etiopathogenic knowledge and therapeutic prospects.
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