Individuals with Primary Open-Angle Glaucoma may have Cognitive Impairment, reveals research

A recent study published in the Journal of Glaucoma revealed that individuals with Primary Open Angle Glaucoma (POAG) show cognitive impairments across various mental domains when compared to healthy individuals. The findings highlight the need for early recognition and comprehensive care for glaucoma patients beyond vision-related treatments.

This case-control study involved 70 POAG patients and an equal number of healthy participants. The study evaluated cognitive function using a series of standardized tests that measured attention, memory, language skills, executive functions, and working memory. Also, serum cortisol levels were assessed as an indicator of stress.

The POAG patients demonstrated significantly higher intraocular pressure and cup-disc ratio, along with a marked reduction in retinal nerve fiber layer thickness and visual field mean deviation. These ophthalmological factors were accompanied by a decline in cognitive test performance.

In cognitive assessments, glaucoma patients scored significantly lower on the Addenbrooke Cognitive Examination (ACE-III) and Post Graduate Institute Memory Scale (PGIMS) tests which indicated deficits in memory, language, and attention. They also took longer to complete the Trail Making Test (TMT-A), a task that measures attention and cognitive flexibility.

Further analysis showed that POAG patients expressed poor performance on the Wisconsin Card Sorting Test (WCST) by highlighting diminished executive functions, as well as reduced inhibitory control on the Go No-Go task.

The elevated serum cortisol levels in the POAG group was averaged around 11.75 mcg/dl which was significantly higher than the 7.93 mcg/dl observed in healthy participants. Cortisol levels were found to correlate significantly with cognitive impairments, particularly with error rates on the WCST and the time taken to complete attention-based tasks such as TMT-A.

Visual field deterioration was also significantly associated with elevated cortisol levels and poorer performance on cognitive tasks. The study emphasized a strong link between glaucoma and cognitive decline, possibly influenced by elevated stress hormones. They advocate for early cognitive assessments in glaucoma care to help improve the overall quality of life for affected individuals.

Overall, this research highlights the need for a shift in glaucoma management by expanding the focus to include cognitive health monitoring and stress management. Further studies are imperative to explore therapeutic strategies to reduce cognitive decline in glaucoma patients and uncover the precise mechanisms behind elevated cortisol levels in this condition.

Reference:

Garg, M., Midha, N., Verma, R., Gupta, V., Angmo, D., Velpandian, T., Maharana, P. K., Satapathy, S., Sharma, N., & Dada, T. (2025). Cognitive impairment in Primary Open Angle Glaucoma: A case control study. Journal of Glaucoma. https://doi.org/10.1097/ijg.0000000000002544