Evaluation of the influence of the markers of Alzheimer's disease or of the vascular type dementia on the emergence of chronic glaucoma (Doctoral thesis)

Τσίλης, Αλέξανδρος Γ.

Chronic glaucoma and Alzheimer’s disease are two neurodegenerative disorders that occur in the elderly. Some studies have shown that several biomarkers are significantly associated with both disorders. Other studies have investigated the association between them, but their results were mixed. Therefore, we performed a systematic review and meta-analysis of the literature. Also, we conducted a case-control study.Material & Methods: We searched systematically in PubMed from 1964 through September 2013 and 239 hits emerged. After abstract and full-text review, we excluded 229 studies. The statistical synthesis of the results was performed using the fixed effects method. With regard to the case-control study, two hundred and twenty-five persons were enrolled {Mean age: 74.1±6.8 (SD)}. The association of chronic glaucoma and dementia (Alzheimer’s disease and vascular dementia) was assessed by Fisher’s exact test. The relationship of quantitative clinical markers of glaucoma such as IOP and C/D ratio with the probability of appearance of dementia was studied by binary logistic regression.Results: Ten articles were finally selected, of which six were conducted in Europe, two in USA and two in Asia. Five reports were case-control studies, three were cohort studies and two were record-linkage studies. The number of patients with glaucoma in these studies ranged between 21 and 63.325. The two largest studies observed that the patients with glaucoma had a reduced risk of Alzheimer’s disease. The remaining studies were basically small and observed significantly positive associations between the two disorders. One study was further excluded. The statistical synthesis of the results showed a summary odds ratio of 0.92% with 95% confidence intervals from 0.89 to 0.94. The study results were extremely heterogeneous (I2=89%, P<0,001). With regard to the case-control study, of the 225 persons included in the study, 55 individuals had dementia (Alzheimer’s disease: 40; vascular dementia: 15), of which 2 persons had chronic glaucoma (3.64%) and 170 persons without dementia, of which 11 individuals had chronic glaucoma as well (6.47%). The association of chronic glaucoma and dementia was estimated statistically as non-significant (p = 0.74). Likewise, the impact of IOP and C/D ratio on the probability of appearance of dementia has not reached statistical significance (p = 0.06).Conclusion: The association of chronic glaucoma and Alzheimer’s disease is heterogeneous in the literature, and most studies are small and poorly designed. The meta-analysis showed that the patients with glaucoma had a lower risk of Alzheimer’s disease, but this result was based essentially on only one large study. With regard to the case-control study, it did not reveal any statistical significant association of glaucoma and its clinical markers with dementia. Future large and prospective studies are warranted.
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Subject classification: Γλαύκωμα
Keywords: Χρόνιο γλαύκωμα,Νόσος Alzheimer,Άνοια αγγειακού τύπου
URI: http://olympias.lib.uoi.gr/jspui/handle/123456789/29211
Appears in Collections:Διδακτορικές Διατριβές

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