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Risk of Alzheimer's Disease and Related Dementias in Persons with Glaucoma : A National Cohort Study

Crump, Casey LU ; Sundquist, Jan LU ; Sieh, Weiva and Sundquist, Kristina LU (2024) In Ophthalmology
Abstract

Purpose: Glaucoma is a heterogeneous group of optic neuropathies that potentially may be associated with other cerebral neurodegenerative processes leading to dementia. However, prior studies have been inconsistent. We examined dementia risks after glaucoma diagnosis in a large population-based cohort. Design: National matched cohort study. Participants: A total of 324 730 persons diagnosed with glaucoma during 1995–2017 in Sweden and 3 247 300 age- and sex-matched population-based controls without prior dementia. Methods: Cox regression was used to compute hazard ratios (HRs) for Alzheimer's disease (AD), vascular dementia (VaD), and all-cause dementia in persons with glaucoma compared with controls, adjusting for sociodemographic... (More)

Purpose: Glaucoma is a heterogeneous group of optic neuropathies that potentially may be associated with other cerebral neurodegenerative processes leading to dementia. However, prior studies have been inconsistent. We examined dementia risks after glaucoma diagnosis in a large population-based cohort. Design: National matched cohort study. Participants: A total of 324 730 persons diagnosed with glaucoma during 1995–2017 in Sweden and 3 247 300 age- and sex-matched population-based controls without prior dementia. Methods: Cox regression was used to compute hazard ratios (HRs) for Alzheimer's disease (AD), vascular dementia (VaD), and all-cause dementia in persons with glaucoma compared with controls, adjusting for sociodemographic factors and comorbidities. Main Outcome Measures: Alzheimer's disease, VaD, and all-cause dementia identified from nationwide inpatient and outpatient diagnoses through 2018. Results: In 16 million person-years of follow-up, 32 339 persons (10%) with glaucoma and 226 896 controls (7%) were diagnosed with dementia. Persons with glaucoma had increased risks for AD (adjusted HR, 1.39; 95% confidence interval [CI], 1.35–1.43), VaD (1.66; 1.61–1.72), and all-cause dementia (1.57; 1.54–1.59). Among glaucoma subtypes, both primary open-angle and normal-tension glaucoma were associated with increased risk for AD (adjusted HR, 1.31; 95% CI, 1.27–1.36; and 1.28; 1.20–1.36, respectively) and VaD (1.61; 1.54–1.68; and 1.39; 1.28–1.50, respectively), whereas primary angle-closure glaucoma was associated with VaD (1.26; 1.02–1.56) but not AD (0.98; 0.82–1.18). These findings were similar in men and women. All risks were highest in persons diagnosed with glaucoma at ages ≥ 70 years and were not elevated for ages < 60 years. Conclusions: In this large national cohort, persons with glaucoma had increased risks for AD, VaD, and all-cause dementia, particularly those diagnosed with glaucoma at older ages. Persons with glaucoma may need increased monitoring for dementia to facilitate earlier detection and treatment. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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author
; ; and
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Alzheimer disease, Dementia, Glaucoma, vascular
in
Ophthalmology
publisher
Elsevier
external identifiers
  • pmid:37839560
  • scopus:85182385408
ISSN
0161-6420
DOI
10.1016/j.ophtha.2023.10.014
language
English
LU publication?
yes
id
75260c85-586b-4d3a-9621-92fad62136e7
date added to LUP
2024-02-16 13:54:08
date last changed
2024-04-17 07:37:21
@article{75260c85-586b-4d3a-9621-92fad62136e7,
  abstract     = {{<p>Purpose: Glaucoma is a heterogeneous group of optic neuropathies that potentially may be associated with other cerebral neurodegenerative processes leading to dementia. However, prior studies have been inconsistent. We examined dementia risks after glaucoma diagnosis in a large population-based cohort. Design: National matched cohort study. Participants: A total of 324 730 persons diagnosed with glaucoma during 1995–2017 in Sweden and 3 247 300 age- and sex-matched population-based controls without prior dementia. Methods: Cox regression was used to compute hazard ratios (HRs) for Alzheimer's disease (AD), vascular dementia (VaD), and all-cause dementia in persons with glaucoma compared with controls, adjusting for sociodemographic factors and comorbidities. Main Outcome Measures: Alzheimer's disease, VaD, and all-cause dementia identified from nationwide inpatient and outpatient diagnoses through 2018. Results: In 16 million person-years of follow-up, 32 339 persons (10%) with glaucoma and 226 896 controls (7%) were diagnosed with dementia. Persons with glaucoma had increased risks for AD (adjusted HR, 1.39; 95% confidence interval [CI], 1.35–1.43), VaD (1.66; 1.61–1.72), and all-cause dementia (1.57; 1.54–1.59). Among glaucoma subtypes, both primary open-angle and normal-tension glaucoma were associated with increased risk for AD (adjusted HR, 1.31; 95% CI, 1.27–1.36; and 1.28; 1.20–1.36, respectively) and VaD (1.61; 1.54–1.68; and 1.39; 1.28–1.50, respectively), whereas primary angle-closure glaucoma was associated with VaD (1.26; 1.02–1.56) but not AD (0.98; 0.82–1.18). These findings were similar in men and women. All risks were highest in persons diagnosed with glaucoma at ages ≥ 70 years and were not elevated for ages &lt; 60 years. Conclusions: In this large national cohort, persons with glaucoma had increased risks for AD, VaD, and all-cause dementia, particularly those diagnosed with glaucoma at older ages. Persons with glaucoma may need increased monitoring for dementia to facilitate earlier detection and treatment. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.</p>}},
  author       = {{Crump, Casey and Sundquist, Jan and Sieh, Weiva and Sundquist, Kristina}},
  issn         = {{0161-6420}},
  keywords     = {{Alzheimer disease; Dementia; Glaucoma; vascular}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Ophthalmology}},
  title        = {{Risk of Alzheimer's Disease and Related Dementias in Persons with Glaucoma : A National Cohort Study}},
  url          = {{http://dx.doi.org/10.1016/j.ophtha.2023.10.014}},
  doi          = {{10.1016/j.ophtha.2023.10.014}},
  year         = {{2024}},
}