Retinal microvasculature changes linked to executive function impairment after COVID-19

Abstract

Background/Objectives: Studies using optical coherence tomography angiography (OCTA) have revealed that individuals recovering from COVID-19 have a reduced retinal vascular density (VD) and larger foveal avascular zones (FAZs) than healthy individuals, with more severe cases showing greater reductions. We aimed to examine aspects of the retinal microvascularization in patients with post-COVID-19 condition (PCC) classified by COVID-19 severity and how these aspects relate to cognitive performance. Methods: This observational cross-sectional study included 104 PCC participants from the NAUTILUS Project, divided into severe (n = 59) and mild (n = 45) COVID-19 groups. Participants underwent cognitive assessments and OCTA to measure VD and perfusion density (PD) in the superficial capillary plexus (SVP) and FAZ. Analysis of covariance and partial Pearson and Spearman correlations were used to study intergroup differences and the relationships between cognitive and OCTA variables. Results: Severe PCC participants had significantly lower central (p = 0.03) and total (p = 0.03) VD, lower central (p = 0.02) PD measurements, and larger FAZ areas (p = 0.02) and perimeters (p = 0.02) than mild cases. Severe cases showed more cognitive impairment, particularly in speed processing (p = 0.003) and executive functions (p = 0.03). Lower central VD, lower central PD, and larger FAZ areas and perimeters were associated with worse executive function performance in the entire PCC sample and in the mild COVID-19 group. Conclusions: Retinal microvascular alterations, characterized by reduced VD and PD in the SVP and larger FAZ areas, were associated with cognitive impairments in PCC individuals. These findings suggest that severe COVID-19 leads to long-lasting microvascular damage, impacting retinal and cognitive health.

This research was funded by La Marató de TV3 Foundation (202111-30-31-32) and Ministerio de Ciencia e Innovación, Fondos Next Generation (TED2021-130409B-C51).

Peer Reviewed

Membres del NAUTILUS-Project Collaborative Group: Jose A. Bernia, Servei d’Anestesia Reanimació i Clinica del Dolor, Consorci Sanitari de Terrassa (CST) (Terrassa, Barcelona, Spain). Laura Sanchez, Servei de Medicina Intensiva. Consorci Sanitari de Terrassa (CST) (Terrassa, Barcelona, Spain). Marta Balague-Marmaña, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral (Sant Joan Despí, Spain). Pérez-Pellejero, Cristian, Hospital Sant Joan Despí Moisès Broggi, Consorci Sanitari Integral (Sant Joan Despí, Barcelona, Spain). Silvia Cañizares. Section of Clinical Psychology of Health, Clinical Institute of Neurosciences, Hospital Clinic of Barcelona. Department of Clinical Psychology and Psychobiology, Universitat de Barcelona (Barcelona, Spain). Jose Antonio Lopez Muñoz. Occupational Health Care Service, Hospital Clínic (Barcelona, Spain). Jesús Caballero, Hospital Universitari Arnau de Vilanova (Lleida, Spain). Anna Carnes-Vendrell, Hospital Universitari de Santa Maria (Lleida, Spain). Gerard Piñol-Ripoll, Hospital Universitari de Santa Maria (Lleida, Spain). Ester Gonzalez-Aguado, Consorci Sanitari Alt Penedès-Garraf (Vilafranca de Penedés, Barcelona, Spain). Carme Tayó-Juli, Consorci Sanitari Alt Penedès-Garraf (Vilafranca de Penedés, Barcelona, Spain). Eva Forcadell-Ferreres, Hospital Verge de la Cinta, (Tortosa, Tarragona, Spain). Silvia Reverte-Vilarroya, Hospital Verge de la Cinta, (Tortosa, Tarragona, Spain). Susanna Forné, Fundació Sant Hospital de la Seu d’Urgell (La Seu d’Urgell, Lleida, Spain). Jordina Muñoz-Padros, Consorci Hospitalari de Vic (Vic, Barcelona, Spain). Anna Bartes-Plan, Consorci Hospitalari de Vic (Vic, Barcelona, Spain). Jose A. Muñoz-Moreno, Servei de Malalties Infeccioses, Fundació Lluita contra les Infeccions—Hospital Universitari Germans Trias i Pujol (Badalona, Barcelona, Spain). Anna Prats-Paris, Servei de Malalties Infeccioses, Fundació Lluita contra les Infeccions - Hospital Universitari Germans Trias i Pujol (Badalona, Barcelona, Spain). Inmaculada Rico Pons, Hospital Universitari de Bellvitge (L’Hospitalet de Llobregat, Barcelona, Spain). Judit Martínez Molina, Hospital Universitari de Bellvitge (L’Hospitalet de Llobregat, Barcelona, Spain). Laura Casas, Hospital Universitari Mútua Terrassa (Terrassa, Barcelona, Spain). Judith Castejon, Hospital Universitari Mútua Terrassa (Terrassa, Barcelona, Spain). Maria José Ciudad, Badalona Serveis Assistencials (Badalona, Barcelona, Spain). Anna Ferré, Badalona Serveis Assistencials (Badalona, Barcelona, Spain).Manuela Lozano, Institut d’Assistència Sanitària (Girona, Spain). Tamar Garzon, Institut d’Assistència Sanitària (Girona, Spain). Marta Cullell, Fundació Salut Empordà (Figueres, Girona, Spain). Sonia Vega, Fundació Salut Empordà (Figueres, Girona, Spain). Sílvia Alsina, Fundació Hospital de Puigcerdà (Puigcerdà, Girona, Spain). Maria J. Maldonado-Belmonte, Hospital Universitario Central de la Cruz Roja San José y Santa Adela (Madrid, Spain). Susana Vazquez-Rivera, Hospital Universitario Central de la Cruz Roja San José y Santa Adela (Madrid, Spain). Eloy García-Cabello. Clínica Universitaria de Psicología. Facultad de Ciencias de la Salud. Universidad Fernando Pessoa (La Palmas de Gran Canaria, Islas Canarias, Spain). Yaiza Molina. Clínica Universitaria de Psicología. Facultad de Ciencias de la Salud. Universidad Fernando Pessoa (La Palmas de Gran Canaria, Islas Canarias, Spain). Sandra Navarro, Servei Andorrà d’Atenció Sanitària (SAAS) (Andorra). Eva Baillès, Servei Andorrà d’Atenció Sanitària (SAAS) (Andorra).

Postprint (published version)