Die alternde Retina im Kontext zerebraler neurodegenerativer Erkrankungen

Zusammenfassung

Hintergrund Neurodegenerative (ND) Erkrankungen bilden eine heterogene Gruppe von Affektionen des Nervensystems mit unterschiedlicher Ätiologie, Lokalisation und Verlauf. Am bekanntesten sind aus klinischer und sozioökonomischer Sicht die zerebralen Erkrankungen von Alzheimer (AD) und weiteren Demenzen, weil ihre Prävalenz in der alternden Bevölkerung erheblich hoch ist und weil die ND nicht kausal therapierbar sind. In dieser Übersicht sollen die ND-Erkrankungen aus der ophthalmologischen Sicht und im Bezug zu analogen Erkrankungen der Netzhaut erläutert werden.

Material und Methoden Bezüglich der epidemiologischen Lage wurde die neurologische Bibliografie zu den ND berücksichtigt. Hinzu kommen ophthalmologische Daten zu retinaassoziierten ND insbesondere im Alter. Letztlich wird die eigene Datenlage bez. gemeinsamer zellulärer und molekularer Biomarker für sowohl retinales als auch zerebrales Altern herangezogen.

Ergebnisse Die Alzheimererkrankung ist aus neurologischer Sicht die häufigste ND-Erkrankung mit steigender Prävalenz. Die altersbedingte Makuladegeneration (AMD) und das Glaukom sind die häufigsten retinalen ND mit ebenfalls steigender Prävalenz. Sowohl im Gehirn als auch in der Retina gehen Neuronen irreversibel zugrunde und es treten gliale, mikrogliale, extrazelluläre und vaskuläre Reaktionen hinzu, die entweder als Atrophien mit Plaquebildungen (AD) oder als Drusen mit späterer ödematöser Transformation mit Makulaneoangiogenese (AMD) oder als Optikusdegeneration (OD) imponieren. Auf zellulärer Ebene ist die strukturelle und funktionelle Irreversibilität allen gemeinsam, wobei die Therapie sich palliativ zur Erhaltung vorhandener Restfunktion gestaltet. Gezielte präventive Behandlungen sind noch nicht hinreichend identifiziert worden. Es sind auf molekularer Ebene gemeinsame Marker analysiert worden, um das Verständnis dieser Degenerationen zu vertiefen und gezieltere Behandlungsmöglichkeiten aufzuzeigen.

Schlussfolgerung Im Vergleich entspricht die zerebrale AD eher der retinalen AMD, die zerebrale allgemeine Demenz der allgemeinen Sehvermögenseinschränkung im Alter und die Optikusdegeneration der retrookulären kompressionsbedingten zerebralen Atrophie. Gemeinsame Aspekte sind vorhanden und werden diskutiert.

Abstract

Background Neurodegenerative diseases (ND) consist of divers affections of the central nervous system related to etiology, localization, and of course of the disease. Alzheimerʼs disease (AD) and related dementias are best investigated together with socioeconomic conditions and play an important role in its high prevalence. This work will present ND diseases in the context of analogous retinal degeneration mechanisms and ophthalmological diseases.

Methods Based on epidemiological data, the current neurological bibliography of ND has been considered. Additional ophthalmological data containing age-related retinal diseases were included in a comparative manner. Moreover, our own data dealing with similarities of cellular and molecular biomarkers in the retinal and cerebral aging process were included.

Results AD is the most important neurological ND disease with increasing prevalence. Age-related macular degeneration (AMD) and glaucoma are the most common retinal diseases with ND background and have an increasing prevalence. Irreversible loss of neurons, together with glial, microglial, extracellular, and vascular reactions are found both in the brain and retina and can show atrophic signs with onsets of plaques (AD), drusen (AMD) or optic degenerations. Alterations of cellular conditions result in irreversible functional impairments. Current therapeutic options preserve only residual function and preventive possibilities are actually missing. Molecular biomarkers have been identified to endorse a better understanding of ND and to provide new therapeutic options.

Conclusions Comparison of cerebral AD shows similarities with retinal AMD, and cerebral dementias are comparable with the physiological age-related impairment of visual acuity. Optic degeneration may be similar to cerebral atrophy associated with retroocular compression. Improved understanding of pathogenetic mechanisms of cerebral and retinal diseases may help to establish preventive and therapeutic concepts in the future.

Schlüsselwörter

Retina - Altern - AMD - Morbus Alzheimer - Glaukom

Key words

retina - aging - AMD - Alzheimerʼs disease - glaucoma

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