Neurocognitive complications and retinal imaging in type 1 diabetes
Type 1 diabetes is associated with an increased risk of cerebral microvascular complications, ultimately manifesting as neurocognitive dysfunction. While neuroimaging can detect advanced markers of cerebral microvascular complications, (e.g. , white matter hyperintensities, lacunar infarcts), biomarkers of earlier stages of cerebral microvascular complications would allow implantation of targeted strategies to prevent or delay progression of cerebral microvascular complications and ultimately, the onset of cognitive impairment. Given their similar morphology and functionality, mechanisms contributing to retinal vessel damage likely exert similar deleterious effects on the cerebral microvasculature. Moreover, recent studies suggest that retinal vascular damage may precede cerebral microvascular damage, making retinal vascular measures candidate biomarkers of early risk of neurocognitive complications. In this pilot study, we propose to assess whether 30-year changes in retinal vascular imaging markers improve the probability of predicting the evolution of cerebral microvascular complications (e.g., 5-year change in white matter hyperintensities) in middle-aged (40-65 years) adults with childhood-onset type 1 diabetes. Our results will characterize the risk profile(s) unique to type 1 diabetes that contribute to the progression of cerebral microvascular complications, important information that must be discerned for the implementation of future large-scale prevention intervention studies.

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