Assessing Retinal Thickness and Associations with Cognitive Function in Women with History of Preeclampsia

Andrea J Ibarra,1 BaDoi N Phan,2 Steven M Silverstein,3 Jay Chhablani,4 Valerie Snyder,4 Ethan A Rossi,4 Meryl A Butters,5 Janet M Catov6– 8 1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA; 2Medical Scientist Training Program, University of Pittsburgh, Pittsburgh, PA, USA; 3Departments of Psychiatry, Neuroscience, and Ophthalmology, University of Rochester Medical Center, Rochester, NY, USA; 4Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA; 5Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; 6Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA; 7Magee-Womens Research Institute, University of Pittsburgh, Pittsburgh, PA, USA; 8Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USACorrespondence: Andrea J Ibarra, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, 300 Pasteur Drive, Room H3580 MC 5640, Stanford, CA, 94305, USA, Email ibarraaj@stanford.eduPurpose: Women with preeclampsia are at risk of developing cognitive changes and dementia later in life. The retina – an extension of the brain – may provide insight about structural changes associated with preeclampsia and serve as a biomarker of long-term neural and vascular consequences. Our goal was to compare retinal thickness measurements between women with and without history of preeclampsia, and to determine associations with cognitive performance.Patients and Methods: This prospective cohort study recruited preeclampsia (N=17) and normotensive (N=18) women 10– 15 years after delivery. We assessed retinal thickness using spectral-domain optical coherence tomography (SD-OCT). Principal component analysis was used to detect retinal regional patterns. Cognitive performance was evaluated to assess memory (Wechsler Memory immediate and delayed), working memory-Letter-Number Sequencing, information processing speed (Digit Symbol, Stroop Word and Color) and executive (WAIS similarities, matrix reasoning, and Stroop interference) domains. Regression models estimated associations between retina measurements, preeclampsia history and cognitive performance.Results: Using the standard early treatment diabetic retinopathy study grid, compared to normotensive, preeclampsia women had thinner outer retina subfields. Similarly, two out of three principal components suggested different patterns of retinal changes at the outer vs central region. The thinner inner nasal and superior quadrants were associated with lower scores on the executive function domain – Stroop Color test (β=12.2, p= 0.032; β=12.9, p= 0.037, respectively). In the memory domain, Letter-Number sequencing test, preE history significantly altered the relationship with the maximum fovea central subfield (β=− 17.3, p= 0.013).Conclusion: Our study provides a novel, integrated assessment of preeclampsia by simultaneously evaluating retina and cognitive markers. Retinal imaging 10– 15 years after delivery in women with a history of preeclampsia showed a decreased thickness in the outer region of the retina. Selective vulnerability of peripheral retinal regions to persistent microvascular changes after preeclampsia may reflect broader central nervous system changes associated with impairments in information processing speed, executive functioning and working memory.Keywords: preeclampsia, OCT, retina, cognition