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

Abstract

Changes in geometry of the retinal microvascular network, including vessel width, vessel density, and tortuosity, have been associated with neurological disorders in adults. We investigated metrics of the retinal microvasculature in association with behavior and cognition in 8- to 12-year-old children. Digital fundus images of 190 children (48.2% girls, mean age 9.9 years) were used to calculate retinal vessel diameters, fractal dimension, lacunarity, and tortuosity. Parents filled out a Strengths and Difficulties Questionnaire (SDQ) for behavioral screening. Cognitive performance testing included a computerized version of the Stroop test (selective attention), the Continuous Performance (sustained attention), the Digit-Symbol (visual scanning and information-processing speed) and the Pattern Comparison (visuospatial analytic ability) tests from the Neurobehavioral Evaluation System (NES3) battery. Retinal vessel geometry was significantly associated with the SDQ problem score, which increased with 1.1 points (95% CI: 0.3 to 1.9 points) per interquartile (IQR) increment in retinal fractal dimension, and decreased 1.4 points (95% CI: −2.4 to −0.4 points) or decreased 1.0 points (95% CI: −2.1 to 0.1 points) per IQR increment in retinal vascular lacunarity or tortuosity, respectively. Sensitivity analyses showed that results were driven by the hyperactivity/inattention and conduct problem scales of the SDQ. Correspondingly, mean reaction time on the Continuous Performance test increased by 11 ms (95% CI: 4.4 to 17.6 ms) with an IQR increase in fractal dimension. The results indicate that a denser retinal microvascular network, exemplified by a higher fractal dimension and lower lacunarity, are inversely associated with behavioral outcomes and sustained attention in children.

Look into my eyes: What can eye-based measures tell us about the relationship between physical activity and cognitive performance?

“… 113 The absence of a positive relationship between cardiorespiratory fitness and global cognitive performance might be related to the small sample size of the study ( n = 20) or to the possibility that some vascular disease associated with aging makes it difficult to detect a relationship of a smaller magnitude. 113 On the other hand, observations from the interventional studies demonstrated a positive relationship between exercise-induced changes in the retinal vasculature and cognitive performance, which is in line with existing findings that indicate regular physical activity (e.g., in form of physical exercise) and physical fitness can positively influence vascular retinal parameters 150 and that a relationship between vascular retinal parameters and cognitive performance exists in (a) children, 97 , 151 , 152 , 153 (b) patients with psychiatric diseases, 154 (c) older adults (i.e., measures of cognitive performance 155 and cognitive decline 156 , 157 , 158 , 159 ), and (d) older adults who are at a higher risk for developing neurological diseases (e.g., vascular dementia, 160 Alzheimer's disease 161 , 162 , 163 ). However, other observational studies did not observe statistically significant correlations between vascular retinal parameters and cognitive performance in older adults, 164 , 165 , 166 suggesting that some other factors might moderate their relationship (e.g., age or assessed cognitive domain).…”