Associations between dementia and exposure to topical glaucoma medications.

Background: Some studies have suggested that glaucoma may be associated with neurodegeneration and a higher risk of dementia.

Objective: To evaluate whether exposure to different categories of topical glaucoma medications is associated with differential dementia risks in people with glaucoma.

Methods: We used data from Adult Changes in Thought, a population-based, prospective cohort study that follows cognitively normal older adults from Kaiser Permanente Washington (KPWA) until Alzheimer's disease (AD) and related dementia development. We included participants with a diagnosis of glaucoma, KPWA pharmacy records of filling topical glaucoma medication (alpha-adrenergic agonists [AAA], beta-adrenergic antagonists, miotics, carbonic anhydrase inhibitors [CAI], and prostaglandins) and at least 10 years of pharmacy records. Eight-year sliding windows were derived for each medication class by computing days on each medication starting 10 years earlier and excluding the most recent 2 years. Cox regression used all 5 classes of medication simultaneously to predict AD and all-cause dementia.

Results: We included 521 participants (mean age 78 [range 65-96], 62% female) with genotype data. Beta-adrenergic antagonists were the most frequently prescribed (n = 431) followed by prostaglandins (351), AAA (239), CAI (162), and miotics (142). Adjusting for time-varying exposure to other glaucoma medications, , demographics, and smoking, each year of use of alpha-adrenergic agonists in an 8-year window was associated with a higher risk of developing dementia (HR = 1.33, 95% CI = 1.03-1.72).

Conclusions: Among older adults with treated glaucoma, exposure to alpha-adrenergic agonists appears to be associated with risk for developing all-cause dementia.