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Retinal pathology as biomarker for cognitive impairment and Alzheimer's disease
  1. Mohammad Kamran Ikram1,2,3,4,5,
  2. Carol Y Cheung1,2,
  3. Tien Y Wong1,2,
  4. Christopher P L H Chen4,6
  1. 1Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  2. 2Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  3. 3Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
  4. 4Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
  5. 5Memory Ageing and Cognition Centre, National University Health System, Singapore
  6. 6Department of Pharmacology, National University of Singapore, Singapore
  1. Correspondence to Dr Mohammad Kamran Ikram, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 7, Department of Ophthalmology, Singapore 119228, Singapore; kamran_ikram{at}


Alzheimer's disease (AD) is the most common cause of dementia. Furthermore, over the last few decades, there has been a shift towards identifying earlier stages of AD, which include mild cognitive impairment (MCI). Improved methods of screening and early detection are essential to identify cognitively normal individuals who have a high risk of developing MCI and AD, so that interventions can be developed to delay the progression of specific disease-related pathologies. Thus far, novel biomarkers that have been examined include structural and functional neuroimaging as well as biochemical analysis of cerebrospinal fluid. However, in spite of these efforts, there is still an urgent need for unravelling additional novel biomarkers for AD and MCI. As the retina shares many features with the brain, including embryological origin, anatomical (such as microvascular bed) and physiological characteristics (such as blood-tissue barrier), it has been suggested that the retina may provide an easily accessible and non-invasive way of examining pathology in the brain. While most AD-related pathology occurs in the brain, the disease has also been reported to affect different regions of the retina, including the macular region and optic disc. Studies have suggested that retinal pathology, such as deposits in the macular region, decreased retinal nerve fibre thickness, and optic disc cupping and retinal microvascular abnormalities may be related to AD and cognitive impairment. This article presents a review of current literature on retinal involvement in AD and MCI.

  • Dementia
  • neuro-ophthalmology
  • stroke
  • alzheimer's disease
  • cerebrovascular disease

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  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.