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      Association Between Glaucoma and the Risk of Dementia

      research-article
      , MD, , MSc, , MD, , MD
      Medicine
      Wolters Kluwer Health

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          Abstract

          We investigated the association of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) with the risk of dementia by evaluating their clinical and epidemiological similarities by using a nationally representative sample in Taiwan.

          Data were collected from the National Health Insurance Research Database of Taiwan. In total, 6509 patients with glaucoma (3304 with POAG and 3205 with PACG) were enrolled, and a comparison cohort of 26,036 individuals without glaucoma was established after matching for age and sex. The cumulative incidence curve of overall dementia for each cohort was evaluated. The risk of dementia was analyzed using univariate and multivariate Cox proportional hazard models after adjustment for demographic characteristics and comorbidities.

          The patients with glaucoma exhibited a significantly higher risk of dementia than the individuals without glaucoma did (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = 1.01–1.27). The patients with POAG exhibited a 1.21-fold increased risk of dementia compared with the individuals without glaucoma (HR = 1.21, 95% CI = 1.02–1.43). However, the patients with PACG were not significantly associated with an increased risk of dementia compared with the individuals without glaucoma (HR = 1.09, 95% CI = 0.95–1.26). Patients with POAG aged ≥65 years were significantly associated with an increased risk of dementia compared with the individuals without glaucoma (HR = 1.28, 95% CI = 1.07–1.54). Females with POAG exhibited a 1.34-fold increased risk of dementia compared with females without glaucoma (95% CI = 1.06–1.69).

          This study demonstrated that patients with POAG but not those with PACG were associated with an increased risk of dementia compared with the general population.

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          Most cited references23

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          Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors.

          Despite mortality due to communicable diseases, poverty, and human conflicts, dementia incidence is destined to increase in the developing world in tandem with the ageing population. Current data from developing countries suggest that age-adjusted dementia prevalence estimates in 65 year olds are high (>or=5%) in certain Asian and Latin American countries, but consistently low (1-3%) in India and sub-Saharan Africa; Alzheimer's disease accounts for 60% whereas vascular dementia accounts for approximately 30% of the prevalence. Early-onset familial forms of dementia with single-gene defects occur in Latin America, Asia, and Africa. Illiteracy remains a risk factor for dementia. The APOE epsilon4 allele does not influence dementia progression in sub-Saharan Africans. Vascular factors, such as hypertension and type 2 diabetes, are likely to increase the burden of dementia. Use of traditional diets and medicinal plant extracts might aid prevention and treatment. Dementia costs in developing countries are estimated to be US$73 billion yearly, but care demands social protection, which seems scarce in these regions.
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            Molecular pathways to neurodegeneration.

            The molecular bases underlying the pathogenesis of neurodegenerative diseases are gradually being disclosed. One problem that investigators face is distinguishing primary from secondary events. Rare, inherited mutations causing familial forms of these disorders have provided important insights into the molecular networks implicated in disease pathogenesis. Increasing evidence indicates that accumulation of aberrant or misfolded proteins, protofibril formation, ubiquitin-proteasome system dysfunction, excitotoxic insult, oxidative and nitrosative stress, mitochondrial injury, synaptic failure, altered metal homeostasis and failure of axonal and dendritic transport represent unifying events in many slowly progressive neurodegenerative disorders.
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              The Public Health Impact of Alzheimer's Disease, 2000–2050: Potential Implication of Treatment Advances

              Recent developments in basic research suggest that therapeutic breakthroughs may occur in Alzheimer's disease treatment over the coming decades. To model the potential magnitude and nature of the effect of these advances, historical data from congestive heart failure and Parkinson's disease were used. Projections indicate that therapies which delay disease onset will markedly reduce overall disease prevalence, whereas therapies to treat existing disease will alter the proportion of cases that are mild as opposed to moderate/severe. The public health impact of such changes would likely involve both the amount and type of health services needed. Particularly likely to arise are new forms of outpatient services, such as disease-specific clinics and centers. None of our models predicts less than a threefold rise in the total number of persons with Alzheimer's disease between 2000 and 2050. Therefore, Alzheimer's care is likely to remain a major public health problem during the coming decades.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                February 2016
                18 February 2016
                : 95
                : 7
                : e2833
                Affiliations
                From the Department of Ophthalmology (C-WS, H-YC); School of Medicine, Medical College (H-YC, C-CL); Management Office for Health Data (C-CL); Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine (C-HK); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK).
                Author notes
                Correspondence: Hsin-Yi Chen, MD, PhD, Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan. No. 2, Yuh-Der Road, Taichung 40447, Taiwan (e-mail: hsin7850@ 123456url.com.tw ).
                Chia-Hung Kao, MD, Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 40447, Taiwan (e-mail: d10040@ 123456mail.cmuh.org.tw ).
                Article
                02833
                10.1097/MD.0000000000002833
                4998642
                26886642
                1c319b85-a292-4f98-88cb-17b28f73abea
                Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

                This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0, where it is permissible to download, share and reproduce the work in any medium, provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0

                History
                : 30 October 2015
                : 19 January 2016
                : 24 January 2016
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