{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T05:12:51Z","timestamp":1788671571885,"version":"build-2803163510"},"reference-count":38,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82471955"],"award-info":[{"award-number":["82471955"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp; Dementia"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>\n                      Vascular and glymphatic dysfunction are increasingly implicated in Alzheimer's disease (AD), particularly among apolipoprotein E (\n                      <jats:italic>APOE<\/jats:italic>\n                      )\n                      <jats:italic>\u03b5<\/jats:italic>\n                      4 carriers. We investigated relationships among retinal microvasculature, glymphatic markers, and AD pathology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Seventy\u2010six AD participants underwent retinal imaging, magnetic resonance imaging, and plasma biomarker assessment. Retinal fractal dimension (FD) and tortuosity (T), diffusion tensor imaging along the perivascular space (DTI\u2010ALPS), periventricular diffusivity (PVeD), and small vessel disease (SVD) markers were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      <jats:italic>APOE \u03b5<\/jats:italic>\n                      4 carriers showed reduced FD, increased T, and lower PVeD. Sparser microvasculature was associated with impaired glymphatic markers, greater vascular burden, abnormal plasma biomarkers, and worse cognition. Mediation analyses indicated that retinal FD and PVeD partially mediated the relationship between\n                      <jats:italic>APOE \u03b5<\/jats:italic>\n                      4 and cognitive performance.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Retinal microvascular alterations reflect vascular\u2013glymphatic dysfunction and may serve as non\u2010invasive biomarkers linking genetic risk to cognitive decline in AD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71785","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T08:54:51Z","timestamp":1787648091000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Retinal microvascular alterations and glymphatic dysfunction mediate the association between\n                    <i>APOE \u03b5<\/i>\n                    4 and cognitive decline in Alzheimer's disease"],"prefix":"10.1002","volume":"22","author":[{"given":"William Robert","family":"Kwapong","sequence":"first","affiliation":[{"name":"Neurology Department, Xuanwu Hospital Capital Medical University  Beijing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caiyun","family":"Wen","sequence":"additional","affiliation":[{"name":"Radiology Department The First Affiliated Hospital of Wenzhou Medical University  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youjie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, West China Hospital Sichuan University  Chengdu China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suqing","family":"Hu","sequence":"additional","affiliation":[{"name":"Geriatrics Department The First Affiliated Hospital of Wenzhou Medical University  Wenzhou 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Sciences, Faculty of Medicine The Chinese University of Hong Kong  Hong Kong Hong Kong SAR China"},{"name":"Gerald Choa Neuroscience Institute The Chinese University of Hong Kong  Hong Kong Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meihao","family":"Wang","sequence":"additional","affiliation":[{"name":"Radiology Department The Second Affiliated Hospital of Wenzhou Medical University  Wenzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Geriatrics Department The First Affiliated Hospital of Wenzhou Medical University  Wenzhou 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