J Clin Neurol.  2020 Jan;16(1):19-28. 10.3988/jcn.2020.16.1.19.

Association between Retinal Vascular Geometric Changes and Cognitive Impairment: A Systematic Review and Meta-Analysis

• Wu H
• Wang C
• Chen C
• Xu X
• Zhu Y
• Sang A
• Jiang K
• Dong J

• KMID: 2467780
• DOI: http://doi.org/10.3988/jcn.2020.16.1.19

Abstract

BACKGROUND AND PURPOSE
Previous studies have explored the association between retinal vascular changes and cognitive impairment. The retinal vasculature shares some characteristics with the cerebral vasculature, and quantitative changes in it could indicate cognitive impairment. Hence, a comprehensive meta-analysis was performed to clarify the potential relationship between retinal vascular geometric changes and cognitive impairment.
METHODS
Relevant databases were scrupulously and systematically searched for retinal vascular geometric changes including caliber, tortuosity, and fractal dimension (FD), and for cognitive impairment. The Newcastle-Ottawa Scale was used to evaluate the methodological quality of included studies. RevMan was used to perform the meta-analysis and detect publication bias. Sensitivity analyses were also performed.
RESULTS
Five studies that involved 2,343 subjects were finally included in the meta-analysis. The results showed that there was no significant association between central retinal artery equivalents (Z=1.17) or central retinal venular equivalents (Z=1.74) and cognitive impairment (both p>0.05). Similarly, no significant difference was detected in retinal arteriolar tortuosity (Z=0.91) and venular tortuosity (Z=1.31) (both p>0.05). However, the retinal arteriolar FD (mean difference: −0.03, 95% CI: −0.05, −0.01) and venular FD (mean difference: −0.03, 95% CI: −0.05, −0.02) were associated with cognitive impairment.
CONCLUSIONS
A smaller retinal microvascular FD might be associated with cognitive impairment. Further large-sample and well-controlled original studies are required to confirm the present findings.

Keyword

retina; cognitive impairment; meta-analysis; retinal vessels

MeSH Terms

Cognition Disorders*
Fractals
Publication Bias
Retina
Retinal Artery
Retinal Vessels
Retinaldehyde*
Retinaldehyde

Figure

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  Fig. 1 Flow chart of included and excluded studies.

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  Fig. 2 Details of the quality assessment of studies using the Newcastle-Ottawa Scale.

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  Fig. 3 Forest plot of the association between the retinal vascular caliber and cognitive impairment. CRAE: central retinal arteriolar equivalents, CRVE: central retinal venular equivalents.

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  Fig. 4 Forest plot of the association between the retinal vascular tortuosity and cognitive impairment. TORa: arteriolar tortuosity, TORv: venular tortuosity.

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  Fig. 5 Forest plot of the association between the retinal vascular FD and cognitive impairment. FD: fractal dimension, FDa: arteriolar FD, FDv: venular FD.

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  Fig. 6 Funnel plot of publication bias for the association between the retinal vascular caliber and cognitive impairment. CRAE: central retinal arteriolar equivalents, CRVE: central retinal venular equivalents, MD: mean difference, SE: standard error.

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  Fig. 7 Funnel plot of publication bias for the association between the retinal vascular tortuosity and cognitive impairment. MD: mean difference, SE: standard error, TORa: arteriolar tortuosity, TORv: venular tortuosity.

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  Fig. 8 Funnel plot of the association between the retinal vascular FD and cognitive impairment. FD: fractal dimension, FDa: arteriolar FD, FDv: venular FD, MD: mean difference, SE: standard error.

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