National Institute of Health and Medical Research (INSERM) Center U897-Biostatistical Epidemiology, Institute of Public Health and Development (ISPED), Bordeaux, France; University of Bordeaux Segalen 2, Bordeaux, France; National Institute of Health and Medical Research Clinical Investigation Center Clinical Epidemiology 7 (CIC-EC7), Bordeaux, France.
Ann Neurol. 2013 Aug;74(2):171-9. doi: 10.1002/ana.23926. Epub 2013 Sep 10.
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.
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.
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.
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.
先前的研究表明，痴呆症与青光眼之间存在通过共同的风险因素或机制产生关联。我们旨在评估开角型青光眼（OAG）与新发痴呆症之间的纵向关系。
Three-City-Bordeaux-Alienor 研究是一项基于人群的队列研究，共纳入 812 名年龄在 72 岁及以上的参与者，随访期为 3 年。所有参与者均接受了眼部检查。根据视神经损伤和视野损失确定 OAG。通过神经科医生积极筛查和确认新发痴呆症病例。
在 3 年的随访期间，共有 41 名参与者发生痴呆症。未来新发痴呆症病例的 OAG 患病率较高（17.5% vs. 4.5%，未患痴呆症的参与者，p = 0.003）。在调整年龄、性别、教育程度、青光眼家族史、血管合并症和载脂蛋白 E4 后，我们的研究结果表明，患有 OAG 的参与者在 3 年随访期间发生痴呆症的可能性增加了 4 倍（优势比=3.9，95%置信区间=1.5-10.4，p = 0.0054）。痴呆症的风险增加也与视神经退行性变的 2 个标志物（垂直杯盘比和最小边缘盘比）相关。然而，高眼压和/或使用降眼压药物与新发痴呆症之间没有关联。
如果 OAG 与痴呆症之间的关联得到证实，那么直接、无创地定量测量视网膜神经节细胞轴突损失的程度，可能成为未来大脑轴突损失的有用生物标志物。这也可能为理解这两种疾病的潜在病理生理机制提供新的突破。
