Provost Eline B, Nawrot Tim S, Int Panis Luc, Standaert Arnout, Saenen Nelly D, De Boever Patrick
Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.
Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.
Front Neurol. 2021 Jan 29;12:547033. doi: 10.3389/fneur.2021.547033. eCollection 2021.
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.
视网膜微血管网络的几何结构变化，包括血管宽度、血管密度和迂曲度，已被证实与成人的神经障碍有关。我们研究了8至12岁儿童视网膜微血管系统指标与行为和认知的关系。利用190名儿童（48.2%为女孩，平均年龄9.9岁）的数字眼底图像计算视网膜血管直径、分形维数、孔隙度和迂曲度。家长填写优势与困难问卷（SDQ）进行行为筛查。认知能力测试包括神经行为评估系统（NES3）电池中的计算机版斯特鲁普测试（选择性注意力）、连续作业测试（持续性注意力）、数字符号测试（视觉扫描和信息处理速度）以及模式比较测试（视觉空间分析能力）。视网膜血管几何结构与SDQ问题得分显著相关，视网膜分形维数每增加一个四分位数间距（IQR），SDQ问题得分增加1.1分（95%置信区间：0.3至1.9分），视网膜血管孔隙度或迂曲度每增加一个IQR，SDQ问题得分分别降低1.4分（95%置信区间：-2.4至-0.4分）或降低1.0分（95%置信区间：-2.1至0.1分）。敏感性分析表明，结果受SDQ的多动/注意力不集中和品行问题量表驱动。相应地，连续作业测试的平均反应时间随着分形维数增加一个IQR而增加11毫秒（95%置信区间：4.4至17.6毫秒）。结果表明，以高分形维数和低孔隙度为特征的更密集的视网膜微血管网络与儿童的行为结果和持续性注意力呈负相关。
