Retinal microvascular alterations in motoric cognitive risk syndrome: an OCT angiography study

Motoric Cognitive Risk Syndrome (MCRS), characterized by subjective cognitive complaints and slow gait, is an early indicator of cognitive decline and dementia.This study aimed to explore retinal vascular changes in individuals with MCRS and assess the potential of Optical Coherence Tomography Angiography (OCTA) as an early diagnostic tool.

A total of 61 participants aged 65 years or older (31 with MCRS and 30 controls) were enrolled between January 2024 and May 2025 in this prospective observational study. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and gait speed was measured. MCRS diagnosis was confirmed by an expert geriatrician based on established criteria. Retinal vasculature, including the foveal avascular zone (FAZ), deep capillary plexus (DCP), and choriocapillary plexus (CCP), was analyzed using OCTA (Topcon Triton, Scan size 6 × 6 mm). In cases where both eyes of a participant had been imaged, the eye that exhibited the higher signal strength and a lower number of artefacts was designated as the analytic eye. Multivariate logistic regression was used to examine the association between retinal changes and MCRS, adjusting for age, sex, education, Deyo-Charlson Comorbidity Index.

A total of 61 participants were included (31 MCRS, 30 controls). The MCRS group showed a significantly larger FAZ area compared with controls (0.26 ± 0.03 vs 0.23 ± 0.02 mm², p = 0.01). Foveal vessel density was higher in the DCP (17.9 ± 4.8 vs 15.1 ± 4.5, adjusted p = 0.048), while CCP values were lower but not significant after correction (48.9 ± 6.0 vs 51.8 ± 4.7, adjusted p = 0.07). No significant differences were observed in SCP parameters. Multivariable logistic regression confirmed that FAZ enlargement was independently associated with MCRS (OR = 1.12 per 0.01 mm² increase, 95% CI: 1.02-1.25; p = 0.02).

Our findings suggest that retinal vascular changes, particularly FAZ enlargement, may serve as early biomarkers for MCRS. OCTA presents a promising, non-invasive method for detecting these alterations, emphasizing its potential in early diagnosis and monitoring of cognitive decline progression. Further research is needed to elucidate the clinical significance of retinal changes in MCRS.