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Decreased retinal vascular density is associated with cognitive impairment in CADASIL: an optical coherence tomography angiography study

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Abstract

Purpose

This study aimed to assess alterations in retinal vascular density in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) patients using optical coherence tomography angiography (OCTA) and investigate their association with MRI and cognitive features.

Methods

Twenty-five patients with CADASIL and forty healthy controls were evaluated by Cirrus HD-OCT 5000 with AngioPlex OCTA to determine changes in macular retinal vasculature. Retinal vasculature parameters between two groups were compared. The MRI lesion burden and neuropsychological scales were also examined in patients. The association between OCTA parameters and MRI/cognitive features was evaluated using partial Spearman rank correlation.

Results

The vessel density and perfusion density of whole image in macular region (vessel density: t =  − 2.834, p = 0.005; perfusion density: t =  − 2.691, p = 0.007) were significantly decreased in patients with CADASIL. Moreover, vessel density of whole image in macular region was negatively associated with Fazekas scores (ρ =  − 0.457; p = 0.025) and the number of lacunar infractions (ρ =  − 0.425, p = 0.038) after adjustment for age. Decreased macular vessel density and perfusion density of whole image were also associated with MoCA scores (vessel density: ρ = 0.542, p = 0.006; perfusion density: ρ = 0.478, p = 0.018) and other domain-specific neuropsychological tests (p < 0.05) after adjustment for age.

Conclusion

Decreased retinal vascular density was associated with increased MRI lesion burden and cognitive impairment in patients with CADASIL. Our findings suggest that the degree of retinal vascular involvement, as demonstrated by OCTA, may be consistent with the severity of MRI lesions and the degree of cognitive impairment in patients.

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Data availability

The raw data supporting the conclusions of this manuscript will be made available by the corresponding authors, without undue reservation, to any qualified researcher.

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Acknowledgements

The authors acknowledge Yue Wu and Zhixin Li (Institute of Biophysics, Chinese Academy of Sciences) for their contribution to 7.0T MRI data acquisition and Yadi Zhang and Xiaopeng Gu (Department of Ophthalmology, Peking University First Hospital) for their contribution to OCTA data acquisition. We appreciate the support of Weili Yang (Department of Neurology, Peking University First Hospital) for administrative assistance.

Funding

This work was supported by the National Natural Science Foundation of China (82101355, 82271323, and 82171059) and the scientific research seed fund of the Peking University first hospital (2021SF06).

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Author notes

  1. Yu Guo and Jianchen Hao contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Department of Neurology, Peking University First Hospital, Beijing, China

    Yu Guo, Li Bai, Yunchuang Sun, Fan Li, Wei Zhang, Zhaoxia Wang, Yun Yuan & Chen Ling

  2. Beijing Key Laboratory of Neurovascular Disease Discovery, Beijing, China

    Yu Guo, Li Bai, Yunchuang Sun, Fan Li, Wei Zhang, Zhaoxia Wang, Yun Yuan & Chen Ling

  3. Department of Ophthalmology, Peking University First Hospital, Beijing, China

    Jianchen Hao, Ruilin Zhu & Liu Yang

  4. Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China

    Yong Shan

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  1. Yu Guo
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  3. Ruilin Zhu
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Contributions

Yu Guo: conceptualization, formal analysis, and writing—original draft. Jianchen Hao: conceptualization, date curation, methodology, review, and editing. Ruilin Zhu: date curation methodology. Li Bai, Yong Shan, Yunchuang Sun, and Fan Li: date curation. Wei Zhang and Zhaoxia Wang: study design. Chen Ling: conceptualization, data curation, funding acquisition, writing, and editing. Liu Yang and Yun Yuan: funding acquisition, supervision, review, and editing. All authors contributed to the article and approved the submitted version.

Corresponding authors

Correspondence to Liu Yang, Yun Yuan or Chen Ling.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board and Ethics Committee at Peking University First Hospital.

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Guo, Y., Hao, J., Zhu, R. et al. Decreased retinal vascular density is associated with cognitive impairment in CADASIL: an optical coherence tomography angiography study. Neurol Sci (2024). https://doi.org/10.1007/s10072-024-07390-2

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