{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:28:22Z","timestamp":1787149702149,"version":"build-2736575974"},"reference-count":30,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,8,2]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>Alzheimer\u2019s disease is a neurodegenerative disorder with a prolonged preclinical phase during which pathological changes begin 15\u201320 years before clinical presentation. We present longitudinal optical coherence tomography angiography (OCTA) images from a cognitively normal female with APOE \u03b54\/\u03b54. Over a 4-year period, she demonstrated an accelerated rate of retinal microvasculature loss compared with that expected due to normal ageing, despite no significant changes in medical history and no development of cognitive symptoms. Four years after initial presentation, brain amyloid was detected on positron emission tomography while she remained cognitively normal. This accelerated retinal microvasculature loss may mirror the pathogenesis of cerebral amyloid angiopathy and may represent a hypothesis-generating observation supporting further study of OCTA-derived retinal microvascular metrics in genetically predisposed individuals.<\/jats:p>","DOI":"10.1136\/bcr-2026-274211","type":"journal-article","created":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:00:20Z","timestamp":1787148020000},"page":"e274211","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Four-year evolution of the retinal microvasculature in an APOE \u03b54\/\u03b54 cognitively normal individual"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7151-0492","authenticated-orcid":false,"given":"Hemal","family":"Patel","sequence":"first","affiliation":[{"name":"iMIND Study Group, Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2369-025X","authenticated-orcid":false,"given":"Elyse","family":"Corpuz","sequence":"additional","affiliation":[{"name":"iMIND Study Group, Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy J","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Whitson","sequence":"additional","affiliation":[{"name":"Department of Neurology, Duke University School of Medicine, Durham, North Carolina, USA"},{"name":"Duke University Aging Center, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dilraj","family":"Grewal","sequence":"additional","affiliation":[{"name":"iMIND Study Group, Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Fekrat","sequence":"additional","affiliation":[{"name":"iMIND Study Group, Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,19]]},"reference":[{"key":"2026081907001346000_19.8.e274211.1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2012.263"},{"key":"2026081907001346000_19.8.e274211.2","unstructured":"National Institute on Aging . Alzheimer\u2019s disease fact sheet. 2023. Available: https:\/\/www.nia.nih.gov\/health\/alzheimers-disease-fact-sheet"},{"key":"2026081907001346000_19.8.e274211.3","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.oret.2019.02.002","article-title":"Retinal Microvascular and Neurodegenerative Changes in Alzheimer\u2019s Disease and Mild Cognitive Impairment Compared with Control Participants","volume":"3","author":"Yoon","year":"2019","journal-title":"Ophthalmol Retina"},{"key":"2026081907001346000_19.8.e274211.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.oret.2022.03.001"},{"key":"2026081907001346000_19.8.e274211.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jalz.2011.03.003"},{"key":"2026081907001346000_19.8.e274211.6","doi-asserted-by":"publisher","DOI":"10.1126\/science.8346443"},{"key":"2026081907001346000_19.8.e274211.7","doi-asserted-by":"publisher","DOI":"10.2967\/jnumed.121.263195"},{"key":"2026081907001346000_19.8.e274211.8","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aws243"},{"key":"2026081907001346000_19.8.e274211.9","doi-asserted-by":"crossref","first-page":"336","DOI":"10.3928\/23258160-20210528-06","article-title":"Assessing the Retinal Microvasculature in Individuals With Early and Late-Onset Alzheimer\u2019s Disease","volume":"52","author":"Robbins","year":"2021","journal-title":"Ophthalmic Surg Lasers Imaging Retina"},{"key":"2026081907001346000_19.8.e274211.10","unstructured":"Mayo Clinic Laboratories . Beta-amyloid 42\/40 ratio, plasma. 2024. Available: https:\/\/www.mayocliniclabs.com\/test-catalog\/overview\/615903"},{"key":"2026081907001346000_19.8.e274211.11","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aww015"},{"key":"2026081907001346000_19.8.e274211.12","doi-asserted-by":"crossref","first-page":"706","DOI":"10.3928\/23258160-20201202-05","article-title":"Association of OCT Angiography Parameters With Age in Cognitively Healthy Older Adults","volume":"51","author":"Polascik","year":"2020","journal-title":"Ophthalmic Surg Lasers Imaging Retina"},{"key":"2026081907001346000_19.8.e274211.13","first-page":"2534","article-title":"Longitudinal Retinal Findings in Individuals with Mild Cognitive Impairment over a Two Year Period","volume":"64","author":"Hemesath","year":"2023","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026081907001346000_19.8.e274211.14","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2990.2010.01139.x"},{"key":"2026081907001346000_19.8.e274211.15","doi-asserted-by":"crossref","first-page":"840386","DOI":"10.3389\/fnagi.2022.840386","article-title":"Prediction Models for Conversion From Mild Cognitive Impairment to Alzheimer\u2019s Disease: A Systematic Review and Meta-Analysis","volume":"14","author":"Chen","year":"2022","journal-title":"Front Aging Neurosci"},{"key":"2026081907001346000_19.8.e274211.16","doi-asserted-by":"crossref","first-page":"117383","DOI":"10.1016\/j.jns.2021.117383","article-title":"The relationship between cerebral and retinal microbleeds in cerebral amyloid angiopathy (CAA): A pilot study","volume":"423","author":"Alber","year":"2021","journal-title":"J Neurol Sci"},{"key":"2026081907001346000_19.8.e274211.17","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1038\/eye.2015.100","article-title":"Dementia of the eye: the role of amyloid beta in retinal degeneration","volume":"29","author":"Ratnayaka","year":"2015","journal-title":"Eye (Lond)"},{"key":"2026081907001346000_19.8.e274211.18","doi-asserted-by":"crossref","first-page":"2360","DOI":"10.3390\/ijms22052360","article-title":"Role of Retinal Amyloid-\u03b2 in Neurodegenerative Diseases: Overlapping Mechanisms and Emerging Clinical Applications","volume":"22","author":"Wang","year":"2021","journal-title":"IJMS"},{"key":"2026081907001346000_19.8.e274211.19","doi-asserted-by":"crossref","first-page":"494","DOI":"10.4103\/ijo.IJO_521_19","article-title":"Age-related changes in macular vessels and their perfusion densities on optical coherence tomography angiography","volume":"68","author":"Pujari","year":"2020","journal-title":"Indian J Ophthalmol"},{"key":"2026081907001346000_19.8.e274211.20","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.19-26848"},{"key":"2026081907001346000_19.8.e274211.21","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(09)70082-8"},{"key":"2026081907001346000_19.8.e274211.22","doi-asserted-by":"crossref","first-page":"3797","DOI":"10.2147\/OPTH.S219268","article-title":"Radiation Retinopathy: Detection and Management Strategies","volume":"15","author":"Sahoo","year":"2021","journal-title":"Clin Ophthalmol"},{"key":"2026081907001346000_19.8.e274211.23","doi-asserted-by":"crossref","first-page":"102796","DOI":"10.1016\/j.autrev.2021.102796","article-title":"Ocular microvascular damage in autoimmune rheumatic diseases: The pathophysiological role of the immune system","volume":"20","author":"Hysa","year":"2021","journal-title":"Autoimmun Rev"},{"key":"2026081907001346000_19.8.e274211.24","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0021-5155(97)00102-0","article-title":"Geographic choroiditis and retinal vasculitis in rheumatoid arthritis","volume":"42","author":"Matsuo","year":"1998","journal-title":"Jpn J Ophthalmol"},{"key":"2026081907001346000_19.8.e274211.25","first-page":"121","article-title":"Retinal vasculitis in rheumatoid arthritis: an angiographic study","volume":"8","author":"Giordano","year":"1990","journal-title":"Clin Exp Rheumatol"},{"key":"2026081907001346000_19.8.e274211.26","doi-asserted-by":"crossref","first-page":"202","DOI":"10.4103\/0974-9233.58423","article-title":"Differential diagnosis of retinal vasculitis","volume":"16","author":"Abu El-Asrar","year":"2009","journal-title":"Middle East Afr J Ophthalmol"},{"key":"2026081907001346000_19.8.e274211.27","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1007\/s40123-024-00985-0","article-title":"OCTA: Essential or Gimmick?","volume":"13","author":"Gandhi","year":"2024","journal-title":"Ophthalmol Ther"},{"key":"2026081907001346000_19.8.e274211.28","doi-asserted-by":"crossref","first-page":"3000605231187933","DOI":"10.1177\/03000605231187933","article-title":"Optical coherence tomography angiography: a review of the current literature","volume":"51","author":"Javed","year":"2023","journal-title":"J Int Med Res"},{"key":"2026081907001346000_19.8.e274211.29","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70299-6"},{"key":"2026081907001346000_19.8.e274211.30","article-title":"The Eye as a Diagnostic Tool for Alzheimer\u2019s Disease","volume":"13","author":"Hussain","year":"2023","journal-title":"Life (Basel)"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2026-274211","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T14:00:22Z","timestamp":1787148022000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2026-274211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,19]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/bcr-2026-274211"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2026-274211","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]}}}