Glaucoma and cognitive function trajectories in a population-based study: Findings from the health and retirement study

Abstract

Introduction: Prior studies on the association of glaucoma and cognitive function have reported mixed results.

Methods: The Health and Retirement Study (HRS) is a nationally representative panel survey of Americans age ≥ 51 years. HRS-linked Medicare claims data were used to identify incident glaucoma cases (by glaucoma type). Cognitive function was measured using the Telephone Interview for Cognitive Status (TICS), administered in each wave (every 2 years). Separate linear mixed models were fitted with either prevalent or incident glaucoma as a predictor of TICS trajectories and adjusting for age, race/ethnicity, educational attainment, gender, and medical history. Negative model estimates indicate associations of glaucoma with worse cognitive function scores or steeper per-year declines in cognitive function scores.

Results: Analyses of prevalent glaucoma cases included 1344 cases and 5729 controls. Analyses of incident glaucoma included 886 cases and 4385 controls. In fully-adjusted models, those with prevalent glaucoma had similar TICS scores to controls (β = 0.01; 95% Confidence Interval [CI]: -0.15, 0.18; p = 0.86). However, in those with incident glaucoma, we detected a statistically significant association between glaucoma and lower TICS scores (β = -0.29; 95% CI: -0.50, -0.08; p = 0.007). However, there was no statistically significant association between either prevalent or incident glaucoma and per-year rates of change in TICS scores. When categorizing glaucoma by type (primary open angle glaucoma, normal tension glaucoma, or other glaucoma), no significant associations were detected between either prevalent or incident glaucoma and levels of or rates of change in TICS scores in fully covariate adjusted models.

Conclusion: The observed associations between glaucoma and cognitive function were small and unlikely to be clinically meaningful. Compared to prior studies on this topic, this investigation provides robust evidence based on its larger sample size, longitudinal follow-up, and repeated measures of cognitive function in a population-based sample.

Keywords: aging; cognitive function; glaucoma; ophthalmology; vision.

FIGURE 1

Associations of prevalent and incident glaucoma with levels and rates of change in Telephone Interview for Cognitive Status (TICS) scores in linear mixed models. TICS, Telephone Interview for Cognitive Statua. Negative model parameter estimates indicate associations of glaucoma with worse cognitive function scores or steeper per‐year declines in cognitive function scores. Both models adjusted for age and baseline TICS score. The fully covariate adjusted model included adjustment for sex, education, self‐reported race, and history of hypertension, type 2 diabetes mellitus, cardiovascular disease, and stroke. (1) The parameter estimate for the glaucoma * time (in years) interaction term is presented in the figure, so this estimate represents differences in per‐year rates of decline in TICS scores.

FIGURE 2

Model predicted Telephone Interview for Cognitive Status trajectories for individuals with and without prevalent and incident glaucoma. Overall, levels and rates of change in Telephone Interview for Cognitive Status scores were similar in the glaucoma an no glaucoma groups.