Association between cognition and the retinal microvasculature in 11-year old children born preterm or at term

Abstract

BackgroundRetinal microvessels can be visualized non-invasively and mirror the status of the cerebral microvasculature.AimsTo investigate whether in young children born prematurely or at term cognitive performance is related to retinal microvascular traits.Study design, subjectsIn 93 prematurely born infants (birth weight < 1000 g) and 87 controls born at term, we measured head circumference (HC) and determined intelligence quotient (IQ) by combining matrix reasoning and spatial span (Wechsler Non-Verbal test, Dutch version) and post-processed retinal photographs using Singapore I Vessel Assessment software (version 3.6).Outcome measures, resultsCompared with controls, cases had smaller HC (51.7 vs 53.4 cm; p < 0.001), lower IQ (93.9 vs 109.2; p < 0.001), smaller retinal arteriolar (CRAE; 162.7 vs 174.0 μm; p < 0.001) and venular (CRVE; 234.9 vs 242.8 μm; p = 0.003) diameters and CRAE/CRVE ratio (0.69 vs 0.72; p = 0.001). A 1-SD decrease in CRAE was associated with smaller HC (−0.53 cm; p < 0.001) and lower total IQ (−3.74; p < 0.001), matrix reasoning (−1.77; p = 0.004) and spatial span (−2.03; p = 0.002). These associations persisted after adjustment for sex and age and risk factors for cognitive impairment, including blood pressure, body mass index and parental educational attainment.ConclusionsHC, total IQ, matrix reasoning and spatial span decrease with smaller retinal arteriolar diameter. Our findings suggest that maldevelopment of the cerebral microcirculation, as mirrored by the retinal microvasculature, has lasting effects on the growth of the brain and cognitive performance of prematurely born children.

Denser Retinal Microvascular Network Is Inversely Associated With Behavioral Outcomes and Sustained Attention in Children

“…Their childhood IQ measured 25 years before was inversely associated with venular diameter. Wei and colleagues report an association between cognitive performance and retinal arteriolar diameter in 11-year old children born preterm and at term (23). Van Aart et al showed an association between retinal vessel diameters and psychosocial stress in childhood but found no association with SDQ problem scores (43).…”

“…In addition, wider retinal venular diameters were also associated with psychosis symptoms in a longitudinal twin-study (22). A decrease in total IQ, matrix reasoning and spatial span was associated with smaller retinal arteriolar vessel diameters in 11-year old children (23). A recent study performed in children aged 4-5 years found retinal venular widening and a higher vessel tortuosity in association with a lower performance of short-term visual recognition memory (24).…”

Retinal Microvasculature in Relation to Central Hemodynamics in a Flemish Population

“…41 With adjustments applied, higher PWV was also associated with greater volume of white matter hyperintensity (β=0.108 mL; P =0.018) and lower memory scores (β=−0.095; P =0.028) in multivariable-adjusted model. 42 A meta-analysis of summary statistics extracted from 3 cross-sectional and 4 longitudinal studies and one study with mixed design addressed the association between intelligence quotient, a potential marker of the cerebral microcirculation, 44 and PWV in participants older than 30 years without comorbidities. 43 Cognitive impairment was associated with higher PWV.…”

<p>Altered Intrinsic Brain Activities in Patients with Diabetic Retinopathy Using Amplitude of Low-frequency Fluctuation: A Resting-state fMRI Study</p>

“… 11 , 12 In addition, retinal microvascular abnormalities constitute useful clinical biomarkers for cognitive decline. 13 Gupta et al demonstrated that strategies focusing on DR screening and prevention of DR progression may reduce the risk of cognitive impairment in patients with diabetes mellitus (DM). 14 Dai et al reported that patients with DR showed altered brain functional networks, with specific decline in cognition, visual function, and motor function.…”