Conventional eye imaging may provide indications of mental health problems in the elderly with type 1 diabetes

As they age, people with diabetes are more likely to develop Alzheimer’s disease and other mental disorders than people without diabetes. Scientists at the Joslin Diabetes Center have now shown that routine eye images can identify changes in the retina that may be associated with mental disorders in the elderly with type 1 diabetes. .

These results could open up a very easy way to detect mental decline in this population early on, providing better ways to understand, diagnose and ultimately treat the decline. , George L. King, MD, Joslin ‘s Chief Scientific Officer and senior author of a study paper, said in the Journal of Clinical Endocrinology & Metabolism.

Previous research had shown an association between chronic diabetic retinopathy (PDR, a diabetic complication that can severely damage vision) and brain impairment in people with type 1 diabetes. knowing that there were cell changes in the retina that could reflect changes in the brain, we were interested to see if imaging techniques that show these changes in the retina could be due to changes in mental functions , “said Ward Fickweiler, MD, a Joslin graduate and first author of the paper.

The scientists were drawing on eye scans routinely collected from patients as part of routine vision care at Joslin’s Beetham Eye Institute. One set of scans was based on optical coherence tomography (OCT, a technique that uses light to provide cross-sections of the retina). A second set of scans used OCT angiography (OCTA, an extension of OCT technology that examines blood vessels in the retina). Both types of scans are non-invasive and widely available in eye clinics in the United States, and can be performed within minutes.

The study enrolled 129 participants in the Joslin Medal Study, which examines outcomes among people who have had type 1 diabetes for 50 years or more. These volunteers underwent a series of cognitive tests that included activities examining memory function as well as psychomotor speed (assessing the time it took to manually set things up).

Interestingly, the researchers found strong links between performance on memory functions and structural changes in deep blood vessel networks in the retina. “Memory is the main mental function that is affected in Alzheimer’s disease and mental retardation, so that was inspiring,” Fickweiler said.

Joslin’s team also found strong links between PDR and psychomotor speed. This result confirmed earlier results identified among a smaller group of Joslin Winners, and provided details of associated changes in retinal structure. In addition, the researchers found that PDR was associated with memory performance among the largest group of coins.

While these findings need to be confirmed in larger clinical studies, the routine eye tests appear to detect the cognitive changes that occur in people with diabetes, he said. Fickweiler.

Currently, other ways to detect conditions such as Alzheimer’s disease such as MRI scans are difficult and expensive. People are usually diagnosed only when they show signs of mental decline and treatments at that level usually do not offer much help.

“If you can detect the condition at an earlier stage, when they are still asymptomatic, that could be beneficial for patients,” Fickweiler said. Earlier detection could also help with the question of developing better treatments for neurocognitive diseases.

Joslin’s team plans to launch a larger prospective study to test the ability of eye images to pick up signs of mental decline over time. This research will include people with type 1 diabetes who are younger and have not got the disease as far as the Bases. The scientists will also analyze MRI brain images and postmortem brain samples provided by medalists.

In addition, the researchers look for common mechanisms that can damage brain and retinal bones, which share many of their early initial developmental pathways. Suspects in people with diabetes include blood vessels with complications and high or low blood glucose levels. The autoimmunity that drives type 1 diabetes could also cause other forms of harm, King said.

In particular, Joslin Winners often exhibit relatively low levels of complications that can affect those with long-term type 1 diabetes. For example, almost half of winners do not develop advanced eye disease, and only one of the 129 Winners in the eye scan study may have Alzheimer’s disease. “It is possible that, in the Winners, a shared mechanism alters the progression of the early stages of retinal and cerebral neurodegeneration, and provides protection against both PDR and Alzheimer’s disease,” Fickweiler said.

In addition to follow-up work in type 1 diabetes, King and his team plan to conduct a similar study for people with type 2 diabetes. PDR is also associated with mental retardation in this much larger group of patients, who also receive OCT and OCTA eye scans as part of their regular vision care.