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Wang X, Chen W, Zhao W, Miao M. Risk of glaucoma to subsequent dementia or cognitive impairment: a systematic review and meta-analysis. Aging Clin Exp Res 2024; 36:172. [PMID: 39162899 PMCID: PMC11335947 DOI: 10.1007/s40520-024-02811-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/13/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Substantial evidence supports that glaucoma and dementia share pathological mechanisms and pathogenic risk factors. However, the association between glaucoma, cognitive decline and dementia has yet to be elucidated. OBJECTIVE This study was aimed to assess whether glaucoma increase the risk of dementia or cognitive impairment. METHODS PubMed, Cochrane Library, Web of Science, and EMBASE databases for cohort or case-control studies were searched from inception to March 10, 2024. The Newcastle-Ottawa Quality Assessment Scale (NOS) was used to the risk of bias. Heterogeneity was rigorously evaluated using the I2 test, while publication bias was assessed by visual inspection of the funnel plot and by Egger' s regression asymmetry test. Subgroup analyses were applied to determine the sources of heterogeneity. RESULTS Twenty-seven studies covering 9,061,675 individuals were included. Pooled analyses indicated that glaucoma increased the risk of all-cause dementia, Alzheimer's disease, vascular dementia, and cognitive impairment. Subgroup analysis showed that the prevalence of dementia was 2.90 (95% CI: 1.45-5.77) in age ≥ 65 years and 2.07 (95% CI: 1.18-3.62) in age<65 years; the incidence rates in female glaucoma patients was 1.46 (95% CI: 1.06-2.00), respectively, which was no statistical significance in male patients. Among glaucoma types, POAG was more likely to develop dementia and cognitive impairment. There were also differences in regional distribution, with the highest prevalence in the Asia region, while glaucoma was not associated with dementia in Europe and North America regions. CONCLUSION Glaucoma increased the risk of subsequent cognitive impairment and dementia. The type of glaucoma, gender, age, and region composition of the study population may significantly affect the relationship between glaucoma and dementia.
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Affiliation(s)
- Xiaoran Wang
- Department of Clinical, Henan University of Chinese Medicine, No.156 Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Wenjing Chen
- Department of Pharmacology, Henan University of Chinese Medicine, No.156 Jinshui East Road, Zhengzhou, Henan, 450046, China
| | - Wenxia Zhao
- The First Affiliated Hospital, Henan University of Chinese Medicine, No. 19 Renmin Road, Jinshui District, Zhengzhou, Henan, 450003, China.
| | - Mingsan Miao
- Department of Pharmacology, Henan University of Chinese Medicine, No.156 Jinshui East Road, Zhengzhou, Henan, 450046, China.
- National International Cooperation Base of Chinese Medicine, Henan University of Chinese Medicine, Zhengzhou, China.
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Kadoh Y, Kubota S, Shimomine S, Tanito M. Exploring Cognitive Impairments Associated with Primary Open-Angle Glaucoma and Exfoliation Glaucoma. Biomedicines 2024; 12:1706. [PMID: 39200171 PMCID: PMC11351631 DOI: 10.3390/biomedicines12081706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/23/2024] [Accepted: 07/25/2024] [Indexed: 09/02/2024] Open
Abstract
This study explored the link between different types of glaucoma and cognitive function in a cohort of 620 Japanese patients. Participants were categorized into primary open-angle glaucoma (PG), exfoliation glaucoma (EG), and non-glaucomatous control groups. The findings revealed a significant decline in cognitive function as indicated by the Mini-Cog test in the EG group (mean ± SD: 4.0 ± 1, 95% CI: 3.9 to 4.2) compared to the PG group (4.4 ± 0.1, 4.3 to 4.5, p < 0.0001). Levels of fingertip measured advanced glycation end-products (AGEs) were significantly higher in the EG group (mean ± SD: 0.45 ± 0.006, 95% CI: 0.44 to 0.46) compared to the PG group (0.43 ± 0.004, 0.42 to 0.44, p = 0.0014). Although the multivariate analysis initially showed no direct association between glaucoma types and Mini-Cog scores, the EG group exhibited higher age and intraocular pressure (IOP) compared to the PG group. Further analysis revealed that high levels of AGEs were associated with cognitive decline and decreased mean visual fields in the EG group. Age was identified as a cofounding factor in these associations. An inverse correlation was observed between the accumulation of AGEs and skin carotenoid levels. Early detection of cognitive decline in glaucoma patients could enable timely intervention to preserve visual fields. Fingertip measurements of skin carotenoids and AGEs offer promising potential as non-invasive, straightforward diagnostic tools that could be widely adopted for monitoring ophthalmic and cognitive health in glaucoma patients.
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Affiliation(s)
| | | | | | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (Y.K.)
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Sapir T, Augello P, Lee R, McCoskey M, Salowe R, Addis V, Sankar P, Ying GS, O’Brien JM. Primary Open-Angle Glaucoma Is Associated with Short-Term Memory Decline and Dementia in Individuals of African Ancestry. J Clin Med 2024; 13:4140. [PMID: 39064180 PMCID: PMC11278361 DOI: 10.3390/jcm13144140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/09/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Over the last decade, studies have suggested that primary open-angle glaucoma (POAG) may be associated with cognitive impairment and dementia, as both pathologies are age-related neurodegenerative processes. It remains unclear to what extent neurodegeneration in POAG extends to other neurological functions beyond vision, such as cognition. This follow-up study examined the potential association between POAG and cognitive decline in an African ancestry population. Methods: The Telephone-Montreal Cognitive Assessment (T-MoCA) was administered to POAG cases and controls previously enrolled in the Primary Open-Angle African American Glaucoma Genetics (POAAGG) study. Cases were assessed for retinal nerve fiber layer (RNFL) thickness and for the presence of dementia via chart review. Comparisons between POAG cases and controls were performed using two-sample t-tests for the T-MoCA total score and five subsection scores, and using chi-squared tests for incidence of dementia. Current scores were compared to scores from this same cohort from 7 years prior. Results: The T-MoCA was administered to 13 cases and 20 controls. The mean ± standard deviation (SD) T-MoCA total score was 15.5 ± 4.0 in cases and 16.7 ± 3.5 in controls (p = 0.36). However, there was a borderline significant difference in the delayed recall sub-score (2.3 ± 1.6 for cases vs. 3.4 ± 1.5 for controls, p = 0.052) and a significant difference in its sub-domain, the memory index score (MIS, 9.1 ± 4.3 for cases vs. 12.1 ± 3.0 for controls, p = 0.02). There were no significant differences between cases and controls for the remaining subsections. During 7 years of follow-up, a higher incidence of dementia was noted in POAG cases (7.1% for cases vs. 0% for controls, p = 0.058). Over 7 years, there was no significant deterioration in the cognitive performance of cases versus controls, and no association was seen between RNFL thinning and cognitive impairment. Conclusions: In this small-sample follow-up study of African ancestry individuals, POAG cases demonstrated worse short-term memory and higher incidence of dementia compared to controls. Future larger studies are needed to further investigate the presence and impact of neurodegeneration in POAG.
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Affiliation(s)
- Tzuriel Sapir
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Patrick Augello
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Roy Lee
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Rebecca Salowe
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Victoria Addis
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Prithvi Sankar
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Joan M. O’Brien
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Philadelphia, PA 19104, USA
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Crump C, Sundquist J, Sieh W, Sundquist K. Risk of Alzheimer's Disease and Related Dementias in Persons with Glaucoma: A National Cohort Study. Ophthalmology 2024; 131:302-309. [PMID: 37839560 DOI: 10.1016/j.ophtha.2023.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/26/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
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 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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Affiliation(s)
- Casey Crump
- Departments of Family and Community Medicine and of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center, Houston, Texas.
| | - Jan Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Weiva Sieh
- Department of Epidemiology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Kristina Sundquist
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
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Huh MG, Kim YK, Lee J, Shin YI, Lee YJ, Choe S, Kim DW, Jeong Y, Jeoung JW, Park KH. Relative Risks for Dementia among Individuals with Glaucoma: A Meta-Analysis of Observational Cohort Studies. KOREAN JOURNAL OF OPHTHALMOLOGY 2023; 37:490-500. [PMID: 37899286 PMCID: PMC10721395 DOI: 10.3341/kjo.2023.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 10/31/2023] Open
Abstract
PURPOSE To investigate the relative risks (RRs) for dementia among individuals with glaucoma. METHODS We conducted a search of PubMed, Web of Science, Scopus, and Cochrane databases for observational cohort studies examining the association between glaucoma and dementia until March 2023. Two authors independently screened all titles and abstracts according to predefined inclusion and exclusion criteria. Pooled RR and 95% confidence intervals (CIs) were generated using random-effect models. RESULTS The meta-analysis included 18 cohort studies conducted in eight countries and involving 4,975,325 individuals. The pooled RR for the association between glaucoma and all-cause dementia was 1.314 (95% CI, 1.099-1.572; I2 = 95%). The pooled RRs for the associations of open-angle glaucoma with Alzheimer dementia and Parkinson disease were 1.287 (95% CI, 1.007-1.646; I2 = 96%) and 1.233 (95% CI, 0.677-2.243; I2 = 73%), respectively. The pooled RRs for the associations of angle-closure glaucoma with all-cause dementia and Alzheimer dementia were 0.978 (95% CI, 0.750-1.277; I2 = 17%) and 0.838 (95% CI, 0.421-1.669; I2 = 16%), respectively. No evidence of publication bias was detected in the Begg-Mazumdar adjusted rank correlation test (p = 0.47). CONCLUSIONS Based on current observational cohort studies, there is evidence supporting that glaucoma is a risk factor for dementia in the adult population.
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Affiliation(s)
- Min Gu Huh
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Young Kook Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
- EyeLight Data Science Laboratory, Seoul National University College of Medicine, Seoul,
Korea
| | - Jaekyoung Lee
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Young In Shin
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Yun Jeong Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon,
Korea
| | - Sooyeon Choe
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
- Department of Ophthalmology, Chungnam National University Hospital, Daejeon,
Korea
| | - Dai Woo Kim
- Department of Ophthalmology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu,
Korea
| | - Yoon Jeong
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Jin Wook Jeoung
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University Hospital, Seoul,
Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul,
Korea
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Kim C, Yu H, Kim DK. The Risk of Ischemic and Hemorrhagic Stroke in Head and Neck Cancer: A Longitudinal Cohort Study. Cancers (Basel) 2023; 15:3503. [PMID: 37444613 DOI: 10.3390/cancers15133503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023] Open
Abstract
Several studies have shown that head and neck cancer is associated with an increased risk of stroke incidence. However, investigations of the association between the two diseases based on a matching cohort dataset are still limited. Therefore, we identified the incidence and risk of stroke in patients with head and neck cancer using a nationwide population-based cohort dataset. A total of 5248 individuals without cancer and 1312 with cancer were enrolled from the dataset after a 4:1 propensity score matching. We found that the incidence of overall stroke (per 1000 person years) was 19.29 for those with head and neck cancer, consisting of 17.32 as ischemic type and 2.74 as hemorrhagic type. Additionally, patients with head and neck cancer had a significantly increased risk of overall and ischemic stroke development but not hemorrhagic stroke. Moreover, the risk of stroke development over time was relatively high within the first year after the diagnosis of head and neck cancer. However, in the subgroup analysis, oral cavity cancer survivors showed an increased risk of both ischemic and hemorrhagic strokes. Therefore, our nationwide population-based cohort study suggests that clinicians should closely monitor patients with head and neck cancers for the early detection of stroke.
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Affiliation(s)
- Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
| | - Hyunjae Yu
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
| | - Dong-Kyu Kim
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
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