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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2020.tde-10092021-112755
Document
Author
Full name
Ana Laura Maciel Almeida
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Cunha, Leonardo Provetti (President)
Júnior, Augusto Paranhos
Monteiro, Mario Luiz Ribeiro
Vessani, Roberto Murad
Title in Portuguese
Correlação entre o déficit cognitivo e a perda neural retiniana avaliada pela tomografia de coerência óptica em pacientes com comprometimento cognitivo leve
Keywords in Portuguese
Comprometimento Cognitivo Leve
Demência
Doença de Alzheimer Tomografia de coerência óptica
Mácula
Nervo óptico
Retina
Abstract in Portuguese
OBJETIVO: Avaliar a capacidade diagnóstica dos parâmetros da espessura da camada de fibras nervosas da retina peripapilar (CFNRp), espessura macular total e das camadas internas da retina medidos pela tomografia de coerência óptica de alta resolução por fonte de varredura (TCO-FV) em diferenciar pacientes com Comprometimento Cognitivo Leve (CCL) de controles normais pareados por sexo e idade. Verificar a correlação entre os parâmetros da espessura da CFNRp, espessura macular total e das camadas internas da retina medidos pelo TCO-FV e o grau de comprometimento cognitivo, avaliados pelo Mini-Exame do Estado Mental (MEEM), Montreal Cognitive Assessment (MoCA) e Questionário de Atividades Funcionais de Vida Diárias de Pfeffer em pacientes com CCL. MÉTODOS: Noventa e quatro olhos, sendo 46 olhos de 23 pacientes com CCL e 48 olhos de 24 controles, foram avaliados. Foram capturadas imagens de alta resolução do disco óptico e da mácula pelo TCO-FV. Os valores de espessura das seguintes estruturas foram analisados: CFNRp, retina total, CFNR macular (CFNRm); camada de células ganglionares da retina (CGR) mais a camada plexiforme interna (CPI), sendo referida como CGR+, CFNRm mais CGR+ (CGR mais CPI), sendo denominada CGR++. Para a avaliação das camadas internas (CFRNm, CGR+ e CGR++), três formas de análise foram utilizadas: mácula global (6x6mm), divisão em nove setores do mapa do ETDRS e em seis setores, ambos com 6mm de diâmetro. Os parâmetros do TCO dos olhos com CCL e controles normais foram comparados utilizando Equações Estimativas Generalizadas (EEG). Para a correlação entre as medidas da CFNRp, espessura macular total e das camadas internas da retina medidos pela TCO-FV e o déficit cognitivo, estimados pelo MEEM, MoCA, Pffefer, foi realizada a correlação de Pearson. RESULTADOS: Os valores da espessura da CFNRp dos pacientes com CCL não apresentaram diferenças significativas quando comparadas aos controles. Os valores da espessura macular total foram significativamente menores nos doentes nos segmentos temporal e inferior internos (p=0,03 em ambos). Os valores das medidas da espessura macular global (6x6mm) foram significativamente menores nos doentes quando comparados aos controles, para as camadas CFNRm e CGR++, com P iguais a 0,04 e 0,03, respectivamente. Os valores da CFNRm de nove setores foram menores nos doentes com significância nos setores superior interno(p=0,03) e inferior externo(p=0,01). Os parâmetros da CGR+ estavam significativamente reduzidos nos setores superior interno(p=0,02) e inferior interno(p=0,01) e nasal interno(p=0,03). Todos os valores de espessura da CGR++ estavam significativamente reduzidos (exceto setores externos superior, temporal e nasal). Os testes MEEM e MoCA apresentaram correlações significativas com diversas medidas da TCO tanto para a espessura macular total, quanto para a espessura macular interna, principalmente para as camadas CGR+ e CGR++, tanto para a divisão de seis quanto a de nove setores. CONCLUSÕES: Os resultados do presente estudo sugerem que o exame de TCO-FV pode ser um método útil na avaliação clínica de pacientes com CCL, e a redução da espessura das camadas internas da retina, em especial na região macular mais central pode promover importantes informações sobre o padrão de envolvimento ocular nesta doença e que esta tecnologia sugere ser um promissor biomarcador ocular em pacientes com CCL
Title in English
Correlation between cognitive impairment and neural retinal loss assessed by optical coherence tomography in patients with mild cognitive impairment
Keywords in English
Alzheimer Disease
Dementia
Macula
Mild cognitive impairment
Optic nerv
Retina
Tomography optical coherence
Abstract in English
PURPOSE: To evaluate the diagnostic ability of the peripapillary retinal nerve fiber layer (pRNFL), total macular thickness and the inner retinal layers thickness measurements by sweptsource optical coherence tomography (SS-OCT) to differentiate patients with mild cognitive impairment (MCI) from normal age-matched controls. To verify the correlation between pRNFL, total macular thickness and the inner retinal layers thicknesses measured by SS-OCT and the degree of cognitive impairment, evaluated by the Mini-Mental State Examination (MMSE), Montreal Cognitive Assesement (MoCA) and Pfeffer Daily Functional Life Activities Questionnaire in patients with MCI. METHODS: Forty-six eyes from 23 MCI patients and 48 eyes from 24 controls were included. High resolution images of the optic disc and macula were obtained by SS-TCO. The thickness measurements of the following structures were analyzed: peripapillary retinal nerve fiber layer (pRNFL), total retina, macular RNFL (mRNFL), retinal ganglion cell layer (GCL) plus inner plexiform layer (IPL), named as GCL+, mRNFL plus GCL+, named as GLC++. For the inner retinal layers (mRNFL, GCL+ and GCL++), 3 patterns of analysis were employed: global macula (6x6mm), 9 sectors of ETDR map and 6 sectors, both with 6mm of diameter. The SS-TCO parameters of MCI patients and controls were compared using Generalized Estimating Equations (GEE). To evaluate the correlation between the SSOCT parameters and cognitive impairment estimated by the MMSE, MoCA, Pffefer, the Pearson correlation was performed. RESULTS: The pRNFL thickness values in MCI patients did not reach significant differences when compared to the controls. The total macular thickness measurements were significantly thinner in the temporal and inferior inner sectors (P = 0.03 for both). The global macular (6x6mm) thickness measurements were significantly lower in patients compared to controls, for the mRNFL and GCL++ layers, with P values of 0.04 and 0.03, respectively. The mRNFL measurements, divided in 9 sectors (excluding the fovea) were significant lower in the superior inner (p = 0.03) and inferior outer (p = 0.01) sectors. The GCL+ parameters were significantly lower in the superior inner (p = 0.02) and inferior inner (p = 0.01) and nasal inner (p = 0.03) sectors. All GCL++ thickness measurements were significantly thinner (except for superior, temporal and nasal outer sectors). The MMSE and MoCA tests showed significant correlations with several OCT measurements for both total macular and inner retinal layers thickness, especially for the GCL+ and GCL++ layers, for both 6 and 9 sectors. CONCLUSIONS: The results of the present study suggest that SS-OCT exam may be a useful method in the clinical evaluation of patients with MCI, and the inner retinal layers impairment, especially around the central macular area, may provide important information about the ocular involvement pattern in this disease and that this technology suggests to be a promising ocular biomarker in patients with MCI.
 
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Publishing Date
2021-09-10
 
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