Cognitive Brain Networks and Enlarged Perivascular Spaces: Implications for Symptom Severity and Support Needs in Children with Autism

Background The severity of autism spectrum disorder (ASD) is clinically assessed through a comprehensive evaluation of social communication deficits, restricted interests, repetitive behaviors, and the level of support required (ranging from level 1 to level 3), according to DSM-5 criteria. Along with its varied clinical manifestations, the neuroanatomy of ASD is characterized by heterogeneous abnormalities. Notably, brain MRI of children with ASD often reveal an increased number of perivascular spaces (PVS) compared to typically developing children. Our recent findings indicate that enlarged PVS (ePVS) are more common in younger male patients with severe ASD, and that specific ePVS locations are significantly associated with ASD symptoms. Objectives In this study, we mapped ePVS across key regions of three major cognitive networks: the default mode network (DMN), the combined central executive/frontoparietal network (CEN/FPN), and the salience network (SN) in 36 individuals with different symptoms severity and rehabilitation needs due to ASD. We explored how the number, size, and location of PVS in these networks are related to specific ASD symptoms and the overall need for rehabilitation and support. Results Our results suggest that ePVS in the DMN, CEN/FPN, and SN are strongly correlated with the severity of certain ASD symptoms, including verbal deficits, stereotypies, and sensory disturbances. We found a mild association between ePVS and the level of support needed for daily living and quality of life. Conclusion Dysfunction in cognitive networks associated with the presence of ePVS has a significant impact on the severity of ASD symptoms. However, the need for assistance may also be influenced by other comorbid conditions and dysfunctions in smaller, overlapping brain networks.