Reading cognition from the eyes: Association of retinal nerve fiber layer thickness with cognitive performance in a population-based study

With the eye as a window to the brain, non-invasive fast screening of retinal nerve fibre layer thickness poses the opportunity for early detection of cognitive decline leading to dementia. Our objective is to determine whether performance in various neurocognitive tests has an association with itemized retinal nerve fibre layer thickness. Detailed investigation of associations factored in sex and eye-side. The large population-based LIFE-Adult study (Leipzig Research Centre for Civilization Diseases) was conducted at Leipzig University, Germany from 2011 to 2014. Randomly selected participants (N = 10 000) were drawn from population registry in an age- and gender-stratified manner, focusing on 40-80 years. Cognitive function was examined with the CERAD-NP Plus test-battery (Consortium to Establish a Registry for Alzheimer's Disease), Stroop-Test, Reading the Mind in the Eyes-Test and Multiple-Choice Vocabulary Intelligence Test. Circumpapillary retinal nerve fibre layer thickness was measured with Optical Coherence Tomography. Subjects with reliable measurements (≥50 B-scan repetitions, signal-to-noise-ratio ≥20 dB, ≤5% missing A-scans) and without clinical eye pathology (sample A) and additional exclusion due to conditions of the central nervous system (sample B) were evaluated. The relationship between cognitive function and retinal nerve fibre layer thickness was investigated for six segments: temporal, temporal-superior, temporal-inferior, nasal, nasal-superior and nasal-inferior. For comparison with other studies, global mean is given. Brain-side projection analysis links results to the corresponding brain hemisphere. We analysed 11 124 eyes of 6471 subjects [55.5 years of age (19.1-79.8 years), 46.9% male]. Low cognitive performance was predominantly associated with thinner retinal nerve fibre layer thickness. Correlation analysis indicated emphasis on global and temporally located effects. Multivariable regression analysis with adjustments (age, sex and scan radius) presented individual results for each test, differentiating between sex and eye-side. For instance, verbal fluency tests and Trail Making Test-B show stronger association in females; Trail Making Test-A shows right-eye dominance. Findings in Trail-Making-Test-A projected to left brain hemisphere, and the ratio incongruent to neutral in the Stroop test projected to right brain-hemisphere. Separate assessment for sex and eye-side is presented for the first time in a population-based study. Location-specific sectorial retinal nerve fibre layer thickness was found to be an indicator for cognitive performance, giving an option for early detection of cognitive decline and the potential of early treatment. The eye as a window to the brain was studied with optical coherence tomography and connected to cognition. Girbardt et al. report that thinner retinal nerve fibre layer thickness was found to be a meaningful index for poorer cognitive performance which presents the potential for prediction of future cognitive decline

Corneal clearance and central endothelial cell repopulation despite graft detachment after Descemet membrane endothelial keratoplasty

Objective: Descemet membrane endothelial keratoplasty (DMEK) is the gold standard procedure for treatment of primary corneal endothelial disorders. Graft detachment is a frequent complication of DMEK, which often requires re-operation or re-bubbling. However, several cases of spontaneous corneal clearance despite graft detachment after DMEK have been reported. The underlying mechanisms of this phenomenon are poorly understood. We report three cases of corneal clearance after graft detachment in patients with Fuchs endothelial dystrophy and provide a review of the literature. Methods: An 81-year-old and a 69-year-old phakic patient as well as a 56-year-old pseudophakic patient with Fuchs endothelial dystrophy underwent Triple-DMEK and DMEK, respectively. All three patients presented postoperatively with blurred vision due to an almost complete detachment of the graft, as shown by slit-lamp photography and anterior segment optical coherence tomography (OCT). Results: Without additional intervention, gradual corneal clearance and presence of endothelial cells on the posterior recipient's stroma were observed in all patients three months postoperatively. Increase in endothelial cell density, decrease in central corneal thickness (CCT), recovery of corneal transparency, and improvement of visual acuity were documented in all patients.Conclusions: Our findings support the theory of corneal clearance after Descemet membrane endothelial transfer (DMET) ("free-floating" donor Descemet graft in the recipient anterior chamber after descemetorhexis). Further understanding on endothelial homeostasis might lead to innovative approaches in handling endothelial disorders

Das Längsschnittcurriculum Kommunikation der Medizinischen Fakultät der Universität Leipzig - Implementierung und erste Erfahrungen

Purpose: Communication skills are an essential instrument for building a sustainable patient-doctor-relationship for future doctors. They are learnable and teachable. The learning should be facilitated with the help of a longitudinal curriculum, which is planned at Leipzig University.Project: At the Medical Faculty of Leipzig University, the Longitudinal Communication Curriculum is established since 2016/17. Up to now, the curriculum consists of four parts in which students repeatedly practise their communication skills in curricular and extracurricular courses. Several formats help to teach an integrated learning of communication and physical examination skills. Assessment of communication skills is also performed. Curricular implementation is accompanied by concomitant evaluation.Results: Three parts of the curriculum already have taken place. Students report an increase in communication skills. Students rate the units as instructive and helpful. The assessment of communication skills occurs in two clinical practical examinations (OSCEs). Together with summative assessment a formative feedback was implemented. Students judge this practice as highly positive.Discussion: The curriculum is part of undergraduate medical education in Leipzig. It would be beneficial to add another simulated patient encounter, as well as interprofessional units. Student questionnaires will be evaluated and results will help to develop the curriculum.Conclusion: Consolidation of the curriculum accompanied by evaluation and adaption of content can help to assure the quality of the curriculum. Additional professions and study units shall be integrated in the Longitudinal Communication Curriculum in the future.Zielsetzung: Kommunikative Kompetenzen gelten für angehende Ärztinnen und Ärzte als wichtiges Instrument zum Aufbau einer tragfähigen Arzt-Patient-Beziehung und sind lehr- und lernbar. Die Vermittlung sollte möglichst über longitudinale Curricula erfolgen. Dies wird an der Universität Leipzig angestrebt. Projektbeschreibung: An der Medizinischen Fakultät der Universität Leipzig wird seit 2016/17 ein longitudinales Curriculum für kommunikative Kompetenzen implementiert. Das Curriculum ist aktuell in vier Abschnitte geteilt, in denen Studierenden in curricularen und extracurricularen Veranstaltungen unterschiedliche Gesprächsführungskompetenzen wiederholt vermittelt werden. Dies erfolgt über verschiedene Lehrformate, wobei besonderer Wert darauf gelegt wird, dass eine integrierte Vermittlung von kommunikativen und klinischen Fertigkeiten erfolgt. Auch die Prüfung verschiedener kommunikativer Kompetenzen soll implementiert werden. Die Implementierung des Curriculums wird von einer Evaluation begleitet.Ergebnisse: Drei Abschnitte des Curriculums wurden bereits implementiert. Studierende berichten einen Zuwachs an Gesprächsführungskompetenzen und erleben die einzelnen Elemente des Curriculums als lehr- und hilfreich. Kommunikative Kompetenzen werden in zwei klinisch-praktischen Prüfungen erhoben. Dabei konnte neben der summativen auch eine formative Prüfung via Feedback eingeführt werden. Dies wird durch die Studierenden positiv bewertet.Diskussion: Das Curriculum ist inzwischen Bestandteil des Leipziger Humanmedizinstudiums. Eine Ergänzung der bisher bestehenden Einheiten insbesondere um ein weiteres Gespräch mit Simulationspersonen sowie interprofessionelle Einheiten erscheint sinnvoll. Die Befragung der Studierenden soll ausgewertet und die Ergebnisse in die Entwicklung des Curriculums einbezogen werden.Schlussfolgerung: Eine Verstetigung des Curriculums einhergehend mit einer Evaluation und Anpassung der Inhalte kann zur Qualitätssicherung beitragen. Weitere Fächer und Studienabschnitte sollen zukünftig Bestandteil des longitudinalen Kommunikationscurriculums werden