Cerebral and Retinal Neurovascular Changes: A Biomarker for Alzheimer’s Disease

OBJECTIVES: Biomarker quest for Alzheimer’s disease (AD) has gone a long way by studying various anatomical, physiological and biochemical parameters for detecting disease onset and predicting prognosis. Almost all the studies converge on the single hypothesis of the amyloid and Tau pathway. Recently, vascular hypothesis has evolved drawing attention towards a complex dynamic anatomical and physiological entity, neuro-vascular (NV) unit. Pathological changes at this level, altering the normal physiology such as auto-regulation and dynamics of blood brain barrier have been hypothesized as a probable basis for AD. This paper attempts to review the existing data on the vascular hypothesis and the current trends in analyzing the NV unit in AD. DESIGN: This review initially focuses on the cerebral NV coupling followed by the retinal neurovascular coupling that mirrors the cerebral pathophysiology. The pathophysiology and the potential tools to diagnose AD at the level of NV unit are analyzed. Further, it examines the drawbacks in existing methods for analyzing the same. FINDINGS: None of the current studies have emphasized the importance of studying the complex dynamic NV unit as a whole. This review strongly recommends the combination of vascular and neuro-glial parameters using objective methods for estimating the physiological and pathological changes in the NV unit. DISCUSSION AND CONCLUSION: This review highlights the importance of retina for non-invasive estimation of the same. Also, novel algorithms for retinal image analysis have been proposed. The purpose of this review is to highlight the importance of retinal findings in neurodegenerative disorders and to create awareness among the neuroophthalmologists, of the potential benefits of ophthalmological tools in screening dementia patients.