Cognitive impairment and dementia are major medical, social, and economic public health
issues worldwide with significant implications for life quality in older adults. The
leading causes are Alzheimer’s disease (AD) and vascular cognitive impairment/dementia
(VCID). In both conditions, pathological alterations of the cerebral microcirculation
play a critical pathogenic role. Currently, the main pathological biomarkers of AD—β-amyloid
peptide and hyperphosphorylated tau proteins—are detected either through cerebrospinal
fluid (CSF) or PET examination. Nevertheless, given that they are invasive and expensive
procedures, their availability is limited. Being part of the central nervous system,
the retina offers a unique and easy method to study both neurodegenerative disorders
and cerebral small vessel diseases in vivo. Over the past few decades, a number of
novel approaches in retinal imaging have been developed that may allow physicians
and researchers to gain insights into the genesis and progression of cerebromicrovascular
pathologies. Optical coherence tomography (OCT), OCT angiography, fundus photography,
and dynamic vessel analyzer (DVA) are new imaging methods providing quantitative assessment
of retinal structural and vascular indicators—such as thickness of the inner retinal
layers, retinal vessel density, foveal avascular zone area, tortuosity and fractal
dimension of retinal vessels, and microvascular dysfunction—for cognitive impairment
and dementia. Should further studies need to be conducted, these retinal alterations
may prove to be useful biomarkers for screening and monitoring dementia progression
in clinical routine. In this review, we seek to highlight recent findings and current
knowledge regarding the application of retinal biomarkers in dementia assessment.
