Abstract
Purpose :
To examine the possible associations between open-angle glaucoma (OAG) subtypes and dementia in 2019 California (CA) Medicare beneficiaries.
Methods :
This cross-sectional study used data from 2019 CA Medicare claims. The diagnosis of OAG was determined by ICD-10 diagnosis codes in Part B claims, including the following OAG subtypes: Primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), pseudoexfoliative glaucoma (PXG) and pigmentary glaucoma (PG). A diagnosis of any dementia and vascular dementia (VD) were identified by ICD-10 diagnosis codes. Covariates included: demographics (age, sex, race and ethnicity), systemic diseases (cardio- and cerebro-vascular diseases, atrial fibrillation and flutter, diabetes, atherosclerosis and atheroembolism, hypertension, lipoprotein metabolism disorders), depression, hearing loss, obesity, smoking related disorders, alcohol related disorders and long-term aspirin, anticoagulant and antithrombotic/antiplatelet use. Unadjusted and adjusted associations were analyzed using univariate and multivariable logistic regression models, adjusting for all covariates. Age-stratified analysis was also performed in beneficiaries aged 65-74 years, 75-84 years and 85+ years.
Results :
Of 2,431,150 CA Medicare beneficiaries included in this study, 104,873 (4.3%) had POAG, 9,199 (0.4%) had NTG, 4,045 (0.2%) had PXG and 1,267 (0.05%) had PG. The overall prevalence of any dementia was 3.2% (n=79,009). In adjusted analyses, the odds of any dementia was lower for all OAG subtypes compared to non-glaucoma subjects (odds ratio [OR]=0.74 for POAG, OR=0.74 for PXG, OR=0.60 for NTG, and OR=0.38 for PG; p<0.001 for all subtypes). In age-stratified analyses, PXG was associated with greater odds of VD (OR=2.84, p=0.006) in the youngest age stratum (65-74 years). The odds for any dementia were lower for all OAG subtypes compared to non-glaucoma patients in beneficiaries 85+ years old but not in the youngest age stratum (65-74 years old).
Conclusions :
In the 2019 CA Medicare population, multiple subtypes of OAG were associated with decreased likelihood of dementia. These findings may suggest selection bias, with older adults who continue to follow-up with glaucoma care being more cognitively intact. Increased likelihood of VD in PXG aligns with shared vascular pathology. Further studies are needed to better understand the complex relationship between glaucoma, dementia and their subtypes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.