Increased monitoring for dementia may be needed in patients with glaucoma
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Key takeaways:
- The risk was greater in those diagnosed with glaucoma at age 80 years or older.
- Findings were similar in men and women.
Individuals diagnosed with glaucoma may benefit from increased monitoring for dementia symptoms, particularly if they were diagnosed at age 80 years or older, according to a study in Ophthalmology.
“To our knowledge, this is the largest study to date of dementia risks in persons with glaucoma,” Casey Crump, MD, PhD, of the University of Texas Health Science Center, and colleagues wrote. “The large sample size afforded high statistical power to examine glaucoma subtypes in relation to major types of dementia while controlling for multiple potential confounders.”
In a national matched cohort study of 324,730 individuals diagnosed with glaucoma between 1995 and 2017 in Sweden and 3,247,300 population-based controls, researchers examined the risk of developing Alzheimer’s disease, vascular dementia and all-cause dementia, adjusting for sociodemographic factors and comorbidities.
Participants with glaucoma had a more than 35% increased risk for Alzheimer’s disease, about 65% greater risk for vascular dementia and about 55% greater risk for all-cause dementia, regardless of sex.
Both primary open-angle glaucoma and normal-tension glaucoma were associated with greater risk for vascular dementia and Alzheimer’s disease, while primary angle-closure glaucoma was associated with a greater risk for vascular dementia but not Alzheimer’s disease.
These risks were higher for those diagnosed with glaucoma at older ages, with the strongest risk for those diagnosed at age 80 years or older.
“Persons diagnosed with glaucoma may need increased monitoring for dementia symptoms to facilitate earlier detection and treatment,” Crump and colleagues wrote.
Perspective
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The concept of the eyes as a “window” to the brain has been proposed in relation to neurodegenerative diseases such as Alzheimer’s and vascular dementia, which share similar pathophysiologies with glaucoma. Previous studies have produced conflicting results regarding the correlation between glaucoma and dementia. This study represents the most extensive investigation to date on this matter, analyzing more than 300,000 individuals with glaucoma and more than 3 million population-based controls.
The study revealed that individuals diagnosed with glaucoma faced an increased risk for Alzheimer’s, vascular dementia and all-cause dementia, particularly after the age of 80 years. A glaucoma diagnosis was associated with a 35% higher likelihood for Alzheimer’s, 65% for vascular dementia and 55% for all-cause dementia compared with controls. Primary open-angle glaucoma and normal-tension glaucoma showed a stronger link with dementia than angle-closure glaucoma. However, the risk for dementia was not elevated for glaucoma patients before the age of 60 years.
The primary strength of this study lies in its large cohort and corresponding statistical power. Its main limitation, however, is that the investigation was confined to Sweden. Nevertheless, this study suggests that clinicians should be aware that their glaucoma patients might require additional monitoring for dementia symptoms to enable earlier diagnosis and treatment.
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