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Is there a link between open-angle glaucoma and dementia?

The Three-City–Alienor Cohort

Authors

  • Catherine Helmer MD, PhD,

    Corresponding author
    1. University of Bordeaux Segalen 2, Bordeaux, France
    2. National Institute of Health and Medical Research Clinical Investigation Center Clinical Epidemiology 7 (CIC-EC7), Bordeaux, France
    • National Institute of Health and Medical Research (INSERM) Center U897–Biostatistical Epidemiology, Institute of Public Health and Development (ISPED), Bordeaux, France
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  • Florence Malet MD,

    1. Department of Ophthalmology, University Hospital, Bordeaux, France
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  • Marie-Bénédicte Rougier MD, PhD,

    1. Department of Ophthalmology, University Hospital, Bordeaux, France
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  • Cédric Schweitzer MD,

    1. Department of Ophthalmology, University Hospital, Bordeaux, France
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  • Joseph Colin MD,

    1. University of Bordeaux Segalen 2, Bordeaux, France
    2. Department of Ophthalmology, University Hospital, Bordeaux, France
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  • Marie-Noëlle Delyfer MD, PhD,

    1. National Institute of Health and Medical Research (INSERM) Center U897–Biostatistical Epidemiology, Institute of Public Health and Development (ISPED), Bordeaux, France
    2. University of Bordeaux Segalen 2, Bordeaux, France
    3. Department of Ophthalmology, University Hospital, Bordeaux, France
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  • Jean-François Korobelnik MD,

    1. National Institute of Health and Medical Research (INSERM) Center U897–Biostatistical Epidemiology, Institute of Public Health and Development (ISPED), Bordeaux, France
    2. University of Bordeaux Segalen 2, Bordeaux, France
    3. Department of Ophthalmology, University Hospital, Bordeaux, France
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  • Pascale Barberger-Gateau MD, PhD,

    1. National Institute of Health and Medical Research (INSERM) Center U897–Biostatistical Epidemiology, Institute of Public Health and Development (ISPED), Bordeaux, France
    2. University of Bordeaux Segalen 2, Bordeaux, France
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  • Jean-François Dartigues MD, PhD,

    1. National Institute of Health and Medical Research (INSERM) Center U897–Biostatistical Epidemiology, Institute of Public Health and Development (ISPED), Bordeaux, France
    2. University of Bordeaux Segalen 2, Bordeaux, France
    3. Memory Consultation, Memory Resource and Research Center, University Hospital, Bordeaux, France
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  • Cécile Delcourt PhD

    1. National Institute of Health and Medical Research (INSERM) Center U897–Biostatistical Epidemiology, Institute of Public Health and Development (ISPED), Bordeaux, France
    2. University of Bordeaux Segalen 2, Bordeaux, France
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Address correspondence to Dr Helmer, INSERM, U897, Université Victor Segalen Bordeaux 2, ISPED case 11, 146 rue Léo Saignat, F-33076 Bordeaux Cedex, France. E-mail: catherine.helmer@isped.u-bordeaux2.fr

Abstract

Objective

Previous research has suggested an association between dementia and glaucoma through common risk factors or mechanisms. Our aim was to evaluate the longitudinal relationship between open-angle glaucoma (OAG) and incident dementia.

Methods

The Three-City–Bordeaux–Alienor study is a population-based cohort of 812 participants with a 3-year follow-up period. All participants were aged 72 years or older. An eye examination was performed on all subjects. An OAG was determined based on optic nerve damage and visual field loss. Incident dementia was actively screened for and confirmed by a neurologist.

Results

A total of 41 participants developed dementia over the 3-year follow-up period. Future incident dementia cases had an increased prevalence of OAG (17.5% vs 4.5% for nondemented participants, p = 0.003). After adjustment for age, gender, education, family history of glaucoma, vascular comorbidities, and apolipoprotein ε4, our results showed that participants with an OAG were four times more likely to develop dementia during the 3-year follow-up period (odds ratio = 3.9, 95% confidence interval = 1.5–10.4, p = 0.0054). An increased risk of dementia was also associated with 2 markers of optic nerve degeneration (vertical cup:disk ratio and minimal rim:disk ratio). However, no association was found between a high intraocular pressure and/or the use of intraocular pressure-lowering medications and incident dementia.

Interpretation

If the association between OAG and dementia is confirmed, direct and noninvasive quantification of the amount of retinal ganglion cell axonal loss may be a useful biomarker of cerebral axonal loss in the future. It may also offer new breakthroughs in understanding the underlying pathophysiological mechanisms of both diseases.

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