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El Husseini N, Schaich CL, Craft S, Rapp SR, Hayden KM, Sharrett R, Cotch MF, Wong TY, Luchsinger JA, Espeland MA, Baker LD, Bertoni AG, Hughes TM. Retinal vessel caliber and cognitive performance: the multi-ethnic study of atherosclerosis (MESA). Sci Rep 2024; 14:4120. [PMID: 38374377 PMCID: PMC10876697 DOI: 10.1038/s41598-024-54412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/12/2024] [Indexed: 02/21/2024] Open
Abstract
Retinal vessel calibers share anatomic and physiologic characteristics with the cerebral vasculature and can be visualized noninvasively. In light of the known microvascular contributions to brain health and cognitive function, we aimed to determine if, in a community based-study, retinal vessel calibers and change in caliber over 8 years are associated with cognitive function or trajectory. Participants in the Multi-Ethnic Study of Atherosclerosis (MESA) cohort who completed cognitive testing at Exam 5 (2010-2012) and had retinal vascular caliber measurements (Central Retinal Artery and Vein Equivalents; CRAE and CRVE) at Exam 2 (2002-2004) and Exam 5 were included. Using multivariable linear regression, we evaluated the association of CRAE and CRVE from Exam 2 and Exam 5 and their change between the two exams with scores on tests of global cognitive function (Cognitive Abilities Screening Instrument; CASI), processing speed (Digit Symbol Coding; DSC) and working memory (Digit Span; DS) at Exam 5 and with subsequent change in cognitive scores between Exam 5 and Exam 6 (2016-2018).The main effects are reported as the difference in cognitive test score per SD increment in retinal vascular caliber with 95% confidence intervals (CI). A total of 4334 participants (aged 61.6 ± 9.2 years; 53% female; 41% White) completed cognitive testing and at least one retinal assessment. On multivariable analysis, a 1 SD larger CRAE at exam 5 was associated with a lower concomitant CASI score (- 0.24, 95% CI - 0.46, - 0.02). A 1 SD larger CRVE at exam 2 was associated with a lower subsequent CASI score (- 0.23, 95%CI - 0.45, - 0.01). A 1 SD larger CRVE at exam 2 or 5 was associated with a lower DSC score [(- 0.56, 95% CI - 1.02, - 0.09) and - 0.55 (95% CI - 1.03, - 0.07) respectively]. The magnitude of the associations was relatively small (2.8-3.1% of SD). No significant associations were found between retinal vessel calibers at Exam 2 and 5 with the subsequent score trajectory of cognitive tests performance over an average of 6 years. Wider retinal venular caliber was associated with concomitant and future measures of slower processing speed but not with later cognitive trajectory. Future studies should evaluate the utility of these measures in risk stratification models from a clinical perspective as well as for screening on a population level.
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Affiliation(s)
- Nada El Husseini
- Department of Neurology, Duke University Medical Center, Duke South, Purple Zone, Suite 0109, Durham, NC, 27710, USA.
| | - Christopher L Schaich
- Department of Surgery, Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Suzanne Craft
- Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Stephen R Rapp
- Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Kathleen M Hayden
- Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Richey Sharrett
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | | | - Tien Y Wong
- Department of Ophthalmology and Visual Sciences, National University of Singapore, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Jose A Luchsinger
- Division of General Medicine, Columbia University Medical Center, New York, NY, USA
| | - Mark A Espeland
- Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Laura D Baker
- Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Alain G Bertoni
- Epidemiology and Prevention, Wake Forest University School of Medicine, Winston Salem, NC, USA
| | - Timothy M Hughes
- Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA
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Mio M, Kennedy KG, Grigorian A, Zou Y, Dimick MK, Selkirk B, Kertes PJ, Swardfager W, Hahn MK, Black SE, MacIntosh BJ, Goldstein BI. White matter microstructural integrity is associated with retinal vascular caliber in adolescents with bipolar disorder. J Psychosom Res 2023; 175:111529. [PMID: 37856933 DOI: 10.1016/j.jpsychores.2023.111529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Reduced white matter integrity is observed in bipolar disorder (BD), and is associated with cardiovascular risk in adults. This topic is underexplored in youth, and in BD, where novel microvascular measures may help to inform understanding of the vascular-brain connection. We therefore examined the association of retinal vascular caliber with white matter integrity in a cross-sectional sample of adolescents with and without BD. METHODS Eighty-four adolescents (n = 42 BD, n = 42 controls) completed retinal imaging, yielding arteriolar and venular caliber. Diffusion tensor imaging measured white matter fractional anisotropy (FA). Multiple linear regression tested associations between retinal vascular caliber and FA in regions-of-interest; corpus callosum, anterior thalamic radiation, uncinate fasciculus, and superior longitudinal fasciculus. Complementary voxel-wise analyses were performed. RESULTS Arteriolar caliber was elevated in adolescents with BD relative to controls (F(1,79) = 6.15, p = 0.02, η2p = 0.07). In the overall sample, higher venular caliber was significantly associated with lower corpus callosum FA (β = -0.24, puncorrected = 0.04). In voxel-wise analyses, higher arteriolar caliber was significantly associated with lower corpus callosum and forceps minor FA in the overall sample (β = -0.46, p = 0.03). A significant diagnosis-by-venular caliber interaction on FA was noted in 5 clusters including the right retrolenticular internal capsule (β = 0.72, p = 0.03), corticospinal tract (β = 0.72, p = 0.04), and anterior corona radiata (β = 0.63, p = 0.04). In each instance, venular caliber was more positively associated with FA in BD vs. controls. CONCLUSION Retinal microvascular measures are associated with white matter integrity in BD, particularly in the corpus callosum. This study was proof-of-concept, designed to guide future studies focused on the vascular-brain interface in BD.
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Affiliation(s)
- Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Beth Selkirk
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada
| | - Peter J Kertes
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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Zou L, Herold F, Ludyga S, Kamijo K, Müller NG, Pontifex MB, Heath M, Kuwamizu R, Soya H, Hillman CH, Ando S, Alderman BL, Cheval B, Kramer AF. Look into my eyes: What can eye-based measures tell us about the relationship between physical activity and cognitive performance? JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:568-591. [PMID: 37148971 PMCID: PMC10466196 DOI: 10.1016/j.jshs.2023.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND There is a growing interest to understand the neurobiological mechanisms that drive the positive associations of physical activity and fitness with measures of cognitive performance. To better understand those mechanisms, several studies have employed eye-based measures (e.g., eye movement measures such as saccades, pupillary measures such as pupil dilation, and vascular measures such as retinal vessel diameter) deemed to be proxies for specific neurobiological mechanisms. However, there is currently no systematic review providing a comprehensive overview of these studies in the field of exercise-cognition science. Thus, this review aimed to address that gap in the literature. METHODS To identify eligible studies, we searched 5 electronic databases on October 23, 2022. Two researchers independently extracted data and assessed the risk of bias using a modified version of the Tool for the assEssment of Study qualiTy and reporting in EXercise (TESTEX scale, for interventional studies) and the critical appraisal tool from the Joanna Briggs Institute (for cross-sectional studies). RESULTS Our systematic review (n = 35 studies) offers the following main findings: (a) there is insufficient evidence available to draw solid conclusions concerning gaze-fixation-based measures; (b) the evidence that pupillometric measures, which are a proxy for the noradrenergic system, can explain the positive effect of acute exercise and cardiorespiratory fitness on cognitive performance is mixed; (c) physical training- or fitness-related changes of the cerebrovascular system (operationalized via changes in retinal vasculature) are, in general, positively associated with cognitive performance improvements; (d) acute and chronic physical exercises show a positive effect based on an oculomotor-based measure of executive function (operationalized via antisaccade tasks); and (e) the positive association between cardiorespiratory fitness and cognitive performance is partly mediated by the dopaminergic system (operationalized via spontaneous eye-blink rate). CONCLUSION This systematic review offers confirmation that eye-based measures can provide valuable insight into the neurobiological mechanisms that may drive positive associations between physical activity and fitness and measures of cognitive performance. However, due to the limited number of studies utilizing specific methods for obtaining eye-based measures (e.g., pupillometry, retinal vessel analysis, spontaneous eye blink rate) or investigating a possible dose-response relationship, further research is necessary before more nuanced conclusions can be drawn. Given that eye-based measures are economical and non-invasive, we hope this review will foster the future application of eye-based measures in the field of exercise-cognition science.
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Affiliation(s)
- Liye Zou
- Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen 518060, China; Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany.
| | - Fabian Herold
- Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen 518060, China; Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany
| | - Sebastian Ludyga
- Department of Sport, Exercise, and Health, University of Basel, Basel 4052, Switzerland
| | - Keita Kamijo
- Faculty of Liberal Arts and Sciences, Chukyo University, Nagoya 466-8666, Japan
| | - Notger G Müller
- Body-Brain-Mind Laboratory, School of Psychology, Shenzhen University, Shenzhen 518060, China; Research Group Degenerative and Chronic Diseases, Movement, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam 14476, Germany
| | - Matthew B Pontifex
- Department of Kinesiology, Michigan State University, East Lansing, MI 48824, USA
| | - Matthew Heath
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London ON N6A 3K7, Canada; Canadian Centre for Activity and Aging, University of Western Ontario, London ON, N6A 3K7, Canada; Graduate Program in Neuroscience, University of Western Ontario, London ON, N6A 3K7, Canada
| | - Ryuta Kuwamizu
- Laboratory of Exercise Biochemistry and Neuroendocrinology, Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-0006, Japan
| | - Hideaki Soya
- Laboratory of Exercise Biochemistry and Neuroendocrinology, Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-0006, Japan; Sport Neuroscience Division, Advanced Research Initiative for Human High Performance (ARIHHP), Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba 305-0006, Japan
| | - Charles H Hillman
- Center for Cognitive and Brain Health, Department of Psychology, Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA 02115, USA
| | - Soichi Ando
- Graduate School of Informatics and Engineering, The University of Electro-Communications, Tokyo 182-8585, Japan
| | - Brandon L Alderman
- Department of Kinesiology and Health, Rutgers University-New Brunswick, New Brunswick, NJ 08854, USA
| | - Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Geneva 1205, Switzerland; Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Geneva 1205, Switzerland
| | - Arthur F Kramer
- Department of Psychology, Center for Cognitive and Brain Health, Northeastern University, Boston, MA 02115, USA; Beckman Institute, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA
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Lee JY, Wang SM, Jeon SH, Kim MH, Han KD, Roh YJ. The Risk of Retinal Vein Occlusion in Young Patients with Mental Disorders: A Nationwide Cohort Study. J Clin Med 2023; 12:4874. [PMID: 37510989 PMCID: PMC10381617 DOI: 10.3390/jcm12144874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
We investigated the association between mental disorders and the incidence rate of retinal vein occlusion (RVO) in young Korean adults. This nationwide cohort study included subjects aged 20-40 years who underwent the Korean National Health Examination between 2009 and 2012. The diagnoses of RVO and mental disorders were based on the International Classification of Diseases Tenth Revision codes. Multivariate Cox proportional hazard regression models were used to evaluate the objective. In total, 6,891,399 subjects were included at baseline and 6,597,803 subjects (mean age, 30.86 ± 4.99) were finally analyzed for a mean follow-up duration of 7.36 ± 1.13 years, with the mental disorders group followed for 7.27 ± 1.15 years and the non-diagnosed group for 7.37 ± 1.12 years. Among a total of 10,145 subjects diagnosed with RVO, 1304 had been diagnosed with mental disorders, while 8841 had not. Cumulative incidence of RVO demonstrated a substantially higher incidence probability in subjects with mental disorders (log-rank p < 0.0001). Mental disorders were associated with an increased incidence rate of RVO (hazard ratio [HR]: 1.268; 95% confidence interval; [CI]: 1.196-1.344). In the subgroup analysis, subjects with depression, sleep disorder, and anxiety disorder exhibited an increased risk of incidence of RVO in all regression models (all p < 0.001). In conclusion, mental disorders and the incidence rate of RVO were significantly positively correlated in a Korean nationwide population-based cohort study. These findings suggest that mental disorders may also be associated with the pathophysiology of RVO in young adults.
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Affiliation(s)
- Ji-Young Lee
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Sheng-Min Wang
- Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Seung-Hee Jeon
- Department of Ophthalmology and Visual Science, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Min-Hee Kim
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Kyung-do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Young-Jung Roh
- Department of Ophthalmology and Visual Science, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
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Kennedy KG, Mio M, Goldstein BI, Brambilla P, Delvecchio G. Systematic review and meta-analysis of retinal microvascular caliber in bipolar disorder, major depressive disorder, and schizophrenia. J Affect Disord 2023; 331:342-351. [PMID: 36958491 DOI: 10.1016/j.jad.2023.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Individuals with a severe mental illness (SMI), such as bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia (SZ), have increased rates of cardiovascular and cerebrovascular disease. Interestingly, it has been reported that retinal microvessels, a proxy cerebrovascular measure, non-invasively assessed via retinal imaging, predict future cardiovascular disease, with some studies also showing anomalous retinal microvascular caliber in SMI. Therefore, this review and meta-analysis evaluated whether retinal microvascular caliber differs between individuals with SMI vs controls and summarized current findings. METHODS A systematic literature search for retinal microvascular caliber and SMI was conducted in Embase and MEDLINE. Studies needed to be published in English before 2022 December 1st and examine retinal microvascular caliber in individuals diagnosed with a SMI. Finally, a meta-analysis of arteriolar and venular caliber in SMI case-controlled studies was also conducted. RESULTS The search yielded 65 unique articles, 11 were included in the review and 6 in the meta-analysis. The meta-analysis found that the SMI group had significantly wider venules than controls (SMD = -0.53; 95 % CI = 0.24, 0.81; p = 0.0004) but not arterioles (SMD = 0.07; 95 % CI = -0.29, 0.44; p = 0.70). Additionally, the systematic review found that poorer retinal microvascular health is associated with greater illness severity. LIMITATIONS Large heterogeneity of findings and small sample size. CONCLUSION This systematic review and meta-analysis found that SMI, specifically SZ, is associated with wider retinal venules. Retinal imaging, a fast, cost-effective, and non-invasive assay of cerebrovascular health, may provide insight into the pathophysiological processes of SMI. However, future longitudinal studies investigating these findings are warranted.
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Affiliation(s)
- Kody G Kennedy
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addictions and Mental Health, Toronto, Canada; Department of Pharmacology, University of Toronto, Toronto, Canada
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Mio M, Grigorian A, Zou Y, Dimick MK, Selkirk B, Kertes P, McCrindle BW, Swardfager W, Hahn MK, Black SE, MacIntosh BJ, Goldstein BI. Neurovascular correlates of retinal microvascular caliber in adolescent bipolar disorder. J Affect Disord 2023; 320:81-90. [PMID: 36162693 DOI: 10.1016/j.jad.2022.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The connection between vascular and brain metrics is well-studied in older adults, but neglected in youth and in psychiatric populations at increased cardiovascular risk. We therefore examined the association of retinal vascular caliber with cerebral blood flow (CBF) in adolescents with and without bipolar disorder (BD). METHODS Ninety-four adolescents (n = 48 BD, n = 46 controls) completed retinal fundus imaging, yielding estimates of arteriolar and venular diameter. Arterial spin labelling MRI was performed to measure CBF. We tested for associations between retinal vascular caliber and CBF in regions of interest; anterior cingulate cortex (ACC), middle frontal gyrus, and hippocampus in BD and controls separately. Complementary voxel-wise analyses were also performed. RESULTS In the BD group, higher arteriovenous ratio (AVR) was associated with greater ACC CBF (β = 0.34, puncorrected = 0.02), after controlling for age, sex, and BMI, however this finding did not survive correction for multiple comparisons. The control group did not show any associations (β = 0.13, puncorrected = 0.40). Voxel-wise analyses within the BD group detected a significant positive association between AVR and regional CBF in two distinct clusters: i) left hippocampus (p < 0.0001); ii) right middle temporal gyrus (p = 0.04). LIMITATIONS Limited sample size; young, medically healthy sample limits signal detection; cross-sectional design. CONCLUSION This study reveals that higher AVR is associated with higher regional CBF in adolescents with BD. Present findings advance understanding of potential neurofunctional mechanisms linking retinal vascular caliber with psychiatric diagnoses. This proof-of-concept study was designed to generate initial insights to guide future studies focusing on the vascular-brain connection in youth and in psychiatry.
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Affiliation(s)
- Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Beth Selkirk
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada
| | - Peter Kertes
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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7
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Atagun MI, Sonugur G, Yusifova A, Celik I, Ugurlu N. Machine learning algorithms revealed distorted retinal vascular branching in individuals with bipolar disorder. J Affect Disord 2022; 315:35-41. [PMID: 35905794 DOI: 10.1016/j.jad.2022.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Converging evidence designate vascular vulnerability in bipolar disorder. The predisposition progresses into distortion in time, thus detection of the vascular susceptibility may help reducing morbidity and mortality. It was aimed to assess retinal fundus vasculature in cardiovascular risk-free patients with bipolar disorder. METHODS Total of 68 individuals (38 patients with bipolar disorder, 30 healthy controls) were enrolled. In order to avoid from degenerative processes, participants were between 18 and 45 years of age, vascular risk factors were eliminated. Microscopic retinal fundus images were processed with machine learning algorithms (multilayer perceptron and support vector machine) and artificial neural network approaches. RESULTS In comparison to the healthy control group, the bipolar disorder group had lower number of breaking points (P < 0.001), lower number of curved vessel segments (P < 0.001). Total length of smooth vessels was longer (P = 0.040), and total length of curved vessel segments was significantly shorter (P < 0.001) than the control group. Vascular endothelial growth factor levels and gender were the confounders. There were significant correlations between vascular measures and serum lipid levels. LIMITATIONS Sample size was small and patients were on various medications. CONCLUSIONS These results indicate distortion in retinal vascular branching in bipolar disorder. Disrupted branching may reflect disturbed prosperity of retinal vascular plexus in patients with bipolar disorder. Alterations in the retinal vessels might be indicators of disruption in cerebral vascular system efficiency and thus neurovascular unit dysfunction in bipolar disorder.
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Affiliation(s)
- Murat Ilhan Atagun
- Department of Psychiatry, Canakkale Onsekiz Mart University Faculty of Medicine, Canakkale, Turkey.
| | - Guray Sonugur
- Mechatronics Engineering, Faculty of Technology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | | | - Ibrahim Celik
- Mechatronics Engineering, Faculty of Technology, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Nagihan Ugurlu
- Department of Ophtalmology, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
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Poulton R, Guiney H, Ramrakha S, Moffitt TE. The Dunedin study after half a century: reflections on the past, and course for the future. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2114508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, Division of Sciences, University of Otago, Dunedin, New Zealand
| | - Hayley Guiney
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, Division of Sciences, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, Division of Sciences, University of Otago, Dunedin, New Zealand
| | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
- SGDP Centre, Kings College London, London, UK
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9
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Neurostructural correlates of retinal microvascular caliber in adolescent bipolar disorder. JCPP ADVANCES 2021. [DOI: 10.1002/jcv2.12029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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10
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Silverstein SM, Lai A, Green KM, Crosta C, Fradkin SI, Ramchandran RS. Retinal Microvasculature in Schizophrenia. Eye Brain 2021; 13:205-217. [PMID: 34335068 PMCID: PMC8318708 DOI: 10.2147/eb.s317186] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/15/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Schizophrenia is associated with alterations in neural structure and function of the retina that are similar to changes seen in the retina and brain in multiple neurodegenerative disorders. Preliminary evidence suggests that retinal microvasculature may also be compromised in schizophrenia. The goal of this study was to determine, using optical coherence tomography angiography (OCTA), whether 1) schizophrenia is associated with alterations in retinal microvasculature density; and 2) microvasculature reductions are associated with retinal neural layer thinning and performance on a measure of verbal IQ. PATIENTS AND METHODS Twenty-eight outpatients with schizophrenia or schizoaffective disorder and 37 psychiatrically healthy control subjects completed OCT and OCTA exams, and the Wechsler Test of Adult Reading. RESULTS Schizophrenia patients were characterized by retinal microvasculature density reductions, and enlarged foveal avascular zones, in both eyes. These microvascular abnormalities were generally associated with thinning of retinal neural (macular and peripapillary nerve fiber layer) tissue (but the data were stronger for the left than the right eye) and lower scores on a proxy measure of verbal IQ. First- and later-episode patients did not differ significantly on OCTA findings. CONCLUSION The retinal microvasculature impairments seen in schizophrenia appear to be a biomarker of overall brain health, as is the case for multiple neurological conditions. Additional research is needed, however, to clarify contributions of social disadvantage and medical comorbidities to the findings.
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Affiliation(s)
- Steven M Silverstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
- Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Adriann Lai
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Kyle M Green
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christen Crosta
- Department of Cell Biology and Neuroscience, Rutgers University, Piscataway, NJ, USA
| | | | - Rajeev S Ramchandran
- Department of Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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11
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Roeh A, Schoenfeld J, Raab R, Landes V, Papazova I, Haller B, Strube W, Halle M, Falkai P, Hasan A, Scherr J. Effects of Marathon Running on Cognition and Retinal Vascularization: A Longitudinal Observational Study. Med Sci Sports Exerc 2021; 53:2207-2214. [PMID: 34033620 DOI: 10.1249/mss.0000000000002699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Physical activity has beneficial effects on both cardiovascular and neurocognitive parameters, and these 2 modalities are known to interact at rest. However, findings on their interaction during exercise are inconclusive. PURPOSE Therefore, this longitudinal study aimed to investigate the effects of different forms of exercise (training period, marathon race, recovery period) on both parameters and their interaction. METHODS We included 100 marathon runners (MA) (mean [SD] age: 43.6 [10.0] years, 80 male) and 46 age- and sex-matched sedentary controls (SC, for baseline comparison). Over the 6-month study period with 6 visits (12 and 2 weeks before the marathon; immediately, 24 hours, 72 hours and 12 weeks after the marathon), we assessed cognitive parameters by evaluating 1-to 3-back d prime, the d2 task, and the Trail Making Test A (TMTA) and B (TMTB); retinal vessel parameters by assessing arteriolar-to-venular ratio (AVR), central retinal arteriolar and venular equivalents (CRAE/CRVE). RESULTS In the long-term analysis, 3-back d prime correlated positively with AVR (P = 0.024, B = 1.86,SE = 0.824) and negatively with CRVE (P = 0.05,B = -0.006,SE = 0.003) and TMTB correlated negatively with CRAE (P = 0.025,B = -0.155,SE = 0.069), even after correcting for age and systolic blood pressure as possible confounders. Acute effects were inconsistent with maximal cognitive improvement 24 hours after the marathon. AVR was significantly smaller in SC compared to MA. CONCLUSION Chronic exercise seems to prime the central nervous system for acute, intensive bouts of exercise. Our findings indicate a possible relationship between cognitive performance in high-demand tasks and retinal vasculature and support the idea of a neuroplastic effect of exercise.
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Affiliation(s)
- Astrid Roeh
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Ludwig-Maximilians University Munich, Munich, Germany Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Munich, Germany Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Bezirkskrankenhaus Augsburg, Medical Faculty, University of Augsburg, Augsburg, Germany University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurick, Zurich, Switzerland
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12
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Provost EB, Nawrot TS, Int Panis L, Standaert A, Saenen ND, De Boever P. Denser Retinal Microvascular Network Is Inversely Associated With Behavioral Outcomes and Sustained Attention in Children. Front Neurol 2021; 12:547033. [PMID: 33584528 PMCID: PMC7880124 DOI: 10.3389/fneur.2021.547033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 01/08/2021] [Indexed: 11/25/2022] Open
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.
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Affiliation(s)
- Eline B Provost
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Public Health and Primary Care, Leuven University, Leuven, Belgium
| | - Luc Int Panis
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.,School for Mobility, Hasselt University, Diepenbeek, Belgium
| | - Arnout Standaert
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Nelly D Saenen
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium.,Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Department of Biology, University of Antwerp, Antwerp, Belgium
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13
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Zhao Y, Yang B, Xu AD, Ruan YW, Xu Y, Hu HL, Tan ZF. Retinal Microvascular Changes in Subtypes of Ischemic Stroke. Front Neurol 2021; 11:619554. [PMID: 33584518 PMCID: PMC7873353 DOI: 10.3389/fneur.2020.619554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/23/2020] [Indexed: 12/03/2022] Open
Abstract
Aims: Retinal microvasculature shares prominent similarities with the brain vasculature. We aimed to assess the association between retinal microvasculature and subtypes of ischemic stroke. Method: We consecutively enrolled ischemic stroke patients within 7 days of onset, who met the criteria of subtype of atherothrombosis (AT), small artery disease (SAD), or cardioembolism (CE) according to a modified version of the Trial of Org 10172 in Acute Stroke Treatment (NEW-TOAST). Digital fundus photographs were taken within 72 h of hospital admission using a digital camera (Topcon TRC-50DX), and fundus photographs were semi-automatically measured by software (Canvus 14 and NeuroLucida) for retinal vasculature parameters. Results: A total of 141 patients were enrolled, including 72 with AT, 54 with SAD, and 15 with CE. AT subtype patients had the widest mean venular diameter within 0.5-1.0 disk diameter (MVD0.5-1.0DD) followed by SAD and CE subtypes (86.37 ± 13.49 vs. 83.55 ± 11.54 vs. 77.90 ± 8.50, respectively, P = 0.047); CE subtype patients had the highest mean arteriovenous ratio within 0.5-1.0 disk diameter (MAVR0.5-1.0DD) followed by the AT and SAD subtype groups (0.97 ± 0.03 vs. 0.89 ± 0.99 vs. 0.89 ± 0.11, respectively, P = 0.010); SAD subtype patients were found with the highest mean venular tortuosity within 0.0-2.0 disk diameter (MVT0.0-2.0DD) followed by the AT and CE subtypes (1.0294 ± 0.0081 vs. 1.0259 ± 0.0084 vs. 1.0243 ± 0.0066, respectively, P = 0.024). After adjusting for clinic characteristics, MVD0.5-1.0DD was significantly different among AT, SAD, and CE subtypes (P = 0.033). By receiver operating characteristic curve analysis, MVD0.5-1.0DD predicted the AT subtype (area 0.690, 95% confidence interval, 0.566-0.815), with a cutoff value of 82.23 μm (sensitivity 61.1%, specificity 73.3%). Conclusion: Retinal MVD0.5-1.0DD (>82.23 μm) might be associated with the AT stroke subtype; however, we need large-scale prospective studies in future to explore the underlying mechanism and causal explanation for this finding.
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Affiliation(s)
- Ying Zhao
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Bing Yang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - An-Ding Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yi-Wen Ruan
- Department of Central Nervous System Regeneration, Guangdong-Hongkong-Macau Institute of Central Nervous System (CNS) Regeneration (GHMICR), Jinan University, Guangzhou, China
| | - Ying Xu
- Department of Central Nervous System Regeneration, Guangdong-Hongkong-Macau Institute of Central Nervous System (CNS) Regeneration (GHMICR), Jinan University, Guangzhou, China
| | - Hui-Ling Hu
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Shenzhen University School of Medicine, Shenzhen, China
| | - Ze-Feng Tan
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Clinical Neuroscience Institute, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Department of Neurology, The Affiliated Shunde Hospital of Jinan University, Guangzhou, China
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A deep-learning system for the assessment of cardiovascular disease risk via the measurement of retinal-vessel calibre. Nat Biomed Eng 2020; 5:498-508. [PMID: 33046867 DOI: 10.1038/s41551-020-00626-4] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 09/08/2020] [Indexed: 12/16/2022]
Abstract
Retinal blood vessels provide information on the risk of cardiovascular disease (CVD). Here, we report the development and validation of deep-learning models for the automated measurement of retinal-vessel calibre in retinal photographs, using diverse multiethnic multicountry datasets that comprise more than 70,000 images. Retinal-vessel calibre measured by the models and by expert human graders showed high agreement, with overall intraclass correlation coefficients of between 0.82 and 0.95. The models performed comparably to or better than expert graders in associations between measurements of retinal-vessel calibre and CVD risk factors, including blood pressure, body-mass index, total cholesterol and glycated-haemoglobin levels. In retrospectively measured prospective datasets from a population-based study, baseline measurements performed by the deep-learning system were associated with incident CVD. Our findings motivate the development of clinically applicable explainable end-to-end deep-learning systems for the prediction of CVD on the basis of the features of retinal vessels in retinal photographs.
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15
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Associations between cannabis use and retinal vessel diameter in young adults. Schizophr Res 2020; 219:62-68. [PMID: 30837202 DOI: 10.1016/j.schres.2019.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/18/2019] [Accepted: 02/20/2019] [Indexed: 12/14/2022]
Abstract
Cannabis appears to have vascular effects that may have implications for cerebrovascular function, but no studies have directly visualized the microvasculature in living cannabis users. The current study used retinal imaging, a tool taken from ophthalmology, to visualize the small retinal microvessels in cannabis users. We compared retinal arteriolar (small arteries) and venular (small veins) diameters in 55 frequent cannabis users and 51 comparison individuals with a mean age of 19.25 years (SD = 2.43). Results indicated that mean arteriolar diameter was statistically significantly wider for cannabis users (M = 157.98, SE = 1.42) than for comparison individuals (M = 153.56, SE = 1.46; F(1,103) = 4.67, p = .033), even after controlling for a variety of covariates and after excluding from analyses cannabis users who had used cannabis in the past 24 h. There was no statistically significant difference in retinal venular diameter between cannabis users and comparison individuals. Findings suggest that frequent cannabis use is associated with wider retinal arterioles, which might represent a residual vasodilatory effect of recent cannabis use or impaired autoregulation resulting from chronic cannabis use. Retinal imaging is a non-invasive, cost-effective tool for visualizing the microvasculature in living individuals and can be combined, in future research, with neuroimaging and other measures of retinal vascular function to better understand the acute and longer-term effects of cannabis use on the microvasculature.
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16
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Meyer ML, Klein BE, Klein R, Palta P, Sharrett AR, Heiss G, Nambi V, Wong TY, Tanaka H. Central arterial stiffness and retinal vessel calibers: the Atherosclerosis Risk in Communities Study-Neurocognitive Study. J Hypertens 2020; 38:266-273. [PMID: 31584520 PMCID: PMC6949400 DOI: 10.1097/hjh.0000000000002252] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The retinal microvasculature provides a window to the cerebral vasculature and enables examination of changes in retinal caliber that may mimic those occurring in cerebrovascular disease. The association of central arterial stiffness and retinal vessel caliber in a population sample is not fully understood. METHODS In 1706 older adults (mean age 76.3, 58.1% women) from the population-based Atherosclerosis Risk in Communities Study, we examined the cross-sectional association of central arterial stiffness [carotid-femoral pulse wave velocity (cfPWV)] with retinal vessel calibers [central retinal arteriolar equivalent (CRAE) and central retinal vein equivalent (CRVE)]. We estimated the association of cfPWV with CRAE narrowing (<25th percentile) and CRVE widening (>75th percentile) after adjustment for age, sex, race-field center, BMI, smoking, and type 2 diabetes. We tested for effect modification by sex, hypertension, and type 2 diabetes. RESULTS Carotid-femoral PWV (m/s) was not associated with the odds of CRAE narrowing [odds ratio (OR): 0.99; 95% CI: 0.95-1.03]. The association of cfPWV with CRVE widening was stronger in those without hypertension (OR: 1.10; 95% CI: 1.01-1.20) versus those with hypertension (OR: 1.01 95% CI: 0.96-1.05) and slightly stronger in those with type 2 diabetes (OR: 1.07; 95% CI: 1.00-1.14) versus without type 2 diabetes (OR: 1.01; 95% CI: 0.96-1.06). CONCLUSIONS In older adults, cfPWV was associated with wider retinal venular caliber, particularly in individuals without hypertension. Central arterial stiffening may be associated with cerebral microvascular changes, as exhibited in its retinal vasculature component.
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Affiliation(s)
- Michelle L Meyer
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Barbara E Klein
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Ronald Klein
- University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI
| | - Priya Palta
- Department of Medicine, Columbia University, New York City, NY
| | - A Richey Sharrett
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gerardo Heiss
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Vijay Nambi
- Michael E DeBakey Veterans Affairs Hospital and Baylor College of Medicine, Houston, TX
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, National University of Singapore, Singapore
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX
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17
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Ludyga S, Köchli S, Pühse U, Gerber M, Hanssen H. Effects of a school-based physical activity program on retinal microcirculation and cognitive function in adolescents. J Sci Med Sport 2019; 22:672-676. [DOI: 10.1016/j.jsams.2018.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/01/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022]
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18
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Jones AR, Robbs CM, Edwards CG, Walk AM, Thompson SV, Reeser GE, Holscher HD, Khan NA. Retinal Morphometric Markers of Crystallized and Fluid Intelligence Among Adults With Overweight and Obesity. Front Psychol 2018; 9:2650. [PMID: 30622502 PMCID: PMC6309102 DOI: 10.3389/fpsyg.2018.02650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/10/2018] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate the relationship between retinal morphometric measures and intellectual abilities among adults with overweight and obesity. Methods: Adults between 25 and 45 years (N = 55, 38 females) with overweight or obesity (BMI ≥ 25.0 kg/m2) underwent an optical coherence tomography (OCT) scan to assess retinal nerve fiber layer (RNFL) volume, ganglion cell layer (GCL) volume, macular volume, and central foveal thickness. Dual-Energy X-ray absorptiometry was used to assess whole-body adiposity (% Fat). The Kaufman Brief Intelligence Test-2 was used to assess general intelligence (IQ), fluid, and crystallized intelligence. Hierarchical linear regression analyses were performed to examine relationships between adiposity and intelligence measures following adjustment of relevant demographic characteristics and degree of adiposity (i.e., % Fat). Results: Although initial bivariate correlations indicated that % Fat was inversely related to fluid intelligence, this relationship was mitigated by inclusion of other demographic factors, including age, sex, and education level. Regression analyses for primary outcomes revealed that RNFL was positively related to IQ and fluid intelligence. However, only GCL was positively related to crystallized intelligence. Conclusion: This work provides novel data linking specific retinal morphometric measures - assessed using OCT - to intellectual abilities among adults with overweight and obesity. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT02740439.
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Affiliation(s)
- Alicia R. Jones
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Connor M. Robbs
- College of Liberal Arts and Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Caitlyn G. Edwards
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Anne M. Walk
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Sharon V. Thompson
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Ginger E. Reeser
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Hannah D. Holscher
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Naiman A. Khan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Neuroscience Program, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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Association between head injury and concussion with retinal vessel caliber. PLoS One 2018; 13:e0200441. [PMID: 29995951 PMCID: PMC6040728 DOI: 10.1371/journal.pone.0200441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/26/2018] [Indexed: 11/21/2022] Open
Abstract
The adverse long-term consequences following traumatic brain injury are poorly understood, particularly on the cerebral microvasculature. Retinal vessels are a surrogate marker of cerebral vascular changes. We therefore aimed to examine the cross-sectional association between serious head injury or being knocked unconscious, and/or concussion and retinal microvascular signs, specifically, mean retinal arteriolar and venular calibre, in older adults after accounting for potential confounders. This cohort study involved 2,624 adults with mean age of 66.9 (±9.1) years who self-reported head injury and concussion parameters, and had gradable retinal photographs. Face-to-face interviews with trained interviewers allowed participants to report prior serious head injury or being knocked unconscious, and/or a previous diagnosis of concussion by a medical professional. Fundus photographs were taken and retinal vascular calibre measured using computer-assisted techniques and summarized. There were 25.9%, 15.3% and 10.1% who reported a prior serious head injury or being “knocked unconscious”, concussion, and both, respectively. Participants in the first group compared to non-injured participants had significantly wider (~2 μm) mean retinal venular calibre (p = 0.02), after adjusting for age, sex, smoking, body mass index, mean arterial blood pressure, type 2 diabetes and fellow vessel calibre. No significant associations were observed in people reporting medically diagnosed concussion or with mean retinal arteriolar calibre. Our exploratory study suggests that head injury is independently associated with wider retinal venular caliber. These findings warrant further investigation in longitudinal cohort studies.
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Van Aart CJC, Nawrot TS, Sioen I, De Boever P, Zaqout M, De Henauw S, Michels N. Longitudinal association between psychosocial stress and retinal microvasculature in children and adolescents. Psychoneuroendocrinology 2018; 92:50-56. [PMID: 29626707 DOI: 10.1016/j.psyneuen.2018.03.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/28/2018] [Accepted: 03/28/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Retinal microvessels provides a window to assess the microcirculation of heart and brain, and might reflect cardio- or cerebrovascular disease risk. Limited information exist on the relation between psychosocial stress and the microcirculation, even though psychosocial stress might trigger vascular diseases. This study investigates whether childhood psychosocial stress is a predictor of retinal microvasculature. METHODS We followed-up 182 Belgian children, aged 5.7-11.3 years at baseline (53.3% boys). Information about psychosocial stress was obtained using emotional, behavioral and negative life events questionnaires and hair cortisol, an objective stress marker. Retinal photographs were used to calculate vessel diameters, bifurcation angles and optimality deviation with semiautomated software. Cross-sectional and longitudinal associations were explored using multivariable regression analysis with retinal parameters in 2015 as outcome, while adjusting for age, sex, socioeconomic status, cardiovascular parameters and lifestyle factors. RESULTS Feelings of happiness, sadness and negative life events were associated with retinal vascular diameter, but behavior and hair cortisol were not. High stress levels over a 4-year time period (less happy, sadder and higher total negative emotions) were associated with larger venules (β = 0.21-0.43) and children who experienced more negative life events had smaller arterioles (β = -0.15). No consistent patterns were seen with bifurcation angles and optimality deviation. CONCLUSION Based on the results, we conclude that high levels of childhood psychosocial stress unfavorably affect the retinal vascular diameters, potentially reflecting the microvasculature of the heart and brain. It seems this might even be independent of lifestyle and BMI, but further research on mechanisms is necessary.
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Affiliation(s)
- Carola J C Van Aart
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium.
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Belgium; Department of Public Health and Primary Care, Leuven University, Belgium
| | - Isabelle Sioen
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Faculty of Bioscience Engineering, Department of Food Technology, Safety and Health, Ghent University, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Belgium; Environmental Risk and Health Unit, Flemish Institute for Technological Research (VITO), Belgium
| | - Mahmoud Zaqout
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
| | - Stefaan De Henauw
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium; Department of Health Sciences, Vesalius, University College Ghent, Belgium
| | - Nathalie Michels
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Belgium
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Goldstein BI. Bipolar Disorder and the Vascular System: Mechanisms and New Prevention Opportunities. Can J Cardiol 2017; 33:1565-1576. [DOI: 10.1016/j.cjca.2017.10.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
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Provost EB, Int Panis L, Saenen ND, Kicinski M, Louwies T, Vrijens K, De Boever P, Nawrot TS. Recent versus chronic fine particulate air pollution exposure as determinant of the retinal microvasculature in school children. ENVIRONMENTAL RESEARCH 2017; 159:103-110. [PMID: 28783615 DOI: 10.1016/j.envres.2017.07.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/31/2017] [Accepted: 07/13/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Microvascular changes may represent an underlying mechanism through which exposure to fine particulate matter with a diameter ≤ 2.5µm (PM2.5) contributes to age-related disease development. We investigated the effect of recent and chronic exposure to PM2.5 on the microcirculation, exemplified by retinal vessel diameters, using repeated measurements in 8- to 12-year-old children. METHODS 221 children (49.1% girls; mean age 9.9 years) were examined repeatedly (25 one, 124 two, and 72 three times) adding up to 489 retinal vessel examinations. Same-day exposure to PM2.5 was measured at school. In addition, recent (same and previous day) and chronic (yearly mean) exposure was modelled at the child's residence using a high-resolution interpolation model. Residential proximity to major roads was also assessed. Changes in retinal vessel diameters associated with recent and chronic exposures were estimated using mixed models, while adjusting for other known covariates such as sex, age, BMI, blood pressure and birth weight. RESULTS Each 10µg/m³ increment in same-day exposure to PM2.5 measured at school was associated with 0.35µm (95% CI: 0.09-0.61µm) narrower retinal arterioles and 0.35µm (-0.03 to 0.73µm) wider venules. Children living 100m closer to a major road had 0.30µm (0.05-0.54µm) narrower arterioles. CONCLUSIONS Blood vessel diameters of the retinal microcirculation of healthy school-aged children respond to same-day PM2.5 exposure. Furthermore, children living closer to major roads had smaller arteriolar diameters. Our results suggest that the microcirculation, with retinal microvasculature as a proxy in this study, is a pathophysiological target for air pollution in children.
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Affiliation(s)
- Eline B Provost
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Luc Int Panis
- Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium; School for Mobility, Hasselt University, Hasselt, Belgium
| | - Nelly D Saenen
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Michal Kicinski
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Tijs Louwies
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Karen Vrijens
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Patrick De Boever
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Environmental Risk and Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Tim S Nawrot
- Centre for Environmental Sciences, Hasselt University, Hasselt, Belgium; Department of Public Health & Primary Care, Leuven University, Leuven, Belgium.
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23
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Naiberg MR, Hatch JK, Selkirk B, Fiksenbaum L, Yang V, Black S, Kertes PJ, Goldstein BI. Retinal photography: A window into the cardiovascular-brain link in adolescent bipolar disorder. J Affect Disord 2017; 218:227-237. [PMID: 28477501 DOI: 10.1016/j.jad.2017.04.066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/21/2017] [Accepted: 04/28/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The burden of cardiovascular disease in bipolar disorder (BD) exceeds what can be explained by traditional cardiovascular risk factors (CVRFs), lifestyle, and/or medications. Moreover, neurocognitive deficits are a core feature of BD, and are also related to CVRFs. We examined retinal vascular photography, a proxy for cerebral microvasculature, in relation to CVRFs, peripheral microvascular function, and neurocognition among BD adolescents. METHODS Subjects were 30 adolescents with BD and 32 healthy controls (HC). Retinal photography was conducted using a Topcon TRC 50 DX, Type IA camera, following pupil dilation. Retinal arteriolar and venular caliber was measured, from which the arterio-venular ratio (AVR) was computed. All measures were conducted masked to participant diagnosis. Peripheral arterial tonometry measured endothelial function. Neurocognition was assessed using the Cambridge Neuropsychological Tests Automated Battery. RESULTS AVR was not significantly different between groups (Cohen's d=0.18, p=0.103). Higher diastolic blood pressure (BP) was associated with lower (worse) AVR in BD (r=-0.441, p=0.015) but not HC (r=-0.192, p=0.293). Similarly, in the BD group only, higher (better) endothelial function was associated with higher AVR (r=0.375, p=0.041). Hierarchical regression models confirmed that, independent of covariates, retinal vascular caliber was significantly associated with diastolic BP and endothelial function in BD. Within the BD group, mood scores were significantly negatively correlated with AVR (β=-0.451, p=0.044). LIMITATIONS This study's limitations include a small sample size, a cross-sectional study design, and a heterogeneous sample. CONCLUSION Retinal photography may offer unique insights regarding the cardiovascular and neurocognitive burden of BD. Larger longitudinal studies are warranted.
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Affiliation(s)
- Melanie R Naiberg
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Jessica K Hatch
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Beth Selkirk
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Lisa Fiksenbaum
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Victor Yang
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Sandra Black
- Sunnybrook Research Institute, Hurvitz Brain Sciences Research Program, Toronto, Canada; University of Toronto, Department of Neurosurgery, Toronto, Canada; Sunnybrook Health Sciences Centre, Department of Medicine (Neurology), Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Peter J Kertes
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Department of Ophthalmology and Vision Sciences, Toronto, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada
| | - Benjamin I Goldstein
- Sunnybrook Health Sciences Centre, Centre for Youth Bipolar Disorder, Toronto, Canada; University of Toronto, Department of Pharmacology and Toxicology, Toronto, Canada; Univeristy of Toronto, Department of Neurology, Toronto, Canada.
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24
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McGrory S, Taylor AM, Kirin M, Corley J, Pattie A, Cox SR, Dhillon B, Wardlaw JM, Doubal FN, Starr JM, Trucco E, MacGillivray TJ, Deary IJ. Retinal microvascular network geometry and cognitive abilities in community-dwelling older people: The Lothian Birth Cohort 1936 study. Br J Ophthalmol 2016; 101:993-998. [PMID: 28400371 PMCID: PMC5530803 DOI: 10.1136/bjophthalmol-2016-309017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/21/2016] [Accepted: 09/26/2016] [Indexed: 11/05/2022]
Abstract
Aim To examine the relationship between retinal vascular morphology and cognitive abilities in a narrow-age cohort of community-dwelling older people. Methods Digital retinal images taken at age ∼73 years from 683 participants of the Lothian Birth Cohort 1936 (LBC1936) were analysed with Singapore I Vessel Assessment (SIVA) software. Multiple regression models were applied to determine cross-sectional associations between retinal vascular parameters and general cognitive ability (g), memory, processing speed, visuospatial ability, crystallised cognitive ability and change in IQ from childhood to older age. Results After adjustment for cognitive ability at age 11 years and cardiovascular risk factors, venular length-to-diameter ratio was nominally significantly associated with processing speed (β=−0.116, p=0.01) and g (β=−0.079, p=0.04). Arteriolar length-to-diameter ratio was associated with visuospatial ability (β=0.092, p=0.04). Decreased arteriolar junctional exponent deviation and increased arteriolar branching coefficient values were associated with less relative decline in IQ between childhood and older age (arteriolar junctional exponent deviation: β=−0.101, p=0.02; arteriolar branching coefficient: β=0.089, p=0.04). Data are presented as standardised β coefficients (β) reflecting change in cognitive domain score associated with an increase of 1 SD unit in retinal parameter. None of these nominally significant associations remained significant after correction for multiple statistical testing. Conclusions Retinal parameters contributed <1% of the variance in the majority of associations observed. Whereas retinal analysis may have potential for early detection of some types of age-related cognitive decline and dementia, our results present little evidence that retinal vascular features are associated with non-pathological cognitive ageing.
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Affiliation(s)
- Sarah McGrory
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adele M Taylor
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Mirna Kirin
- Faculty of Medicine, University of Split, Split, Croatia
| | - Janie Corley
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Alison Pattie
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Simon R Cox
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network: A Platform for Scientific Excellence Collaboration, Edinburgh, UK
| | - Baljean Dhillon
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Scottish Imaging Network: A Platform for Scientific Excellence Collaboration, Edinburgh, UK
| | - Fergus N Doubal
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Emanuele Trucco
- VAMPIRE project, Computing, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Thomas J MacGillivray
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Edinburgh Clinical Research Facility, University of Edinburgh, Edinburgh, UK
| | - Ian J Deary
- Department of Psychology, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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25
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Marosi C, Köller M. Challenge of cancer in the elderly. ESMO Open 2016; 1:e000020. [PMID: 27843603 PMCID: PMC5070391 DOI: 10.1136/esmoopen-2015-000020] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 12/21/2022] Open
Abstract
Despite the sustained trend of decreasing overall cancer incidence, the number of elderly patients with cancer will considerably increase in the coming years, as the incidence of cancer is elevated 11-fold after the age of 65 years compared to adults up to 65 years. This soon-to-erupt tsunami of elderly patients with cancer requires adequate treatment, for which guidelines and evidence-based data are still scarce, given the longlasting under-representation of elderly patients with cancer in cancer trials. Older adults present not only with the physiological decreases of organ functions related to age, but also with an individual burden of comorbidities, other impairments and social factors that might impact on their potential for undergoing cancer care. Close collaboration with gerontologists and other health professionals to assess the personal resources and limitations of each person enables providing adequate therapy to elderly patients with cancer. There are promising achievements in each of the requirements listed, but a huge, holistic effort has still to be made.
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Affiliation(s)
- Christine Marosi
- Clinical Division of Medical Oncology, Department of Internal Medicine I , Medical University of Vienna , Vienna , Austria
| | - Marcus Köller
- Sophienspital der Gemeinde Wien & Department of Internal Medicine III , Medical University of Vienna , Vienna , Austria
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26
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Abstract
Antiaging therapies show promise in model organism research. Translation to humans is needed to address the challenges of an aging global population. Interventions to slow human aging will need to be applied to still-young individuals. However, most human aging research examines older adults, many with chronic disease. As a result, little is known about aging in young humans. We studied aging in 954 young humans, the Dunedin Study birth cohort, tracking multiple biomarkers across three time points spanning their third and fourth decades of life. We developed and validated two methods by which aging can be measured in young adults, one cross-sectional and one longitudinal. Our longitudinal measure allows quantification of the pace of coordinated physiological deterioration across multiple organ systems (e.g., pulmonary, periodontal, cardiovascular, renal, hepatic, and immune function). We applied these methods to assess biological aging in young humans who had not yet developed age-related diseases. Young individuals of the same chronological age varied in their "biological aging" (declining integrity of multiple organ systems). Already, before midlife, individuals who were aging more rapidly were less physically able, showed cognitive decline and brain aging, self-reported worse health, and looked older. Measured biological aging in young adults can be used to identify causes of aging and evaluate rejuvenation therapies.
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27
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Abstract
Although visual processing impairments are common in schizophrenia, it is not clear to what extent these originate in the eye vs. the brain. This review highlights potential contributions, from the retina and other structures of the eye, to visual processing impairments in schizophrenia and high-risk states. A second goal is to evaluate the status of retinal abnormalities as biomarkers for schizophrenia. The review was motivated by known retinal changes in other disorders (e.g., Parkinson’s disease, multiple sclerosis), and their relationships to perceptual and cognitive impairments, and disease progression therein. The evidence reviewed suggests two major conclusions. One is that there are multiple structural and functional disturbances of the eye in schizophrenia, all of which could be factors in the visual disturbances of patients. These include retinal venule widening, retinal nerve fiber layer thinning, dopaminergic abnormalities, abnormal ouput of retinal cells as measured by electroretinography (ERG), maculopathies and retinopathies, cataracts, poor acuity, and strabismus. Some of these are likely to be illness-related, whereas others may be due to medication or comorbid conditions. The second conclusion is that certain retinal findings can serve as biomarkers of neural pathology, and disease progression, in schizophrenia. The strongest evidence for this to date involves findings of widened retinal venules, thinning of the retinal nerve fiber layer, and abnormal ERG amplitudes. These data suggest that a greater understanding of the contribution of retinal and other ocular pathology to the visual and cognitive disturbances of schizophrenia is warranted, and that retinal changes have untapped clinical utility.
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28
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Poulton R, Moffitt TE, Silva PA. The Dunedin Multidisciplinary Health and Development Study: overview of the first 40 years, with an eye to the future. Soc Psychiatry Psychiatr Epidemiol 2015; 50:679-93. [PMID: 25835958 PMCID: PMC4412685 DOI: 10.1007/s00127-015-1048-8] [Citation(s) in RCA: 200] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 03/19/2015] [Indexed: 12/03/2022]
Abstract
The Dunedin Multidisciplinary Health and Development Study began more than four decades ago. Unusual at the time, it was founded as a multidisciplinary research enterprise, and was strongly supported by the Dunedin community, both professional and lay, in its early years. Seven research themes have evolved over the past 40 years focusing on mental health and neuro-cognition, cardiovascular risk, respiratory health, oral health, sexual and reproductive health, and psychosocial functioning. A seventh, more applied theme, seeks to maximise the value of the Study findings for New Zealand's indigenous people-Māori (or tangata whenua transl people of the land). The study has published over 1200 papers and reports to date, with almost 2/3 of these being in peer-reviewed journals. Here we provide an overview of the study, its history, leadership structure, scientific approach, operational foci, and some recent examples of work that illustrate the following: (a) the value of multidisciplinary data; (b) how the study is well positioned to address contemporary issues; and (c) how research can simultaneously address multiple audiences-from researchers and theoreticians to policy makers and practitioners. Near-future research plans are described, and we end by reflecting upon the core aspects of the study that portend future useful contributions.
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Affiliation(s)
- Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand,
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29
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Meier MH, Gillespie NA, Hansell NK, Hewitt AW, Hickie IB, Lu Y, McGrath J, MacGregor S, Medland SE, Sun C, Wong TY, Wright MJ, Zhu G, Martin NG, Mackey DA. Retinal microvessels reflect familial vulnerability to psychotic symptoms: A comparison of twins discordant for psychotic symptoms and controls. Schizophr Res 2015; 164:47-52. [PMID: 25694186 PMCID: PMC4409503 DOI: 10.1016/j.schres.2015.01.045] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/26/2015] [Accepted: 01/29/2015] [Indexed: 11/29/2022]
Abstract
Mounting evidence suggests that individuals with schizophrenia have an underlying vulnerability to cardiovascular disease, and a recent study suggested that this vulnerability might be reflected in the retinal microvasculature. The purpose of this study was to test the hypothesis that the retinal microvessels reflect familial vulnerability to psychotic symptoms. Participants were 531 adolescent and young adult twins who took part in the Brisbane Longitudinal Twin Study and the Twins Eye Study in Tasmania. The twins had photographs taken of their retina when they were adolescents or young adults (M age=20.6 years), and retinal vessel diameter was assessed using computer software. The twins completed an assessment of psychosis symptoms approximately six years later. We compared retinal venular diameters of individuals with one or more symptoms of psychosis (n=45), their unaffected co-twins (n=24), and controls (n=462). Individuals with one or more symptoms of psychosis had wider venules (standardized mean=0.29) than controls (standardized mean=-0.04; p=.03), and unaffected co-twins had venular diameters that were intermediate (standardized mean=0.13) between the two groups, suggesting that wide venules may represent a proxy marker of familial vulnerability to psychosis symptoms. Consistent with previous work, there were no differences in arteriolar diameter between individuals with and without symptoms of psychosis. Findings suggest that wide retinal venules may serve as a proxy marker of familial liability to psychosis symptoms. The pathophysiological mechanisms linking psychosis and cardiovascular disease may be operative from early in life, possibly at the level of the microvasculature.
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Affiliation(s)
| | - Nathan A. Gillespie
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond,VA, USA,QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Alex W. Hewitt
- Centre for Eye Research Australia (CERA), University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia,Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Ian B. Hickie
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Yi Lu
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - John McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia,Queensland Brain Institute, University of Queensland, St Lucia, Australia
| | | | | | - Cong Sun
- Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Tien Y. Wong
- Singapore Eye Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore,Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore
| | | | - Gu Zhu
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - David A. Mackey
- Centre for Eye Research Australia (CERA), University of Melbourne, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia,Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
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30
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Li LJ, Aris I, Su LL, Tint MT, Cheung CYL, Ikram MK, Gluckman P, Godfrey KM, Tan KH, Yeo G, Yap F, Kwek K, Saw SM, Chong YS, Wong TY, Lee YS. Associations of maternal retinal vasculature with subsequent fetal growth and birth size. PLoS One 2015; 10:e0118250. [PMID: 25909909 PMCID: PMC4409150 DOI: 10.1371/journal.pone.0118250] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/18/2014] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We aimed to study the maternal retinal microvasculature at mid-trimester and its relationship with subsequent fetal growth and birth size. METHODS We recruited 732 pregnant women aged 18-46 years in the first trimester with singleton pregnancies. All had retinal photography and fetal scan performed at 26-28 weeks gestation, and subsequent fetal scan at 32-34 weeks gestation. Infant anthropometric measurements were done at birth. Retinal microvasculature was measured using computer software from the retinal photographs. RESULTS In multiple linear regression models, each 10 μm narrowing in maternal retinal arteriolar caliber was associated with decreases of 1.36 mm in fetal head circumference at 32-34 weeks gestation, as well as decreases of 1.50 mm and 2.30 mm in infant head circumference and birth length at delivery, respectively. Each standard deviation decrease in maternal retinal arteriolar fractal dimension was associated with decreases of 1.55 mm in fetal head circumference at 32-34 weeks gestation, as well as decreases of 1.08 mm and 46.42 g in infant head circumference and birth weight at delivery, respectively. CONCLUSIONS Narrower retinal arteriolar caliber and a sparser retinal vascular network in mothers, reflecting a suboptimal uteroplacental microvasculature during mid-pregnancy, were associated with poorer fetal growth and birth size.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Izzuddin Aris
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Lin Lin Su
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mya Thway Tint
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carol Yim-Lui Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- DUKE-NUS Graduate Medical School, Singapore
| | - M. Kamran Ikram
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Departments of Epidemiology & Ophthalmology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Memory Aging & Cognition Centre, National University Health System, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton, Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | | | - George Yeo
- KK Women’s and Children’s Hospital, Singapore
| | - Fabian Yap
- KK Women’s and Children’s Hospital, Singapore
| | - Kenneth Kwek
- Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton, Biomedical Research Centre, University of Southampton, Southampton, United Kingdom
| | - Seang-Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Yap-Seng Chong
- Department of Obstetrics and Gynecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tien-Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yung Seng Lee
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
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31
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Taylor AM, MacGillivray TJ, Henderson RD, Ilzina L, Dhillon B, Starr JM, Deary IJ. Retinal vascular fractal dimension, childhood IQ, and cognitive ability in old age: the Lothian Birth Cohort Study 1936. PLoS One 2015; 10:e0121119. [PMID: 25816017 PMCID: PMC4376388 DOI: 10.1371/journal.pone.0121119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/10/2015] [Indexed: 01/19/2023] Open
Abstract
Purpose Cerebral microvascular disease is associated with dementia. Differences in the topography of the retinal vascular network may be a marker for cerebrovascular disease. The association between cerebral microvascular state and non-pathological cognitive ageing is less clear, particularly because studies are rarely able to adjust for pre-morbid cognitive ability level. We measured retinal vascular fractal dimension (Df) as a potential marker of cerebral microvascular disease. We examined the extent to which it contributes to differences in non-pathological cognitive ability in old age, after adjusting for childhood mental ability. Methods Participants from the Lothian Birth Cohort 1936 Study (LBC1936) had cognitive ability assessments and retinal photographs taken of both eyes aged around 73 years (n = 648). IQ scores were available from childhood. Retinal vascular Df was calculated with monofractal and multifractal analysis, performed on custom-written software. Multiple regression models were applied to determine associations between retinal vascular Df and general cognitive ability (g), processing speed, and memory. Results Only three out of 24 comparisons (two eyes × four Df parameters × three cognitive measures) were found to be significant. This is little more than would be expected by chance. No single association was verified by an equivalent association in the contralateral eye. Conclusions The results show little evidence that fractal measures of retinal vascular differences are associated with non-pathological cognitive ageing.
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Affiliation(s)
- Adele M. Taylor
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas J. MacGillivray
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Clinical Research Imaging Centre, University of Edinburgh, Edinburgh, United Kingdom
- Clinical Research Facility, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail: (IJD); (TJM)
| | - Ross D. Henderson
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Lasma Ilzina
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Baljean Dhillon
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - John M. Starr
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Ian J. Deary
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail: (IJD); (TJM)
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32
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Abstract
OBJECTIVE Previous longitudinal studies suggest that depression and anxiety are associated with risk for cardiovascular disease. The aim of the present study was to test whether an association between depression and anxiety symptoms and retinal vessel caliber, an indicator of subclinical cardiovascular risk, is apparent as early as adolescence and young adulthood. METHODS Participants were 865 adolescents and young adults who participated in the Brisbane Longitudinal Twin Study and the Twin Eye Study in Tasmania. Participants completed an assessment of depression/anxiety symptoms (the Somatic and Psychological Health Report) when they were 16.5 years old (mean age), and they underwent retinal imaging, on average, 2.5 years later (range, 2 years before to 7 years after the depression/anxiety assessment). Retinal vessel caliber was assessed using computer software. RESULTS Depression and anxiety symptoms were associated with wider retinal arteriolar caliber in this sample of adolescents and young adults (β = 0.09, p = .016), even after adjusting for other cardiovascular risk factors (β = 0.08, p = .025). Multiple regression analyses revealed that affective symptoms of depression/anxiety were associated with retinal vessel caliber independently of somatic symptoms. CONCLUSIONS Depression and anxiety symptoms are associated with measurable signs in the retinal microvasculature in early life, suggesting that pathological microvascular mechanisms linking depression/anxiety and cardiovascular disease may be operative from a young age.
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33
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Meier MH, Shalev I, Moffitt TE, Kapur S, Keefe RSE, Wong TY, Belsky DW, Harrington H, Hogan S, Houts R, Caspi A, Poulton R. Microvascular abnormality in schizophrenia as shown by retinal imaging. Am J Psychiatry 2013; 170:1451-9. [PMID: 24030514 PMCID: PMC3857729 DOI: 10.1176/appi.ajp.2013.13020234] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Retinal and cerebral microvessels are structurally and functionally homologous, but unlike cerebral microvessels, retinal microvessels can be noninvasively measured in vivo by retinal imaging. The authors tested the hypothesis that individuals with schizophrenia exhibit microvascular abnormality and evaluated the utility of retinal imaging as a tool for schizophrenia research. METHOD Participants were members of the Dunedin Study, a population-representative cohort followed from birth with 95% retention. Study members underwent retinal imaging at age 38. The authors assessed retinal arteriolar and venular caliber for all members of the cohort, including individuals who developed schizophrenia. RESULTS Study members who developed schizophrenia were distinguished by wider retinal venules, suggesting microvascular abnormality reflective of insufficient brain oxygen supply. Analyses that controlled for confounding health conditions suggested that wider retinal venules are not simply an artifact of co-occurring health problems in schizophrenia patients. Wider venules were also associated with a dimensional measure of adult psychosis symptoms and with psychosis symptoms reported in childhood. CONCLUSIONS The findings provide initial support for the hypothesis that individuals with schizophrenia show microvascular abnormality. Moreover, the results suggest that the same vascular mechanisms underlie subthreshold symptoms and clinical disorder and that these associations may begin early in life. These findings highlight the promise of retinal imaging as a tool for understanding the pathogenesis of schizophrenia.
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Caspi A, Houts RM, Belsky DW, Goldman-Mellor SJ, Harrington H, Israel S, Meier MH, Ramrakha S, Shalev I, Poulton R, Moffitt TE. The p Factor: One General Psychopathology Factor in the Structure of Psychiatric Disorders? Clin Psychol Sci 2013; 2:119-137. [PMID: 25360393 DOI: 10.1177/2167702613497473] [Citation(s) in RCA: 1375] [Impact Index Per Article: 125.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Mental disorders traditionally have been viewed as distinct, episodic, and categorical conditions. This view has been challenged by evidence that many disorders are sequentially comorbid, recurrent/chronic, and exist on a continuum. Using the Dunedin Multidisciplinary Health and Development Study, we examined the structure of psychopathology, taking into account dimensionality, persistence, co-occurrence, and sequential comorbidity of mental disorders across 20 years, from adolescence to midlife. Psychiatric disorders were initially explained by three higher-order factors (Internalizing, Externalizing, and Thought Disorder) but explained even better with one General Psychopathology dimension. We have called this dimension the p factor because it conceptually parallels a familiar dimension in psychological science: the g factor of general intelligence. Higher p scores are associated with more life impairment, greater familiality, worse developmental histories, and more compromised early-life brain function. The p factor explains why it is challenging to find causes, consequences, biomarkers, and treatments with specificity to individual mental disorders. Transdiagnostic approaches may improve research.
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Affiliation(s)
- Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University ; Institute for Genome Sciences and Policy, Duke University ; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center ; Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London
| | - Renate M Houts
- Department of Psychology and Neuroscience, Duke University
| | - Daniel W Belsky
- Center for the Study of Aging and Human Development, Duke University Medical Center
| | | | | | - Salomon Israel
- Department of Psychology and Neuroscience, Duke University
| | | | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department, of Preventive and Social Medicine, School of Medicine, University of Otago
| | - Idan Shalev
- Department of Psychology and Neuroscience, Duke University
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department, of Preventive and Social Medicine, School of Medicine, University of Otago
| | - Terrie E Moffitt
- Department of Psychology and Neuroscience, Duke University ; Institute for Genome Sciences and Policy, Duke University ; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center ; Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London
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