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Y. Ou, D. Grossman, F. A. Sloan, P. P. Lee; Assessing the Relationship Between Open-Angle Glaucoma and Alzheimer's Disease in the Health Retirement Survey. Invest. Ophthalmol. Vis. Sci. 2009;50(13):4086.
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Based on retrospective chart reviews and case control studies that examined the incidence of open-angle glaucoma in patients with Alzheimer's disease, it has been hypothesized that there is a relationship between Alzheimer's disease and glaucoma. A common underlying pathogenetic mechanism has also been raised given that amyloid beta, a known player in Alzheimer's disease, has been implicated in retinal ganglion cell death. However, no studies to date have assessed whether patients with open-angle glaucoma have an increased risk of subsequent development of Alzheimer's disease and other dementias. Here we explore this relationship using longitudinal data from a nationally representative population of older persons.
A cohort of U.S. community-dwelling persons aged 65 and older was drawn from the Health and Retirement Study (HRS) and merged with Medicare claims data in 1996 with follow-up through 2002. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes specific to Alzheimer's disease, other dementias, and open-angle glaucoma were queried. The hazard ratio of time to development of Alzheimer's disease and other dementias was calculated considering whether or not a person had open-angle glaucoma at baseline using the Cox proportional hazards model, controlling for covariates such as age, gender, education, and race.
Of 15,679 persons enrolled in the HRS, 481 developed Alzheimer's disease during the follow-up period. Multivariate analyses of development of Alzheimer's disease with a baseline diagnosis of open-angle glaucoma, controlling for age, gender, education, and race, were performed. We find a hazard ratio of 1.09 (p < 0.5) of developing Alzheimer's disease for those persons diagnosed with open-angle glaucoma at baseline. When the same analysis was repeated to examine the risk of developing any dementia including Alzheimer's disease, the hazard ratio was 1.08 (p < 0.35).
While there is limited evidence to suggest an increased incidence of open-angle glaucoma in patients with Alzheimer's disease, no such relationship was found when examining whether open-angle glaucoma patients have an increased risk of developing Alzheimer's disease or other dementias. Longitudinal analysis of health surveys merged with Medicare claims data may be a useful tool for examining uncommon relationships, such as between glaucoma and Alzheimer's disease, in the elderly population.
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