Circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and key domains of cognitive function

Abstract

Purpose : While Alzheimer's disease was previously associated with lower cpRNFLT, it remains unclear which dimensions of cognitive functions are related to retinal nerve fiber layer thinning. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists six key domains of cognitive function relevant for diagnosing neurocognitive disorders. Here, we associate each of these domains with pointwise cpRNFLT.

Methods : From the age and gender stratified, population-based Leipzig Research Centre for Civilization Diseases - LIFE Adult study, spectral domain optical coherence tomography cpRNFLT scans (768 A-scans, diameter: 12°) were selected from participants with reliable measurements (≥50 B-scan repetitions, quality ≥20 dB, ≤5% missing A-scans) and without clinically significant findings on fundus and/or OCT images in either eye. The six DSM-5 domains were operationalized by (sub-)scales of the Trail-Making Test, the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Neuropsychological Battery, and the Reading the Mind in the Eye Test (see figures for details). To adjust for demographics and individual eye anatomy, age, sex, and an estimation of true scanning radius based on scanning focus were used as additional regressors.

Results : 11,879 eyes of 6,917 subjects were selected (age range: 20-79 years). After adjustment for multiple comparisons, there were no significant (p<0.05) cpRNFLT locations for the DSM-5 dimensions Executive Function, Learning and Memory, Perceptual−motor Function, and Social Cognition. For dimensions Language and Attention, worse performance was related to significant RNFL thinning on 14% and 40% of the locations, respectively. Thinning was most pronounced on temporal locations (see figures).

Conclusions : Thinner Retinal nerve fiber layer was significantly associated with lower performance in two out of the six DSM-5 key domains (Attention and Language). The thinning was highly location specific and mostly focused on retinal locations temporal to the optic disc. As cpRNFLT can be obtained conveniently within seconds, our results might help to earlier identify patients at risk for developing cognitive decline associated with diseases like Alzheimer’s and assist clinicians in the specific choice of cognitive tests.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

 

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