Nailfold Capillary Morphology in Alzheimer’s Disease Dementia

Article type: Research Article

Authors: Cousins, Clara C.^{a; b} | Alosco, Michael L.^{a; f} | Cousins, Henry C.^c | Chua, Alicia^{a; d} | Steinberg, Eric G.^a | Chapman, Kimberly R.^a | Bing-Canar, Hanaan^a | Tripodis, Yorghos^{a; d} | Knepper, Paul A.^e | Stern, Robert A.^{a; f; g; 1; *} | Pasquale, Louis R.^{b; h; 1}

Affiliations: [a] Boston University Alzheimer’s Disease Center, Boston University School of Medicine, Boston, MA, USA | [b] Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA | [c] Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, USA | [d] Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA | [e] Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA | [f] Department of Neurology, Boston University School of Medicine, Boston, MA, USA | [g] Department of Neurosurgery and Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA | [h] Department of Medicine, Channing Division of Network Medicine, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA

Correspondence: [*] Correspondence to: Robert A. Stern, Boston University Alzheimer’s Disease Center, 72 East Concord Street, Suite B7800, Boston, MA 02118, USA. Tel.: +1 617 358 5375; E-mail: bobstern@bu.edu.

Note: [1] These authors contributed equally to this work.

Abstract: Background:Cerebrovascular disease (CVD) is highly comorbid with Alzheimer’s disease (AD), yet its role is not entirely understood. Nailfold video capillaroscopy (NVC) is a noninvasive method of live imaging the capillaries near the fingernail’s cuticle and may help to describe further vascular contributions to AD. Objective:To examine finger nailfold capillary morphology using NVC in subjects with AD dementia, mild cognitive impairment (MCI), and normal cognition (NC). Methods:We evaluated nailfold capillary hemorrhages, avascular zones ≥100 microns, and degree of tortuosity in 28 NC, 15 MCI, and 18 AD dementia subjects using NVC. Tortuosity was measured with a semi-quantitative rating scale. To assess the relation between nailfold capillary morphological features and diagnostic grouping, univariate and multivariable logistic regression models were fit to the data. Results:56% of subjects with AD dementia compared to 14% with NC and 13% with MCI displayed moderate to severe tortuosity. Greater severity of tortuosity was associated with 10.6-fold (95% confidence interval [CI]: 2.4, 46.2; p = 0.0018) and 7.4-fold (95% CI: 1.3, 41.3; p = 0.023) increased odds of AD dementia relative to NC and MCI, respectively, after adjusting for multiple covariates. Conclusion:Greater nailfold capillary tortuosity was found in participants with AD dementia compared to those with MCI or NC. These data provide preliminary evidence of a systemic microvasculopathy in AD that may be noninvasively and inexpensively evaluated through NVC.

Keywords: Alzheimer’s disease, biomarkers, cerebral blood flow, cerebrovascular disease, dementia, mild cognitive impairment, nailfold capillaroscopy, tortuosity

DOI: 10.3233/JAD-180658

Journal: Journal of Alzheimer's Disease, vol. 66, no. 2, pp. 601-611, 2018