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M. A. Williams, V. Silvestri, D. Craig, P. Passmore, G. Silvestri; The Prevalence of Age-Related Macular Degeneration in Alzheimer's Disease. Invest. Ophthalmol. Vis. Sci. 2010;51(13):543.
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Advanced age-related macular degeneration (AMD) is the most common cause of blindness in those aged over 65 years in the developed world and the third most common cause globally. Alzheimer’s disease (AD) is the most common form of dementia. Part of the basis for difficulties that AD patients have may be visual. AD and AMD are both characterised by the presence of abnormal extracellular materials; drusen in AMD and plaques in AD; associated with neuronal degeneration. These pathological deposits in AD and AMD show similarities in content. Shared components include the proteins vitronectin, amyloid P and apolipoprotein E. β-amyloid, the hallmark of AD plaques, has been found in drusen of eyes with AMD. Epidemiologically associations between AD and AMD have rarely been studied. The purpose of this study was to compare the prevalence of age-related macular changes in a sample of subjects with AD with controls.
Subjects over 65 years of age with AD and cognitively normal controls were recruited in an opportunistic fashion from hospital clinics and hospital databases. Ethical committee approval was granted prior to commencement of the study. A standardised testing protocol was followed for each participant, all testing being performed by the same investigator. Data on cognitive status and potentially confounding factors were collected from the subject, their carer and where possible, medical notes. Dilated retinal photography was performed. Photographs were anonymised and graded in a masked fashion by one person. Random number tables were used to select 5% of the subjects for regrading for quality control. Statistical analysis was performed on SPSSv17.
259 subjects with AD and 338 controls volunteered; 256 with AD and 324 controls participated. The average age of AD subjects was 76.6y+/-6.8, and of controls 80.2y+/-7.7. Retinal photographs were taken on 226 with AD and 305 controls. Intraobserver agreement was acceptable: kappa values ranged from 0.64 to 1.0. 94.5% of controls photos were of good or fair quality, compared with 88.3% of cases. Drusen were evident in 53.1% of controls and 48.7% of AD cases. No significant difference between AD cases and controls was found in the prevalence of drusen under or over 125um.
Most people with AD are able to undergo dilated retinal examination. Drusen are not more prevalent in AD subjects compared with cognitively normal controls. However ocular disease should not be neglected as a source of difficulties in patients with AD.
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