The People's Perspective on Medicine

Can You See Alzheimer Disease with Retina Scan?

A type of retina scan known as optical coherence tomography angiography, or OCTA, can detect changes indicative of Alzheimer Disease before symptoms appear.
Ophthalmic image detailing the retina and optic nerve inside a healthy human eye

New technology allows for non-invasive imaging of the retina. Now, such a retina scan may allow eye doctors to diagnose Alzheimer disease.

Why Would a Retina Scan Be Helpful?

The retina is richly supplied with blood through a dense network of fine blood vessels. In Alzheimer disease, however, this network thins and becomes more sparse. Possibly this reflects what is happening elsewhere in the brain as well.

What Type of Retina Scan Is Useful?

The imaging is optical coherence tomography angiography (OCTA). Researchers at the Duke Eye Center compared the retinas of 39 people with Alzheimer disease to the retinas of 37 people with mild cognitive impairment and 133 people with healthy cognitive function (Yoon et al, Ophthalmology Retina, online March 11, 2019).

People with Alzheimer Disease had fewer fine blood vessels and one layer of the retina was thinner. These changes did not show up in people with mild cognitive impairment.

Previous Research on Detecting Alzheimer Disease with a Retina Scan:

This is the second time we’ve heard about the possibility that OCTA may offer early diagnosis for Alzheimer Disease. In addition to the Duke team, scientists at the Goldschleger Eye Institute at Sheba Medical Center in Israel reported markers of the disease that can be seen in a retina scan (AAO 2018, Chicago, IL Oct. 28, 2018). The back of the eye starts to show changes even before people notice serious memory loss.

Ophthalmologists already use OCTA to detect diabetic retinopathy, uveitis, age-related macular degeneration and normal-pressure glaucoma.  Impressively, this test is able to distinguish between people with mild cognitive impairment and those who progress to Alzheimer Disease. The Israeli scientists and those at the Duke Eye Center saw the same changes. In conclusion, you could act on an early diagnosis using a retina scan. This would permit earlier intervention to slow or prevent cognitive decline.

Can You Slow Cognitive Decline?

We have heard from many people who say they would not want an early diagnosis of Alzheimer disease because they don’t know of any way to reverse the condition.

For example, James in Colorado wrote:

“There is no cure for Alzheimer’s, not even a hint of a treatment. An early, accurate test sounds like a suicide machine to me.”

Linda sounded a word (or two) of caution:

“I’m all for early diagnosis if the test is conclusive and proven, and there is a treatment protocol. If not, what’s the point of scaring people when there is nothing to be done about it? We’ve seen the dangers of premature advice on nutrition: the food pyramid that encouraged a high simple carb diet; testing that is so invasive it’s worse than a cure; false positives, etc.

“Now we are in a new health care era in which profit has become the motive, and our medical system is in the hands of insurance companies, some heavily invested in diagnostic testing devices and pharmaceuticals. Look at the profits of colonoscopies, for one thing. They are so profitable that whole buildings are being devoted to them. We have a non-invasive test–Cologuard–available but colonoscopy is still considered the “Gold Standard” even though every part of it has damage potential: the cleanse, the invasive procedure, the anesthetic, and the flexible instrument used.

“A retina scan may prove to be a wonderful diagnostic tool but what happens with the information? And what happens to the patient who is diagnosed with Alzheimer’s that may be years in the future? Or maybe not at all, depending on the conclusiveness of the test after years of being used and, maybe, destroying lots of lives. Who can enjoy life with a diagnosis like that hanging over their head, especially with no clear guidelines to avoid it?

“Technology is a wonderful tool, and it would be so welcome if only we had a health care system in the hands of medical professionals in which good health, rather than profit, was the motive.”

Diane responded:

“Early diagnosis makes sense to me. You could plan for intervention therapy. You could also state how you’d wish to be treated at a particular stage of Alzheimer’s should it develop.”

Will, a physician, sounded a very hopeful note from New Mexico:

“I see a lot of comments about the lack of treatment for Alzheimer’s. I have been treating patients for the last two years with Dr Dale Bredesen’s methods [see The End of Alzheimer’s]. It’s true that people deep in Alzheimer’s have very little chance of reversal, but we have seen some in early Alzheimer’s and nearly all in Mild Cognitive Decline reverse their condition. MRIs have even documented increases in hippocampal volume. It is real.”

In the meantime, watch out for drugs that could lead to confusion and memory loss. Also, do what you can to avoid insulin resistance, as that appears to increase the risk for Alzheimer disease as well.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I can see the advantages of knowing ahead of time if you have the tendency to Alzheimer’s. I would want to know so ‘arrangements’ can be made. I shall discuss this with my eye doctor later this year.

I totally agree with the “thoughts or two” made by Linda in the article – very well said!

Bredesen’s book and research gives people some hope, but unfortunately, you’d have to be wealthy to travel to a place where you could get all the testing necessary, and to afford the treatment. That’s the sad part for anyone worried about getting Alzheimers.

I was glad to see the comment referencing use of Dr Dale Bredesen’s methods. It is challenging to address the multi-component protocol. But with support to develop a concrete plan, and adaptations to the the patient’s needs, increased ease of compliance improves quality of life. As a bonus, overall health (reduction in systemic inflammation) and wellness are improved through some parts of the protocol, such as nutrition and stress-reduction activities.

I have a genetic marker for late onset Alzheimers. This doesn’t mean I’ll for sure get it, but I’m glad to know to watch out for changes. An eye test that told me those changes were beginning would be welcome, so that I could plan how to best enjoy the coming years while planning for the care that I would eventually need. Also I would have a chance, while still “of sound mind”, to put in writing my wishes for medical care and treatment as my Alzheimers progressed, as well as making sure my children were prepared to take over my financial life when I no longer could.

Terry, your article states, “People with Alzheimer Disease had fewer fine blood vessels and one layer of the retina was thinner.” Please, which layer of the retina was thinner?

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